More evidence that routine multivitamin use should be avoided

[SidDithers]

If scientific evidence guides our health decisions, we will look back at the vitamin craze of the last few decades with disbelief. Indiscriminate use is, in most cases, probably useless and potentially harmful. We are collectively throwing away billions of dollars into supplements, chasing the idea of benefits that have never materialized. Multivitamins are marketed with a veneer of science but that image is a mirage – rigorous testing doesn’t support the health claims. But I don’t think the routine use of vitamins will disappear anytime soon. It’s a skillfully-marketed panacea that about half of us buy into.

Not all vitamin and mineral supplementation is useless. They can be used appropriately, when our decisions are informed by scientific evidence: Folic acid prevents neural tube defects in the developing fetus. Vitamin B12 can reverse anemia. Vitamin D is recommended for breastfeeding babies to prevent deficiency. Vitamin K injections in newborns prevent potentially catastrophic bleeding events. But the most common reason for taking vitamins isn’t a clear need, but rather our desire to “improve overall health”. It’s deemed “primary prevention” – the belief that we’re just filling in the gaps in our diet. Others may believe that if vitamins are good, then more vitamins must be better. And there is no debate that we need dietary vitamins to live. The case for indiscriminate supplementation, however, has never been established. We’ve been led to believe, through very effective marketing, that taking vitamins is beneficial to our overall health – even if our health status is reasonably good. So if supplements truly provide real benefits, then we should be able to verify this claim by studying health effects in populations of people that consume vitamins for years at a time. Those studies have been done. Different endpoints, different study populations, and different combinations of vitamins. The evidence is clear. Routine multivitamin supplementation doesn’t offer any meaningful health benefits. The parrot is dead.

This week’s Annals of Internal Medicine published three papers on multivitamins, with a frankly written editorial that should not surprise regular readers of this blog: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements:

The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.

While these papers have generated a lot of press, the findings are not surprising. They are consistent with what the accumulated scientific evidence already tells us: there is no compelling reason for most people to take regular vitamin supplements. At best there are an expensive placebo. At worst, they may be harmful.

http://www.sciencebasedmedicine.org/more-evidence-that-routine-multivitamin-use-should-be-avoided/


More common sense from the science-based medical community. Don't believe the supplement-pushers.

Sid

[Rex]

1. Yes, people in developing countries with no access to a well rounded diet

should avoid supplements! Yeah, that's the ticket!

[intaglio]

2. People in developing countries can afford supplements?

and they have access to stores that stock these supplements?

Try again.

[Rex]

3. Yeah right, ignore the thousands of groups out there that help

feed others in developing countries. I admit it took you long enough to come up with a lame answer, but you fail.

EDIt - please do continue to spread the FUD in GD, it is amusing to watch.

[intaglio]

16. That help by providing food not fantasies to people whose normal diet has been disrupted

They also check the constituents of that food to make sure that it provides enough balanced nutrition in line with the science you foolishly decry. In other words those agencies do what the recipients of that aid cannot do they check the make up of the food the recipients receive.

Labeling over in Europe tells us what nutrients we are getting in our food and what proportion of the RDA (recommended daily amount) each constituent is. You can check for yourself, you are a healthy inhabitant of the USA who can read and has access to the internet. The only thing that you must do with those advantages is avoid the internet sites of the snake oil salesmen who want only one thing - your money for pointless and sometimes dangerous "supplements".

[Gravitycollapse]

6. It's almost as if you didn't bother to read the OP.

You wouldn't do such a thing, would you?

[longship]

8. Straw man!

The article says nothing about developing countries. And does anybody realistically think that vitamin supplementation should be preferred over just feeding the people in those developing countries?

I don't.

I know you and your family are hungry. I am here from the One-A-Day corporate offices. Here! Take this pill. No, you'll still be hungry, but we'll feel better that in our dreams you might live longer before you starve to death. Plus, we get product placement to market our mostly worthless pills on your country's media.

I know that this is also a straw man. Touché. Mea culpa.

But what the Sam Hell are people trying to say with this argument? It does not make any sense at all. It certainly does not address the science in the OP.

Either address that, or I don't think one is making a cogent argument. One is just denying. Never a good tact.

[Blanket Statements]

4. The body can only absorb so much

Most supplements exceed what the body actually needs and can get from a balanced diet

[newfie11]

5. Just curious who paid for this study? Nt

Dont have time to read now but will later.

[SidDithers]

7. It's actually 3 studies...

Last edited Fri Dec 20, 2013, 10:59 PM - Edit history (1)

Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial
http://annals.org/article.aspx?articleid=1789248
Primary Funding Source: National Institutes of Health

Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial
http://annals.org/article.aspx?articleid=1789250
Primary Funding Source: National Institutes of Health, BASF, Pfizer, and DSM Nutritional Products.

