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The Vitamin Myth: Why We Think We Need Supplements
July 28, 2013 10:37 PM   Subscribe

Nutrition experts contend that all we need is what's typically found in a routine diet. Industry representatives, backed by a fascinating history, argue that foods don't contain enough, and we need supplements. Fortunately, many excellent studies have now resolved the issue.
(SLAtlantic)
posted by anazgnos (110 comments total) 56 users marked this as a favorite

 
Nice piece. I get a bit leary about a blanket rule regarding supplements - who should take them, when, why. But the evidence certainly suggests that the majority of most popular vitamins (taken by mostly healthy people) do very little, that's clear.
posted by smoke at 11:05 PM on July 28, 2013


Studies have shown that vitamin supplements are ineffective, but there are some that have been proven, and that is why I take TwelveTwo Brand Men's & Women's All Natural Herbal Vitamin Ultra Health Support with Reservatol+. It has the minerals and organic adaptogens that support a full life.
posted by TwelveTwo at 11:10 PM on July 28, 2013 [35 favorites]


...and a lucrative affiliate program...
posted by oneswellfoop at 11:16 PM on July 28, 2013 [13 favorites]


Linus Pauling is brilliant and crazy and all, but I think supplement fever has more to do with a) how amazingly supplements actually do cure diseases of malnutrition like scurvy and rickets, so much so that vitamin fortification in milk and bread is one of the great public health victories of the 20th century and b) how multivitamins for pregnant women ACTUALLY ARE pretty much miraculous in how tiny pill can prevent spinal defects.

Indiscriminate multivitamin use is trying to kill us all for money, but the popularity of multivitamins comes from actual public health miracles, not just magical thinking or an appeal to authority.
posted by Eyebrows McGee at 11:19 PM on July 28, 2013 [68 favorites]


and that is why I take

My favorite throwaway line of late seems to apply:

You can't reason someone out of a position they didn't reason themselves into
posted by philip-random at 11:20 PM on July 28, 2013 [34 favorites]


More than half of all Americans take supplements? Assuming that means pills, not just fortified foods (in which case the numbers would be close to 100%) and that Australia is the same, that is remarkable. Apart from my hippy sister who took a bunch of bullshit such as rescue remedy (whatever the fuck that is), I can’t think of anyone I know who regularly wastes their money on that stuff.
posted by wilful at 11:52 PM on July 28, 2013


a) how amazingly supplements actually do cure diseases of malnutrition like scurvy and rickets, so much so that vitamin fortification in milk and bread is one of the great public health victories of the 20th century

Yes. Vitamin (and mineral, such as iodine) fortification of food can do a lot of good for public health, though it may sometimes be a bit of a blunt instrument, in that everyone consumes the f.ex. fortified bread, but not everyone needs the extra folate (or whatever) and too much of it can result in increased rates of colorectal, prostate and breast cancer (for folate). In other words: harm can also result.

and b) how multivitamins for pregnant women ACTUALLY ARE pretty much miraculous in how tiny pill can prevent spinal defects.

Not exactly - we have to be very careful and precise. Benefits result more precisely not from the multivitamin, but some ingredients in the multi. That's not the same thing - see below.

Indiscriminate multivitamin use is trying to kill us all for money, but the popularity of multivitamins comes from actual public health miracles, not just magical thinking or an appeal to authority.

Not sure about the multivitamin per se. Certain vitamins and minerals under certain circumstances, yes, but very definitely not the whole multi.

Regarding multis, there are some contradictory studies, but unequivocal studies showing benefits are scarce. Most interestingly, this applies not merely to individuals whose dietary intake of vitamins and minerals is such that they don't actually need multis. It also actually applies to those who have generally poor diets, nutritionally deficient - popping a multi does NOT seem to fix this. See this study:

The Randomized Linxian Dysplasia Nutrition Intervention Trial After 26 Years of Follow-up: No Effect of Multivitamin Supplementation on Mortality.
Wang JB, Abnet CC, Fan JH, Qiao YL, Taylor PR.
JAMA Intern Med. 2013 Jul 8;173(13):1259-61. doi: 10.1001/jamainternmed.2013.6066. No abstract available.

I do happen to have access to the study, so I can quote this:

"In conclusion, during 6 years of multivitamin supplementation and 20 years of postintervention follow-up, we observed no effect of multivitamins on total or cause-specific mortality in a nutrient-deficient population. Together with data from previous trials, these results demonstrate little benefit of multivitamin supplementation on mortality in either well- or poorly nourished populations." [emph. mine VS]

Devastating. It would seem supremely reasonable to expect a benefit from a multi in poorly nourished populations. And yet, studies show no benefit - at all. Surprising.

The science of nutrition likes nothing so much as contradictory studies, so I'm sure this is not the last word on multis, but at least as of now, we know that science does not - currently - support multis under any circumstances and regardless of nutritional status. Targeted vitamins and minerals a qualified yes - in appropriate circumstances (pregnant mothers, scurvy, rickets etc.) - but multis - no (as of July 2013).
posted by VikingSword at 11:59 PM on July 28, 2013 [27 favorites]


My uncle was in the Finnish smokers study that were taking vitamin A and beta-carotene that was stopped because they were dying at a significantly higher rate than the controls. Unfortunately he was one of the ones that died of cancer. What surprises me is that study was 19 years ago and was quite well publicised, as have several since, and yet there is still this huge anti-oxidant/vitamin industry. People don't hear what they don't want to.
posted by drnick at 11:59 PM on July 28, 2013 [4 favorites]


My uncle was in the Finnish smokers study that were taking vitamin A and beta-carotene that was stopped because they were dying at a significantly higher rate than the controls.

*Throws generic multivitamin pill bottle slowly aging on top of fridge into trash*
posted by figurant at 12:07 AM on July 29, 2013 [4 favorites]


All that being said, I don't take vitamins as pills. My doctor gives me an injection occasionally, for B-12. But then, apparently I have a genetic variation that prevents me from absorbing B-12 in the usual way. Weird. A shot lasts me a year or so. Not sure how I managed to get to 50+ years without those shots.
posted by Goofyy at 12:10 AM on July 29, 2013 [2 favorites]


I have a disease which would kill me if I didn't take very potent supplements; almost did kill me a few years ago; and which killed quite a few people before supplements were developed: pernicious anemia.

On the whole, I approve of supplements.
posted by jamjam at 12:16 AM on July 29, 2013 [11 favorites]


I am not ashamed to admit that (even as a grown woman) the reason I take vitamin supplements is that they make them as gummis in the shape of Disney princesses. Well, I am a little bit ashamed but still I buy them once in a while. DISNEY PRINCESSES! That truly is a wonder of the modern world.
posted by lesbiassparrow at 12:24 AM on July 29, 2013 [21 favorites]


I've been dealing with health issues over the past two years of an unknown origin. Unfortunately it has been debilitating, and affected every aspect of my life.

Let me tell you, there is nothing like chronic illness to bring the supplement crazies out. I have heard so many insane things about what will cure me. Emails about coconut oil; a friend asking if I've tried x supplement, recommendations for chiropractors, the whole 9 yards.

My own family being the worst. They are doctor-adverse, but will gladly pay a "naturopath" hundreds of dollars a month for supplements that are not only unproven but also only a few dollars a month in raw materials. I eventually had to stop speaking to them because there was only so many times I could listen to them insist my illness was my fault due to my unwillingness to see one of their witch doctors.

