Scarce evidence that Vitamins work

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Older Americans are hooked on vitamins
despite scarce evidence they work

source:April 6, 2018 by Liz Szabo, Kaiser Health News

There's no conclusive evidence that dietary supplements prevent chronic disease. There’s no solid evidence that taking multi- or any other kind of vitamin is beneficial to your health unless you’re vitamin-deficient:-


July 2019: Vast majority of dietary supplements don't improve heart health or put off death, study of studies finds (antioxidants,  ß-carotene, vitamin B-complex, multivitamins, selenium, vitamin A, vitamin B3/niacin, vitamin B6, vitamin C, vitamin E, vitamin D alone, calcium alone, calcium and vitamin D together, folic acid, iron and omega-3 fatty acid (fish oil).)


May 2018: Multivitamins, vitamin D, calcium and vitamin C, — the most common supplements, — showed no advantage in the prevention of cardiovascular disease, heart attack, stroke or premature death.
The multivitamins included A, B1, B2, B3 (niacin), B6, B9 (folic acid), C, D and E; and ß-carotene; calcium; iron; zinc; magnesium; and selenium.
It's most beneficial to rely on a healthy diet to get your fill of vitamins and minerals," Dr. Jenkins said

From a systematic review of existing data and single randomized control trials published from 2012 to 2017.

  • Rigorous studies have failed to show that fish oil supplements prevent heart attacks. Fish Oil Pills Don't Prevent Heart Attacks, a Study of Studies Finds
  • Neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause. Vitamin E, also an antioxidant, increased the risk of prostate cancer in men
  • folic acid pills had no overall benefit for heart disease
  • beta carotene pills actually increased lung cancer rates
  • calcium supplement doesn't protect against bone fractures but increase the risk of kidney stones and heart disease.
  • The "90+ Study" on AGING -- Anti-Oxidants & some Vitamins DON'T make you live longer, including E, A, C & Calcium
  • If you're taking vitamin D you're probably taking too much.

Food is Better Than Supplements for Increasing Longevity, New Study Shows

When it comes to a longer lifespan, a healthy diet works better than pills  --- By Trisha Calvo April 08, 2019

A new Tufts University study involving more than 27,000 Americans is the latest research to show that most supplements may not do much to improve health—or at least can’t compete with the benefits of a healthy diet. The researchers found that taking supplements didn’t lower the risk of death during the study follow-up period, while those who got the recommended amount of certain nutrients from foods had a lower risk of death in that time frame.

“These results are consistent with current dietary recommendations,” says study author Fang Fang Zhang, M.D., Ph.D., associate professor in the Friedman School of Nutrition Science and Policy at Tufts University. “The general U.S. population should aim to get adequate nutrition from healthy foods, and a healthy diet.”­­­

What the Study Found

The researchers analyzed National Health and Nutrition Examination Survey (NHANES) data on supplements such as multivitamins, vitamin C, and calcium—which the study participants took—along with info on the foods they ate. Taking supplements, the study authors found, didn’t translate to a lower risk of death from cardiovascular disease, cancer, or any cause for that matter. Getting adequate amounts of vitamin K and magnesium from food, however, reduced the risk of dying overall by more than 20 percent. And those whose diet had enough of vitamins A and K, copper, and zinc cut the risk of death from cardiovascular disease by half.

When the researchers analyzed the data, they found that in supplement takers, nutrients from the foods they ate were protective, but nutrients from the supplements were not. In fact, they didn’t need supplements at all to meet their daily requirements for vitamins and minerals.

The study also highlighted the negative effects of overuse of supplements: For example, getting 1,000 mg per day of calcium in pill form was linked to a 62 percent increased risk of cancer. However, when people got that much calcium from food, it didn’t increase cancer risk, Zhang says.

Stephen Fortmann, M.D., senior director of science programs at the Kaiser Permanente Center for Health Research, who worked on a systematic review of supplements for the U.S. Preventive Services Task Force in 2013, says the results from this new study are in line with the findings from that report. “There’s not a lot of evidence that these supplements do any good.”

When Are Supplements Needed?

More than half of American adults take multivitamins or another supplement, according to the NHANES data, perhaps in part because of what they are—or aren’t—already eating. It’s no secret that many Americans don’t follow a healthy diet; for example, about 90 percent of people don’t eat the daily recommended 1½ to 2 cups of fruit and 2 to 3 cups of vegetables, according to the Centers for Disease Control and Prevention.

But can supplements make up for those shortfalls? Supplement proponents argue that it can be challenging for Americans to stick to dietary guidelines. “The majority of U.S. adults do not get the recommended amount of nutrients," says Andrew Shao, interim senior vice president for scientific and regulatory affairs at the Center for Responsible Nutrition (CRN), a trade association for the supplement industry. “It is a health benefit to get the nutrients you need.”