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
http://annals.org/article.aspx?articleid=1767855
Primary Funding Source: Agency for Healthcare Research and Quality.



The three studies are accompanied by an editorial:
Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements
http://annals.org/article.aspx?articleid=1789253

Sid

[MerryBlooms]

9. Wait... Wut?

When I clicked on your links: All 4 of your links are to the ACP.

You are presenting your argument as if there were three different entities doing these studies.

[SidDithers]

10. There are 3 different studies...

all 3 are published in the same issue of the Annals of Internal Medicine, which is a publication of the ACP.

Each study is conducted by a different research group. with different sources of funding.

The information is right there in the article information that goes with each study.



Sid

[MerryBlooms]

13. Ah, got it, my bad.

[Vashta Nerada]

11. Evidence-based science isn't allowed in these forums!

K&R

[Liberal_in_LA]

12. says who?

[Vashta Nerada]

15. ...that was sarcasm.

[SidDithers]

18. Great thread in V&MM right now promoting the hell out of Dr. Oz...

DU used to have standards. Not so much anymore.

Sid

[Vashta Nerada]

22. Ohhhhhh, really?

Really?



The standards are gone, it seems.

[Arcanetrance]

14. I take Vitamin D as prescribed by my doctor cause it was low in my last blood test thing

[intaglio]

17. Probably, certain infections or metabolic problems can decrease the production of vitamin D

If you are healthy 10 - 15 minutes in sunlight on face and hands produces more than enough vitamin D for the day. If you want you can go into a low intensity tanning booth for 5 minutes and your supplies are boosted enough for a week.

Or it could be your doctor was just being lazy. Always ask why something is being prescribed and remember that there are still doctors out there who prescribe antibiotics for viral infections or who think that acupuncture or osteopathy or (Grud* help us) homeopathy are actually useful.


++++++++++++++++++++++++++++++++++++++++++++++++

*Grud - the Troll equivalent of Aesculapius who discovered retrophrenology -with apologies to Sir Terry.

[pnwmom]

19. That is not true if you are dark skinned and/or live in northern, cloudy latitudes. n/t

[intaglio]

33. Ok make it 30 minutes in the sunlight

or 10 in the sun booth. Human skin makes vitamin D, certain food include or have vitamin D added - milk has it added. Oily fish (mackerel and salmon types) have plenty naturally as do eggs. Given these natural resources provide plenty of vitamin D you really must ask your doctor why he has prescribed a supplement.

[pnwmom]

40. A tanning booth for black people instead of a supplement?

You've got to be kidding.

http://www.cbsnews.com/news/vitamin-d-cuts-heart-risk-in-african-americans/

A new study shows that supplements of vitamin D - sometimes called the "sunshine vitamin" because the body produces it upon exposure to sunlight - curbs African-Americans' cardiovascular risk by improving the health of blood vessels.

The finding could be significant, because blacks often face a higher risk for cardiovascular disease than other groups.

Blacks are more likely to develop type 2 diabetes and severe high blood pressure - both of which are risk factors for cardiovascular disease, according to a statement released in conjunction with the study. And because dark pigmentation inhibits skin cells' ability to make vitamin D in response to ultraviolet light, blacks are more likely to be deficient in vitamin D.

SNIP

"This points to a beneficial effect of vitamin D supplementation on endothelial cell function," researcher Dr. Ryan A. Harris, an assistant professor at the university, said in the statement. "If you're deficient in vitamin D and you take supplements, you have a good probability of increasing endothelial function and therefore decreasing the risk of cardiovascular disease."

[intaglio]

42. Well, every human makes vitamin D in sunlight, whatever their skin colour

Some human types are more efficient than others. Additionally, as I pointed out many foods contain vitamin D.

Now, looking at the synopsis provided by Eurekalert. It is a piss poor study.

1) There was a very, very limited selected group (45 individuals) of only one particular body type, age range and skin colour. There was no assessment of exercise patterns or investigation into the source of excess weight and no BMI monitoring.

2) There was no preliminary study to see how just turning up to the lab affected the participants.

3) the study only went on for only 16 weeks, involved very high doses of the medication every 4 weeks. There was no gradation of the dosage presumably because of the tiny size of the group.

4) There appears to have been no assay of the blood, different people eliminate vitamin D at different rates, which would also have provided a better measure of compliance.

5) There was no follow up to see the effects after the study, because of this the assurances about no side effects being observed are not worth the air taken to speak them. Indeed there is no indication about how they measured even short term side effects or if they relied on the participants reporting side effects.

