The word is out—it pays to take your vitamins.
In 2002, the American Medical Association (AMA) reversed its long-held anti-vitamin stance and began to encourage all adults to supplement daily with a multi-vitamin. A landmark review of 38 years of scientific evidence by Harvard researchers, Dr. Robert Fletcher and Dr. Kathleen Fairfield convinced the conservative Journal of the American Medical Association (JAMA) to rewrite its policy guidelines regarding the use of vitamin supplements. In two reports, published in the June 19, 2002 edition of JAMA, the authors concluded that the current US diet, while sufficient to prevent acute vitamin deficiency diseases, such as scurvy and pellagra, is inadequate to support long-term health.
Insufficient vitamin intake is apparently a cause of chronic diseases. Recent evidence has shown that suboptimal levels of vitamins (below standard), even well avocet those causing deficiency syndromes, are risk factors for chronic diseases such as cardiovascular disease, cancer and osteoporosis. A large portion of the general population is apparently at increased risk for this reason. — Dr. Fletcher and Dr. Fairfield
In the study, the authors examined several nutrients, including vitamins A, B6, B12, C, D, E, K, folic acid and several of the carotenoids (including alpha and beta carotene, cryptoxanthin, zeaxanthin, lycopene and lutein). Among their conclusions, they noted:
- folic acid, vitamin b6 and B12 are required for proper homocysteine metabolism, and low levels of these vitamins are associated with increased risk of heart disease (homocysteine is a sulphur-containing amino acid that, at high blood levels, can damage the cardiovascular system);
- inadequate folic acid status increases the risk of neural tube defects and some cancers (a neural tube defect is an incomplete closing of the spinal cord that occurs early in fetal development);
- vitamin E and lycopene (the red pigment found in ripe tomatoes) appears to decrease the risk of prostate cancer;
- vitamin D is associated with a decreased risk of osteoporosis and fracture when taken with calcium (osteoporosis is a hollowing out of the bones caused by the loss of calcium);
- inadequate vitamin B12 is associated with anaemia and neurological disorders (anaemia is a decrease in number of red blood cells or a lack of hemoglobin in the blood);
- low dietary levels of carotenoids, the brightly colored pigments in peppers, carrots and fruits, appear to increase the risk of breast, prostate and lung cancers (carotenoids belong to the family of nutrients called bioflavonoids);
- inadequate vitamin C is associated with increased cancer risk; and
- low levers of vitamin A are associated with vision disorders and impaired immune function
In a striking departure from JAMA’s long held anti-vitamin stance, the authors concluded that, given our modern diet, supplementation each day with a multi-vitamin is a prudent preventive measure against chronic disease. The researchers based their guidance on the fact that more than 80% of the American population does not consume anywhere near the five servings of fruits and vegetables required each day for optimal health.
JAMA’s previous comprehensive review of vitamins, conducted in the 1980’s, concluded that people of normal health do not need to take a multivitamin and can meet all their nutritional needs through diet alone. Since that time, nutritional science has compiled an impressive wealth of studies affirming the health benefits of supplementation as an adjunct to a healthy diet. The American Medical Association’s about-face in light of the Fairfield-Fletcher studies, and its public declaration that supplementation is now deemed important to your health, underscores the strength of the scientific evidence that now prevails.
The Case for Supplementation
We now have convincing evidence that the lifetime risk of cancer; heart disease; stroke; diabetes; neurological disorders, such as multiple sclerosis and amyotrophic lateral sclerosis (Lou Gehrig’s disease); macular degeneration; osteoporosis; Alzheimer’s disease and other forms of dementia can be reduced by providing the cells of the body with sufficient amount of the right nutrients.
One of the first human studies to substitute the benefits of vitamin supplements was announced in 1992 and showed that men who took 800 mg/day of vitamin C lived six years longer than those who consumed the US Food and Nutrition Board’s recommended daily allowance of 60 mg/day. Published in the journal Epidemiology, this ten year follow-up study showed that high vitamin C intake extended average lifespan and reduced mortality from both cardiovascular disease and cancer.
