Medical experts opinions
These medical experts opinions about peoples use of synthetic vitamins via supplements are unedited and are as posted on the Web by the Authors.
These Authors are expressing their own Medical Opinions and are NOT aligned in any way nor promoting Healthier Tips and their views are published in the interest of the public.
This discussion relates to the Unleashing Innovation: Health Care Report and formed the basis of a discussion on The Experts blog on 21 Nov 2013.
A lot of people incorporate vitamins into their daily health routines, but are they worth it?
With this question in mind, we posed the following question to The Experts: “Do you recommend vitamin supplements for healthy people”?? The following answers are unedited and printed as is from the article and may contain grammatical errors.
Taking Vitamins Is Easy—and Pointless
GURPREET DHALIWAL : It has been repeatedly demonstrated that vitamin supplements do not decrease cancer, heart disease, dementia or infections, and they don’t make healthy individuals live longer. That’s the upshot of many well-designed studies. A few studies have suggested that smokers who take vitamins increase their risk of cancer.
Why then do healthy people continue to spend millions of dollars on vitamins? The average person is repeatedly exposed to common myths about vitamins, e.g., vitamin C’s purported ability to help ward off a cold, but will rarely hear about the results of the aforementioned scientific trials. Because vitamins are essential for good health, it’s easy (but wrong) to conclude that more is better. And people naturally want to take an active role in improving their health, but the proven methods—stopping smoking, moderating drinking, exercising regularly and eating a balanced diet (with plenty of fruits and vegetables that are rich in vitamins)—are hard. Taking a pill on occasion is not.
With one exception (folic acid for women planning pregnancy), healthy people who take vitamin supplements should be informed that they are paying good money for a placebo effect.
Dr. Gurpreet Dhaliwal is an associate professor of clinical medicine at the University of California, San Francisco, and a staff physician at the San Francisco VA Medical Center.
Take One Daily Multivitamin. And That’s It.
ROBERT WACHTER : I do. In fact, I myself now take one multivitamin a day. Please note that this is a single multivitamin—not boatloads of pills, nor megadoses of vitamins.
For most of my career, I played down the value of vitamins, mainly because there was no convincing evidence that they made a difference. It struck me as unfair that vitamins, as well as many forms of alternative medicine, were always given a free pass, when more traditional medications were subject to rigorous assessment through clinical research and the FDA approval process. When vitamins and alternative treatments did undergo rigorous testing, virtually all of them proved to be no better than a placebo…and sometimes worse. Famously, studies of once-touted vitamins and supplements such as beta carotene and vitamin E have demonstrated increased mortality rates. Many hucksters have prayed on people’s hopes and dreams to scam small fortunes from vulnerable individuals.
This situation changed with last year’s publication by Gaziano and colleagues in the Journal of the American Medical Association (http://jama.jamanetwork.com/article.aspx?articleid=1380451).In a study of nearly 15,000 U.S. physicians followed for an average of 11 years, those doctors who were randomly selected to take a single multivitamin daily had significantly fewer cancers. Because this was a relatively healthy population, the benefits in a less highly selected population of patients who are at greater baseline risk might be even greater.
Given that a single multivitamin a day is very low risk (both clinically and financially), this seems like a reasonable thing to do. As for the rest of the vitamins, for now, the best advice is the one your mother gave you: “Eat your vegetables.” Save your money!!
Dr. Robert M. Wachter (@Bob_Wachter) is professor and associate chairman of the department of medicine at the University of California, San Francisco, and immediate past-chairman of the American Board of Internal Medicine. He is the author of a textbook on patient safety, "Understanding Patient Safety," and blogs at www.wachtersworld.org
I’d Recommend Some Vitamin D
MARISA WEISS : The best source of vitamins is a plant-based diet, consisting of fruits, vegetables, grains, beans and spices. You’re most likely to get all the vitamins you need by including produce of all colors of the rainbow. Some vitamins like vitamin D, have low concentrations in produce. Oily fish and sun exposure are the best sources. Vitamin D is important not just for bones, but for helping to regulate normal cell function. Many if not most women are vitamin D deficient. That’s because we’re inside most of the time, and when we’re out in the sun, we’re covering up with clothes or using sunscreen. Plus, the darker the skin color, the more sun you need to activate vitamin D. Given the value of vitamin D and the prevalence of deficiency, supplementation with Vitamin D3 is recommended. High doses are recommended to correct a deficiency. Maintenance doses range from 800-2000IU/day.
Dr. Marisa C. Weiss (@drmarisaweiss) is the founder and president of Breastcancer.org. She is also director of breast radiation oncology and breast health outreach at the Lankenau Medical Center in Wynnewood, Pa.
Two Key Questions About Taking Vitamins
CHARLES DENHAM : In our instant-fix society, many of us believe that if we don’t eat vegetables and do not have a balanced diet, then we can fill the gap with over-the-counter pills and supplements.
Some of these may have been manufactured with little or no regulatory control and may unintentionally and even intentionally have additives that may make us feel good short-term and could harm us long term.
