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The vitamin debate

By Debbie Farris

The case is closed on multivitamins

Debate over value of vitamin supplements rages on

Linus Pauling Institute researchers and three other institutions refuted recent claims that “the case is closed” on whether or not most people should take a multivitamin/mineral supplement to obtain vital micronutrients.

The Annals of Internal Medicine published researchers’ response that portend this type of dietary supplement might help prevent chronic disease and improve general health without causing any harm—well worth the cost of roughly three cents a day. To “call the case closed” is wrong and “misinforms the public and the medical community,” the researchers wrote. Their statements were a response to an editorial in the same publication last year that received widespread publicity. The statement was authored by nutrition experts from Oregon State University, the Children’s Hospital Oakland Research Institute, Tufts University and the Harvard University School of Public Health. While most nutrition experts agree that a balanced and nutritious diet is the best way to obtain needed nutrients, the researchers in this commentary point out that many Americans have a less-than-perfect diet – long on calories and short on nutrients - and the vast majority are deficient in one or more important micronutrients. “It’s naïve to ignore the fact that most people have nutritional inadequacies, and wrong to condemn a daily supplement that could cover these nutritional gaps safely and at low cost,” said Balz Frei, distinguished professor Biochemistry and Biophysics in the College of Science as well as professor and director of the Linus Pauling Institute. “There’s strong evidence that such a supplement may help improve overall health, largely eliminate a deficiency disease, and even help prevent chronic disease,” Frei said.

“It’s ridiculous to ignore decades of nutrition research and tell the people of the United States they have no need for a supplement that could be so helpful, and costs about $1 a month.”

The researchers raised the following points in their commentary:

  • The vast majority of people in the United States do not meet all of the guidelines for dietary intake of vitamins and minerals.
  • More than 93% of adults in the United States do not get the estimated average requirement of vitamins D and E, 61% enough magnesium, and 50% enough vitamin A and calcium.
  • Many subpopulations have even more critical needs for micronutrients, including older adults, African Americans, obese persons and some people who are ill or injured.
  • Concerns about “increased mortality” from supplements of vitamins A and E have been based on extremely high use through supplements far beyond the amount available in a multivitamin, and in the case of vitamin E largely refuted by comprehensive meta-analyses.

The value of proper nutrition, on the other hand, is wide-ranging and positive. Micronutrients maintain normal cell and tissue function, metabolism, growth and development. A supplement that helps a person “cover all the bases” can help protect daily, routine health. Overt deficiency diseases such as scurvy or rickets, while increasingly rare in the United States due to improved diet and fortified foods, are still a huge issue in the developing world. More than 650,000 children under the age of five die around the world every year from inadequate vitamin A. The potential for vitamins and other micronutrients to help reduce or prevent chronic disease continues to show promise. One of the longest, largest controlled studies ever done, the Physicians’ Health Study II, found a significant 8% reduction in total cancer incidence in male physicians – people who, through their education, income and lifestyle, probably had diets much closer to optimal than the average American.

“There are many issues that have helped to mislead people when it comes to the study of micronutrients,” Frei said.

“For instance, most research is done without first checking to see if a person is deficient in a nutrient, and you won’t find much effect from a supplement if it isn’t needed. “In similar fashion, too much research has been done with groups such as doctors and nurses who are probably not representative of the general population,” he said. “Whatever has been shown to be useful in such research probably would be even more effective in people who have poor diets or clear nutritional deficiencies.”