Still, experts say that eating healthfully is a preferred way to stay healthy. “Using dietary supplements shouldn’t be a substitute for a healthy, balanced diet,” Zhang says. What’s more, when you get nutrients from food, you are also getting a variety of other compounds, such as phytochemicals, that interact with one another in myriad ways, some of which scientists may not even understand yet.

“It’s possible that these particular benefits we’ve seen here could reflect the complex interaction among multiple nutrients from food,” Zhang says. “We don’t eat isolated nutrients.”

Another concern with supplements is that the Food and Drug Administration classifies them differently from drugs. So the companies that make and sell them aren’t required to prove that they’re safe for their intended use, that they work as advertised, or even that their packages contain what the labels say they do.

There are times when supplements are recommended, such as if a patient is deficient in a certain nutrient due to a health issue, Zhang says. In some cases, a doctor might also suggest taking prescription supplements, which are subject to FDA regulations for drugs.

People who may need supplements include:

Women planning to become pregnant within a month. Folic acid supplements are recommended to reduce the risk of brain and spinal-cord abnormalities (called neural tube defects) that can occur in the first months of pregnancy.

Pregnant women. Folic acid is needed to protect against neural tube defects, and vitamin D is needed to help prevent pre-eclampsia.

Strict vegans who consume no meat, fish, eggs, or dairy. A daily vitamin B12 supplement can be recommended; B12 is found only in animal foods.

People over age 60. At this age, you may need vitamin B12, because with age, some people lose the ability to absorb vitamin B12 from food.

A person who rarely gets out in the sun. He/she may need vitamin D3. Our bodies make vitamin D from sunlight.

Those taking certain drugs. Vitamin B12 and magnesium supplements may be needed for people taking diabetes medication such as metformin (Glucophage and generic) and long-term users of heartburn drugs, such as lansoprazole (Prevacid and generic) or famotidine (Pepcid and generic).

Eating a Healthier Diet

One main takeaway from the study, Zhang says, is that if your diet is made up mostly of nutritious foods, supplements won’t necessarily offer any additional benefits.

You can get the nutrients highlighted in this study from many foods. For example, dark green vegetables such as broccoli and kale have vitamins A and K. Butternut squash, carrots, sweet potatoes, and egg yolks are rich in vitamin A. Leafy greens, nuts, and whole grains supply copper and magnesium. "But it is best not to focus on specific nutrients, but rather trust that a balanced diet of healthy foods will meet your nutritional needs," says Charlotte Vallaeys, M.S., Consumer Reports' senior food and nutrition policy analyst. "When you eat a variety of healthy whole foods—whole grains, fruits and vegetables, nuts, legumes, and lean meats—you get the vitamins and minerals you need."


When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.
She urged her father to pop the pills as well: "Dad, you should be on these vitamins, because every cardiologist is taking them or putting their patients on (them)," recalled Gulati, now chief of cardiology for the University of Arizona College of Medicine-Phoenix.

But just a few years later, she found herself reversing course, after rigorous clinical trials found neither
vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause. "'You might want to stop taking (these),'" Gulati told her father.

More than half of Americans take
vitamin supplements, including 68 percent of those age 65 and older, according to a 2013 Gallup poll. Among older adults, 29 percent take four or more supplements of any kind, according to a Journal of Nutrition study published in 2017.

Often, preliminary studies fuel irrational exuberance about a promising
dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies—which can take many years to complete—almost never find that vitamins prevent disease, and in some cases cause harm.
"The enthusiasm does tend to outpace the evidence," said Dr. JoAnn Manson, chief of preventive medicine at Boston's Brigham and Women's Hospital.

There's no conclusive evidence that dietary supplements prevent chronic disease in the average American, Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven't been strong enough to recommend supplements to the general U.S. public, she said.
The National Institutes of Health has spent more than $2.4 billion since 1999 studying
vitamins and minerals. Yet for "all the research we've done, we don't have much to show for it," said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.

A big part of the problem, Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet provides; that megadoses are always safe; and that scientists can boil down the benefits of vegetables like broccoli into a daily pill.

Vitamin-rich foods can cure diseases related to vitamin deficiency. Oranges and limes were famously shown to prevent scurvy in vitamin-deprived 18th-century sailors. And research has long shown that populations that eat a lot of fruits and vegetables tend to be healthier than others. But when researchers tried to deliver the key ingredients of a healthy diet in a
capsule, Kramer said, those efforts nearly always failed.
It's possible that the chemicals in the fruits and vegetables on your plate work together in ways that scientists don't fully understand—and which can't be replicated in a tablet, said Marjorie McCullough, strategic director of nutritional epidemiology for the American Cancer Society.

