Are supplements safe and effective
Multivitamins and breast cancer mortality and overall cancer risk in men
Studies designed to fail
Better diet improves quality of life for elderly
A recent flurry of articles in the news and in some medical journals have claimed that supplements are ineffective for prevention or treatment of disease, and may, in fact, increase risks. This conclusion is NOT justified by the vast weight of the medical literature. My colleagues in the Orthomolecular Medicine News Service have responded to these articles, and with their permission, and with links to other sources of information, I am reprinting their comments here:
Commentary by Mark McCarty
(OMNS Dec 21, 2013) "Centrum Silver Adults 50+" was the low-dose multivitamin tested in a much-trumpeted recent study that "proved that supplements don't work." Here is the manufacturer's webpage for this paragon of applied nutritional science: http://www.centrum.com/centrum-silver-adults-50-plus#tablets However, to actually see in detail what's in the product, you have to click the tiny "Product Labeling" link directly under the package illustration . . . and then scroll all the way down to the fine print in the "Ingredients" box.
But it is worth the effort. In addition to three artificial colors, note the whopping big doses (this is satire, now) of protective nutrients such as:
Vitamin D - 500 IU (Bet they thought they were going way out on a limb, adding that great extra 100 IU!)
Vitamin E - 50 IU (All provided by cutting edge, synthetic dl-alpha-tocopheryl acetate)
Magnesium - 50 mg (Wow, one-eighth of the RDA, in the ever-so-soluble oxide form!)
Zinc - 11 mg (Cleverly well below the elevated range shown to exert any "dangerous antioxidant activity" by inducing metallothionein )
Calcium - 220 mg (Note the 4.4 to 1 ratio of calcium to magnesium; way too high, and that is not a satirical comment)
Lutein - 250 mcg (Macular degeneration is now a thing of the past!)
Evidently, the failure of this nutritional powerhouse to prevent dementia can only mean that all supplementation is inherently worthless.
Granted this supplement did reduce cancer incidence by 8% (http://www.nbcnews.com/health/daily-multivitamin-cuts-mens-cancer-risk-8-percent-large-study-1C6519472), but who can remember back that far?
Of course, you would think that even modest, conservative doses of micronutrients might provide some benefit to the many mentally-challenged people whose baseline diets are overloaded with empty calories. So to give the supplement the very best chance to demonstrate efficacy, the researchers chose a population of research subjects most likely to be nutritionally deficient: American physicians!
Now that we have gotten all this supplements nonsense out of our systems, we can all go to our doctors to get prescriptions for the many drugs proven to prevent dementia (of which there are none).
But as for vitamins, thank heavens our ever-vigilant media have set us straight again! What would we do without them?
(Mark McCarty is a nutritionist and Research Director at the non-profit organization Catalytic Longevity. He is also President of NutriGuard Research, and a consultant to several medical clinics.)
