Rebuttal to Anti-Vitamin Editorial: "Enough is Enough"

Doctor Rhonda Patrick Here today I'm going to discuss the recent headline grabbing editorial that was published in the Annals of Internal Medicine. The editorial, entitled Enough Is Enough Stop Wasting Money on Vitamin and Mineral Supplements, reviewed the topic of multivitamin use and chronic disease prevention. It served as a direct call to action for medical professionals to actively advise against the daily supplementation of multivitamins and for scientists to stop further research on the potential benefits of of vitamin and mineral supplements.

Now, before I get started, I just want to preface this by telling you this editorial really burns me up, primarily because it ignores decades of well done nutrition research that has demonstrated the positive benefits of micronutrient supplementation such as vitamins D, e, B and omega 3 fatty acids on disease prevention and decreasing all cause mortality primarily due to the widespread dietary inadequacies of micronutrient intake. In a recent NHANES and CDC report published in 2012, the percentage of adults in the United States not taking a vitamin and mineral supplement and falling below the estimated average requirement for vitamins and minerals are the 96% of adults not taking a vitamin or mineral supplement have inadequate levels of vitamin D, 48% have inadequate levels of vitamin C, 96% have inadequate levels of vitamin E and 58% have inadequate levels of vitamin A. Now compare this to the percentage of adults in the United States that are taking a vitamin and mineral supplement.

Only 25% have inadequate levels of vitamin D, 3% have inadequate levels of vitamin C, 5% have inadequate levels of vitamin E and and only 2% have inadequate levels of vitamin A. Now this report tells us two important things. One is that many adults in the United States have dietary inadequacies in vitamins and minerals and two is that there's an inverse correlation between vitamin and mineral supplementation and these dietary inadequacies. What this report does not tell us is whether or not supplementation with vitamins and minerals has any functional consequences on someone's health status. Let's take into account, just for a minute, vitamin D. Vitamin D is a steroid hormone that controls the expression of over a thousand different genes in the human body.

That's 1 24th of the human genome. If 96% of adults in the United States not taking a vitamin and mineral supplement have inadequate levels of this essential steroid hormone, one can probably assume there's going to be some substantial deleterious effects on someone's health status. Status. And the converse is most likely true. If vitamin D controls 1 24th of the human genome supplementation with vitamin d to bring your status back up to adequate levels most likely will have a positive benefit on someone's health. So let's take an in depth look at the editorial itself which covered three specific the effects of vitamin and mineral supplementation on cancer incidence, on cognition and cognitive decline, and on cardiovascular disease.

The editorial included a meta analysis which included several different studies and two other studies. I personally read and analyzed over 30 studies included in this editorial and identified a few common methodological problems which the authors used as supporting evidence for their claim. These common methodological problems were the problem. Problem number one most of the studies lacked any quantitative biochemical analyses of vitamin and mineral concentrations in plasma or blood cells at baseline, which is before the trial started or at follow up, which is after the treatment.

Problem number two many individuals in some of the studies were severely deficient in a particular vitamin and mineral and after the treatment they were still deficient in this particular vitamin and mineral, but which suggests that the dose of the vitamin and mineral supplement was inadequate. Problem number three in some of the studies, excessive amounts of vitamins and minerals were given. Problem number four in some of the studies, individuals were in a severely advanced disease state, which is kind of funny because the editorial focuses on the effects of vitamin and mineral supplementation on disease prevention. And finally, in the AMETA analysis, some of the studies included positive effects of vitamin and mineral supplementation on cancer incidence and cardiovascular disease.

And yet this positive data was left out and not mentioned in the editorial, which makes me believe that it's possible the authors of the editorial have an overt bias or an agenda. So let's begin by focusing on the claim that vitamin and mineral supplementation has no effect on cancer incidence by looking at the first meta analysis that was cited in this editorial entitled Vitamin and Mineral Supplementation in the Primary Prevention of Cardiovascular Disease in Cancer. Out of the 11 cancer related studies in this meta analysis, two studies showed a positive effect on cancer incidence and yet those studies were not mentioned in the editorial.

In addition, several of the studies included in this meta analysis did not measure the concentrations of vitamins and minerals in individuals in the study at baseline or follow up. Therefore, any negative data is difficult to interpret and no conclusions should be made because it's impossible to know whether or not the dosing was adequate of vitamins and minerals and or whether or not people were compliant. Let me give you an example. In one of the studies, a positive effect was shown on daily multivitamin use on cancer incidence in men but not in women. Now, when I closely examined the data, what I Found was that when you look at the vitamin and mineral concentrations in plasma in the treatment group in women, compared to the placebo group in women, their concentrations were identical.

And in fact, in some cases, the placebo group had higher concentrations of a certain mineral. So this explains why there was no effect of multivitamin use in women, but there was in men. Now, if there was no biochemical data presented in this study, it would have been impossible to understand why there was a selective protective effect on cancer incidence in men. And this really highlights the importance of having biochemical endpoints in order to quantify the effect of your treatment and whether or not individuals are compliant.

Some of the studies included in this meta analysis began with a population of individuals that were either in an early or late stage of cancer and found that giving them excessive levels of a particular vitamin, namely folic acid or vitamin A, actually accelerated the cancer. This is an important point that I want to emphasize. It's extremely important to understand potential mechanism before designing a clinical trial in which the treatment may potentially harm the participants. For example, folate is an essential B vitamin that is required for DNA synthesis and repair, among other things. So folate is required for the incorporation of a particular nucleotide, thiamine, into newly synthesized DNA. This is important because your body synthesizes new DNA as it makes new cells.

