November 25, 2014

013 – Multivitamins

29 minutes

Transcriptions:

Dr. Kevin: Vitamins and minerals are substances that your body cannot manufacture and must be received into the body in one form or another. If you eat an excellent diet on a daily basis and you live a relatively stress free existence and you avoid pollutants in your environment as well as no alcohol and caffeine you probably do not need to supplement your diet with vitamins and minerals

Rob: Why do you say stress free existence?

Dr. Kevin: Stress hormones such as cortisol actually deplete the body of many B vitamins, as well as vitamins C and A and magnesium and zinc which also get used up during stress responses such as the tensing of muscles and the rise of blood pressure

When you are chronically stressed, you can become magnesium deficient even if you eat the right foods regularly. The complex relationship between magnesium and stress explains why many of the patients I see require magnesium supplements, because even a nutritious diet does not correct their magnesium deficiency. It’s one of the most common nutrient deficiencies in North America.

And here’s why – the best food sources of magnesium are buckwheat (kasha), lima beans, navy beans, kidney beans, green beans, soy beans (including tofu), blackeyed peas, broccoli, spinach, chard, oats, barley, millet, berries, dates, Brazil nuts, cashews, hazel nuts, shrimp, and tuna – foods that many people never eat.

Rob: OK so there has been a fair bit of press recently stating that multivitamins are a waste of time and money and may even be harmful

Dr. Kevin: According to researchers at the Kaiser Permanente Center for Health Research, vitamin supplements are probably useless when it comes to preventing heart disease and/or cancer.

Their analysis is being used by the US Preventive Services Task Force (USPSTF) to update its recommendations on supplement use, and the findings were reported by NBC News under the headline: “Vitamins don’t prevent heart disease or cancer, experts find.”

NBC specifically said that a ‘very extensive look at the studies that have been done show it may be a waste of time when it comes to preventing the diseases most likely to kill you.

This ‘very extensive look’ encompassed 26 preselected studies.

This preselection was done by two investigators who “independently selected and reviewed fair and good quality trials for benefit and fair and good quality trials and observational studies for harms.”

So no consensus, but rather “independently” picked and chose which ones they wanted to include in the analysis.

Out of the more than 12,760 study abstracts screened, a total of 26 studies were selected for inclusion in their analysis. They already had an agenda

Dietary Supplements and Mortality Rate in Older Women – The Iowa Women’s Health Study

Jaakko Mursu, PhD; Kim Robien, PhD; Lisa J. Harnack, DrPH, MPH; Kyong Park, PhD; David R. Jacobs, PhD

Arch Intern Med. 2011 Oct 10

Background Although dietary supplements are commonly taken to prevent chronic disease, the long-term health consequences of many compounds are unknown.

Methods We assessed the use of vitamin and mineral supplements in relation to total mortality in 38 772 older women in the Iowa Women’s Health Study; mean age was 61.6 years at baseline in 1986. Supplement use was self-reported in 1986, 1997, and 2004. Through December 31, 2008, a total of 15 594 deaths (40.2%) were identified through the State Health Registry of Iowa and the National Death Index.

Results In multivariable adjusted proportional hazards regression models, the use of multivitamins (hazard ratio, 1.06; 95% CI, 1.02-1.10; absolute risk increase, 2.4%), vitamin B6 (1.10; 1.01-1.21; 4.1%), folic acid (1.15; 1.00-1.32; 5.9%), iron (1.10; 1.03-1.17; 3.9%), magnesium (1.08; 1.01-1.15; 3.6%), zinc (1.08; 1.01-1.15; 3.0%), and copper (1.45; 1.20-1.75; 18.0%) were associated with increased risk of total mortality when compared with corresponding nonuse. Use of calcium was inversely related (hazard ratio, 0.91; 95% confidence interval, 0.88-0.94; absolute risk reduction, 3.8%). Findings for iron and calcium were replicated in separate, shorter-term analyses (10-year, 6-year, and 4-year follow-up), each with approximately 15% of the original participants having died, starting in 1986, 1997, and 2004.

Conclusions In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.

The authors of the study reached an incorrect conclusion, based on the data that were collected. They did not report the actual death rates, only the statistically-adjusted death rates of supplement users compared to non-users. The problem is, for every category in which they made this adjustment—caloric intake, cigarette smoking, body mass index, blood pressure, diabetes, physical activity, and intake of fruits and vegetables—the supplement users were in the healthier category. Because they were healthier, they were probably less likely to die. So the researchers adjusted the supplement users’ death rates upward, which may have skewed the results by over-adusting their data. When the data were adjusted only for age and caloric intake, there was no statistically significant difference in death rate between the two groups. Unfortunately, the media picked up on this story without understanding the potential problems in the study’s statistical methods.