6) and finally they used only one particular measure of arterial and venous flow; no other measurement was taken.

The article was published as follows Dong, Y., I.S. Stallmann-Jorgensen, N.K. Pollock, R.A. Harris, D. Keeton, Y. Huang, K. Li, R. Bassali, D. Guo, J. Thomas, G.L. Pierce, J. White, M.F. Holick, H. Zhu. A 16-week randomized clinical trial of 2,000 IU daily vitamin D3 supplementation in black youth: 25 hydroxyvitamin D, adiposity, and arterial stiffness. Journal of Clinical Endocrinology & Metabolism. 95.

In addition to all the other flaws I can see no indication as to who provided the funding for this study.

[pnwmom]

43. It is ludicrous to suggest that black people should go to tanning booths

instead of taking Vitamin D supplements, if needed.

All that will do is make their skin darker, which will mean they absorb LESS vitamin D through their skin.

It is also ludicrous to complain that a study of black people, Vitamin D, and heart disease, includes only black people. Or that it focuses on the black people most at risk for heart disease: those who are overweight and older.


"1) There was a very, very limited selected group (45 individuals) of only one particular body type, age range and skin colour. "

[intaglio]

44. It is ridiculous to suggest that supplements are needed

What you are saying is that black people do not make vitamin D from UV exposure which is a lie. I am not saying that the booth should be used for tanning, just to top up vitamin D production. In the UK (not the sunniest portion of the world) the only people for whom vitamin D supplements are recommended are women who habitually wear a burqa or a hijab that covers the face and who have had 2 or three children in succession.

As to the limitation on skin colour in the experiment you cannot compare effects between racial groups without that - idiot. If there had been a white element the experimenters could have seen whether the dilation and increase in flow was common across all groups and if so the supplement would not be indicated as a method of limiting arterioschlerotic disease. Limiting a study to any one racial group is always flawed because you cannot make valid comparisons especially when you are using a novel method of measurment in this case of arterial flow. The study was also limited as to the age range, it studies "black youth", which suggests that it was a campus study enrolling only students. There was no indication of how much cardio-vascular exercise the participants took. There is not even a mention of what time of year it occurred which would also have skewed the results. There should have been at least 150 people in the cadre. There should have been assays of vitamin D.

It is a crap piece if research and there is no way you should be using it as a basis for your healthcare decisions.

[pnwmom]

46. No medical authorities recommend that black people "top up" their

Last edited Sun Dec 22, 2013, 05:47 AM - Edit history (3)

Vitamin D production by using a tanning bed. But the Harvard School of Public Health, the National Institutes of Health, the National Cancer Institute and others recommend Vitamin D supplements for people with low vitamin D levels, which is more common in higher latitudes and among people with darker skin.

The reason for this particular study including only black people was to study the effects of vitamin D supplementation ON BLACK PEOPLE, "idiot."


The point of the study was NOT to compare the effects across different groups, so it is not a flaw that it didn't do so -- it was a purposeful part of the study design. Including a handful of black people in a study with a broad cross-section of people would have yielded no meaningful results for the subgroup of black people they wanted to study.

There is nothing flawed about limiting a study to any particular group, as long as you don't assume the results apply to the larger population.

That being said, there have been numerous studies showing that Vitamin D supplementation is helpful for many people. You're just flat out wrong to say that Vitamin D supplements are never needed.


From the Harvard School of Public Health

If you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, odds are that you don’t get enough vitamin D. The same holds true if you don’t get outside for at least a 15-minute daily walk in the sun. African-Americans and others with dark skin, as well as older individuals, tend to have much lower levels of vitamin D, as do people who are overweight or obese.

Worldwide, an estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. (1-3) Indeed, in industrialized countries, doctors are even seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification. (4-6)
Why are these widespread vitamin D deficiencies of such great concern? Because research conducted over the past decade suggests that vitamin D plays a much broader disease-fighting role than once thought.

Food sources: Very few foods naturally contain vitamin D. Good sources include dairy products and breakfast cereals (both of which are fortified with vitamin D), and fatty fish such as salmon and tuna. For most people, the best way to get the recommended daily intake is by taking a supplement, but the level in most multivitamins (400 IU) is too low; encouragingly, some manufacturers have begun adding 800 or 1,000 IU of vitamin D to their standard multivitamin preparations.

Getting vitamin D from the sun: Correctly applied sunscreen reduces our ability to absorb vitamin D by as much as 90 percent. At higher latitudes (in the northern U.S., for example), exposure to the sun in winter will not form vitamin D (due to the angle of the sun's rays), so a supplement is advisable.

http://jn.nutrition.org/content/136/4/1126.full

Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year. . . . Clinicians and educators should be encouraged to promote improved vitamin D status among blacks (and others) because of the low risk and low cost of vitamin D supplementation and its potentially broad health benefits.

