Do Vitamins Work?
We were all taught that vitamins are essential to our well-being. That much used to be indisputable. However, these days, it’s not uncommon to see headlines such as “Vitamins and Supplements: Do They Work?,” “News Keeps Getting Worse for Vitamins,” and “Doctor: Vitamins Don’t Work, Could Be Harmful,” from major news outlets like the NY Times, CBS and US News and World Report. These headlines are eye catchers because they are contrary to what we have been taught for all of our lives. Controversy sells. Anytime you headline something that is contrary to popular wisdom, you have an opportunity to sell. On the other hand, headlines that point out the obvious, or what we already know does not sell well.
For example, the US Nutritional Prevention of Cancer Trial demonstrated a statistically significant reduction in lung cancer incidence with selenium supplementation, with 200 micrograms per day cutting the incidence of cancer by nearly 50%. Lung cancer is the number one killer cancer in the U.S., so one would expect to see such findings in the headlines. Sadly, however, because such findings are what most people would expect, they rarely garner the kind of media attention received by negative studies.
But besides selling extra copies and hoping to attract new readers, is there actually any truth to the overall message that vitamins do not work, or that they may even be harmful? Is it true that vitamins are a waste of money? Are the people taking these vitamins not receiving any increased health benefits whatsoever? Let’s take a look.
An important point to remember is that these reports are generally old news re-packaged with flashy headlines. Many reports fail to tell the whole story of a study and more importantly, fail to address the conclusions of their peers in the scientific community regarding the findings of the study. Much of the information presented is taken out of context and often misleading because of the omission of relevant material. For example, these negative reports fail to acknowledge the plethora of studies that have conclusively shown that vitamins can be beneficial to those who take them. Taking a look at the whole body of evidence is a necessary element to reach any unbiased conclusions. This is all common sense. It is easy to see that these findings are editorials masked as news reports in order to sell us an idea. An objective report would present both sides of the argument. Again, this is all common sense.
In the early 1990s, several large population studies showed significant decreases in cardiovascular disease in people who consumed more vitamin C or vitamin E. For example, in a 10-year study conducted at UCLA, men who supplemented daily with 800 mg of vitamin C lived six years longer on average than men who consumed the recommended daily allowance (RDA) of 60 mg a day. The study, which enrolled over 11,000 people, showed that the higher vitamin C intake lowered the death rate from cardiovascular disease by 42%.
Similarly, several clinical trials have found that a combination dietary supplement of vitamins and minerals or a probiotic agent (Lactobacillus casei) may lower recurrence rates for people with bladder cancer, as reported in the September 2003 issue of Current Opinion in Urology. One randomized controlled trial, conducted by urologist David Lamm and colleagues at the West Virginia University School of Medicine, found that “megadoses” of multiple vitamins resulted in a nearly 50% lower cancer recurrence rate compared to supplementing with the RDA levels of those same nutrients.
Findings like these have seemed promising enough to attract the attention of the NIH, which subsequently invested hundreds of millions of dollars in an attempt to determine whether vitamins or antioxidant supplements could help ward off heart attacks, strokes, cancer, and other major diseases. When these large, expensive studies failed to show any difference in these problems between the vitamin and placebo groups, the media announced that people should not take these supplements. But again, because the science was being presented in a simplistic or “sound byte” fashion, a great deal of critical information was lost in translation. For example, what doses were used in these studies? Which forms of nutrients were chosen? Was adherence to the supplement regimen carefully monitored? And is it possible that certain combinations of nutrients are needed to see a beneficial effect?
Vitamins do work when consumed from food in the correct combination, sufficient quantities and appropriate ratios. Period. If they did not, we would all be dead. There are countless studies that prove this beyond a shadow of a doubt. Then how do some studies reach their conclusions about the ineffectiveness of vitamins? There is a simple answer. The studies are usually flawed regarding the dosages, using the correct form of the nutrients, how they monitored the subjects’ adherence to the supplement regimen, and using incorrect combinations of nutrients. Any one of these problems by itself is enough to make the results of the study unreliable. But we often find that some of these studies have multiple flaws that make the findings questionable at best.
A common mistake made with many studies is that they isolate one nutrient and study its efficacy. These studies fail to take into consideration the fact that vitamins minerals and other nutrients work synergistically and that their effectiveness in providing benefits is increased when taken together in combinations in the proper dosages. The ratios of the nutrients is also a major factor in their effectiveness. The key is in figuring out which combinations of nutrients are ideal for a particular individual, based on their biochemistry and other factors. This is all common knowledge. The researchers that failed to take these factors into consideration in their studies are irresponsible and wasting time and money, along with creating undue confusion among the population of people who are genuinely looking towards supplements for better health.