Don't get me wrong, on my own journey, I've discovered I had iron deficiency and vitamin d deficiency, and I had real doctors help me correct those problems with the right supplements. There is a time and a place where they make sense. This willy-nilly MLM vitamin schemes and similar are just nonsense.

The worst experience I had was with an alternative medicine doctor I saw in desperation. He prescribed a number of supplements along with thyroid medication that was a high enough dose that it probably would have killed me with the existing heart conditions I had. I purchased the supplements even though I was skeptical, because I thought maybe I was being resistant to something I that could help. Before I took them though, I researched what they were when I got home. They were marked up about 500%-1000% over what I could find online, and two of them were considered dangerous - the were natural molecules that are found in some medications, one being an MAO Inhibitor.

Then again this same doctor offered foot baths that pulled toxins from your feet.

I've often thought if I really wanted to get rich, I'd drop my morals and sell supplements and other woo treatments to the masses.
posted by [insert clever name here] at 12:24 AM on July 29, 2013 [15 favorites]


Yeah the article very conveniently jumps over all the diseases caused by nutrient deficiency that supplements and fortified foods have reduced to near non-existence. We think we need supplements because we do need them. Vitamins may not save you from cancer or heart disease. But they sure as hell do prevent frigging rickets and scurvy.
posted by Authorized User at 12:27 AM on July 29, 2013 [3 favorites]


The recommended daily dose for vitamin C advised by the World Health Organisation is 45mg. An orange contains about 50mg of vitamin C. Sure, there are medical conditions that may need to be treated with supplements, but nobody on a reasonable diet is getting scurvy.
posted by drnick at 12:33 AM on July 29, 2013 [17 favorites]


The article sure seemed to me to have a strong slant, a strong bias, trying to build their case. Maybe they are trying to sell as many magazines by saying that vitamins are bunk as Time sold with their issue saying that vitamins are the salvation of mankind -- they wouldn't do that though, would they? I don't know the facts, for sure, but I don't believe that they presented the whole of the argument without bias.

I found the conclusion to be particularly tacky:
In May 1980, during an interview at Oregon State University, Linus Pauling was asked, "Does vitamin C have any side effects on long-term use of, let's say, gram quantities?" Pauling's answer was quick and decisive. "No," he replied.

Seven months later, his wife was dead of stomach cancer. In 1994, Linus Pauling died of prostate cancer.


Okay, true enough. But let me re-write those last two sentences for them: Seven months later, his wife was dead of stomach cancer at the age of 78. Fourteen years later, in 1994, Linus Pauling died of prostate cancer at the age of 93.