The randomized, double-blind, placebo-controlled experimental design has prevailed as the “gold standard” in biomedical research, intends to control potential bias in patient/group assignment, investigator allegiance, patient expectations, and nonspecific therapeutic effects – not exactly what these studies embraced.

So just 2 of many examples of how if you have an agenda you can make a study say anything you want it to

Rob: So it sounds like you recommend the use of multivitamins for most people

Dr. Kevin: While I strongly recommend multivitamin supplements, as I personally take one daily, I most certainly do not support using supplements as a way to justify poor food choices.

Harvard School of Public Health – A daily multivitamin is a great nutrition insurance policy. Some extra vitamin D may add an extra health boost.

Rob: As a population do we get enough vitamins and minerals from our food?

Dr. Kevin: The Estimated Average Requirement (EAR) has been established, representing the amount of a nutrient that would meet the actual requirement for half of the people in a given population group. The RDA (Recommended Dietary Allowance) is derived by adding two standard deviations to the EAR. (In many cases, the standard deviations are not known with certainty and are based on estimates.) Thus, the RDA is always higher than the EAR, and the RDA remains the desirable target for individual nutrient intake

These data are summarized in the USDA (US Dept Of Agriculture) report What We Eat in America. (Moshfegh, Goldman, et al., 2005)

(EAR) Estimated Average Requirement

(RDA) Recommended Dietary Allowance

VITAMIN AND POPULATIONPERCENT BELOW EARPERCENT BELOW RDA

VITAMIN A

Men

Women

57%

48%

80%

75%

VITAMIN E

Men

Woman

89%

97%

Over 95%

Over 97%

VITAMIN C

For Non Smokers

Men

Woman

36%

32%

45%

VITAMIN C

For Smokers

Men

Woman

69%

84%

75%

90%

NIACIN

Men

Women

Women over 70

13%

20%

35%

VITAMIN B-6

Men 50-70

Men over 70

Women 19-50

Women 51-70

Women over 70

16%

23%

22%

33%

49%

30%

35%

30%

50%

60%

MINERAL AND POPULATIONPERCENT BELOW EARPERCENT BELOW RDA

MAGNESIUM

Men

Women

64%

67%

80%

IRON

Girls 14-18

Women 19-50

16%

70%

85%

ZINC

Men 51-70

Men over 70

Women 19-50

Women 51-70

Women over 70

20%

30%

12%

18%

36%

35%

50%

25%

35%

55%

A study published in the Archives of Internal Medicine 2009 showed that between 1988 and 1994, 45 percent of 18,883 people (who were examined as part of the federal government’s National Health and Nutrition Examination Survey) had 30 nanograms per milliliter or more of vitamin D, the blood level a growing number of doctors consider sufficient for overall health; a decade later, just 23 percent of 13,369 of those surveyed had at least that amount.

The slide was particularly striking among African Americans: just 3 percent of 3,149 blacks sampled in 2004 were found to have the recommended levels compared with 12 percent of 5,362 sampled two decades ago.

Rob: Vitamin D? What’s up with that – we get it from the sun – why are so many people deficient?

Dr. Kevin: The one word answer is sunscreen……..and everyone is told to stay out of the sun.

Rob: So it sounds like most of us are depleted in minerals and vitamins

Dr. Kevin: We are and the scary part is that as people age they become more depleted at a time when they need their vitamins and minerals even more

Rob: So are there any studies that show efficacy for vitamins?

Studies showing the Efficacy of Multivitamins/vitamins

JAMA 2012:7 Multivitamin supplements were found to reduce cancer risk by eight percent.

International Journal of Cancer 2011:8 A mere 10 ng/ml increase in serum vitamin D levels was associated with a 15 percent reduction in colorectal cancer incidence and 11 percent reduction in breast cancer incidence.

American Heart Journal 2011:9 Each 20 micromole/liter (µmol/L) increase in plasma vitamin C was associated with a nine percent reduction in heart failure mortality. According to Dr. Saul, if everyone were to take 500 mg of vitamin C per day—the dose required to reach a healthy level of 80 µmol/L—an estimated 216,000 lives could be spared each year.

International Journal of Cancer 2011:10 While the NBC declared that “Vitamin E does no good at all in preventing cancer or heart disease,” this study found that gamma-tocotrienol, a cofactor found in natural vitamin E preparations, decreases prostate tumor formation by a respectable 75 percent.

International Journal of Cancer 2008: Here, 300 IUs of vitamin E per day reduced lung cancer risk by 61 percent.