A compelling report that high-potency supplements extend human lifespan was published in August 1996, in the American Journal of Clinical Nutrition. The study involved 11,178 elderly people who participated in trial to establish the effects of vitamin supplements on mortality. Supplementation with vitamin E, alone, reduced the risk of overall mortality by 34% and reduced the risk of coronary disease mortality by 47%. However, when vitamin C and E were used together, overall mortality was reduced by 42% and coronary mortality dropped by 53%, demonstrating the synergistic effects of multiple vitamin therapy. What made these findings of even greater significance was that the study compared people who took low potency one-a-day multivitamins to those who took higher potency vitamin C and E supplements. Only those participants taking high-dose vitamin C and E supplements benefitted.
A 1997 study published by the British Medical Journal evaluated 1,605 healthy men with no evidence of pre-existing heart disease. Those men deficient in vitamin C were found to have a 350% increased incidence of sudden heart attacks compared to those who were not deficient in vitamin C. The authors concluded that vitamin C deficiency, as measure by low blood levels of ascorbate, is a significant risk factor for coronary heart disease.
A massive cohort study, published in 1998, investigated the risk for colon cancer in 88,756 nurses who took folic acid (a B-complex vitamin) as part of a daily multivitamin supplement.
The study found that intakes of 400 mg/day or more of folate, compared to intakes of 200 mg/day or less, were strongly related to lowered risk. While no significant protective effects were noted over shorter periods, an inverse relationship between folate intake and cancer risk became apparent after five years of use. After 15 years, a remarkable 75%reduction in the risk of colon cancer was noted among those women taking the supplements containing the B-complex vitamin. The authors concluded that longterm use of multivitamins might substantially reduce the risk for colon cancer, an effect likely related to the folic acid contained in these products.
In this same study, nurses who took multivitamins containing vitamin B6 also reduced their risk of heart attack by 30%. The evidence revealed that the more vitamin B6 they took, the lower the risk was of suffering a sudden cardiac event. These finding support those of another cohort study conducted in Norway that demonstrated a combination of folic acid and vitamin B6 can reduce homocysteine levels by up to 32% in healthy individuals. Homocysteine, a harmful amino acid at high blood levels, can markedly increase the level of inflammation and oxidative stress in blood vessels, which can precipitate both heart attack and stroke.
In 2005, an international coalition led by Canadian researchers at McMaster University, Ontario, provided evidence that a comprehensive ‘cocktail’ of nutritional supplements can significantly improve lifespan in animal models. The nutrient mixture, containing 31 nutrients common to many better quality broad-spectrum supplements available on the market, targeted key factors in the again process, including the proliferation of reactive oxygen species (ROS aka free radicals), inflammatory processes, insulin resistance and mitochondrial dysfunction. In the study, the treatment group of mice exhibited an 11% increase in lifespan compared to normal mice who did not receive the supplement cocktail. Previously, the same researcher established that the supplement cocktail completely abolished severe cognitive decline expressed by aging untreated mic. The results from these animal-model experiments demonstrate that broad-spectrum dietary supplements may be effective in ameliorating the effects of again and age-related pathologies where simpler formulation have generally failed.
The benefits of supplementation with n-3 polyunsaturated fatty acids (omega-3 fats) after a heart attack are well documented. Omega-3 fatty acids, commonly found in cold-water fish, nuts and grains, dramatically reduce the risk of premature death in high-risk individuals. A 2008 study on post-myocardial infarction (heart attack) patients revealed a significantly lowered likelihood of dangerous cardiac arrhythmia and an 85% reduction in the risk of premature death by simply maintain an optimal level of omega-3 fats in the diet. Moreover, these protective effects are also seen in healthy populations. In healthy people with no evidence of heart disease, men and women appear to achieve the same level of protection against premature death by supplementing with omega-3 oils from fish and nuts. In a 2010 Norwegian study, elderly men with no evidence of overt heart disease who supplemented with fish oil experience a 47% reduction in the risk of premature death compared to those who did not supplement. Similarly, a large Australian study found that women with the highest levels of omega-3 consumption from nuts and fish had a 44% reduction in the risk of premature death from inflammatory disease. The protective effect was dose-related to the level of omega-3 intake. The ability of omega-3 fats to reduce the level of systemic inflammation through the production of anti-inflammatory prostaglandins (primitive cell signaling hormones) appears to be the source of their protective talents.