Yes, they died of cancer, but both of them had pretty long runs, Pauling especially lived considerably longer than the average US man (Wikipedia says 76 for US men, 81 for US women.) Many people die of cancer if they live long enough to do so.

~~~

I have a fair diet, not great, not like I eat everything that "I'm supposed to" according to whatever expert I might read on whatever blog I might see today. Maybe I'm missing something? So I figure "What the hell." and toss vitamins into the cart at the grocery store, costs as close to nothing as there is, I get this big honkin' bottle of big honkin' pills, they're ugly and taste like shit so I figure it's probably good for me, like parsley, or liver. Not that I'll eat either of those of course, but just sortof that same general idea.

They provide something to me, vitamins, or so it seems -- perhaps I'm kidding myself? I don't think I'm kidding myself but I've sure been wrong before. When I take them, it's not so much that I notice "Oh boy, I sure do feel great!" and then go out and play suntanned tennis with a big festive smile plastered on my head like people in vitamin commercials on TV no doubt do. I notice the effect when I stop taking them; a few days later I'm a shade weaker, or something. I just don't feel as well. It's subtle, and, as noted above, perhaps non-existent.

I did find it interesting to learn a little bit about antioxidants. I'd all the time heard antioxidant this and antioxidant that and I didn't pay it all that much mind. That is until I found out that coffee is this like major super mega antioxidant, and then, since I love the coffee anyways, and wouldn't stop drinking it antioxidant or not -- I wouldn't stop drinking the shit if studies showed it caused polio in tall US men -- I found myself fervently applauding antioxidants, I'm all about antioxidants now, I'd march in a flippin' antioxidant parade, carrying a banner or whatever. Especially after that first cup in the morning...
posted by dancestoblue at 12:33 AM on July 29, 2013 [11 favorites]


The recommended daily dose for vitamin C advised by the World Health Organisation is 45mg. An orange contains about 50mg of vitamin C. Sure, there are medical conditions that may need to be treated with supplements, but nobody on a reasonable diet is getting scurvy.

Yeah scurvy is not a very realistic threat. But osteoporosis is. So if you want to have fractures when you're old, go ahead and ignore your vitamin D intake. Vitamin deficiencies are still a real and ongoing thing even in developed countries and even for people who have a reasonable diet.
posted by Authorized User at 12:39 AM on July 29, 2013 [5 favorites]


After so many years of pro-vitamin propaganda, it's going to take a few years more to convince people that it was mostly bullshit, that almost no one needs or benefits from vitamin pills, and that vitamin supplements can actually do you harm.
posted by pracowity at 12:39 AM on July 29, 2013 [2 favorites]


The gold standards for unbiased medical evidence are the Cochrane reviews. For these they find every single trial that has published data on a subject and pool it. For instance, here they pooled 78 randomised trials containing a total of almost 300,000 people. There they found increased mortality amongst anti-oxidant takers.
posted by drnick at 12:41 AM on July 29, 2013 [15 favorites]


Yeah scurvy is not a very realistic threat. But osteoporosis is.

True, the Cochrane review on osteoporosis and preventative vitamin D and calcium liked them since they increased radial bone mineral density, though they didn't get a statistically significant effect on fracture rate. Now I'll get back in my box.
posted by drnick at 12:52 AM on July 29, 2013 [4 favorites]


By the way (or perhaps not), the author of the article is Paul Offit, who is big in vaccine research and development (and is a strong anti-anti-vaxxer).
posted by pracowity at 1:35 AM on July 29, 2013


Yes, but what about electrolytes? That's what I crave.
posted by subbes at 1:41 AM on July 29, 2013 [23 favorites]


Well, there is now officially a market (of one) for candies that taste like the Flintstones vitamins of yore but that contain absolutely no vitamins.
posted by GoingToShopping at 1:41 AM on July 29, 2013 [10 favorites]


I thought this study was interesting.

It surprised me, given how negative the recent data on supplements have been.
posted by professor plum with a rope at 1:56 AM on July 29, 2013 [1 favorite]


After so many years of pro-vitamin propaganda, it's going to take a few years more to convince people that it was mostly bullshit, that almost no one needs or benefits from vitamin pills, and that vitamin supplements can actually do you harm.

Totally. My mum gave us a multivitamin every morning - this was the 80s - and even now she'll remind us of this in a 'see how well I looked after you guys' way. And because it was a total habit I still take one every day, as well as calcium supplements. After reading this I think I'll stop (although I know psychologically I'll be feeling like I'm actually neglecting myself) because those studies seem fairly definitive. (I would like to know more about other supplements, though, like the calcium ones for example - are they also harmful or just useless?) But I know that no matter what I say to my mum she'll continue to take them, because its just so ingrained in her mind that taking MVs is an important way to stay healthy.
posted by billiebee at 1:58 AM on July 29, 2013


The supplement industry is one of the great right wing forces in this country. Never relent in pointing out that their business is built on lying to the gullible.
posted by spitbull at 2:33 AM on July 29, 2013 [2 favorites]


Thanks to this thread (and I sincerely mean that--THANK YOU), I've just discovered that my gynecologist recommended I take FIVE TIMES the recommended highest daily dose of folic acid because I am a woman over 35 trying to conceive. Thanks doc! Now I can have some variety in what I'm currently stressed out about--in addition to infertility I can worry about dying of cancer because of overdosing on folic acid! Jesus Christ.
posted by Secret Sockdentity at 2:51 AM on July 29, 2013


Just take your multi-vitamins in homeopathic doses and you'll be fine.
posted by Segundus at 3:11 AM on July 29, 2013 [20 favorites]


nobody on a reasonable diet is getting scurvy

I went to college with two people who had scurvy. One of them ate nothing but uncooked dry pasta for six months; the other subsisted on flour and water "pancakes". Of course it was an engineering school.
posted by Ralston McTodd at 3:58 AM on July 29, 2013 [19 favorites]


Like Pauling, I have noticed a startling decrease in the frequency with which I get colds over the last few years. Unlike him, I have not been taking vitamins. I have attributed the change to my having developed immunity to most of the common cold strains over my lifetime. I work with a lot of 20-somethings, and colds (& intestinal bugs) rip through the office like it's kindergarten, but I seldom get them. Now, if I could develop immunity to osteoarthritis, I'd be all set.
posted by mr vino at 4:24 AM on July 29, 2013


Now I can have some variety in what I'm currently stressed out about--in addition to infertility I can worry about dying of cancer because of overdosing on folic acid!
Folic Acid is water-soluble, so you'll probably just pee the excess out.
posted by yeoz at 4:28 AM on July 29, 2013 [2 favorites]


You can't reason someone out of a position they didn't reason themselves into

Which is wrong, of course, of civilization would never have gotten off the ground.
posted by DU at 4:38 AM on July 29, 2013 [5 favorites]


Totally on board with the idea that general-purpose multi-vitamins are useless at best. But also leaving room for the fact that there are actually a very few people that need them for an identifiable medical reason. Kind of like the whole "gluten free" thing is a bunch of hogwash for most people but a real life-changer for that single-digit percentage of the population that actually has celiac disease. But just like you wouldn't take insulin if you weren't diabetic, there's no reason to take vitamins unless you have a specific, diagnosed need for them.
posted by valkyryn at 4:43 AM on July 29, 2013 [5 favorites]


I was saddened to hear that the museum where I have worked on and off for fifteen years is going to build their next show around the transhumanist flim-flam carnival of the odious Ray Kurzweil, who, after building a number of excellent synthesizers, went off the deep end and started swallowing hundreds of supplements, "alkaline water," and otherwise attempting to "reprogram" his biochemistry each day. Sad. It takes a brilliant engineer to believe a brilliantly convoluted self-reinforced flim-flam, alas.

Of course, I live in a country in which the people I knew who swore by Airborne continue to swear by it even after the manufacturer lost a class action suit because their idiot product for idiots (see also 5 Hour Energy) didn't work and had to pay back everyone who bought the crap, albeit with the shrug of surrender to superstition.
posted by sonascope at 4:44 AM on July 29, 2013 [3 favorites]


But just like you wouldn't take insulin if you weren't diabetic, there's no reason to take vitamins unless you have a specific, diagnosed need for them.

I'm pretty sure every single person on the planet has a need for vitamins.
posted by Authorized User at 4:58 AM on July 29, 2013 [1 favorite]


What about prenatal vitamins? It seems that every woman who is trying to conceive or is already pregnant is told to take prenatal vitamins. I think this is mainly because of the folic acid, but does a "normal" healthy diet satisfy that requirement as well?