From the National Institutes of Health:

http://www.nlm.nih.gov/medlineplus/druginfo/natural/929.html

Nevertheless, vitamin D deficiency is more common than you might expect. People who don’t get enough sun, especially people living in Canada and the northern half of the US, are especially at risk. Vitamin D deficiency also occurs even in sunny climates, possibly because people are staying indoors more, covering up when outside, or using sunscreens consistently these days to reduce skin cancer risk.

Older people are also at risk for vitamin D deficiency. They are less likely to spend time in the sun, have fewer “receptors” in their skin that convert sunlight to vitamin D, may not get vitamin D in their diet, may have trouble absorbing vitamin D even if they do get it in their diet, and may have more trouble converting dietary vitamin D to a useful form due to aging kidneys. In fact, the risk for vitamin D deficiency in people over 65 years of age is very high. Surprisingly, as many as 40% of older people even in sunny climates such as South Florida don’t have enough vitamin D in their systems.

Vitamin D supplements may be necessary for older people, people living in northern latitudes, and for dark-skinned people who need extra time in the sun, but don’t get it.

The National Cancer Institute:

http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D

IOM states that people should not try to increase vitamin D production by increasing their exposure to sunlight because this will also increase their risk of skin cancer

[intaglio]

51. The National Cancer institute would like everybody to go round in Burqas

A little sun every day is plenty, if you have no sun then you can eat if you are terrified of 5 minutes in a tanning booth

Foods with much vitamin D
Swiss cheese 1% RDA per slice; 1 boiled egg has 6-8% RDA; goats cheese 1% RDA per 30 grams (1 oz); white mushrooms 1% per 30 grams, shitake mushrooms 3% per 4, portobello mushrooms 64% RDA per cup, canned salmon 91% RDA per 100% grams, canned tuna 39% RDA per 100 grams, kippers about 35% RDA per 100 grams, smoked salmon and fresh salmon 250% RDA per 100 grams if wild, 120% if farmed; mackerel and sardines 45% RDA per 100 grams; if you are not Jewish or Muslim sausages or salami 30% RDA per 100 grams, and shellfish varies but over 1% per 50 grams; if you are not Hindu then beef liver - which has bonus iron, 8% per 100 grams; if you really need fortified foods then breakfast cereals, milk, orange juice and many yogurts are fortified with extra vitamin D.

As an example Cornflakes (in the UK) have 100% of RDA per 100 grammes of vitamin D, vitamin B1 (thiamin), vitamin B2 (riboflavin), niacin, vitamin B6, vitamin B12, pantothenic acid, and iron. That same 100 grammes has 200% of the RDA for folic acid.

Most milk in the USA is fortified with 10 micrograms per quart of vitamin D (400 IU) which is twice the RDA. Therefore 2 bowls of cereal a day (60 gram total) with milk and a glass of orange juice and you have just had your total RDA of vitamin D without enriching patent pill merchants and your pharmacist.

Given this why the blue blazes do you need tablet supplements?

[pnwmom]

52. I can't believe you're still pushing tanning booths for black people.

It's just nutty.

With supplements, people know exactly how much they're getting and they're not at risk for skin cancer.

The current RDA is low, and getting 1,000 - 4,000 units is hard through food alone. That's why the National Cancer Institute, the National Institutes of Health, and Harvard School of Public Health all advise people who are low in vitamin D levels to take supplements.

[intaglio]

56. I am not saying you do it for a tan

Last edited Sun Dec 22, 2013, 03:56 PM - Edit history (1)

For the last time everybody makes vitamin D using UV from the sun; from Mitt Romney to the darkest Sudanese. The darker your skin the more sun you need but even then there is often enough even in winter in northern latitudes except we cannot go naked; so you can up your intake in 3 ways.
1) you can very briefly use a tanning bed not for a full session just briefly. For some reason the US medical authorities have decided to scare everyone about the sun - even African Americans who have greater protection. The object is not to tan but to boost your production of vitamin D.

2) You can look at the foods you eat. Sensible eating will provide you with excess vitamin D very easily and cheaply. 2 bowls of cereal with milk on the cereal and an orange juice gives you 100% of the RDA. Add in some portobello mushrooms and a boiled egg or a canned tuna sandwich and you are at 150% of your RDA without trying.

3) You can take supplements in tablet form, enriching snake oil salesmen.

UK/Europe RDA is significantly lower than US RDA

[pnwmom]

57. I can't easily get 4,000 units a day without eating a lot of calories

I shouldn't be eating -- even if I could drink milk, which I can't. And my husband can't easily get his 2,000 a day. You clearly have no idea what levels of supplements many people require.