1. In regard to zinc - are you aware of this result from the AREDS1 study?: http://www.ncbi.nlm.nih.gov/pubmed/15136320 The 27% reduction in total mortality observed in those getting 80 mg zinc daily has been largely ignored - even though it was a robust finding in a rather massive controlled study - presumably because few people understand it. It likely represents a protective effect of metallothionein induction, which is dose-dependent above the usual dietary range of zinc (and is likely of minimal significance with modest zinc intakes). A key target of metallothionein is cadmium, which is emerging as a major mediator of multiple risks, even in people without industrial exposure: http://catalyticlongevity.org/prepub_archive/Cd.pdf published here: http://www.ncbi.nlm.nih.gov/pubmed/22959313
For further reading:
Are Antioxidants Bad for Us? A Response to Dr. Paul Offit http://catalyticlongevity.org/prepub_archive/Are%20Antioxidants%20Bad%20for%20Us.pdf
Excellent analysis of the flawed research used to attack multivitamin supplements: http://www.lef.org/featured-articles/Flawed-Research-Used-to-Attack-Multivitamin-Supplements.htm
Gossard B, Schmid K, Huber L, Joyal SV. Flawed research used to attack multivitamin supplements. http://www.lef.org/featured-articles/Flawed-Research-Used-to-Attack-Multivitamin-Supplements.htm
Additional humorous commentary on vitamin-bashing:Multivitamins dangerous? Latest leak from the World Headquarters of Pharmaceutical Politicians, Educators and Reporters:
How to destroy confidence in vitamins when you do not have the facts: http://orthomolecular.org/resources/omns/v06n02.shtml
Confidential Memorandum from the World Headquarters of Pharmaceutical Politicians, Educators and Reporters: scroll down at http://orthomolecular.org/resources/omns/v08n11.shtml
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The conclusions from these reports appear to be that multi-vitamins are useless or worse, and that Americans (and other populations around the world) are wasting their money. Again, this is not justified. For example, breast cancer patients are greatly benefited by multivitamin/mineral (MVM) supplements. In a part of the Women’s Health Initiative, 7,728 postmenopausal women aged 50-79 had a diagnosis of invasive breast cancer. They were followed for 7.1 years. The outcome being assessed was breast cancer mortality. (Wassertheil-Smoller S, et al., Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the Women's Health Initiative. Breast Cancer Res Treat. 2013 Oct;141(3):495-505. doi: 10.1007/s10549-013-2712-x. Epub 2013 Oct 9.)
At the end of the follow-up period, there were 518 deaths from breast cancer. Among those women who reported MVM use, mortality was 30 percent lower than in non-users. The researchers reported that the results were very strong (highly robust, in researcher terminology) and persisted after adjustment for many potential confounding variables.
In this study, they also found a 12 percent reduction in mortality that did not quite reach statistical significance, but for men who had a history of cancer at the start of the study, they found a 27 percent lower total cancer risk.
In another study, from 1997 to 2011, 14,641 men received either a placebo pack or the relatively poor quality Centrum Silver (the same as the one in the first report above). At the end of the study, the MVM group had an 8 percent lower risk of cancer. (Gaziano JM, Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA. 2012 Nov 14;308(18):1871-80.)
It is easy to design a study that will fail to show significant results. You can use a low dose of the product you are studying, or too few subjects to show significance, and even if you detect benefits, you can create such strict criteria for success that they can’t be met (for example, if you set the mark at complete cure, you can ignore any reduction in symptoms short of a cure). Thus, if there is any bias at all, either conscious or not, you can basically design the study to confirm or refute your hypothesis.
Older adults who follow a better-than-average diet have better health and improved quality of life. This is hardly a surprising conclusion, but one for which it is good to have research backup. In Sydney, Australia, 1305 participants were followed for 5 years, and 895 for 10 years. They were evaluated with a 36-item Short-Form Survey assessing quality of life, with higher scores reflecting better quality. (Gopinath B, et al., Adherence to dietary guidelines positively affects quality of life and functional status of older adults. J Acad Nutr Diet. 2013 Nov 14. pii: S2212-2672(13)01409-3. doi: 10.1016/j.jand.2013.09.001. [Epub ahead of print])
They were grouped in fourths for highest to lowest diet quality (adherence to the Australian Guide to Healthy Eating). Those in the highest quartile for total diet score had a 50 percent reduced risk of impaired activities of daily living. This functional ability includes eating and walking, shopping and housework, climbing stairs, getting in and out of cars, walking on uneven ground, and bathing, among other activities.
As people get older, the importance of healthy diets does not diminish. This is important information for long-term care facilities or assisted living situations. The dietary offerings in most of these institutions are far from ideal, thus enhancing the problems that their residents start with. Improving the diets will be cost effective, as the residents will be less of a drain on resources, and they will continue to pay their residential fees for a longer time. The side benefit, of course, is that they will feel better and be more capable of taking care of themselves.
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