posted by like_neon at 4:59 AM on July 29, 2013


I've never put much stock in supplements but then I started to have some really disturbing symptoms. Blood work showed that I had very low B12. Apparently as we age some of us lose the ability to absorb sufficient B12 from diet. The symptoms of significantly low B12 mimics the onset of Parkinson's, ALS and related neurodegenerative nightmares. After 6 months of injections I now happily pop a fruity sub-lingual dose daily but still will pass on the Flintstones...
posted by jim in austin at 5:05 AM on July 29, 2013 [6 favorites]


like_neon, this Cochrane review on folic acid shows taking supplements during pregnancy decreases neural tube defects. Since these studies would be compared against normal diet controls, it would suggest folic acid supplements are worthwhile during pregnancy. They do note "more research is needed on different types of supplementation programmes and the use of different types of supplements (such as 5-methyl-tetrahydrofolate -5-MTHF), particularly in countries where folic acid fortification of staple foods like wheat or maize flour is not mandatory and where the prevalence of NTDs is still high."
posted by drnick at 5:15 AM on July 29, 2013


Previous discussion of a similar piece by the same author.
posted by Pfardentrott at 5:15 AM on July 29, 2013 [1 favorite]


The real problem is manufactured vitamins. You can make a far superior nutritional supplement at home, using only commonly found ingredients.
posted by orme at 5:27 AM on July 29, 2013 [10 favorites]


Apart from my hippy sister who took a bunch of bullshit such as rescue remedy (whatever the fuck that is), I can’t think of anyone I know who regularly wastes their money on that stuff.

Rescue Remedy, unlike most homoeopathic preparations, actually has a genuinely active ingredient. If you live with somebody who thinks Rescue Remedy is the business, you can save them money while keeping their placebo intact by surreptitiously topping up their Rescue Remedy vial with a 1:1 mixture of tap water and cheap brandy.

As for "wasting money on that stuff": I eat multivitamins at the minimum rate required to prevent ms. flabdablet worrying at me for not eating enough multivitamins. I don't like them. They make my piss smell bad.

That said: I have had consistently good results with B complex supplements as a treatment for cold sores. I don't get cold sores very often any more. When I do, they are generally quite small and if I do nothing about them they will go away in a week to ten days. When I eat a daily B complex supplement at the first sign of a tingle, I've never had one last for more than three days. Beats "proper" antivirals all hollow.
posted by flabdablet at 5:36 AM on July 29, 2013


Rescue remedy isn't a homeopathic preparation: it's even weirder than that. It's a Bach Flower Remedy. Just as diluted, with an even stranger rationale.
posted by Wylla at 5:43 AM on July 29, 2013 [3 favorites]


I'm pretty sure every single person on the planet has a need for vitamins.
Not sure if this was intentional or not... but again, the concept is that most decently-nourished persons get the majority of the necessary vitamins from what can really only be classified as normal (first world?) food consumption.

What I do think would be interesting would be to compare the population that does buy into the multi-vitamin industry story-line... with that portion of the population who disparage the classic food-pyramid-slash-Mrs.-Obama-food-plate because it's the government telling them what to do.

I dunno, if I were to live for a couple hundred years I think I'd enjoy watching a small portion of humanity de-evolutionize themselves out of existence.
posted by Blue_Villain at 5:51 AM on July 29, 2013 [1 favorite]


Nutrition experts contend that all we need is what's typically found in a routine diet. Industry representatives, backed by a fascinating history, argue that foods don't contain enough, and we need supplements

I really wish the article actually went into this. I wanted this to be a study of what typical diets actually are. There was as recent AskMe on potassium intake that had a lot to it but looking into I found one could get the RDA of 4700 mg by eating a lot of vegetables and fruit. This is probably true for a lot of vitamins and minerals but I know plenty of people who do not eat any significant quantity of vegetables or fruit. I want to see various weekly food intakes recorded with tallies for vitamins, minerals, fiber, essential fats and proteins, etc.

I think the reason I wanted this to be on nutrition rather than Pauling is that I've heard of Pauling's crazy before; I have gotten that in my diet. I am sure this article is interesting for those that have that deficiency.

And it feels as if that is a lot of what is going on here; we all have different diets, metabolisms, chemical balances, nutritional needs... so all of this is going to be so individualized that blanket recommendations are going to be difficult to worthless.

Also the human body can take a lot of abuse; a deficiency or overabundance in many things may take a long time to cause problems and that casual chain isn't always clear.
posted by mountmccabe at 5:53 AM on July 29, 2013 [2 favorites]


Vitamins are big business in the US. It's been quipped that Americans have the most expensive urine in the world.
posted by Benny Andajetz at 5:56 AM on July 29, 2013 [6 favorites]


Actually, most people's thinking on folic acid is all wrong. Women of childbearing potential should probably be taking a folic acid supplement even if they are not pregnant, and even if they are not intending to conceive.

This is because the folic acid may be doing the most good between four weeks before the start of pregnancy and eight weeks in. Pregnancy is not usually detectable four weeks before the start of pregnancy. If you start only once you know you are pregnant, it may be too late.

I don't know of any downside to taking a folic acid supplement by itself when not pregnant. Ask your doctor. Also, here's the reference:
JAMA study

Also agree that most vitamins are a waste of money and may even harm health. I wanted to believe, oh how I wanted to believe, but study after study has turned up very little in the way of positive effects, and a lot of harmful ones.

I do take 162mg aspirin every day for cancer prevention: NHI fact sheet . This puts me at more risk of bleeding, especially if I fall and bump my head. I don't go up on the roof, I rarely ride a bike, and I don't climb ladders more than 6 feet tall. Aspirin CAN hurt you. Ask your doctor. Although most aren't aware of its cancer-prevention properties.

I also take 2000 IU of vitamin D every day for cancer prevention. NIH Fact sheet. The jury is still out.
posted by etherist at 6:08 AM on July 29, 2013 [6 favorites]


Does anybody know the percentage of pro Medical Doctors who take vitamin supplements? I take the generic one pill per day multivitamin multimineral by habit with 2.3 mg of manganese, which is the worst thing in it according to the report desribed in this link. (By the way the guy who wrote that report is the doctor who wrote the blog post that was on the front page of metafilter last week describing cruelly over treating the terminallly ill.) The full report is well worth reading but at the moment the link to is dead to me.
posted by bukvich at 6:13 AM on July 29, 2013


So....what constitutes a reasonable diet? The article was wonderfully vague, or rather, didn't even address it.
posted by Atreides at 6:23 AM on July 29, 2013 [1 favorite]


This isn't an "article" per se (that's why there's no much info missing). It's an excerpt from a book.
posted by Wylla at 6:27 AM on July 29, 2013 [2 favorites]


I know there is a word limit and probably a limit to how many number-filled-tables (if any) can be inserted into widely-consumable articles like these, but I wish there were more data from the studies the author references, or at least references at the bottom of the article so I can at least look them up. How does the amount of each supplement given to the experimental groups compare with RDAs? Is the 2005 vitamin E study at Hopkins that the author refers to, this one (2005, same approx number of participants), where high-doses of vitamin E were used? Or maybe another study?
posted by mayurasana at 6:31 AM on July 29, 2013


In 1994, Linus Pauling died of prostate cancer.

The writer left out the part about Pauling being 93. Not exactly a life cut short by the evils of Vitamin C.
posted by grounded at 6:51 AM on July 29, 2013 [7 favorites]


drnick: "Sure, there are medical conditions that may need to be treated with supplements, but nobody on a reasonable diet is getting scurvy."

But talk to a pediatrician, especially one who treats a higher-end population, about rickets, which are making a tiny comeback since they now tell you to keep the baby out of the sun (because CANCER) and to slather children in sunblock. D doesn't pass basically at all in breastmilk, and if you get a certain sort of wealthy-granola mom who only gives her kids raw milk (no D fortification) and doesn't let them play in the sun ... rickets. They encourage fully-breastfed children to take vitamin D drops these days, but I don't know if they bring it up with older kids. There's also been an increase in the incidence of wealthy kids with teeth problems whose parents only let them drink bottled water (not tap), which typically isn't fluoridated.

like_neon: "What about prenatal vitamins? It seems that every woman who is trying to conceive or is already pregnant is told to take prenatal vitamins. I think this is mainly because of the folic acid, but does a "normal" healthy diet satisfy that requirement as well?"

