Writing in response to three articles on vitamin and mineral supplementation published in Annals of Internal Medicine, MDs from Johns Hopkins, the University of Warwick in the UK, and the American College of Physicians wrote: "Beta-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.
"Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed -- supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough."
The editorial has led to headlines like Forbes' Case Closed: Multivitamins Should Not Be Used , and CNN's Are multivitamins a waste of money? Editorial in medical journal says yes.
What Does It Take To Be Well-Nourished?
In a nut shell, a miracle compared to what it took to be well-nourished just 60 years ago. Some experts have stated that our level of nutrition today is more than 500% less dense than it was under a century ago.
Fruits and vegetables grown decades ago were much richer in vitamins and minerals than the varieties most of us get today. The main culprit in this disturbing nutritional trend is soil depletion: Modern intensive agricultural methods have stripped increasing amounts of nutrients from the soil in which the food we eat grows. Sadly, each successive generation of fast-growing, pest-resistant fruit or vegetable is truly less good for you than the one before.
A landmark study on the topic by Donald Davis and his team of researchers from the University of Texas (UT) at Austin’s Department of Chemistry and Biochemistry was published in December 2004 in the Journal of the American College of Nutrition. They studied U.S. Department of Agriculture nutritional data from both 1950 and 1999 for 43 different vegetables and fruits, finding “reliable declines” in the amount of protein, calcium, phosphorus, iron, riboflavin (vitamin B2) and vitamin C over the past half century. Davis and his colleagues chalk up this declining nutritional content to the preponderance of agricultural practices designed to improve traits (size, growth rate, pest resistance) other than nutrition.
Efforts to breed new varieties of crops that and GMO's claimed to provide greater yield, pest resistance and climate adaptability have allowed crops to grow bigger and more rapidly, but their ability to manufacture or uptake nutrients has not kept pace with their rapid growth. There have been declines in nutrients such as magnesium, zinc and vitamins B-6 and E, but they were not studied in 1950 and more research is needed to find out how much less we are getting of these key vitamins and minerals.
The Organic Consumers Association cites several other studies with similar findings: A Kushi Institute analysis of nutrient data from 1975 to 1997 found that average calcium levels in 12 fresh vegetables dropped 27 percent; iron levels 37 percent; vitamin A levels 21 percent, and vitamin C levels 30 percent. A similar study of British nutrient data from 1930 to 1980, published in the British Food Journal,found that in 20 vegetables the average calcium content had declined 19 percent; iron 22 percent; and potassium 14 percent. Yet another study concluded that one would have to eat eight oranges today to derive the same amount of Vitamin A as our grandparents would have gotten from one.
Tomatoes grown by organic methods contain more phenolic compounds than those grown using commercial standards. That study -- published in the Journal of Agricultural and Food Chemistry -- analysed the phenolic profiles of Daniela tomatoes grown either using 'conventional' or organic methods, finding that those grown under organic conditions contained significantly higher levels of phenolic compounds than those grown conventionally.
Other findings published in the Journal of Agricultural and Food Chemistry showed that organically produced apples have a 15 percent higher antioxidant capacity than conventionally produced apples.
Once pesticides enter soil they spread at rates that depend on the type of soil and pesticides, moisture and organic matter content of the soil and other factors. A relatively small amount of spilled pesticides can therefore create a much larger volume of contaminated soil.
Due to the degrading landscape of nutrients in whole foods, the only alternative for most people living in developed nations is to optimize their levels of vital vitamins and minerals through supplementation. This is a very convenient fact left out from almost every study assessing the validity of vitamins.
The Case Is NOT Closed
Cara Welch, Sr VP of Scientific & Regulatory Affairs for Natural Products Association (NPA), stated that the case is not closed. "The intention of supplements is to supplement the diet. Don't expect supplements to cure the common cold or prevent cancer, but they are part of the puzzle of a healthy lifestyle."
