Journal Pounces on Multivitamins

PHILADELPHIAThe Dec. 17, 2013 issue of the Annals of Internal Medicine (Vol. 159, No. 12) features two new study reports and one study report previously published online only, each discussing the use of multivitamins in chronic disease, including cardiovascular and neurological diseases. The issue also includes an editorial from several physicians, arguing consumers are wasting their time and money buying and using multivitamin supplements. These articles were immediately covered widely in mainstream press, and supplement industry groups moved quickly to balance the story.

One new study served as an arm of the Physician's Health Study II and concluded long-term multivitamin supplementation in 5,947 male physicians aged 65 years or older did not significantly improve, compared to placebo, cognitive function test scores including verbal memory testing considered predictive of Alzheimer's disease (AD). However, the researchers noted the multivitamin doses may have been too low or the population studied may have been too well-nourished to benefit from the additional supplementation.

"These findings come from a well-nourished population, raising the question of whether they would be more pronounced among most Americans who are not eating a healthy diet and who do have nutrient inadequacies ," noted Duffy MacKay, ND, VP of scientific and regulatory affairs for the Council for Responsible Nutrition (CRN), who advised people to manage their expectations about taking multivitaminsresearch shows that the two main reasons people take multivitamins are for overall health and wellness and to fill in nutrient gaps.  "While people should not expect that multivitamins in isolation can prevent disease, the fact that an affordable and convenient addition of a multivitamin to your daily health regimen may provide benefits on top of filling nutrient gaps makes it a smart choice in combination with other healthy habits."

Another new study published in this issue  reported high doses of multivitamins did not statistically significantly reduce subsequent cardiovascular events in U.S. and Canadian heart attack patients 50 years and older who received standard medications. However, the researchers noted many subjects either failed to follow the protocol or withdrew from the study, thereby limiting the ability to draw solid conclusions on the endpoints.

The more damaging article may be the editorial calling multivitamins and dietary supplements a  "waste of time" for consumers; this was the focus of much mainstream press coverage of multivitamins following the release of this issue of the journal. Written by several physicians from Johns Hopkins University, Baltimore; University of Warwick, Coventry, England; and the College of Physicians, publisher of the Annals of Internal Medicine.

Titled, "Enough is Enough: Stop Wasting Money on Vitamin And Mineral Supplements," the editorial focuses on studies showing lack of significant evidence that multivitamins have a healthy effect on "mortality or morbidity due to major chronic disease." They also concluded beta-carotene, vitamin E and maybe even high-dose vitamin A are harmful.

"The authors of this editorial base their argument against vitamins and minerals on the premise that most supplements do not prevent chronic disease or death," said Cara Welch, Ph.D., senior VP of scientific and regulatory affairs for the Natural Products Association (NPA). " But the authors hypothesis is flawed in that multivitamins are not intended to cure chronic disease or prevent death solely on their own." Instead, Welch noted vitamin and mineral supplements are meant to help with nutrient deficiencies and well-being, not as answers to all life's health problems. "They are, however, an important piece of the puzzle in leading a healthy lifestyle," she assured.

John Shaw, CEO of NPA said it is baffling that medical professionals would author a piece that  claims multivitamin use is not justified. "Its extremely unfortunate to see this overblown editorial that aims to misinform consumers and attack our industry," he said. "Its no secret that many consumers in this country dont get the recommended nutrients from their diet alone, and multivitamin and mineral supplements are an affordable alternative."

Steve Mister, president and CEO of CRN, also took issue with the editorial, calling it close-minded and one-sided, and noting the authors dismiss even the proven benefits of vitamins and minerals.  "Its a shame for consumers that the authors refuse to recognize the real-life need for vitamin and mineral supplementation, living in a fairy-tale world that makes the inaccurate assumption that were all eating healthy diets and getting everything we need from food alone," he said. "We would not suggest that vitamin supplements are a panacea for preventing chronic disease, but we hope the authors would agree that there is an appropriate place for supplements. Given that government research repeatedly demonstrates that the typical consumer diet is falling short on critical nutrients, vitamin supplements are an appropriate option to meet those needs."

Video responses from Mister and MacKay were posted to CRN's website.

This issue of the journal also included the print version of a study that it  first published online ahead of print in November 2013,a systematic research review of  vitamin and mineral supplements in primary prevention of cardiovascular disease  (CVD) and cancer, conducted by the U.S. Preventive Services Task Force (USPSTF). Limiting the review were several factors: study periods no longer than ten years, subjects who were "older" adults and with unknown nutritional deficiencies; and, variations in supplement formulas and  doses. The review concluded the evidence of any beneficial effect of multivitamin supplementation on chronic disease is limited, with only two small trials finding a "borderline-significant" benefit in men only for cancer, but not CVD.

USPSTF used this review as the basis for its draft recommendations in  November 2013, which concluded, "The current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (with the exception of beta-carotene and vitamin E) for the prevention of cardiovascular disease or cancer." In the draft, USPSTF also recommended against the use of beta-carotene or vitamin E supplements for the prevention of CVD or cancer.

CRN, which issued a response to the draft back in November, noted USPSTF the did not identify safety concerns for vitamins at nutritional doses. Mister explained, "Specifically, several scientific authorities have dismissed the concerns raised by the editorial for vitamin E, including this USPSTF report, which states: 'The USPSTF found adequate evidence that supplementation with vitamin E has little or no significant harm.'  The concerns around beta carotene are isolated to high doses in smokers, and are not a concern for the majority of consumers taking a multivitamin; we would, however, recommend that smokers pay strict attention to their beta-carotene intake under the advice of their doctor. The evidence does not indicate any real health risk for multivitamin use."

Mister further noted the authors purposefully ignored the very real benefits for reducing the risk of cancer and cataracts found in the Physicians Health Study II. "These findings are even more impressive by the fact that the benefits were found in a well-nourished population, and we havent yet begun to explore the potential benefits for most Americans who are not eating a healthy diet and have nutrient inadequacies," Mister added. "So, we agree enough is enough. Stop the reductionist approach to nutritional research. Stop insinuating there is evidence of harm. Stop ignoring the scientific evidence that demonstrates there is value to getting your essential nutrients. There is plenty of scientific evidence that recognizes that vitamin and mineral supplements have a role in good health for all Americans."