The excess folic acid from supplements reduces the incidence of neural tube defects even in first-world countries where grain products are fortified with B vitamins (which also reduces the incidence). B vitamins are water soluble so you pee out the extra. That makes it harder to overdose than on fat-soluble vitamins (A, D, E, K) but it also means you don't do a great job of storing up B vitamins. That is to say -- there is basically no downside to taking extra B vitamins when you're trying to get pregnant, and there's a HUUUUUUUGE potential downside (spina bifida, etc.) if you turn out to be lacking folic acid. The calcium in prenatal vitamins is also important, since pregnancy leaches calcium from your bones, as well as some other things (magnesium, maybe?). I mean basically when the baby needs vitamins or minerals to built itself, it steals those from mom; frequent pregnancy is one of the risks for osteoperosis, since all your calcium is being leached out of your bones by the baby to build his. You need increased iron intake to support the increased blood volume. And so on. Generally prenatals are in fairly restrained doses (compared to the supplement industry as a whole), with doses that are fairly well-supported by research, and are taken for limited periods of time to deal with specific issues and well-understood issues (i.e., 6 months before conception, pregnancy, and frequently throughout breastfeeding). The OTC ones all have similar dosages (from the research) of the same particular minerals and vitamins or precursors (you always get beta carotene, never vitamin A). If you're non-average you can get a variety of prescription prenatal vitamins with different doses of various things to deal with specific deficiencies or diets or whatever.
posted by Eyebrows McGee at 6:51 AM on July 29, 2013 [3 favorites]


Second-hand anecdote that really brought home for me how careful I need to be with my vitamin-supplement intake:

The last time I had a physical, the doctor (different from my regular one) asked what I was taking, and I said that I had a Vitamin D prescription (I don't get much sunlight), and I took 1000mg of Vitamin C, largely because why not. He advised me to cut that back to 500mg and then told me about a patient of his who "C-bombed" with some huge amount (I want to say 5000mg a day). She went into the hospital for some unrelated thing and didn't take her supplements while she was there.

And she got scurvy in the few days she was in the hospital. Not because she wasn't getting enough Vitamin C from what the hospital was giving her, but because her system had gotten so used to processing out 99 percent of the Vitamin C she did take in that it continued to do so, so a perfectly normal amount just got pushed right out.

I have no idea whether it was true. But it really hammered into me that I need to discuss stuff like this with my doctor before I start doing it.
posted by Etrigan at 7:23 AM on July 29, 2013 [3 favorites]


I'm going to remain skeptical of an article that conflates the "orthomolecular" nonsense espoused by Pauling in his later years to taking a generic multivitamin every day, which I've been doing for years. Clearly, people need vitamins, and the idea that no one needs supplemental vitamins because everyone gets whatever they need from their diet, regardless of what they eat, doesn't make sense. (I seem to recall a factoid from somewhere claiming that part of the effect of big factory farms is that the vitamin content of some foods has been degraded.)
posted by Halloween Jack at 7:46 AM on July 29, 2013 [1 favorite]


What this article doesn't address is that many people eat an impoverished diet, low in nutrients. You certainly see people with rickets walking about the place: I don't mean the children of over-protective families, but impoverished and drug-addicted people. Goitre is another example. The level of anaemia among women is high.

And these (rickets, goitre, anaemia) are extreme and obvious nutritional deficiencies. It seems implausible to me that there are no other nutritional deficiencies in our population. We know many people eat very little, or eat one or two foods only. I teach students who more or less starve themselves because they don't have very much money, and fill up on crisps and soda. It seems implausible to say 'people don't need nutritional supplements' when the quality and content of individual diet is so varied.
posted by communicator at 7:49 AM on July 29, 2013 [3 favorites]


I started taking D with calcium because I don't drink milk and I've reduced cheese a lot. Maybe I should stop? Should I wait until another study contradicts these?
posted by thelonius at 7:49 AM on July 29, 2013


I'm more concerned about a placebo effect which may be masking further deficiencies in populations that don't have reasonable access to a complete and nutritional diet (whatever that may be).

If it's a matter of overdosing antioxidants or particular vitamins, just turn down the dosage but let people still buy and take their daily health pills. Everybody wins.
posted by Johann Georg Faust at 7:59 AM on July 29, 2013


the concept is that most decently-nourished persons get the majority of the necessary vitamins from what can really only be classified as normal (first world?) food consumption.

Only because many foods in our normal diet already include supplements. And even so there are quite a few normal diets that don't give an average person enough vitamins.
posted by Authorized User at 8:03 AM on July 29, 2013


"Based on current research, it's not possible to recommend for or against the use of MVMs to stay healthier longer." - from NIH Fact Sheet on multi-vitamins.

The fact sheet goes on to point out when certain supplements can be helpful. It says risks from supplements are mainly from taking too much of some specific ones (e.g., A, iron).

So, take them or don’t (I take a daily multi) but base your decision on an authoritative overview and/or your physician’s recommendation.
posted by neutralmojo at 8:07 AM on July 29, 2013 [1 favorite]


Clearly, people need vitamins, and the idea that no one needs supplemental vitamins because everyone gets whatever they need from their diet, regardless of what they eat, doesn't make sense.

The article is talking about otherwise healthy people who take supplements because it seems like a good idea to do so. Of course there really are people who suffer from malnutrition, vitamin deficiencies, anemia, etc., but that's a separate issue. The thing is, far fewer people need anything resembling a supplement than most people realize. There is no proven need for reasonably healthy people with reasonably healthy diets to take vitamin supplements. If you think that sounds wrong, try to find evidence which says so.

With regard to diet, the article does not say that malnutrition does not exist, but rather that malnutrition is simply not the default nowadays. For the vast majority of people who live in a modern environment, their diet really does have all of the vitamins they need. For example, most people would have to go out of their way to completely avoid any and all iodized salt. Yes, poverty can create situations in which people really do get rickets, etc., but the issue there is poverty and diet, not One-A-Days.

Vitamin supplements are almost never as effective as simply changing one's diet. There may be concrete reasons why that would be difficult for someone to do, viz. poverty, but if you have both the need to eat healthier and the resources to do so, then you would be better served a thousand times over by just eating a more balanced diet. It's not as pat a solution as supplements, and everyone has different needs, but unlike supplements taken as a blanket precaution, it's actually effective.

As for conditions such as anemia, the condition is not necessarily caused by a "bad" diet, although it certainly can be. The person with that condition has a medical issue which requires them to treat their diet with extra attention. An anemic who takes iron supplements is not an otherwise reasonably healthy person who takes supplements just because it seems like a good idea. They're treating a specific medical condition.
posted by Sticherbeast at 8:13 AM on July 29, 2013 [2 favorites]


For example, most people would have to go out of their way to completely avoid any and all iodized salt.

FYI 'out of the way' includes all of the UK.
posted by srboisvert at 8:18 AM on July 29, 2013


FWIW, I know many many NPs and Midwives who recommend to all sexually active fertile women in their child bearing years to take prenatal vitamins. The beneficial effects of these vitamins occur really early during a pregnancy, so even people who aren't trying to get pregant will benefit if they accidently do.
posted by MisantropicPainforest at 8:20 AM on July 29, 2013


It's amazing how people can still convince themselves that they are the exception to the rule, even after science hammers a final nail. Now pass the Geritol!
posted by Brocktoon at 8:20 AM on July 29, 2013 [3 favorites]


Of course there really are people who suffer from malnutrition, vitamin deficiencies, anemia, etc., but that's a separate issue

And one strongly suspects that they are not the usual market for vitamins... Not enough money in most of the malnourished, for one.
posted by lesbiassparrow at 8:24 AM on July 29, 2013


It's amazing how people can still convince themselves that they are the exception to the rule, even after science hammers a final nail.