Now, if you already have cancer, this could potentially be a bad thing. And here's why. Cancer, among other things, is a disease of rapid and excessive cellular proliferation. That is, cancer cells continuously need a new supply of nucleotides, amino acids and energy to flourish. Now, since folate is required for new DNA synthesis, cancer cells actually use this to their advantage to flourish. In fact, inhibition of folate metabolism in is a very well known chemotherapeutic target to kill many different types of cancer. Now, this should not be generalized to all vitamins and minerals. In fact, folate is also very important to prevent cancer. So adequate levels of folate actually have been shown to prevent cancer. And the converse is true.

Inadequate levels of folate can actually damage your DNA, similar to irradiation, which is known to cause cancer. And, and I'm actually going to cover this topic in depth in a future video. One other vitamin that has been shown to have paradoxical effects is vitamin A. Vitamin A gets converted into a steroid hormone, retinoic acid, that regulates the expression of many different genes in the body. For example, retinoic acid is important for the function of the immune system, which is one of the first lines of defense against cancer cells. Now, with that said, individuals that are at a high risk for lung cancer due to excessive smoking or asbestos exposure should actually avoid high doses of vitamin A supplementation because it's been shown to actually accelerate carcinogenesis.

The same dose of vitamin A supplementation in non smokers does not have the same effect on cancer incidence. And here's the reason why. It's been shown that the lungs of smokers are a highly oxidative environment. And and in combination with deficiencies in certain antioxidants such as vitamin C and E, it has been shown that carotenoids, which are part of the vitamin A family under these highly oxidative conditions, can actually get cleaved into products that damage DNA, which has been shown to cause cancer. And in fact, these cleaved products also inhibit the ability of these carotenoids to be formed into the vitamin A hormone.

Now, this is a very specific condition in which smokers are at a high risk for this type of cleavage product from the carotenoids due to the highly oxidative environment. This should not be generalized to other vitamins and minerals and to other types of cancer. The bottom line is that dietary inadequacies in vitamins and minerals have been shown to cause cancer. However, if you already have cancer, things can get a bit more complicated and that's why it's extremely important to understand the mechanism. And in fact, there are a multitude of studies that have shown that vitamin and mineral supplementation can actually prevent cancer as well as prevent cancer metastasis. These studies should not be ignored.

Now, let's take a look at the two studies that investigated the role of vitamin and mineral supplementation on cognitive function. In the first study, which was included in the meta analysis that I mentioned previously, they investigated the role of vitamin D supplementation on cognitive function cognition. Now, since this study actually analyzed or quantified the levels of vitamin D after the treatment, we can critically analyze it. The treatment group had serum levels of vitamin D of 39 ng ML compared to the placebo group which had levels of 30 ng per ML. Not a big difference. In fact, both 30 and 39 ng per ML are considered adequate levels of vitamin D. Therefore, it's difficult to make any conclusions about the effects of vitamin D on cognitive function and between these two groups.

In the second study titled Long Term Multivitamin Supplementation and Cognition in Men, they investigated the effects of multivitamin use on cognitive function in men over the age of 65. However, since the study had no quantitative biochemical data either at baseline or after treatment, it's difficult to make any conclusions about whether or not this multivitamin had any effect on cognition. Another drawback to this study was that cognitive function was assessed by a phone call as opposed to any real substantive quantitative metric. Now let's take a look at some of the effects on cardiovascular diseases. Two studies investigated the role of multivitamin use on cardiovascular diseases and neither of the studies had any biochemical data either at baseline or follow up.

For example, one of the studies entitled Oral High Dose Multivitamins and Minerals after Mitocardial Infarction required that the subject took six pills a day for four and a half years. With no real biochemical data at any point throughout the study, it's difficult to know whether any of these subjects were really compliant over the course of four and a half years. I can't remember what I had for breakfast this morning, let alone whether or not I took six pills a day for the last six months. What about you? Now the other study was part of the meta analysis that I previously mentioned and found that supplementation with vitamins C, C and E actually reduced the incidence of atherosclerotic lesions.

In fact, this reduction in atherosclerotic lesions corresponded to an increase in plasma levels of vitamin C by 72% and an increase in plasma levels of vitamin E by 90%. Now why wasn't this positive effect mentioned in the editorial? Because the editorial cited the meta analysis that included the study. Is it because positive effects don't grab the attention of the press as much? In summary, some of the failures of this editorial as failure to mention the widespread dietary inadequacies of many vitamins and minerals in the United States population, failure to critically analyze the data in these studies and to make too many overgeneralizations lumping together all vitamins and minerals when in fact dosing is important, as well as specific disease states and also failure to quantify the biochemical levels of many of these vitamins and minerals at baseline or follow up.

The answer is not to stop all research or to stop vitamin and mineral supplementation, but in fact it's quite the opposite. It's to conduct more well done research in order to determine the effects, both positive and negative of vitamin and mineral supplementation in both healthy individuals as well as in specific disease states so that healthcare providers can make well informed recommendations based on these well conducted studies as opposed to making recommendations because of lack of knowledge or from reading too many misleading editorials. I'm Dr. Rhonda. Patrick. And I'll catch you next time.