By Dr. Jeremy Fischer, a naturopathic doctor and acupuncturist practicing in Los Angeles, serving West LA, Hollywood, Santa Monica, Beverly Hills, Culver City, Studio City, and the surrounding areas.
I want to address an issue that made headlines over a year ago, and which continues to be misinterpreted in the media. Article content and headlines have oversimplified this issue for the benefit of creating an attractive soundbite. The topic is the benefit – or lack thereof – of taking vitamins.
There was an article in the NY Times in June 2013 entitled, “Don’t Take Your Vitamins”, http://www.nytimes.com/2013/06/09/opinion/sunday/dont-take-your-vitamins.html, that reviewed several studies, and concludes that vitamins aren’t beneficial – and in fact may be harmful – to your health. The studies were on the use of particular vitamins, for particular populations. In the end, the studies cited ruled out the benefit of taking those particular vitamins in groups of individuals with certain characteristics. They ignored the wealth of evidence of other vitamins, or the benefits of the same vitamins in groups of people with other characteristics. Thus, they found lack of benefit based on a limited number of studies. To extrapolate this to infer lack of benefit for vitamins as a whole is irresponsible and can only be done by ignoring evidence to the contrary.
Let’s take a quick look at what the studies the author mentioned showed:
The first study mentioned, from the New England Journal of Medicine, found that smokers had increased rates of lung cancer if supplemented with beta carotene (20mg), the compound that breaks down to form vitamin A in the body, compared to placebo.
The second study from the same journal similarly showed increased risk of lung cancer in smokers or those exposed to asbestos, when given high doses of vitamin A (25,000 IU) and beta carotene (30mg), compared with placebo.
The third study, a review of randomized trials for the Cochrane database, showed supplementing with vitamins A, C, E and Selenium to prevent gastrointestinal cancers, had no effect on the risk of gastrointestinal cancer, but actually increased mortality. I was unable to access their 2004 version of this study. However upon reviewing their updated 2008 and 2012 versions, they found that: when Selenium was taken on its own, it may have actually decreased the risk of gastrointestinal cancers. Also, beta carotene, vitamin A, and vitamin E increased mortality. Selenium and vitamin C did not have any effect one way or the other.
I see here a preponderance of evidence showing increased risk of disease with certain fat-soluble vitamins. Vitamins A, E, D, and K are fat soluble. All the other vitamins, namely the B’s and C, are water-soluble). Fat-soluble vitamins have a much higher risk of building up in the body, as they get stored in fat tissue, and this is one reason they may be more risky, among other reasons. However, both fat-soluble and water-soluble vitamins may cause toxicity if taken in excess. This does not negate the beneficial effects we have seen for all vitamins in certain conditions, or the fact that some individuals and some populations actually are deficient in fat-soluble vitamins. Vitamin D is one example where we can easily point to large amounts of the population with deficiency, particularly individuals living in northern latitudes, those who don’t get much sun exposure, and those with darker skin.
The importance of supplementation with certain vitamins, due to inadequacy of the standard American diet, has been so widely recognized, that some countries have actually mandated that we include certain nutrients in our foodstuffs. For example, Canada requires that milk and margarine are fortified with vitamin D, due to the recognition of widespread hypovitaminosis D. Vitamin D is also commonly found added to milk products in the US. This supplementation prevents the childhood disease of rickets, and the adult disease of osteomalacia. The FDA has guidelines as to required amounts of iron, thiamin, niacin, riboflavin, and folate in enriched grain products, such as enriched flours, breads, cereals, and pasta. All of the above except iron are water-soluble B vitamins. These are all added to correct for nutrient deficiencies that exist in the population. However, not everyone eats these fortified foods, thus making them potentially susceptible to the nutrient deficiencies that these FDA regulations were designed to prevent.
All this is not to say that we shouldn’t or can’t try to get our nutrition from foods. Vitamins and supplements, no matter how fancy, can’t match the benefits of a healthy diet rich in a variety of deeply colored, nutritious plants, with their myriad of known and unknown compounds. However, taking a low-dose multivitamin/multimineral that contains an assortment of nutrients in small amounts can act as an ‘insurance policy’, avoiding the possibility of deficiency, while still being low enough to not run the risk of toxicity from excess.
Nutrient deficiencies may arise from poor food choices (whether due to ignorance, cultural issues, financial constraints, etc), unavailability of proper foods, and poor quality of the soil in which the food was grown, among other reasons. Even if you eat what you believe to be the healthiest, most optimum diet, you still can run the risk of being deficient in certain nutrients.
We have numerous examples of diseases that have been treated or prevented by supplementing with specific vitamins, at times at very high concentrations. For example, supplemental vitamin C has been shown to reduce LDL cholesterol (1), as well as reducing heart disease risk (2) and reducing blood pressure (3). It has also been shown to reduce risk of gout (4) However, we also know that individual vitamins can cause problems when misused, when used in people with certain disease conditions, or when used in excess. Thus, I always recommend that rather than self-medicating based on some current fad or article, the best choice is always to work with a qualified healthcare practitioner who knows his/her stuff. As a naturopathic doctor, I am trained in-depth as to the ins and outs of nutrient supplementation. I also check if I am not sure about a nutrient’s suitability in a given condition, as I am not below admitting that there is always more to learn. Furthermore, I constantly review the research literature to update my knowledge. We are always improving our knowledge about the workings of the body.
In conclusion, I recommend not jumping on this bit of sensationalism (or any, for that matter!), and recognizing that often health issues are quite more complex and nuanced than a short article in the New York Times might have you believe.
I’m Dr. Jeremy Fischer and I practice integrative medicine in Los Angeles, including the areas of Beverly Hills, Burbank, Encino, North Hollywood, Sherman Oaks, Studio City and Van Nuys.
To your health,
Jeremy Fischer, ND, L.Ac
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*Dr. Fischer sees patients for various mental, emotional, and physical health concerns. Please feel free to contact him at vitalityintegrativemedicine@gmail.com or 424-278-HEAL (4325), or CLICK HERE to sign up for a free ten minute phone consultation.
References:
1. http://www.ncbi.nlm.nih.gov/pubmed/19674720
2. http://www.ncbi.nlm.nih.gov/pubmed/15585762?dopt=Abstract
3. http://www.ncbi.nlm.nih.gov/pubmed/22492364
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2767211/