Treat­ment Overkill: Older Amer­i­cans are hooked on vi­ta­mins de­spite scarce ev­i­dence they work

Walker County Messenger - - Front Page - By Liz Sz­abo

This story also ran on The New York Times. In this se­ries, “Treat­ment Overkill,” Kaiser Health News investigates the causes and con­se­quences of med­i­cal overtreat­ment, both for pa­tients and the health care sys­tem.

When she was a young physi­cian, Dr. Martha Gu­lati no­ticed that many of her men­tors were pre­scrib­ing vi­ta­min E and folic acid to pa­tients. Preliminary stud­ies in the early 1990s had linked both sup­ple­ments to a lower risk of heart dis­ease.

She urged her fa­ther to pop the pills as well: “Dad, you should be on these vi­ta­mins, be­cause ev­ery car­di­ol­o­gist is tak­ing them or putting their pa­tients on [them],” re­called Gu­lati, now chief of car­di­ol­ogy for the Univer­sity of Ari­zona Col­lege of Medicine-Phoenix.

But just a few years later, she found her­self re­vers­ing course, after rig­or­ous clin­i­cal tri­als found nei­ther vi­ta­min E nor folic acid sup­ple­ments did any­thing to pro­tect the heart. Even worse, stud­ies linked high­dose vi­ta­min E to a higher risk of heart fail­ure, prostate can­cer and death from any cause.

“‘You might want to stop tak­ing [these],’” Gu­lati told her fa­ther.

More than half of Amer­i­cans take vi­ta­min sup­ple­ments, in­clud­ing 68 per­cent of those age 65 and older, ac­cord­ing to a 2013 Gallup poll. Among older adults, 29 per­cent take four or more sup­ple­ments of any kind, ac­cord­ing to a Jour­nal of Nu­tri­tion study pub­lished in 2017.

Of­ten, preliminary stud­ies fuel ir­ra­tional ex­u­ber­ance about a promis­ing di­etary sup­ple­ment, lead­ing mil­lions of peo­ple to buy in to the trend. Many never stop. They con­tinue even though more rig­or­ous stud­ies — which can take many years to com­plete — al­most never find that vi­ta­mins pre­vent dis­ease, and in some cases cause harm.

“The en­thu­si­asm does tend to out­pace the ev­i­dence,” said Dr. JoAnn Man­son, chief of pre­ven­tive medicine at Bos­ton’s Brigham and Women’s Hospi­tal.

There’s no con­clu­sive ev­i­dence that di­etary sup­ple­ments pre­vent chronic dis­ease in the av­er­age Amer­i­can, Man­son said. And while a hand­ful of vi­ta­min and min­eral stud­ies have had pos­i­tive re­sults, those find­ings haven’t been strong enough to rec­om­mend sup­ple­ments to the gen­eral U.S. pub­lic, she said.

The Na­tional In­sti­tutes of Health has spent more than $2.4 bil­lion since 1999 study­ing vi­ta­mins and min­er­als. Yet for “all the re­search we’ve done, we don’t have much to show for it,” said Dr. Bar­nett Kramer, di­rec­tor of can­cer preven­tion at the Na­tional Can­cer In­sti­tute.

In Search Of The Magic Bul­let

A big part of the prob­lem, Kramer said, could be that much nu­tri­tion re­search has been based on faulty as­sump­tions, in­clud­ing the no­tion that peo­ple need more vi­ta­mins and min­er­als than a typ­i­cal diet pro­vides; that mega­doses are al­ways safe; and that sci­en­tists can boil down the ben­e­fits of veg­eta­bles like broc­coli into a daily pill.

Vi­ta­min-rich foods can cure dis­eases re­lated to vi­ta­min de­fi­ciency. Or­anges and limes were fa­mously shown to pre­vent scurvy in vi­ta­min-de­prived 18th-cen­tury sailors. And re­search has long shown that pop­u­la­tions that eat a lot of fruits and veg­eta­bles tend to be health­ier than oth­ers.

But when re­searchers tried to de­liver the key in­gre­di­ents of a healthy diet in a cap­sule, Kramer said, those ef­forts nearly al­ways failed.

It’s pos­si­ble that the chem­i­cals in the fruits and veg­eta­bles on your plate work to­gether in ways that sci­en­tists don’t fully un­der­stand — and which can’t be repli­cated in a tablet, said Mar­jorie McCul­lough, strate­gic di­rec­tor of nu­tri­tional epi­demi­ol­ogy for the Amer­i­can Can­cer So­ci­ety.

More im­por­tant, per­haps, is that most Amer­i­cans get plenty of the es­sen­tials, any­way. Al­though the Western diet has a lot of prob­lems — too much sodium, sugar, sat­u­rated fat and calo­ries, in gen­eral — it’s not short on vi­ta­mins, said Alice Licht­en­stein, a pro­fes­sor at the Friedman School of Nu­tri­tion Sci­ence and Pol­icy at Tufts Univer­sity.

And al­though there are more than 90,000 di­etary sup­ple­ments from which to choose, fed­eral health agen­cies and ad­vis­ers still rec­om­mend that Amer­i­cans meet their nu­tri­tional needs with food, es­pe­cially fruits and veg­eta­bles.

Also, Amer­i­can food is highly for­ti­fied — with vi­ta­min D in milk, io­dine in salt, B vi­ta­mins in flour, even cal­cium in some brands of or­ange juice.

With­out even re­al­iz­ing it, some­one who eats a typ­i­cal lunch or break­fast “is es­sen­tially eat­ing a mul­ti­vi­ta­min,” said jour­nal­ist Cather­ine Price, au­thor of “Vi­ta­ma­nia: How Vi­ta­mins Rev­o­lu­tion­ized the Way We Think About Food.”

That can make study­ing vi­ta­mins even more com­pli­cated, Price said. Re­searchers may have trou­ble find­ing a true con­trol group, with no ex­po­sure to sup­ple­men­tal vi­ta­mins. If ev­ery­one in a study is con­sum­ing for­ti­fied food, vi­ta­mins may ap­pear less ef­fec­tive.

The body nat­u­rally reg­u­lates the lev­els of many nu­tri­ents, such as vi­ta­min C and many B vi­ta­mins, Kramer said, by ex­cret­ing what it doesn’t need in urine. He added: “It’s hard to avoid get­ting the full range of vi­ta­mins.”

Not all ex­perts agree. Dr. Wal­ter Wil­lett, a pro­fes­sor at the Har­vard T.H. Chan School of Pub­lic Health, says it’s rea­son­able to take a

Drug stores’ shelves are filled with a broad range of vi­ta­min sup­ple­ments. (Ly­dia Zu­raw/KHN)

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