The RDA of 400 you're referring to is now considered much too low.

Harvard School of Public Health:

http://www.hsph.harvard.edu/nutritionsource/vitamin-d/

For most people, the best way to get the recommended daily intake is by taking a supplement, but the level in most multivitamins (400 IU) is too low; encouragingly, some manufacturers have begun adding 800 or 1,000 IU of vitamin D to their standard multivitamin preparations.

[intaglio]

63. See my response to your other post

Keep well.

[KitSileya]

45. That's true, for sure!

Apparently, about half off all Norwegians suffer from vitamin D deficiency, but are unaware. My physiotherapist told me she, a very healthy and health-conscious athlete, had only discovered it when she couldn't figure out why she was so tired all the time. When she got the results of blood tests back, they said they couldn't find anything, and when she questioned her vit D levels, they just said, pretty much everyone's level in our town is too low. It rains 255 days a year here, and is overcast another 80-100 depending on the year. Other parts of the country has no sun at all 4-6 months a year. So she started supplementing - as did I, after the summer, and I have yet to get my yearly cold/pneumonia. That is just anecdata, however, but I wish they would do studies on those with dark skin living at our latitudes, especially girls who wear hijab.

[REP]

20. There are a number of causes of vitamin D deficiency

Malabsorption (common with Crohn's, Celiac Disease, ulcerative Colitis, etc)

Hypoparathyroidism (common in kidney disease)

Sunlight intolerance (lupus, sunlight allergy)

Dark skin tone

Etc

It's also painful.

I found this out the old-fashioned way: I'm deficient, and it's due to malabsorption, sunlight allergy and kidney disease Not my dx; my doctor's and I take Rx supplementation.

[DebJ]

21. Also dietary insufficiency. I had a job a few years ago

substitute teaching. With winter, I was leaving in the dark, coming home it was almost dark.
And the classrooms in the high school in the city are like prison cells: grey block walls with
just one little window on the far end of the room, and darn if almost every classroom teacher
had not blocked the window with piles of junk so i couldn't even open the shades. So,
no sunlight for months.

I just can't eat breakfast until I've been up about two hours, so I ended up skipping breakfast
all the time, and the milk was my main source of Vitamin D, something I really had never thought
about before.

By New Year's Eve, I was seriously suicidal, for no real life-changing reasons. I made an appointment
to see a shrink. (You say you are suicidal and they say, Okay, you can come in in three weeks, ha!)
Right after the first appointment, I began to suspect a bad case of SAD due to lack of light plus
the Vitamin D not in my diet, so I began insuring I ate Vitamin D foods, took some vitamins as well
for awhile. Shrink of course doubted my self-diagnosis. But within two weeks I was almost back to
normal. It was a very strange thing to happen, to feel so completely out of control, and it was all
chemical imbalance, from lack of a simple vitamin.

Sources of vitamin D in food:
Cereal with Vit D fortified milk, tuna and salmon each once a week, yogurt. Others at the link.
http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/


REP I know about the kidney disease, my husband has been shifting between stage 4 and more recently back
to stage 3. He takes Vitamin D. Also, my son has bipolar, and even though his blood tests showed a Vitamin D
deficiency, his doctor didn't follow up beyond saying take 'an' over the counter supplement. Yeah, right, like
how many IU's would that be? The range is like 400 to 50,000. My son was battling a deep depression all year;
after several months I asked him about the Vitamin D and found out he had been tested, was deficient, had received
the lackadasical advice from the doc, but no follow up from him, and he wasn't taking any. Then I found out that
a new depression med the doc prescribed for him to begin taking will suck out Vitamin D from your system like
crazy. So after calling the doc and leaving numerous, unanswered messages, my son finally called and we forced
the doctor to give him an IU dosage. It was like pulling teeth. He's been taking the Vit D now and is doing much,
much better.

[pnwmom]

48. And many people are supposed to be using sun screens,

to prevent skin cancer, and this also prevents absorption of vitamin D through the skin.

[Sgent]

38. true

but some people have genetic or metabolic issues which can cause severe problems.

One of my doctors ordered a Vit-D test in addition to some other bloodwork being done, and it came back dangerously low. Repeated again 1 wk later by my internal medicine doc and had the same result.

I'm of white, European descent, get plenty of sunlight (10-20 min / day minimum in South Louisiana, often times MUCH more than that), and still had a Vit D level that would have qualified me for rickets had I been a pediatric case. I even had issues with 3 fractures in 5 years (mid thirties). Bone density was also very low for someone of my age due to probable leaching.

Fortunately supplementation put it into the normal range, and it seems to have made a fairly large difference in my mental health if nothing else.