More important, perhaps, is that most Americans get plenty of the essentials, anyway. Although the Western diet has a lot of problems—too much sodium, sugar, saturated fat and calories, in general—it's not short on
vitamins, said Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University.

And although there are more than 90,000 dietary
supplements from which to choose, federal health agencies and advisers still recommend that Americans meet their nutritional needs with food, especially fruits and vegetables. Also, American food is highly fortified—with vitamin D in milk, iodine in salt, B vitamins in flour, even calcium in some brands of orange juice. Without even realizing it, someone who eats a typical lunch or breakfast "is essentially eating a multivitamin," said journalist Catherine Price, author of "Vitamania: How Vitamins Revolutionized the Way We Think About Food."

That can make studying vitamins even more complicated, Price said. Researchers may have trouble finding a true control group, with no exposure to supplemental vitamins. If everyone in a study is consuming fortified food,
vitamins may appear less effective.
The body naturally regulates the levels of many nutrients, such as
vitamin C and many B vitamins, Kramer said, by excreting what it doesn't need in urine. He added: "It's hard to avoid getting the full range of vitamins."

Not all experts agree. Dr. Walter Willett, a professor at the Harvard T.H. Chan School of Public Health, says it's reasonable to take a daily
multivitamin "for insurance." Willett said that clinical trials underestimate supplements' true benefits because they aren't long enough, often lasting five to 10 years. It could take decades to notice a lower rate of cancer or heart disease in vitamin takers, he said.

For Charlsa Bentley, 67, keeping up with the latest nutrition research can be frustrating. She stopped taking
calcium, for example, after studies found it doesn't protect against bone fractures. Additional studies suggest that calcium supplements increase the risk of kidney stones and heart disease. "I faithfully chewed those calcium supplements, and then a study said they didn't do any good at all," said Bentley, from Austin, Texas. "It's hard to know what's effective and what's not."
Bentley still takes five
supplements a day: a multivitamin to prevent dry eyes, magnesium to prevent cramps while exercising, red yeast rice to prevent diabetes, coenzyme Q10 for overall health and vitamin D based on her doctor's recommendation.
Like many people who take dietary
supplements, Bentley also exercises regularly—playing tennis three to four times a week—and watches what she eats.

People who take
vitamins tend to be healthier, wealthier and better educated than those who don't, Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are.

Preliminary findings can also lead researchers to the wrong conclusions.
For example, scientists have long observed that people with high levels of an amino acid called homocysteine are more likely to have heart attacks. Because
folic acid can lower homocysteine levels, researchers once hoped that folic acid supplements would prevent heart attacks and strokes. In a series of clinical trials, folic acid pills lowered homocysteine levels but had no overall benefit for heart disease, Lichtenstein said.

Studies of
fish oil also may have led researchers astray. When studies of large populations showed that people who eat lots of seafood had fewer heart attacks, many assumed that the benefits came from the omega-3 fatty acids in fish oil, Lichtenstein said.
Rigorous studies have failed to show that fish oil supplements prevent heart attacks. A clinical trial of fish oil pills and vitamin D, whose results are expected to be released within the year, may provide clearer questions about whether they prevent disease.

But it's possible the benefits of sardines and salmon have nothing to do with
fish oil, Lichtenstein said. People who have fish for dinner may be healthier due to what they don't eat, such as meatloaf and cheeseburgers.
"Eating fish is probably a good thing, but we haven't been able to show that taking
fish oil (supplements) does anything for you," said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic Foundation.

Taking megadoses of vitamins and minerals, using amounts that people could never consume through food alone, could be even more problematic. "There's something appealing about taking a natural product, even if you're taking it in a way that is totally unnatural," Price said. Early studies, for example, suggested that
beta carotene, a substance found in carrots, might help prevent cancer.
In the tiny amounts provided by fruits and vegetables,
beta carotene and similar substances appear to protect the body from a process called oxidation, which damages healthy cells, said Dr. Edgar Miller, a professor of medicine at Johns Hopkins School of Medicine.
Experts were shocked when two large, well-designed studies in the 1990s found that
beta carotene pills actually increased lung cancer rates.

 Likewise, a clinical trial published in 2011 found that vitamin E, also an antioxidant, increased the risk of prostate cancer in men by 17 percent. Such studies reminded researchers that oxidation isn't all bad; it helps kill bacteria and malignant cells, wiping them out before they can grow into tumors, Miller said.

Vitamins are not inert," said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. "They are biologically active agents. We have to think of them in the same way as drugs. If you take too high a dose of them, they cause side effects."

Gulati, the physician in Phoenix, said her early experience with recommending
supplements to her father taught her to be more cautious. She said she's waiting for the results of large studies—such as the trial of fish oil and vitamin D—to guide her advice on vitamins and supplements. "We should be responsible physicians," she said, "and wait for the data."