Newsflash! Vitamins are not drugs

Seriously, is someone trying to make nutrition look bad?

This is the kind of pointless research that drives me nuts.  The headline reads “Multivitamins Don’t Help the Heart“.  Who thought they would?  As part of the ongoing Physicians Health Study, 13,000+ male physicians aged 50+ were followed for more than 11 years each on average. Half of them got a multivitamin; half got a placebo.  The multivitamin users did not have significantly different rates of cardiovascular problems than the placebo users.  The conclusion is that multivitamins don’t prevent heart disease.  Well alrighty then.  Must mean multivitamins have no purpose.  After all, if something doesn’t prevent heart disease, what’s the point?

This is a lot like saying spark plugs, oil, new tires and engine tune ups don’t prevent car accidents.  Well perhaps in the sense that, when the car runs properly, you won’t have an accident caused by some random breakdown or flat tire.  The vitamins and minerals found in multis are nutrients.  They are all essential for health, the same way spark plugs and tires and oil are essential for a car to run.  If you get too little of a nutrient for too long, many metabolic functions go haywire.  If you get too much, excesses (water soluble vitamins) can be flushed out or simply not absorbed (many minerals).  Some excesses (fat soluble vitamins) can cause problems.  Heart disease is a complicated process that takes years to develop, and is highly dependent on genetics, lifestyle and diet.  Other than insuring you have an adequate intake of many vitamins/minerals, how exactly would a multiple prevent a complicated disease?

So what was the purpose of this study?  The researchers were perhaps trying to dissuade people from believing that multivitamins will prevent heart (or other) disease, assuming beforehand that there would be no benefit.  Certainly there are people who think a daily multiple makes up for a junk diet.  Or perhaps the researchers did believe there would be some benefit, at least from this particular multi vitamin preparation.

The problem with using the term “multiple vitamin” is that there is no standard formula.  The different brands make up their own formulas; sometimes I think they pulled numbers out of a hat.  Let’s have 500% of this vitamin and 10% of that mineral.  Let’s see, how big can the pill be?  Well we can’t fit too much of this mineral, it makes the pill too large.  And we can’t afford too much of this expensive nutrient, but let’s put just a smidgen so we can list it on the label.  A long list of stuff sure looks good!

By coincidence, I tried shopping for a multiple the other day.  I was sort of horrified.  Too much of many B vitamins.  I don’t need to be constantly overdosed on folate.  I don’t need 500% of the RDA for thiamine.  Way too much vitamin D for me, too much unwelcome calcium carbonate.  Some excessively high doses of zinc and vitamin E to take daily.  Vitamin A was all over the map, and in fact this fat soluble vitamin can be a problem in excess.  Some had silly tiny amounts of probiotics, for marketing purposes.  Omega-3 is another popular marketing come-on (NOTE: it’s pretty difficult to get any meaningful amount of omega-3 fats into a multiple vitamin pill).  At one point I started examining the children’s vitamins, since those would likely have lower doses to match a child’s recommended intake.  No such luck.  And in some cases, the children’s preparation was lacking several key nutrients.  I was so annoyed I bought nothing.

In fact it seemed like Silly Research Week.  Another study headline breathlessly gushed that high dose vitamin D also doesn’t prevent heart disease.  Who thought it would?  Why would it?  Another study on cancer risk in older women found that after modest supplementation for 4 years, women in the placebo group had an insignificantly higher risk for developing cancer.  To the women who did get cancer, it probably wasn’t insignificant.  By the way, the women in the vitamin D supplemented group achieved an average blood vitamin D level of about 44 ng/ml, while the placebo group average remained at about 32 ng/ml.  So while blood measurements are pretty clear cut, statistics on cancer risk are fuzzier.  Which cancer?  Cancer is not just one disease.  Maybe we’d have more meaningful information if the types of cancer were specified.  Back to the drawing board.