A 19-year study of colorectal cancer rates found the relative risk in men with poor vitamin D status was almost triple that of men with sufficient vitamin D. In a meta-analysis conducted on research worldwide from 1966 to 2004, researchers from the University of California concluded that 1,000 IU/day of vitamin D lowers an individual’s risk of developing colorectal cancer by as much as 50%. A 2006 review of vitamin D status and cancer risk in the northeastern United States concluded that efforts to improve vitamin D status through vitamin D supplementation could markedly reduce cancer incidence and mortality at low cost and with few or no adverse effects. A 2008 review of current research findings on the cancer-protective effects of vitamin D concluded that intakes of between 1000 and 4000 IU per day protect against cancers of the breast, colon, prostate, ovary, lungs and pancreas. Lastly, a 2009 review on ultraviolet radiation, vitamin D and cancer concluded that circulating levels of vitamin D play an important role in determining the outcomes of several cancers. According to the authors of this review, support for the sunlight/vitamin D/cancer link is scientifically strong enough to warrant the use of vitamin D in cancer prevention and treatment protocols.
These studies and their finding are but a few of the thousands of independent scientific reports confirming the efficacy of supplementation with high quality nutritional supplements as a prudent, preventative measure for optimal health and disease prevention.
The Other Side of the Coin
To be certain, the premise of life extension and disease prevention through supplementation does not have universal support amongst the scientific community. As is inevitably the case, in an evidence based discipline there will arise conflicting studies that cast doubt on the evidence. Many researchers argue that supplements provide a convenient and effective means for supplying the optimal intakes of essential nutrients required to support long-term health; others counter that there is no conclusive proof that supplements provide any real health benefits at all.
Unfortunately, much of the debate is framed by a media more interested in selling newspapers than in ferreting out the truth. Sloppy reporting, distorted editorial sensationalism, and conflicts of interest by researchers and publishers have unnecessarily alarmed the public and have treated to destroy its trust in complementary health care. Health conscious consumers and medical practitioners alike have become frustrated at the mixed messages promulgated through the headlines: one day we are told something is good for us and the next day we are told it is bad for us. Why do so many recently published studies appear to refute the prevailing scientific evidence about the benefits of natural approaches to wellness? How can vitamin E be good for us one day and bad for us the next? For once, why can’t the experts just get it straight?
If it is of any consolation, it may be helpful to understand that science never progresses smoothly—there will always be new findings that appear to refute long established theories. Controversy is the crucible for change and paves the road that science must travel to arrive at a final truth. Unfortunately, media bias and conflicts of interest place unnecessary detours along the way.
Firstly, the consumer must understand that out of 100 clinical studies that investigate a particular effect, probability dictates that five of these studies—no matter how well designed—will show results that are not real. There will always be a statistical fluke in the bunch.
Secondly, about one-fifth of clinical trials investigating a particular effect will not have the needed number of subjects to show a statistically significant result. This occurs because in most clinical trials the probability of finding a real result, known as the power of a test, is set at a minimum of 80%. Consequently, there is up to a 20% chance of missing your mark and failing to find a different when one actually exists. This is merely the gremlin of probability at work.
Thirdly, some investigations are just bad science, improperly conducted, poorly reported and inadequately reviewed. Unfortunately, as has been the case in several recent studies, their findings attract an inordinate amount of attention from a media hungry for headlines.