To precisely answer the question of whether “healthy people” should take vitamin supplements begs two questions. First, what do we define as “healthy” and whether such people are already maintaining a healthy diet. Second, vitamin supplements must be considered as a medication and should be properly included in the list of medications that one provides to and co-maintains with one’s primary-care physician.
Although not an expert in this field, consultation with my colleagues at Harvard Medical School and the Mayo Clinic has led me to believe that one should first consult their doctor, who should make sure to reconcile all medications and dietary supplements with a patient’s current state of health. And those patients should follow the recommendations accordingly. Studies are under way to answer the questions regarding what vitamins should be taken and we will soon have answers.
Stories abound of diseases and harm that have occurred to patients and families due to indiscriminate use of vitamins and supplements. Many researchers have found that vitamins and supplements sold in health-food stores that are not manufactured with strict care may not have the active ingredients that are advertised and may even contain ingredients not listed on labels.
The good news on the horizon is that groups such as Google GOOG +1.15% are leading virtual food innovation labs that will help the world understand the supply chain from the farm to the firm to the family. Such work with leading academics and industry leaders will help us identify better, safer and healthier food that may reduce the perceived real need for dietary supplements. The experts may identify performance-enhancing foods that may even enrich our lives with acceptable risk. In the interim, we must be careful of the quick-fix silver bullets that may be targeting more than your wallet.
Dr. Charles Denham (@Charles_Denham) is the founder of the nonprofit TMIT medical-research organization and the for-profit HCC Corp., an innovation accelerator.
Vitamins Have an Important Role to Play
FRED HASSAN : Yes. Healthy diet and exercise are important, but many people may not eat or sufficiently absorb all essential foods and nutrients needed for homeostasis (the body’s own regulatory balance).
Fred Hassan is the chairman of Bausch & Lomb.
Stop Buying Vitamins and Just Get a Massage!
RITA REDBERG : I do not recommend vitamin supplements for healthy people, because repeated randomized controlled trials show that they offer NO health benefits. In fact, one large observational study with 19-year follow up published in the Archives of Internal Medicine in 2011 found a 6% increased mortality in women who take multivitamins. In any event, there is no reason to take these vitamin pills every day (or ever) when there are no health benefits associated with their use.
If you want to improve your health through things you put in your mouth, eat some fruits and vegetables and avoid processed food. Ample studies show these simple guidelines are strongly associated with less heart disease, less cancer and longer life. NONE of these benefits come from vitamin supplements.
Indeed, many people who take vitamins are already healthy from eating well, engaging in regular physical activity and avoiding smoking; the ones who are not will receive no benefit from a pill. Moreover, vitamin pills can be insidious by providing the false assurance that taking a vitamin or two (or 10) somehow will make up for that fast-food burger. But it will not. And the supplements are remarkably expensive; we spend over $20 billion annually on dietary supplements.
Stop buying vitamin supplements, and take the money you save each month and do something that truly will improve how you feel—get a massage!
Dr. Rita Redberg (@RFRedberg) is a professor of medicine and a cardiologist at the University of California San Francisco Medical Center.
Let Patients Decide on Vitamins
DAVID FOSTER : I encourage patients to educate themselves and make up their own mind. There is no great benefit or harm that compels a physician to weigh in on the topic. It’s a chance for patients to sort through the information and come to their own conclusions based on personal preferences and predilections. Patients can and will do what they want, so I say, get out of the way.
Dr. David Foster was a co-executive producer of the Fox medical drama "House."
Who Benefits From Vitamins? The Makers and Sellers.
CAROL CASSELLA: The majority of recent data would suggest that the main beneficiary of vitamin supplements is the industry that produces and sells them—it’s a $24 billion-a-year business. Unless you are pregnant or restricted from getting adequate vitamins through your diet or natural sunlight (vitamin D), many studies are showing actual harm resulting from taking supplements. Rather than preventing cancer, antioxidants have led to more tumors in some studies. Vitamin E has been linked to increased risks of prostate cancer. Calcium and vitamin D may increase the risk of kidney stones and heart disease in women but not change rates of osteoporosis—the condition they are touted to improve. That’s not to say vitamins aren’t important; they’re critical to good health and normal function. But over the eons humans evolved to absorb vitamins and minerals from whole foods, not pills and capsules. Science hasn’t begun to untangle how individual doses of vitamins affect the body when taken in this laboratory-created and discretely packaged form. Perhaps we should be spending less money on bottled supplements and more in the produce section of our grocery stores or, even better, on our kitchen gardens.
Dr. Carol Cassella (@CarolCassella) is a practicing physician and author of the novels "Oxygen" and "Healer."