This is a bit insulting to anyone who understands that they are not a group mean. Aggregated data is useful for making decisions at a population level but really really dumb to rely on at an individual level. As has already been pointed out here multiple times there are numerous subsets of the population where supplementation can range from beneficial all the way to essential. No doubt many people are deluding themselves but many are not.

Put down your science hammer and try picking up a statistics text and you will learn the difference between a statistic and a rule.
posted by srboisvert at 8:29 AM on July 29, 2013 [8 favorites]


I take a One-a-Day Men's Health multi. I have for a couple of years now, and have noticed that I haven't seemed to get sick as often as I did before. This is, of course, equivalent to buying a dark grey car and noticing that I haven't seemed to get sick as often as I did before, but, welp.

It's not that I suspect scurvy, rickets and lurgi are about to strike if I don't, but more so that I have my doubts that my regular diet is sufficiently varied to hit all the essentials. I subscribe to the Michael Pollanesque view that foods containing vitamins/aminos/tiny foody things are a much better source for those than pills containing them and nothing else, but a generic multi seemed like a decent way to hedge my bets without diving into the "x thousand units of Vitamin Q will keep me cancer-free and lengthen my penis" pool.
posted by delfin at 8:33 AM on July 29, 2013 [4 favorites]


It is good for your health to get a sufficient amount of vitamins from your diet, sometimes this means you should take supplements, especially if you have some underlying condition. Ingesting more vitamins than is necessary is not helpful to your health and can have harmful side effects, even serious ones.


There is no proven need for reasonably healthy people with reasonably healthy diets to take vitamin supplements. If you think that sounds wrong, try to find evidence which says so.

In conclusion, vitamin D deficiency and insufficiency are globally still very common especially in risk groups such as young children, pregnant women, elderly and immigrants.

This is a fairly good summary of a whole lot of studies on vitamin D.
posted by Authorized User at 8:33 AM on July 29, 2013 [2 favorites]


Of course there really are people who suffer from malnutrition, vitamin deficiencies, anemia, etc., but that's a separate issue

How can the existence of nutritional deficiencies be a separate issue from the need for nutritional supplements?

Pellagra was literally epidemic in the United States before nutritional supplementation. Iodine deficiency was Literally epidemic in Bangladesh before Unicef mandated nutritional supplementation.

What constitutes an adequate diet? Who among us get such a diet? Which groups are systematically not getting the nutrition they need? Simply knowing that 'most people get sufficient nutrition from their diet' is not really very helpful, without being able to pinpoint those who are not.
posted by communicator at 8:36 AM on July 29, 2013 [3 favorites]


My husband and I both take vitamin D supplements. My midwife tested my D levels when I was pregnant with my second child, and said "You're a bit low -- try taking 2,000IU of D a day." When I pointed out that I was already taking 2KIU, she said "Um. Up it to 5,000." My husband takes 5,000IU, because he was also a bit low and he has an autoimmune disease, which emerging research suggests may be correlated with low D. (He also takes 1000mcg of folic acid, to help counteract side effects from the methotrexate he takes for that condition.)

But my doctor doesn't even test people for D deficiency any more, she just recommends that everyone in her practice take 2000 units. Why? We live in Seattle, and when she was testing people, more than 95% of them were coming back deficient. Why waste the money on the blood test?

That having been said, I don't take any other vitamins any more unless I'm hungover. Instead, I eat 8-12 servings of fruit and vegetables every day. Hopefully that covers me.
posted by KathrynT at 8:45 AM on July 29, 2013


For people who keep pointing out that this or that issue wasn't covered or that there are no footnotes, etc...the Atlantic did a not-so-great job of excerpting this from the larger book. The table of contents shows the section on supplements in the book itself is 41 pages long, of which this seems to be a shortened version of one sub-chapter. The table of contents (under "search inside this book") shows 38 pages of notes and a 10-page bibliography, so the references you are looking for are presumably there.
posted by Wylla at 8:59 AM on July 29, 2013 [1 favorite]


The table of contents seems to suggest that the rest of the book is much the same, more about personalities than data. Other chapter titles mention Suzanne Somers, Jenny McCarthy and Steve Jobs.

To be clear I have not read any more of the book than the excerpt in this FPP... but based on that excerpt and those chapter titles I am not at all interested.
posted by mountmccabe at 9:08 AM on July 29, 2013 [1 favorite]


Since neutralmojo's above link is broken for me I am going to link to NIH factsheet on multivitamin/mineral supplements as that was a good idea.
posted by mountmccabe at 9:11 AM on July 29, 2013


How can the existence of nutritional deficiencies be a separate issue from the need for nutritional supplements?

When supplements are routinely marketed to people who do not need them, which is what the article is about and what I was talking about as well. If you have a deficiency of something, then you will need more of it; if you do not have a deficiency of something, then you probably do not need more of it.

That is, indeed, a completely separate issue from, say, pellagra, where there is an actual medical condition that can be treated with changed diet or with supplementation.

...

FYI 'out of the way' includes all of the UK.

My apologies for being North America-centric. That said, my understanding was that iodized salt is mostly useful in places where people do not have regular access to fish and dairy. Google-fu indicates that goiters plummeted in the UK from the chance increase of iodine in milk, which rendered iodized salt to be less necessary than it would be in other places.
posted by Sticherbeast at 9:25 AM on July 29, 2013 [1 favorite]


Since neutralmojo's above link is broken for me I am going to link to NIH factsheet on multivitamin/mineral supplements as that was a good idea.

Linked to that page, also check out the NIH's Dietary Supplement Fact Sheet. It goes over the ups and downs of vitamin supplements. As always, there is insufficient proof that vitamin supplements should be recommended for general use, although some supplements can be useful for some people with specific needs. Most people get enough nutrition simply through their diet, and if there is a problem with your nutrient intake from your diet, then it will almost always be better to improve your diet, rather than to take a vitamin supplement.
posted by Sticherbeast at 9:38 AM on July 29, 2013


Fortunately, many excellent studies have now resolved the issue.

Science is always tentative.
posted by Obscure Reference at 9:39 AM on July 29, 2013 [3 favorites]


communicator: "I teach students who more or less starve themselves because they don't have very much money, and fill up on crisps and soda. It seems implausible to say 'people don't need nutritional supplements' when the quality and content of individual diet is so varied."

Um, but if they don't have enough money for a better diet then wouldn't they also not have money for supplements?
posted by Hairy Lobster at 9:43 AM on July 29, 2013 [2 favorites]


purely anecdotal ...

I had a health crash in my late twenties ... a half decade of various lifestyle abuses finally bringing me to my knees with what amounted to a prolonged minor flu that would not end. Various trips to the doctor, tests etc found nothing in particular wrong with me ... other than the fact that I'd been living like an idiot ever since university.

Long-story-short. I finally surrendered to the fact that I had to live better, get proper sleep, regular exercise, eat more nutritional foods, take multivitamins. It took a while (maybe six months) but I got better. Within a year, I was as healthy as I'd been since my mid-teens (when I'd ceased being a committed jock).

Were the multivitamins part of this resurgence of good health? I don't know. What they definitely were, was just one part of my taking an overall more responsible and holistic approach to my health. Which, for me, is where the whole vitamin biz gets insidious, because it does such a good job of slotting itself in with the overall notion of taking one's health more seriously. Which, on one level, may be harmless as long as you don't over-imbibe (as some have suggested). But on another, it's deliberate confusion, a little chaos lobbed into the very critical discussion that is health/nutrition etc ... for mercenary ends.

Or put it this way. I'm in my 50s now and have had no resurgence of that late 20s fatigue. What's my secret (other than perhaps having fortunate genes)? Get proper sleep, regular exercise, eat more nutritional foods, take multivitamins.

Also, a little marijuana every now and then.
posted by philip-random at 9:50 AM on July 29, 2013 [1 favorite]


srboisvert--would you not agree that as a general rule we are statistically much more likely to be near the "average" than the exception especially when the mean/mode/median are nearly the same . And that in the absence of specific knowledge of "exceptionalism" it is generally a good idea to treat oneself as one of the statistically average.