Steve Mister, President and CEO of the Council for Responsible Nutrition (CRN), said: "The editorial demonstrates a close-minded, one-sided approach that attempts to dismiss even the proven benefits of vitamins and minerals. It's a shame for consumers that the authors refuse to recognize the real-life need for vitamin and mineral supplementation, living in a fairy-tale world that makes the inaccurate assumption that we're all eating healthy diets and getting everything we need from food alone.
"We would not suggest that vitamin supplements are a panacea for preventing chronic disease, but we hope the authors would agree that there is an appropriate place for supplements. Given that government research repeatedly demonstrates that the typical consumer diet is falling short on critical nutrients, vitamin supplements are an appropriate option to meet those needs."
The editorial is based on results from a sub-study of a large, randomized, placebo-controlled trial (The Physicians' Health Study II), a study of high dose multivitamins and minerals in heart attack survivors, and the previously published systematic review from the United States Preventive Services Task Force (USPSTF) .
The PHS II sub-study, an analysis of 5,947 male physicians aged 65 years or older found no difference in cognitive function between the multivitamin and placebo groups. It is important to note that data from the whole PHS II study, which included 15,000 men, has previously shown that low-dose vitamins and minerals may reduce the risk of cancer by a modest 8% , while another report from the PHS II indicated no reduction in cardiovascular disease risk .
In contrast to the PHS II regimen, with its emphasis on low doses of vitamins and minerals, another study in the Annals of Internal Medicine found that there was no difference between high doses of multivitamins and minerals and placebo for cardiovascular events in people who had suffered a heart attack.
"In stable patients with a history of myocardial infarction and receiving appropriate, evidence-based medical therapy, the use of high-dose oral multivitamins and multiminerals seemed safe but did not statistically significantly reduce cardiovascular events. These conclusions must be interpreted cautiously because of a high rate of non-adherence to the study regimen," wrote the researchers.
In the editorial, the authors wrote: "The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action.
"The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries."
In response to the editorial's claims, John Shaw, CEO and Executive Director of the NPA, said: "It's extremely unfortunate to see this overblown editorial that aims to misinform consumers and attack our industry. It's no secret that many consumers in this country don't get the recommended nutrients from their diet alone, and multivitamin and mineral supplements are an affordable alternative. For the medical professionals who authored this piece to claim that the use of supplements is not justified, is, quite frankly, baffling.
"Consumers should in no way be deterred from continuing to take the products that contribute to their improved health on a daily basis, and we encourage all consumers to discuss their dietary supplement regimen with their health care professional."
Regarding the safety issues, CRN's Mister said that the USPSTF draft recommendation, the basis for which comes from a study in the same issue of the Annals of Internal Medicine, did not identify safety concerns for vitamins at nutritional doses.
"Specifically, several scientific authorities have dismissed the concerns raised by the editorial for vitamin E, including this USPSTF report, which states 'The USPSTF found adequate evidence that supplementation with vitamin E has little or no significant harm'.
"The concerns around beta carotene are isolated to high doses in smokers, and are not a concern for the majority of consumers taking a multivitamin; we would however recommend that smokers pay strict attention to their beta-carotene intake under the advice of their doctor. The evidence does not indicate any real health risk for multivitamin use.
"Further, the authors attempt to ignore the very real benefits for reducing the risk of cancer and cataracts found in the Physicians' Health Study II. These findings are even more impressive by the fact that the benefits were found in a well-nourished population, and we haven't yet begun to explore the potential benefits for most Americans who are not eating a healthy diet and have nutrient inadequacies.
"So we agree enough is enough," said Mister. "Stop the reductionist approach to nutritional research. Stop insinuating there is evidence of harm. Stop ignoring the scientific evidence that demonstrates there is value to getting your essential nutrients. There is plenty of scientific evidence that recognizes that vitamin and mineral supplements have a role in good health for all Americans."
Natasha Longo has a master's degree in nutrition and is a certified fitness and nutritional counselor. She has consulted on public health policy and procurement in Canada, Australia, Spain, Ireland, England and Germany.