Focus on Eating Healthy, Not Popping Pills
DAVID BLUMENTHAL : No, it is not necessary for otherwise healthy individuals to take vitamin supplements, provided they have a balanced diet. While there have been numerous studies, the benefits of supplement use remain mostly unproven. There is also some evidence that too much of certain vitamins and minerals can be harmful. Given the ambiguity, my advice to healthy patients is that vitamin supplements are not necessary, and should be used in moderation if a person chooses to do so. It is more beneficial for individuals to focus on healthy eating—a balanced diet can provide all the nutrients a healthy person needs. Of course, when an individual’s physician recommends vitamin supplementation for a particular medical problem, that is an entirely different circumstance.
Dr. David Blumenthal (@DavidBlumenthal) is the president and CEO of the Commonwealth Fund, a national health-care philanthropy based in New York.
Today’s Snake Oil: Vitamins?
MURALI DORAISWAMY : No. A balanced diet is all that is necessary. When Linus Pauling (the winner of two Nobel Prizes) first claimed in the 1950s that high dose vitamins may have health benefits (especially vitamin C for prevention of common cold and cancer) he was called a quack by the medical community. Some 20 years later the medical and alternative medicine community began touting high-dose vitamins for ailments from cancer to heart disease to stress to Alzheimer’s—many of the same conditions that Linus Pauling was criticized for!
Now after millions of Americans have taken daily vitamins for two decades, the results of the clinical trials are in and the news is not good. Most vitamin-supplement trials (with a few exceptions) for healthy people have shown no benefit and some showed they may be harmful. For example, a 19-year study of 38,000 women showed that multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper supplements were all linked with a 2-5% increased risk of death. A 12-year trial of 35,000 men showed that vitamin E raised risk for prostate cancer. And a study of over 180,000 people showed that antioxidant supplements were linked to a 5% greater risk of dying.
Vitamins are now being compared to snake oil, a sure sign that we have come full cycle again. Denmark took the wise step of banning foods and drinks from being fortified with vitamins.
Dr. P. Murali Doraiswamy is professor of psychiatry and medicine at Duke University Medical Center, where he also serves as a member of the Duke Institute of Brain Sciences and as a senior fellow at the Duke Center for the Study of Aging and Human Development.
For Better or Worse, Vitamins Are Medicine, Too
JOHN SOTOS : Vitamins have a good reputation. Many people think they can do only good, and never harm. Sadly, this is false.
Biologically, the only difference between a vitamin and a medication is that some amount of the vitamin is necessary for life. Once you go above that amount, however, it is better to think of vitamins as pharmaceuticals, endowed with the potential for both benefit and harm.
In short, despite their positive-sounding name, it is better to think of vitamin supplements as medications, with all their attendant risks.
For example, not many years ago, there was enormous enthusiasm for vitamin E’s potential to lower the risk of coronary artery disease, and many physicians began recommending vitamin E supplementation. Later research has shown no such benefit and, rather horrifyingly, has raised suspicions that vitamin E supplements increase the risk of heart failure. Even a vitamin having no known toxic effects at any dose, e.g. vitamin B12, can cause harm by obscuring the diagnosis of a disease.
Possibly excepting women who are contemplating or experiencing pregnancy, any decision about vitamin supplementation should be undertaken with the same deliberation used in recommending a pharmaceutical. Many supposedly healthy people (discussion of the term “healthy” is a topic unto itself) will indeed benefit from vitamin D or other supplements, but it is far safer to rephrase the question “Do you recommend vitamin supplements for healthy people?” as: “Do you recommend pharmaceutical medications for healthy people?”
Dr. John Sotos, a cardiologist and flight surgeon, was a medical technical adviser to the television series "House." He is currently CEO of the medical-expertise search company Expertscape (www.expertscape.com and @expertscapenews).
Wrap Up and conclusion.
These expert medical opinions are interesting, evocative and even provocative!! Of thought that is !! Why are some people fixated on taking chemicals in plastic capsules from plastic bottles at a premium price that have been copied from the “Real Thing”, (plants, vegetables, animal, mineral salts or soils and other natural sources)??
Could some of these capsule contents be genetically modified or contain possible impurities and can any supplier genuinely claim that their capsules contents are legitimately Organic and preservative free?? You should ask yourself, what unseen fillings, mixing or binding agents; along with what chemical additives are in these synthetic capsules? Where were they manufactured and under what medical supervision, for in essence they should be looked at as no different than the prescription your Doctor asks you to take to improve your Health?? IE, their benefits need to be legitimate !!
Finally and most importantly of all, is the euphoric lift that you think the capsule brings you; perhaps an added stimulant produced in a third world country sweat shop??
The obvious healthy alternative, is all the fresh produce in the form of vegetables, fruit and nuts, yoghurts and cheeses, olives and sundried tomatoes, as well as the occasional sizzling steak, chicken fillet, oysters or juicy salmon steak.
As Dr. Rita Redberg, Professor of medicine and a cardiologist at the University of California San Francisco Medical Center said, “Indeed, many people who take vitamins are already healthy from eating well, engaging in regular physical activity and avoiding smoking, the ones who are not, will receive no benefit from a pill.” It is indeed something to reflect upon on your next trip to the weekend markets or on your next herb and grocery trip to your local supermarket . Bon appertit.