“It is disappointing that the Wall Street Journal would devote space to such a sensationalist and inaccurate item. Trying to scare Americans away from taking dietary supplements to improve their health is just plain irresponsible. Consumers deserve to hear more about the many benefits of vitamins and other dietary supplements, and I call on the Wall Street Journal to bring fairness to its reporting.
The story makes use of two recent studies that NPA believes did a disservice to the tens of millions of American who take dietary supplements. Detailing the flaws in the studies and the conclusions reached would take too much space, but to pick one major issue: as the Wall Street Journal acknowledges, “Observational trials can only show an association, not a cause and effect.” We agree, and find it troubling that a story in the Journal would use such a study to assert that “the case for dietary supplements is collapsing.”
In fact, nothing could be further from the truth. More and more studies show that vitamins have real and widely accepted health benefits. These include providing nutrients, boosting immune systems, and improving overall health. Even the authors of the vitamin E study mentioned in the article noted the benefit of vitamin E with Alzheimer’s disease and age-related macular degeneration.
The article itself notes that calcium is “important to bone health” and folic acid “reduces the likelihood of a common birth defect if taken by pregnant women.” It also states that “Researchers and nutritionists are still recommending dietary supplements for the malnourished or people with certain nutrient deficiencies or medical conditions.”
Far from collapsing, the case for vitamins is supported by experts who know best the value of good nutrition. That is why NPA has long advocated that consumers use dietary supplements as part of a healthy lifestyle. Half of all Americans take dietary supplements because they know they work.”
Jeff Wright, NPA president and owner of Wright’s Nutrients in New Port Richey, Fla., adds:
“Like so many of my fellow health food store owners, I’m dedicated to helping consumers supplement their diets with the nutrients they need. Research is the cornerstone of our industry, and it seems that every week there is a new report about the importance of vitamins to the health of millions of Americans. Stories like the one in the Wall Street Journal might scare some Americans away from taking dietary supplements to improve their health, and that is just plain irresponsible.”
What Kind of Medical Study Would Have Grandma Believe that Her Daily Multivitamin is Dangerous?
by Robert G. Smith, PhD
- The study was observational, in which participants filled out a survey about their eating habits and their use of supplements. It reports only a small increase in overall mortality (1%) from those taking multivitamins. This is a small effect, not much larger than would be expected by chance. Generalizing from such a small effect is not scientific.
- The study actually reported that taking supplements of B-complex, vitamins C, D, E, and calcium and magnesium were associated with a lower risk of mortality. But this was not emphasized in the abstract, leading the non-specialist to think that all supplements were associated with mortality. The report did not determine the amounts of vitamin and nutrient supplements taken, nor whether they were artificial or natural. Further, most of the association with mortality came from the use of iron and copper supplements, which are known to be potentially inflammatory and toxic when taken by older people, because they tend to accumulate in the body [2,3,4]. The risk from taking iron supplements should not be generalized to imply that all vitamin and nutrient supplements are harmful.
- The study lacks scientific plausibility for several reasons. It tabulated results from surveys of 38,000 older women, based on their recall of what they ate over an 18-year period. But they were only surveyed 3 times during that period, relying only on their memory of what foods and supplements they took. This factor alone causes the study to be unreliable.
- Some of these women smoked (~15%) or had previously (~35%), some drank alcohol (~45%), some had high blood pressure (~40%), and many of them developed heart disease and/or cancer. Some preexisting medical conditions were taken into account by adjusting the risk factors, but this caused the study to contradict what we already know about efficacy of supplements. For example, the study reports an increase in mortality from taking vitamin D, when adjusted for several health-relevant factors. However, vitamin D has recently been clearly shown to be helpful in preventing heart disease  and many types of cancer , which are major causes of death. Furthermore, supplement users were twice as likely to be on hormone replacement therapy, which is a more plausible explanation for increased mortality than taking supplements.
- The effect of doctor recommendations was not taken into account. By their own repeated admissions, medical doctors and hospital nutritionists are more likely to recommend a daily multivitamin, and only a multivitamin, for their sicker patients. The study did not take this into account. All it did was tabulate deaths and attempt to correct the numbers for some prior health conditions. The numbers reported do not reflect other factors such as developing disease, side effects of pharmaceutical prescriptions, or other possible causes for the mortality. The study only reports statistical correlations, and gives no plausible cause for a claimed increase in mortality from multivitamin supplements.
- The effect of education was not taken into account. When a doctor gives advice about illnesses, well-educated people will often respond by trying to be proactive. Some will take drugs prescribed by the doctor, and some will try to eat a better diet, including supplements of vitamins and nutrients. This is suggested by the study itself: the supplement users in the survey had more education than those who did not take supplements. It seems likely, therefore, the participants who got sick were more likely to have taken supplements. Because those who got sick are also more likely to die, it stands to reason that they would also be more likely to have taken supplements. This effect is purely statistical; it does not represent an increase in risk that taking supplements of vitamins and essential nutrients will cause disease or death. This type of statistical correlation is very common in observational health studies and those who are health-conscious should not be confounded by it.
- The known safety of vitamin and nutrient supplements when taken at appropriate doses was not taken into account. The participants most likely took a simple multivitamin tablet, which contains low doses. Much higher doses are also safe [4,7], implying that the low doses in common multivitamin tablets are very safe. Further, because each individual requires different amounts of vitamins and nutrients, some people must take much higher doses for best health .
Also of Interest: Orthomolecular Medicine News Service, April 29, 2010. Multivitamins Dangerous? Latest News from the World Headquarters Of Pharmaceutical Politicians, Educators and Reporters. http://orthomolecular.org/resources/omns/v06n15.shtml
“The Natural Products Association advocates that consumers use dietary supplements as part of a healthy lifestyle. Most vitamin and mineral supplements are taken to address or prevent deficiencies. While we would prefer that Americans get these nutrients from their diet, studies have consistently shown that they do not take in the essential compounds they need.
I’m always pleased to see analysis on the long-term effects of supplementation. This study, however, is quite limited in scope; the data is observational and self-reported so contributing factors are not addressed. Subsequently, the authors cannot conclude any cause and effect and there is no reason why women should change what they’re doing based on this report.
There are plenty of studies published that demonstrate the benefit of supplementation and fortification. This specific study should not dissuade the general public from the benefits of addressing a vitamin or mineral deficiency with dietary supplements. As always, consumers should discuss their supplement usage with their health care professional.”
And from the UK –