posted by rmhsinc at 9:52 AM on July 29, 2013 [1 favorite]


As the NIH points out, those whose diets are insufficiently nutritive are often exactly those who cannot afford supplements and those to whom those supplements are not marketed. Most people who actually take multivitamins already eat well enough such that they do not actually need multivitamins.
posted by Sticherbeast at 9:54 AM on July 29, 2013


For the vast majority of people who live in a modern environment, their diet really does have all of the vitamins they need. For example, most people would have to go out of their way to completely avoid any and all iodized salt

So because supplements ensure that you get enough nutrients, that somehow means supplements are unnecessary and vitamins are a "myth". How does that work exactly?
posted by Authorized User at 9:58 AM on July 29, 2013


the myth is that a personally directed recipe of multivitamins is a key part of good health.
posted by philip-random at 10:03 AM on July 29, 2013 [1 favorite]


So because supplements ensure that you get enough nutrients, that somehow means supplements are unnecessary and vitamins are a "myth". How does that work exactly?

The two instances of 'supplements' in this sentence are not referring to the same thing.
posted by inire at 10:05 AM on July 29, 2013 [1 favorite]


I'm one of those people who has absorption problems after taking some really harsh antibiotics in my teens. I wish I didn't have to take vitamin supplements, but I do because my diet alone cannot provide me with the nutrients I need to be healthy. This past week I was lax and didn't take my extra iron or Vitamin D supplements because ugh, I never remember even though it's so important, and wouldn't you know it? I feel exhausted and gross today. Sigh. I miss being a little kid with no health issues.
posted by These Birds of a Feather at 10:17 AM on July 29, 2013


the myth is that a personally directed recipe of multivitamins is a key part of good health.

Yeah OK. It's just that an article that goes through a short history of the science of vitamins without any mention of the public health gains made by supplemental nutrients in foods and then goes on to say that supplements are unneeded does really seem like it's got an agenda. Like it's about to mention how fluoridated water is going to rob us of our precious bodily fluids.
posted by Authorized User at 10:27 AM on July 29, 2013 [1 favorite]


Perhaps someone can clue me in here, but I am assuming that doctor's check patient's vitamin levels as part of regular bloodwork because deficiencies in certain vitamins is common enough in people who are otherwise healthy.
posted by inertia at 10:35 AM on July 29, 2013 [1 favorite]


Hairy Lobster: ' if they don't have enough money for a better diet then wouldn't they also not have money for supplements?'

Not at all, fresh fruit and vegetables are much more expensive to buy store and prepare than vitamin tablets. Also you can get vitamins for free on the NHS. I agree a varied and healthy diet would be better, but not everyone has access to that.

I personally don't take vitamin supplements because I have a good diet, but that's because I am fairly affluent. But many people are not. I didn't used to be affluent, and I was given vitamins as a child.

For example somebody higher up the thread said that the daily recommended dose for Vitamin C is only equivalent to one orange a day. Well, how many people can eat fresh oranges on a daily basis? When I was a kid I ate an orange once a year; it was a Christmas treat. We only had cereal, bread and jam except at weekends (though I did get meat and veg school dinners). I was given vitamin supplements, and I believe that did compensate for the lack of nutritional food.
posted by communicator at 10:51 AM on July 29, 2013


My favorite throwaway line of late seems to apply:

You can't reason someone out of a position they didn't reason themselves into


This is really, really, stupendously wrong. People are frequently reasoned out of positions that they assumed were correct without examining the evidence, or that they were indoctrinated into. It's not like anyone is born will a complete set of well-reasoned positions about anything. One of the functions that reason serves is to help people ascertain the truth regarding things that had not been critically examined up until that point. It's a frustrating irony that the people who repeat this "throwaway line" seem to have not done much reasoning about whether the position they are articulating is actually true.
posted by Pater Aletheias at 10:55 AM on July 29, 2013 [2 favorites]


Sticherbeast: 'if there is a problem with your nutrient intake from your diet, then it will almost always be better to improve your diet, rather than to take a vitamin supplement.'

But as I say two issues here. First, how do we know whether our diet is fine. The message here is 'Your diet is fine, unless it isn't fine.'

Secondly, improving your nutrition through eating a wide range of fresh foods is expensive. You are saying to poor people 'stop being poor', to old people 'stop being old'.
posted by communicator at 10:56 AM on July 29, 2013 [2 favorites]


> But my doctor doesn't even test people for D deficiency any more, she just recommends that everyone in her practice take 2000 units. Why? We live in Seattle, and when she was testing people, more than 95% of them were coming back deficient

I wonder if we have the same doctor, as mine told me all her patients she tested had low Vitamin D.
posted by The corpse in the library at 11:04 AM on July 29, 2013


communicator, as I said upthread, "Yes, poverty can create situations in which people really do get rickets, etc., but the issue there is poverty and diet, not One-A-Days." Poverty is the problem with poverty. If you cannot afford to get the food you need, then that is a shame, and that is of course not your fault. However, it still does not take away from the point that people with otherwise healthy diets derive no provable, observable benefit from multivitamin supplements. That is not a dig against people who cannot get the food that they otherwise need, nor is it a dig to say that, compared to an improved diet, multivitamins are a poor second even in the best of circumstances. This is no more of a moral judgment than, say, the simple fact that non-diabetics do not require regular insulin shots.

As for what constitutes a "good" diet from a vitamin intake perspective, there are many resources which try to answer that question. It should be telling, however, that most serious vitamin deficiencies are relatively rare in the developed world. For example, even with all of the problems with the US and the UK, Vitamin A deficiency is still under control in both countries. You do not need to eat like the proverbial king (or even health nut) in order to stave it off.

...

Perhaps someone can clue me in here, but I am assuming that doctor's check patient's vitamin levels as part of regular bloodwork because deficiencies in certain vitamins is common enough in people who are otherwise healthy.

It depends on what you mean by common, I guess. This is a US-only answer, but according to the CDC, most Americans do indeed get all the nutrients they need. However, nothing is ever perfect, and some groups suffer disproportionately from some specific insufficiencies or deficiencies.
posted by Sticherbeast at 11:14 AM on July 29, 2013


Hairy Lobster: ' if they don't have enough money for a better diet then wouldn't they also not have money for supplements?'

Not at all, fresh fruit and vegetables are much more expensive to buy store and prepare than vitamin tablets. Also you can get vitamins for free on the NHS. I agree a varied and healthy diet would be better, but not everyone has access to that.


Someone upthread linked to a study showing that there was little benefit to poorly nourished populations taking multivitamins.
posted by ultraviolet catastrophe at 11:18 AM on July 29, 2013 [2 favorites]


This is a double of something that was deleted a week ago for being a too-close-to-double of something from last month.
posted by Flunkie at 11:26 AM on July 29, 2013


The supplement industry is one of the great right wing forces in this country. Never relent in pointing out that their business is built on lying to the gullible.

Intuitively I believe that this is true, but can you point to a body of evidence?
posted by RandlePatrickMcMurphy at 11:37 AM on July 29, 2013


You can always turn to The Chasers recent short series called The Checkout. The First Episode beginning at 40secs covers how the supplement industry scams the TGAs controls in Australia and implicitly also by the FDA.

Swisse attempted to call them out on their report and this is their response.
posted by michswiss at 11:56 AM on July 29, 2013 [1 favorite]


I read this on The Atlantic a few weeks ago. My personal view is that unless there is a specific medical need, supplements are a waste of money and potentially dangerous. As someone else mentioned up stream, I too take Vit D and Folic Acid under the guidance of my specialist to offset potential side-effects of medications necessary for my autoimmune disease.
posted by michswiss at 12:02 PM on July 29, 2013 [1 favorite]


I had a psychiatrist I no longer see tell me I should take Vitamin D a while back, and it seems to help with my energy levels, which are still very, very low (but seem to be a bit better on days I take Vitamin D). But Vitamin D seems to be sort of an exception to a lot of this malarky.
posted by NoraReed at 1:13 PM on July 29, 2013


