A recently published article in the Annals of Internal Medicine, Dec 17, 2013, Vol 159, No. 12, looked at the results of 27 studies involving over 450,000 participants taking various types and doses of vitamins to prevent cardiovascular disease, mortality, cancer and cognitive decline. None of the trials found any benefit and some trials found that a particular supplement actually caused harm.
These findings have led many doctors and health minded consumers to react by not recommending or not using their regular multivitamin regimen.
Over the course of my medical career, I have learned to take pause and analyze information before making abrupt decisions. After all, I have created a medical practice that is based upon using vitamin and nutraceutical supplementation as a preference over pharmaceuticals. My current patients look and feel healthier than any prior practice of mine, and their labwork is consistent with how they feel. Therefore, it surprises me that such a large number of patients demonstrated no appreciable benefit in these trials.
The norm when a groundbreaking study comes out is that the analytical scientists from “the opposing camp” (in this case – the medical organization that supports nutraceutical use) will pick apart the details of the study, suggesting that study flaws are the reason for the conclusions. You can read an example of such a rebuttal at: www.lef.org
Given that I am a clinical practitioner who does not spend countless hours reading and analyzing research studies, I will propose some common sense reasons as to why these studies should not necessarily change why you should take vitamins.
- Vitamins are not intended to replace a poor diet. Not a single patient leaves my office without advice on changing their nutrition, exercise, and sleep habits. If I ignored the patient’s poor lifestyle, and simply promoted a multivitamin, I highly doubt that therapy would produce any significant benefit to that patient.
- Vitamins and nutraceuticals do not work on their own. There is a major difference between pharmaceutical drugs and vitamins. A drug is a powerful agent with a single mode of action designed to block or stimulate a single enzyme. The entire purpose of the “Gold Standard” randomized double-blinded controlled trial (RCT) is to assess for the difference between taking a drug and not taking one. Like the human body, vitamins do not work in this way. For example, vitamin E for heart disease has been a controversial issue, with some studies showing benefit, and some showing none. Vitamin E works as a potent oxidation buffer, but also is involved in the inflammatory cascades. If one does not use the correct amount of omega 3 oils, they will not attain the full benefit of vitamin E. I use principles of physiology and experience to suggest a treatment plan that involves lifestyle changes and a selection of vitamins to guide the body towards better health. This approach simply cannot be studied in an RCT. All of the failed vitamin studies were conducted as RCT’s, comparing taking a single vitamin vs placebo, with no other allowed interventions.
- I am always skeptical of large-scale clinical trials. One cannot deny the financial impact that large studies have on the industry of medical therapeutics. It costs millions of dollars to conduct a large RCT. Therefore, whether one is studying a drug or a vitamin, someone has a financial interest in that study, otherwise, it would not have been conducted. Many of the negative studies that I have seen on vitamins (vitamin E is a classic example) use poor quality or wrongly dosed vitamins to show they are ineffective. The drug industry has opposing interests to the vitamin industry, and this tete-a-tete is played out through studies proving the other therapy to be ineffective. As stated above, I will leave the critical reviews to the experts, but as a practitioner and consumer, I am allowed to be skeptical of the source of the data, and so should you.
In summary, the most important difference between my practice and a standard medical doctor practice is not that I use vitamins and they use pharmaceutical drugs. My goal is to promote the health and well being of my patients, and I attend to various aspects of that person’s health to help them reach their optimal health. The drug-oriented doctor has been trained to use pharmaceuticals to treat a disease that has developed in that patient. I suggest my patients live a life that promotes optimal health, and I still feel that using vitamin supplementation is a part of that health plan.
Dr. Rishi Verma
Dr. Verma travels and trains extensively to learn new and innovative approaches to improve healthcare delivery in Canada. His focus is on personalized medicine and the application of genomic and proteomic testing in the clinical setting. He believes these areas will have a great impact on the evolution of medicine.
Dr. Verma is Vice-President of the Canadian Integrative Medicine Association and is a fellowship candidate with the Institute for Functional Medicine.
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