Benefits of Vitamin D3

It is crucial for the absorption and metabolism of calcium and phosphorous, which have various functions, especially the maintenance of healthy bones.

It is an immune system regulator.

Aids the immune system – vitamin D may be an important way to arm the immune system against disorders like the common cold, say scientists from the University of Colorado Denver School of Medicine, Massachusetts General Hospital and Children’s Hospital Boston.

MS risk – it may reduce the risk of developing multiple sclerosis. Multiple sclerosis is much less common the nearer you get to the tropics, where there is much more sunlight, according to Dennis Bourdette, chairman of the Department of Neurology and director of the Multiple Sclerosis and Neuroimmunology Center at Oregon Health and Science University, USA.

Maintaining cognitive functions – vitamin D may play a key role in helping the brain keep working well in later life, according to a study of 3000 European men between the ages of 40 and 79.

Healthy body weight – vitamin D probably plays an important role in maintaining a healthy body weight, according to research carried out at the Medical College of Georgia, USA.

Asthma symptoms and frequency – it can reduce the severity and frequency of asthma symptoms, and also the likelihood of hospitalizations due to asthma, researchers from Harvard Medical School found after monitoring 616 children in Costa Rica.

Rheumatoid arthritis – it has been shown to reduce the risk of developing rheumatoid arthritis in women.

Protects from radiation damage – a form of vitamin D could be one of our body’s main protections against damage from low levels of radiation, say radiological experts from the New York City Department of Health and Mental Hygiene.

Vitamin D and cancer risk – various studies have shown that people with adequate levels of vitamin D have a significantly lower risk of developing cancer, compared to those whose levels are low. Vitamin D deficiency was found to be prevalent in cancer patients regardless of nutritional status in a study carried out by the Cancer Treatment Centers of America.

T.B. recovery – high vitamin D doses can help people recover from tuberculosis more rapidly, researchers reported in September 2012 in the Proceeding of the National Academy of Sciences (PNAS).

Heart attack risk – a study published in September 2012 suggested that low levels of vitamin D may increase the risk of heart attack and early death.

Rob: So it makes sense based on this information that most of us should take vitamins but are they safe….is there a downside?

Dr. Kevin: Well……..

Safety of Supplements

• 1,080 dietary supplement AERs (adverse effect reports) were reported to FDA4

• 526,527 prescription drug AERs were reported4

• 26,517 vaccine AERs were reported4

Dr. Kevin: When you do the math, there were 488 times as many adverse events reported from prescription drugs as from dietary supplements. In all, the number of AERs is miniscule compared to the hundreds of millions of supplement servings consumed each year.22 In fact, according to a 2007 National Health Interview Survey,23 more than half of American adults (157 million individuals) take nutritional supplements. Further compare that to the statistic that about the same number of people—just over half of all Americans—take two or more prescription drugs,24 and the difference in safety between supplements and drugs becomes even clearer. Other data further supports the remarkable safety record of dietary supplements. For example:

• In 2002, the Journal of the American Medical Association (JAMA) reversed its long-standing anti-vitamin stance with the publication of two scientific reviews (based on 30 years’ worth of scientific papers looking at vitamins in relation to chronic diseases), both of which recommended daily multivitamin supplementation for all adults.25

• Data from the US National Poison Data System’s annual report, which tracked data from 57 U.S. poison centers, showed vitamin and mineral supplements caused zero deaths in 2010. For comparison, pharmaceuticals caused more than 1,100 of the total 1,366 reported fatalities.

• FDA-approved drugs cause 80 percent of poison control fatalities each year.26 Poison control centers report 100,000 calls, 56,000 emergency room visits, 2,600 hospitalizations and nearly 500 deaths each year from acetaminophen (Tylenol) alone.

• Data from the European Union indicate that pharmaceutical drugs are 62,000 times as likely to kill you as dietary supplements. You’re actually more likely to be struck dead by lightning or drown in your bathtub than have a lethal reaction to a dietary supplement.

Rob: And what about the quality of our food?

Dr. Kevin: It’s processed, GMO – it has preservatives, dyes, chemicals, artificial flavours, decreased nutrients in our soils because of over farming and decreased crop rotation. Common sense tells us that based on the facts most of us should be taking at the very least a good quality multivitamin every day, some vitamin C – at least 1000 mg daily, and most of us should take some vitamin D3 at least 2000 IUs per day!

Rob: That’s great. I’d like to thank you for listening to “Your Best You Today.” Check back soon for another episode. If you have any comments or questions please leave them below.

If you like this podcast please let your friends know about it too. Thanks a lot. You’re listening to Your Best You Today.

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