[intaglio]

39. As I said originally you need to know why your doctor is prescribing

and in the case of vitamin deficiencies the underlying cause. But, as I also said, some doctors are lazy and prescribe what are, in effect placebos.

[pnwmom]

49. Placebos don't make blood levels of vitamin D rise. n/t

[intaglio]

50. How do you know they have risen? Have you had blood assays done?

How does your doctor know you are deficient in vitamin D?

I do not want to know why he has prescribed but you must find out. Why has he prescribed it? What is his evidence? What other steps could you take to avoid taking tablets that only enrich your pharmacist and the company making the pills?

Why are you not increasing your consumption of swiss cheese, goat cheese, eggs, white mushrooms, shitake mushrooms, portobello mushrooms, canned salmon, canned tuna, kippers, smoked salmon, fresh salmon, fresh tuna, mackerel, sardines; if you are not Jewish or Muslim sausages, salami and shellfish contain a lot; if you are not Hindu then beef liver - which has bonus iron; if you really need fortified foods then breakfast cereals, milk, orange juice and many yogurts are fortified with extra vitamin D.

I am not saying you may not need to increase your sources of Vitamin D, just that you have absolutely no need to take tablet supplements.

[pnwmom]

53. My doctor checks them at least annually. That's why she put me on

supplements.

Doesn't your doctor check yours?

You are wrong about easily being able to get enough Vitamin D through food, especially for people who have lactose intolerance. That's why so many people in northern latitudes have low levels.

And it's pretty silly to think that Vitamin-D fortified milk is a better source of Vitamin D than a supplement.

Why do you have such paranoia about supplements when you eat vitamin-D fortified food products? They fortify those foods with the same Vitamin D that they sell separately. It makes zero sense to think one is okay and the other isn't.


From the Harvard School of Public Health

http://www.hsph.harvard.edu/nutritionsource/vitamin-d/

If you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, odds are that you don’t get enough vitamin D. The same holds true if you don’t get outside for at least a 15-minute daily walk in the sun. African-Americans and others with dark skin, as well as older individuals, tend to have much lower levels of vitamin D, as do people who are overweight or obese.

Worldwide, an estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. (1-3) Indeed, in industrialized countries, doctors are even seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification. (4-6)
Why are these widespread vitamin D deficiencies of such great concern? Because research conducted over the past decade suggests that vitamin D plays a much broader disease-fighting role than once thought.

Food sources: Very few foods naturally contain vitamin D. Good sources include dairy products and breakfast cereals (both of which are fortified with vitamin D), and fatty fish such as salmon and tuna. For most people, the best way to get the recommended daily intake is by taking a supplement, but the level in most multivitamins (400 IU) is too low; encouragingly, some manufacturers have begun adding 800 or 1,000 IU of vitamin D to their standard multivitamin preparations.

Getting vitamin D from the sun: Correctly applied sunscreen reduces our ability to absorb vitamin D by as much as 90 percent. At higher latitudes (in the northern U.S., for example), exposure to the sun in winter will not form vitamin D (due to the angle of the sun's rays), so a supplement is advisable.

[intaglio]

54. Hopeless

And it's pretty silly to think that Vitamin-D fortified milk is a better source of Vitamin D than a supplement.

I is not better - it is precisely the same

2 bowls of cereal a day, with milk and a glass of orange is your RDA of vitamin D

1 serving of even farmed salmon a day is 125% of your RDA

I'll never convince you, tablets are obviously better than eating well in your book.

[pnwmom]

55. My doctors have me taking 4,000 units of Vitamin D.

I have health issues that make me require more than some people. My husband needs to take 2,000, and so do my kids.

Not very doable with food alone.

And yes, our blood levels are regularly checked. Doctors are conscientious about that in my northern section of the country. And they also warn us against tanning beds.

[intaglio]

61. Please read what I have written here - it might be very important to you

I take it by "units" your doctor is using the US IU scale - which no other country uses

200 - 600 IU are the RDA for humans (depends on source). I had not realised but the UK/European RDA is significantly lower than the US but still your doctor is asking you to take nearly 7 times the US amount. This is the maximum dose recommended by the US Institute of Medicine including dietary intake.

The Mayo Clinic says 600 RDA, that is still only a fraction of what you are being asked to take. Luckily your skin will not produce vitamin D due to the excessive levels in your blood but you will still be getting some vitamin D from your food. Depending on how well you eat up to another 1000 IU per day, you should have been advised of this.