Nutrition scientist Lester Packer of the University of California at Berkeley was among the first to drive home the importance of this perspective. Dr. Packer views the interactions between antioxidant vitamins as a kind of “network”, with each vitamin’s activities complementing and reinforcing those of the other vitamins. When antioxidants encounter powerful free radicals and neutralize them, they themselves become weak oxidants and can then be neutralized or recycled by other antioxidants. The end result of combining antioxidants, then, is to minimize the generation of oxidants and create a high degree of antioxidant power. The so-called “network” effect may be critical to the success of vitamin studies, and yet, because vitamins have been viewed in the same way as drugs, they continue to be studied in isolation.
Incidentally, we also know that the activities of the fat-soluble supplements (e.g., vitamins A and E) tend to complement and reinforce those of the water-soluble supplements (e.g., vitamins C and B-Complex), affording superior protection against oxidative stress when compared to either group of antioxidants alone. The trick is in figuring out which combinations of nutrients are ideal for a particular individual, based on their biochemistry and other factors.
The real question is not about the effectiveness of vitamins in general. The question is whether or not the supplement forms are beneficial. The answer is both yes and no. Some supplements do not work as advertised for numerous reasons that will be discussed below. However, taking the correct combination of vitamins in the proper forms, ratios and quantities is definitely beneficial.
It is important to understand that a supplement is what it is. It is a supplement to your diet, not a replacement for healthy foods. Although it is recognized that a bad diet can sabotage even the most complete supplement regimen, none of the negative studies bothered to monitor the diets of their subjects. It is common sense that if you eat a diet that promotes disease, you will negate the effects of the supplements you consume. These studies failed to take common sense into consideration. A healthy diet is the foundation for nutrition, complemented with supplements to fill any gaps.
Even when multiple nutrients are studied, as in the clinical trials of multivitamins, there can be major flaws in the way the study is carried out. Not using the correct forms of the nutrients is a common problem. Not all vitamins are the same. Different forms have different properties that perform different functions.
Jane Brody’s Personal Health column in the 24 March 2009 edition of the New York Times is a case in point. The report was titled “Extra Vitamin E: No Benefit, Maybe Harm.” Because Brody is widely respected as a health journalist, her messages are often taken as gospel. But those who understand the fundamentals of nutrition and the science of supplements can read between the lines. For example, before discussing the vitamin E research, Brody makes this comment: “Some vitamin E enthusiasts object that the clinical studies used what they consider the wrong form of the vitamin, saying that each of the vitamin’s eight forms has its own biological activity. But the kind of vitamin E used in most studies, alpha-tocopherol, is the most active form in humans, according to the National Institutes of Health’s (NIH’s) Office of Dietary Supplements.
In that single, artful statement, the esteemed Times journalist managed to dismiss the crucial argument that mixed tocopherols—the eight forms of vitamin E to which she alludes—have effects that differ markedly from those of alpha tocopherol. Rather than discuss the science that demonstrates the superiority of mixed tocopherols, the forms that are naturally present in food, she points to the NIH—which happens to be the main source of funding for the vitamin E clinical trials she subsequently cites—as the final word on whether alpha tocopherol, in isolation, is a valid form of micronutrient for study. Never mind that human studies published in peer-reviewed scientific journals have shown that mixed tocopherols, when compared to alpha-tocopherol alone, are far more powerful in protecting cells against the ravages of free radicals and maintaining various measures of cardiovascular health. Some studies suggest that gamma-tocopherol and tocopherol mixtures exert more potent effects against cancer as well.
Cheap synthetic vitamins are less effective than organic supplements. Cheaply manufactured tablets often pass through the system without even being completely dissolved. This is because these pills are semi-indigestible pills that are hard pressed at high temperature and pressure with a pharmaceutical glaze coating and bound with synthetic chemicals. Virtually every ingredient in cheap multivitamins are the cheapest and least absorbed synthetic form of the many different forms available. In most cases, this not only makes them more difficult to assimilate, but can have adverse reactions, as opposed to the non-adverse effects of organically chelated minerals and food based vitamins and binders.
