Editorial calling for end to vitamin use flies in face of existing research

An editorial published in the Annals of Internal Medicine late Monday US time suggesting that there are no benefits to taking multivitamins and mineral (MVM) supplements flies in the face of research which repeatedly demonstrates that the typical consumer diet falls short on critical nutrients. According to the Complementary Healthcare Council of Australia (CHC) the editorial demonstrates “a closed-minded approach that attempts to dismiss even the proven benefits of vitamins and minerals and completely fails to acknowledge the significant and ever-growing body of research that exists to support dietary supplementation". The editorial, which calls for an end to research into MVMs, is entitled, ‘Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.’  and was drafted in response to three US studies on multivitamin and mineral supplements appearing in the same issue of the journal. The first is a randomised controlled trial entitled ‘Long-Term Multivitamin Supplementation and Cognitive Function in Men: The Physicians’ Health Study II’ looking at whether vitamins affect thinking and memory skills. This trial included about 6,000 older male doctors (i.e educated and affluent) who took either a standard multivitamin or vitamin-free placebo as part of a larger men's health study.  Lead researcher, Dr Howard Sesso, Professor of Medicine at Brigham and Women's Hospital in Boston, and his colleagues found no cognitive differences between the vitamin and placebo groups at any time point. Nor did scores on the memory tests drop any faster among men in one group versus the other. But, according to the CHC the editorialists took this study’s findings out of context, arguing that when looked at in its entirety the study actually highlights the need for a balanced consideration of the findings. “While this study did not find benefit in cognitive function of male physicians aged 65 years or older, two other recently released arms of the Physicians’ Health Study II did find benefit in the specific study population in reducing the risk of cancer and cataracts,” says the CHC. In fact, in an article in response to the editorial issued by Reuters Health Monday US time, Dr Sesso himself stated “because of the possible cancer-related benefits tied to multivitamins, they are still worth considering - in particular for people who may not get enough vitamins in their diet”. That is an important point and one which the editorialists neglect to consider as they call for people to stop taking supplements and an end to research in this area. Australians are well-fed and overweight but they are not necessarily well-nourished. So the premise that "people should get enough vitamins and minerals from their diet and therefore don't need to take MVM supplements" is true in theory but not in practice. For example according to a national food and nutrition survey conducted last year (2012) by the Australian Institute of Health and Welfare (AIHW), Australia produces enough food to feed 60 million people yet more than nine in 10 people aged 16 and over do not consume sufficient serves of vegetables.  The survey also shows that one in four children have an unhealthy body weight and six in 10 adults are overweight or obese. In a statement on the editorial Mr Carl Gibson, CEO of the CHC says; “Taking a multivitamin in isolation should not be expected to prevent disease. Rather, taking a multivitamin should be seen as part of an integrated health approach, where supplementation may provide benefits on top of filling nutrient gaps when taken in combination with other healthy lifestyle choices.” Neal Mercado, Director of Blackmores Institute echoes Mr Gibson’s statement saying that “a balanced diet is the best way to get your vitamins and minerals. “However achieving a truly balanced intake of essential vitamins and minerals from your diet can be easier said than done. Therefore, a daily multivitamin is in reality an insurance policy — a supplement, not a substitute, for a healthful diet,” he says. Mr Mercado adds that for the editorial's authors to take the blanket approach of saying people are wasting their money on vitamins on the basis of some of the findings from only three studies "flies in the face of a mass of research that shows otherwise". One of the co authors of the Physicians' Health Study, John Michael Gaziano, a researcher at Brigham and Women's Hospital and the VA Boston Healthcare System, told USA Today that research gaps remain too. Saying: "It drives me crazy that [the editorial authors] say 'enough is enough,' when there's only been one large study of (standard) multivitamins and it's ours". Mr Gibson believes it will be a huge shame for Australian consumers if the editorial's one-sided approach influences the recognition of the very real need for vitamin and mineral supplementation.  “In Australia, as in the US, the typical person’s food and lifestyle choices fall far short of the desired healthy diet and healthy behaviours,” he says. Backing this up, Dr Tim Gill, principal research fellow at The Boden Institute at the University of Sydney, says the Australian diet now is based on processed foods, foods that have calories added to them, where food is relatively cheap and bad food even cheaper.  “It's widely available, it's heavily marketed … anywhere you go, there's food,'' Gill said in an article in goodfood.com.au.  “Take your local supermarket: back in the 1970s it had 3000-4000 food items; now it has 80,000 - and yet variety has hardly improved because most of those items are essentially the same: manufactured foods based on wheat flour, sugar and fat”, he adds. The other aspect to this debate, that is often overlooked, is that both the US and Australia have large, ageing populations. According to Nutrition Australia as we get older our lifestyles and appetite can change and this can affect the types and amounts of foods we eat.  “A decreasing appetite or reduced ability to buy and prepare healthy foods can mean that many older people don’t get enough essential vitamins, mineral and fibre, and this can contribute to general unwellness or exacerbate some chronic illness,” they say. “However achieving a truly balanced intake of essential vitamins and minerals from your diet can be easier said than done. Therefore, a daily multivitamin is in reality an insurance policy — a supplement, not a substitute, for a healthful diet,” he says. Importantly the researchers of the studies referred to in the editorial say that none of the studies found side effects tied to multivitamin use “so people probably aren't hurting themselves by taking multivitamins, especially in standard doses”. The second study in the Annals of Internal Medicine - 'Oral High-Dose Multivitamins and Minerals After Myocardial Infarction', by Lamas, MD, et al - for the TACT (Trial to Assess Chelation Therapy) investigators  - concluded that high-dose oral multivitamin and minerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications.    However, the authors of this study say their conclusion “is tempered by the nonadherence rate.” They state: "The high-dose vitamins used in TACT showed an 11% relative reduction in the primary composite end point relative to the placebo group that was not statistically significant. This difference was substantially smaller than the trial was powered to measure. Thus, although this trial does not support the routine use of this high-dose oral multivitamin regimen for all patients who have had MI, the reduced statistical power due to a small difference between groups, as well as nonadherence to the study regimen, limits the conclusion of nonefficacy.”   Furthermore the authors comment: “Our study had important limitations. The statistical plan was based on an effect size (25% reduction) that may have been overly optimistic for the oral vitamins”. The third study in the Annals of Internal Medicine is titled 'Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force (USPSTF)' – the basis of this study was the USPSTF draft recommendation, which, with regard to safety issues, did not identify safety concerns for vitamins at nutritional doses. Specifically, several scientific authorities have dismissed the concerns raised by the editorial for vitamin E, including this USPSTF report which states “The USPSTF found adequate evidence that supplementation with vitamin E has little or no significant harm.” The CHC recently welcomed the publication of the WHO Traditional Medicine Strategy 2014-2023, which is intended to support countries to harness the potential contribution that complementary medicines, including vitamins and minerals, can make to health, wellness and people-centred health care through appropriate integration into health systems. “If it shows anything at all, this recent editorial in the Annals of Internal Medicine highlights the fact that academics also fall short of the the cohesive and integrative approach that will ultimately allow consumers to access complementary medicines in an effective, safe and respectful manner” said Mr Gibson. A statement in response to the Annals of Internal Medicine editorial from US peak body, the Council for Responsible Nutrition (CRN), Vice President of Scientific and Regulatory Affairs, Duffy MacKay, N.D. reads, “these findings come from a well- nourished population, raising the question of whether they would be more pronounced among most Americans who are not eating a healthy diet and who do have nutrient inadequacies”. “We all need to manage our expectations about why we’re taking multivitamins. Research shows that the two main reasons people take multivitamins are for overall health and wellness and to fill in nutrient gaps. Science still demonstrates the multivitamin works for those purposes, and that alone provides reason for people to take a multivitamin,” Dr Duffy says. References: http://www.goodfood.com.au/good-food/food-news/how-australia-eats-the-ultimate-pie-chart-20131102-2wstm.html http://www.nutritionaustralia.org/national/resource/nutrition-and-older-adults https://www.aihw.gov.au/publication-detail/?id=10737422319

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