Vitamins are not drugs, except when they are

Speaking of cancer, here’s a study that used a vitamin — vitamin C — as a drug.  Don’t try this at home.  In fact, you can’t try this at home.  This study was part of an investigation into using infused vitamin C to enhance chemotherapy.  The thinking goes that extremely high vitamin C levels disrupt cancer cell — but not normal cell — metabolism, which destabilizes the cells, making them more susceptible to attack by chemotherapy drugs.  In this phase of the study, patients with brain cancer were infused with vitamin C over a 7 month period, while getting chemotherapy.  The infusion was tolerated well.  Patients getting vitamin C survived 4-6 months longer.  So not a cure.

Why infusion?  When you consume a high vitamin C food or a supplement, you absorb it from the intestines.  As your blood level approaches a certain maximum, kidneys start to flush out the excess.  So it’s hard to raise the level beyond a certain point.  With infusion, vitamin C is dumped directly into the blood raising the concentration to 20,000 micromoles, vs a normal level of 70 micromoles.  The level would stay extremely elevated as the kidneys worked to clear out that excess, so the vitamin C would have time to disrupt cancer cell metabolism.  It’s an interesting strategy, and it’s nice to know even this level of vitamin C does not adversely impact normal cells, unlike many chemotherapy agents.  But basically the vitamin is being used as a drug, administered in an extremely high dose directly into the blood to perform a non-nutrient function.

What to do about multis

So back to multiple vitamin/mineral supplements.  Are they worth it?  The intent should be that they supplement your diet, with small additional amounts of key nutrients.  They are not supposed to replace your nutrient intake.  You do get nutrients from actual food, unless your diet is limited to table sugar and vegetable oil.  And from what I can see right now, there are no suitable multiples that supplement.  They all look like replacements and then some.

There’s another problem: multiples all include a requisite list of nutrients:

  • Vitamin A
  • vitamin D
  • vitamin C
  • all known B vitamins
  • vitamin E
  • iron
  • zinc
  • some calcium
  • maybe magnesium, manganese, chromium, iodine, copper
  • maybe trivial amounts of potassium or other minerals
  • random other stuff for marketing purposes, such as probiotics, antioxidants or omega-3 fats

So if you already take vitamin D or E, now you’re getting more, perhaps more than you should.  We’re now all getting dosed with extra folate by way of mandatory wheat flour fortification.  Try buying flour or flour-based products that do not contain this added vitamin.  So if you eat any of those, plus take a multiple plus eat plenty of green leafy vegetables and high folate fruits, you’re now getting a lot of folate.  ConsumerLab (subscription required) recently reported that the folate in some B-vitamin supplements was actually more potent than the form found in vegetables and fruits, so if you’re unknowingly taking that extra potent form in a multiple, you’re getting even more folate in your system than you may realize.  Frankly I’m inclined to stick to the folate found naturally in fruits and vegetables, you know, like Mother Nature intended.  Problems with too much folate?  The major known problem is that folate can mask a B12 deficiency.  You might be B12 deficient, but the usual signs doctors look for will not be apparent if your folate is high.  So the deficiency could go on undetected.  The official Tolerable Upper Intake level of folate is 1000 micrograms/day.  Let’s do the math: you get 400 from a multiple, you eat a fortified “energy bar” which has 500 micrograms, you eat a ready-to-eat cereal with 400 micrograms/serving, you eat a big spinach salad and some bread (200-300).  Now you’re up to 1500 or more micrograms.  Hmm is anyone thinking about this?

Also it’s important to point out that many chemotherapy drugs work by blocking folate.  If you’re being treated while consuming a lot of folate from supplements, flour and other foods, the drugs might not work so well.  When in doubt in that situation, you should talk to a registered dietitian who is knowledgeable about diet for cancer patients.

Meanwhile here’s what I’m doing for the moment: continuing my quest for a suitable multiple.  I like to have one around, even if I only take it once or twice a week.  I’ll let you know if I ever find one.

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