Part of the reason for using these synthetic binders and inferior forms of minerals that are inorganic salts, as opposed to superior organic chelated minerals, is to be able to get everything into one convenient pill that’s not too big. Synthetic binders and inorganic salts take up less space. The per unit costs are reduced so a greater corporate profit is realized. An unfortunate side effect of the corporate profit is that it degrades the product to the point of possible health hazards and uselessness. In contrast some of the better, more expensive supplements using food based binders and organic chelated minerals usually have to use a bigger tablet or capsule, or separate the daily dose into 2, 3 or 4 tablets or capsules. Also, the higher quality tablets or capsules are pressed under a more expensive, cooler temperatures. Furthermore, the chemical form of the vitamins or minerals incorporated are likely the best absorbed non-synthetic forms available. I suspect that most people who know very little about nutritional supplementation could easily visualize how dividing nutrients into 3 separate doses would be a good thing by giving our bodies a constant supply of nutrients instead of just one massive dose. After all, don’t we all try to eat three meals a day for that very reason? On top of that, because most supplements work in synergy with food, is it not common sense to take these supplements 3 times daily with meals? It has already been established that there is a limit to how much certain nutrients can be absorbed at one time. For example, one can only absorb about 500mg of Calcium at any one time. So if you take more than that at once, you are wasting it.
Here are some tips on how to spot inferior supplements. A good measuring stick is the price. If its dirt cheap, it is prob low quality. If the supplement is more expensive than the other available forms, there’s a good chance that it is higher quality. However, it is possible for low quality products to be marketed at a high cost so you must be careful.
- Vitamin E: The most obvious indicator of an inferior multivitamin is the use of the petrochemical synthetic form of Vitamin E, dl-alpha tocopherol, as opposed to the natural forms d-alpha and/or, even better, natural mixed tocopherols (includes d-beta, d-gamma, and d-delta along with the d-alpha). With the synthetic “dl” forms, less than half of what you ingest gets absorbed.
- Vitamin D: Vitamin D2 (ergocalciferol) is the synthetic, lower quality version. D3 (cholecalciferol) is the form in higher quality supplements.
- Mineral Forms: The other sure sign of product inferiority is the form of minerals used. These are the cheap inorganic salts like carbonate, oxide, and phosphate. These inorganic mineral forms are difficult to absorb and they are much more likely to cause problems (ie magnesium oxide causing diarrhea). Always look for organic chelation in the preferred form amino acid chelation, citrate (especially for calcium) or malate, lactate, etc.
Furthermore, many studies did not monitor whether the subjects actually took the supplements, and how often. These studies did not actually measure the effectiveness of vitamins and their conclusions are unreliable and misleading.
As a case in point, consider the recent study published in the 9 February 2009 issue of the Archives of Internal Medicine. This eight-year study included 161,808 postmenopausal women, making it the largest study ever of older women taking multivitamins. Based on the findings, the researchers claimed that multivitamins were useless in preventing cancer and cardiovascular disease in women.
Despite the media’s gleeful announcement that this study “proved” the ineffectiveness of supplements, the researchers never actually monitored what the women were taking during the study period. It’s quite likely that most were taking cheap, synthetic vitamins. In addition, however, there was no measurement of how often the women actually took their vitamins — or indeed whether they were taking them at all. Because this massive study never actually measured the effects of multivitamins, its conclusions can only be considered misleading and unfounded – in short one of the worst examples of junk science we have to date.
There are many other problems in the way vitamin studies are conducted these days. For example, many of the faulty studies have used dosages well below the amount shown in earlier vitamin studies to be effective in preventing heart disease, cancer and other conditions. This is obviously a huge error that would create doubts about the relevance of the data collected.
Finally, these studies fail to take a close look at the individual. We all have different nutritional needs based on our diet, exercise and lifestyle choices. Unless you individually tailor your supplement regimen, many supplements are just a waste of money. Unless you actually measure what the body needs, or what the specific nutrient deficiencies are, you are shooting in the dark and most likely be missing the biological targets that would otherwise engender health and vitality.
Sensational reporting on the “vitamins don’t work” theme can be very effective in discouraging the public from taking these micronutrients and encouraging them to rely on synthetic chemical replacements. But the conclusions from the best research to date should instead be a call to the FDA to help improve the quality of research on dietary supplements, to urge an individually tailored approach to supplementation, to improve the quality of dietary supplements, and to increase the recommended dose of vitamins to the level that is known to be effective for those individuals who are deficient.
YES, VITAMINS DO WORK when you take them in the correct forms, combination, ratio and dosage!
It’s all common sense.