Below is a link to an article by the Mayo on hypervitaminosis D, they say the danger commences at 50,000 UI per day but other countries have significantly lower thresholds

http://www.mayoclinic.com/health/vitamin-d-toxicity/AN02008

I know there is a push in the US to up the maximum allowed dose to 10,000 IU but I know that elsewhere there is significant doubt because there is no evidence that humans need that amount.

There has also been some discussion about a link to long term high doses with arteriosclerosis. This is not proven but it is something about which your doctor should be aware.

In my fathers' words "Be happy - but don't trust any medic," and he was one!

[pnwmom]

64. I'm at 4,000, which is well under 50,000 and even 10,000.

I don't drink fortified milk because of lactose intolerance, and I live in a region without much sun for most of the year.

And my blood levels are NOT excessive. They were low when I was taking 2,000, but now they're right in mid-range, where they should be.

[intaglio]

62. You might find this of interest

I take it by "units" your doctor is using the US IU scale - which no other country uses

200 - 600 IU are the RDA for humans (depends on source). I had not realised but the UK/European RDA is significantly lower than the US but still your doctor is asking you to take nearly 7 times the US amount. This is the maximum dose recommended by the US Institute of Medicine including dietary intake.

The Mayo Clinic says 600 RDA, that is still only a fraction of what you are being asked to take. Luckily your skin will not produce vitamin D due to the excessive levels in your blood but you will still be getting some vitamin D from your food. Depending on how well you eat up to another 1000 IU per day, you should have been advised of this.

Below is a link to an article by the Mayo on hypervitaminosis D, they say the danger commences at 50,000 UI per day but other countries have significantly lower thresholds

http://www.mayoclinic.com/health/vitamin-d-toxicity/AN02008

I know there is a push in the US to up the maximum allowed dose to 10,000 IU but I know that elsewhere there is significant doubt because there is no evidence that humans need that amount.

There has also been some discussion about a link to long term high doses with arteriosclerosis. This is not proven but it is something about which your doctor should be aware.

In my fathers' words "Be happy - but don't trust any medic," and he was one!

[HereSince1628]

23. There is this thing...The Goldilock's Principle...

It's about optimization. No one should be surprised that too little or too much of a dietary supplement can be problematic. Or that some level is 'just right'.

Individual physiological states vary with health, age, diet and medications. Everyone knows that.

The statements that are being published are being interpreted as universal statements on this subject. They really aren't meant to be universal, but rather general. There is a difference. One means for everyone and the other means for half or more of the population. Clearly general advice leaves a lot of people--up to just under half subject to advice that is contrary for the other 50+ percent of people...


My Dr recommends me away from bananas and vitamin/mineral supplements containing potassium because I have a too slow heart beat. Consequently, excess potassium might do me harm. Does that mean everyone should not eat bananas? NO.

I can't use sugar, or alcohols of sugars, as sweetners because they make it impossible to control my blood glucose levels. Does that mean no one should consume sugar? NO.

I have a cousin who has 2 drug eluting stents in his heart. He is advised away from dark leafy greens and sweet potatoes. Does that mean no one should eat sweet potatoes? NO.

At the same time, because of medication at times I've had difficulty making good cholesterol and so I was prescribed B vitamin to push it up. Does that mean everyone should do that? NO.

[Motown_Johnny]

24. Show me evidence that they can be harmful.

Evidence not produced by pharmaceutical companies that is.


The cost is nominal. If people feel that a multivitamin is a good idea for them then they should not be discouraged from taking them.


Personally, I take vitamins over the winter and then don't the rest of the year. I feel it helps me fight off illnesses as well as making up for the lack of sunlight.

Until I see real evidence that it can be harmful (and I seriously doubt I ever will) I will continue this habit.

[HereSince1628]

25. Here's a place to start...

http://en.wikipedia.org/wiki/Vitamin_poisoning

[Motown_Johnny]

26. Ahh yes, wikipedia. Because big phama would never update anything there.

You are falling for it.



Maybe you should start here: (this is worst case scenario stuff, I am slanting toward your side)



http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/


^snip^



Health Risks from Excessive Vitamin A

Because vitamin A is fat soluble, the body stores excess amounts, primarily in the liver, and these levels can accumulate. Although excess preformed vitamin A can have significant toxicity (known as hypervitaminosis A), large amounts of beta-carotene and other provitamin A carotenoids are not associated with major adverse effects [35]. The manifestations of hypervitaminosis A depend on the size and rapidity of the excess intake. The symptoms of hypervitaminosis A following sudden, massive intakes of vitamin A, as with Arctic explorers who ate polar bear liver, are acute [36]. Chronic intakes of excess vitamin A lead to increased intracranial pressure (pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death [2,4,5]. Although hypervitaminosis A can be due to excessive dietary intakes, the condition is usually a result of consuming too much preformed vitamin A from supplements or therapeutic retinoids [3,5]. When people consume too much vitamin A, their tissue levels take a long time to fall after they discontinue their intake, and the resulting liver damage is not always reversible.