So back in February my potassium levels dropped so low that my heart could have stopped. I was eating at least 1 banana each day. Do I stop taking the multivitamin my doctor recommended and risk that again or do I keep taking it and risk a higher rate of cancer? Damned if I do, etc.

Also I sometimes take a vitamin B complex because it makes my wrists and elbows stop hurting so much from carpal and cubital tunnel. So I guess I have to weigh the evils of vitamin B against the evils of ibuprofen/other OTC painkillers.
posted by IndigoRain at 3:14 PM on July 29, 2013


So back in February my potassium levels dropped so low that my heart could have stopped. I was eating at least 1 banana each day. Do I stop taking the multivitamin my doctor recommended and risk that again or do I keep taking it and risk a higher rate of cancer?

I don't think most multivitamins have much in the way of potassium. Your RDI is 4700 mg (about the weight of a nickel). A multivitamin weighs what, maybe 750 mg?
posted by etherist at 3:41 PM on July 29, 2013


how amazingly supplements actually do cure diseases of malnutrition like scurvy

IANAD, but why would you do that when you can kill scurvy with gin & tonics?
posted by ersatz at 3:46 PM on July 29, 2013 [2 favorites]


G&Ts were for malaria, not scurvy.
posted by ambrosia at 4:34 PM on July 29, 2013


G&Ts were for malaria, not scurvy.

Limes, which of course you are using to garnish your G&T, are a decent source of vitamin C.

Unfortunately, lime wedges are quite small. You'll probably need to have a few drinks to get a suitable dosage.
posted by figurant at 4:40 PM on July 29, 2013 [5 favorites]


FUN FACT: Tonic water actually used to taste so disgusting that they invented gin and tonics so the gin would dull the flavor of the tonic a bit, rather than to dilute the gin and make it delicious.
posted by NoraReed at 5:16 PM on July 29, 2013


I take a bunch of stuff to help with my barbell training. ZMA. Fish oil. Creatine. A few different multis, for comprehensiveness. Diatomaceous earth. Flavonoids and coenzymes. Glutinoids. Protons. Snus. Various ores. All in a big shake.
posted by turbid dahlia at 6:32 PM on July 29, 2013 [4 favorites]


Perhaps someone can clue me in here, but I am assuming that doctor's check patient's vitamin levels as part of regular bloodwork because deficiencies in certain vitamins is common enough in people who are otherwise healthy.

I get regular full check ups with standard blood work and everything and my vitamin levels have never been checked as a matter of course (either in the US or the UK). Generally what gets tested is my cholesterol and blood sugar. In fact, my doctor here just wrote me a referral to get some blood tests to get my vitamin levels checked (because I have an FSA I need to use up).

I've seen the studies questioning the use of multivitamins enough times to be skeptical of the claims; but as mentioned in this thread there are a few supplements that are useful in otherwise relatively healthy adults - folic acid and Vitamin D. I thought I've also read that fish oil/Omega-3 supplements are also useful - can anyone confirm? I don't eat enough fatty fish and while I have flaxseed to sprinkle on my cereal, I also don't eat cereal that often. I would really like there to be a way for me to get sufficient fatty acids without having to also get a huge dose of mercury.
posted by triggerfinger at 6:53 PM on July 29, 2013


Okay, I looked at the above linked Cochrane Library and it turns out they have a ton of stuff on Omega-3s. Here's a summary from Omega 3 fatty acids for prevention and treatment of cardiovascular disease (a conclusion which I was a little surprised by):

It is not clear that dietary or supplemental omega 3 fats alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population. There is no evidence we should advise people to stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm suggestions of a protective effect of omega 3 fats on cardiovascular health.

There is no clear evidence that omega 3 fats differ in effectiveness according to fish or plant sources, dietary or supplemental sources, dose or presence of placebo.


This is the first time I've ever heard of the Cochrane Review and I'm glad to have found it. It seems like a trustworthy source.
posted by triggerfinger at 7:07 PM on July 29, 2013


srboisvert--would you not agree that as a general rule we are statistically much more likely to be near the "average" than the exception especially when the mean/mode/median are nearly the same . And that in the absence of specific knowledge of "exceptionalism" it is generally a good idea to treat oneself as one of the statistically average.

Feel free to tell your significant other that they are likely average in all respects.

The thing is you have more information about yourself (and hopefully also your significant other) than just population membership. Population statistics are for talking about populations. Using them for individuals is a category error.
posted by srboisvert at 7:31 PM on July 29, 2013 [1 favorite]


Every time I see my endocrinologist, every four months, she tests me for B12 and D and potassium levels, to make sure the amount I'm taking is enough.

2000 micrograms daily of oral B12 is working out to be just right, far more convenient than the shots she first offered, and far cheaper than the lovely cherry-colored B12 nasal spray. (Vitamin B12 is naturally a beautiful cerise color for very much the same reason that chlorophyll is green.) Evidently I, like a surprisingly large fraction of people my age, cannot make the transporter protein needed to absorb normal dietary quantities of B12, but it turns out a massive oral dose overrides the need for the intrinsic factor system. My blood tests are showing that the massive dose I'm taking is just right.

Today the endocrinologist expressed concern about my low vitamin D levels, only at 34 micrograms per decaliter or whatever the usual unit is, where she really wants it at 38 or higher. I have been taking 2400 IU of D3 each day, but, she says, it's not enough. Must take more pills! She's proven repeatedly to always be right, in her decisions about my medical case, so I am doing as she says.

She prescribes 750 mg potassium pills for me (take four a day, plus eat high potassium foods) since some years ago, following a miserable week of tests in the hospital that mostly failed to produce a useful diagnoses for why I couldn't walk (though it was extremely valuable to rule out the ones that they did, such as a brain tumor, which they, happily, decided not to explicitly mention to me as one of their fears until after that test proved normal). One of the few clear cut test results they had for me showed seriously low potassium. No idea why, but boy do I feel better for getting it (in addition to eating lots of high-potassium foods besides bananas). It solves the unquenchable thirst problem I've had since my early twenties. Note that there was never any good reason to test my potassium levels; it took a week of hospital tests to get anyone interested enough in the question to order the blood test. "Unquenchable thirst" is not the sort of symptom that inspires most PCPs to look for nutritional deficiencies. The associated KCl deficiency can have grim effects if untreated.

So these are just three cases in which doctor-supervised use of nutritional supplements is absolutely needed for me to be healthy at all. No particular reason why I should be so affected. It could happen to anyone. Supplementary vitamins may be used in some of the biggest scams, but they are also completely necessary for a large minority of the population.
posted by artistic verisimilitude at 10:22 PM on July 29, 2013 [1 favorite]


The original article also does not link to the original studies, which leaves me with a bunch of questions.

On October 10, 2011, researchers from the University of Minnesota evaluated 39,000 older women and found that those who took supplemental multivitamins, magnesium, zinc, copper, and iron died at rates higher than those who didn't.

How much vitamins were these women taking? Did the study control for the mechanism of delivery (were they taking over the counter supplements with additives, injections, etc.) Did they search for women who were already taking a large vitamin regime to compare to women who did--thus potentially self-selecting for women who already had health concerns, or anxiety about their health, that they were attempting to treat with vitamins?

That same year, a study published in the Journal of the American Medical Association evaluated more than 9,000 people who took high-dose vitamin E to prevent cancer; those who took vitamin E were more likely to develop heart failure than those who didn't.

So, I couldn't find this study, but I found a similar one from 2009 from the Journal of the American Medical Association, which actually reflects the exact opposite--less cardiovascular events among the group who took vitamin E, but probably not statistically significant.

In short, I'm pretty skeptical of a lot of the claims from this article. I'm also skeptical of a lot of the claims made by the supplement industry.
posted by inertia at 7:50 AM on July 30, 2013


srboisvert--I do know quite a bit about myself and my partner but none of what I know is particularly helpful in understanding or evaluating the need/appropriateness of vitamin supplements. So, I am going to go with the huddled masses and assume that they are not particularly helpful, could be dangerous and continue to eat a fairly well balanced diet and exercise regularly.
posted by rmhsinc at 10:24 AM on July 30, 2013


Dr. William Li on vitamins and cancer
posted by millardsarpy at 3:32 AM on July 31, 2013


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