Observational studies have suggested an association between high intakes of preformed vitamin A (more than 1,500 mcg daily—only slightly higher than the RDA), reduced bone mineral density, and increased fracture risk [1,4,37]. However, the results of studies on this risk have been mixed, so the safe retinol intake level for this association is unknown.

Total intakes of preformed vitamin A that exceed the UL and some synthetic retinoids used as topical therapies (such as isotretinoin and etretinate) can cause congenital birth defects [2-4]. These birth defects can include malformations of the eye, skull, lungs, and heart [4]. Women who might be pregnant should not take high doses of vitamin A supplements [2].
Unlike preformed vitamin A, beta-carotene is not known to be teratogenic or lead to reproductive toxicity [1]. And even large supplemental doses (20–30 mg/day) of beta-carotene or diets with high levels of carotenoid-rich food for long periods are not associated with toxicity. The most significant effect of long-term, excess beta-carotene is carotenodermia, a harmless condition in which the skin becomes yellow-orange [1,22]. This condition can be reversed by discontinuing beta-carotene ingestion.

[HereSince1628]

27. No, because it's a place to learn some key words

that you can take to a search engine.

It really can make a difference on the results the search engines produce.

[Motown_Johnny]

28. did you read my post?

[HereSince1628]

29. Yes, are you open minded enough to take some of the terms you learned

into a search engine to look for something like a link to an academic article on the topic?

Got some slant on the propaganda at medscape?

http://emedicine.medscape.com/article/819426-overview

or maybe you don't think much of the National Institutes of Health?

http://www.ncbi.nlm.nih.gov/pubmed/18689406

[Motown_Johnny]

32. I can't verify that "60,000 annual vitamin poisoning claim"

From my point of view, what you are posting is the propaganda.

All my results keep coming back with things like "Zero deaths from vitamins, 3 million from prescription drugs".


Of course there are lots of results if you search for doctors getting paid to prescribe drugs. Lots of them.



http://www.nytimes.com/2004/06/27/business/27DRUG.final.html


^snip^


The check for $10,000 arrived in the mail unsolicited. The doctor who received it from the drug maker Schering-Plough said it was made out to him personally in exchange for an attached "consulting" agreement that required nothing other than his commitment to prescribe the company's medicines.





http://www.thehealthyhomeeconomist.com/half-of-doctors-routinely-prescribe-drugs-they-know-wont-work/


^snip^


Big Pharma has your doc’s back though. $7 Billion was paid out by the pharmaceutical industry between 2007 and 2010 for lawsuits where doctors were actually paid to prescribe drugs for unapproved uses.

[HereSince1628]

34. It seems you're trying to erect a strawman rather than address the issue of the published comment

which is that most (not all) people regularly consuming vitamin supplements don't benefit from their consumption.

I suspect you would find it impossible to show proof that ALL people do benefit from taking vitamins.

You asked for evidence of vitamins being harmful. I did, in fact, introduced you to the terminology that makes it possible to hook yourself into information that provides the answer you seek.

You want to dispute details of what was presented not as best available evidence but to point you into other people communicating about the phenomenon of vitamin toxicity pushing false criteria --one could say a criteria that creates a strawman--for toxicity, which needn't always cause death.

I don't get why it isn't quite possible that both pharmaceutical and dietary supplement industries be involved in propagandizing for profit AND vitamin supplements are quite useful for many, if not most, people, but are also capable of toxic symptoms.

I don't get why, a priori, I must be a victim of marketing propaganda and you cannot also be a victim of beliefs that you have acquired which were placed into our culture by marketing propaganda.

[Motown_Johnny]

66. No, I am taking issue with the last line in that quote.

" At worst, they may be harmful.



There really is no evidence at all that they may be harmful. The idea that one multivitamin a day can be dangerous is simply ridiculous to me. It also claims that these are costly. If people can't afford them then they won't buy them The truth is they are very inexpensive. Here is a link that sells multivitamins for less than $0.17 each.

http://www.vitaminshoppe.com/search/controller?N=200789250&type=category



So long as $0.17 cents a day is affordable to someone, there is no reason not to take a multivitamin a day.


I never claimed that all people benefit from taking vitamins. I will never make that claim. It is simply that the risk / benefit ratio is all in favor of benefit with nothing on the risk side.


The idea that you introduced me to these terms is pure insanity. I have been following this subject for decades. The hubris in your claim is nearly beyond belief. You introduced me to nothing other than the continuation of the same BS that has been out there for a very long time.


I don't doubt that both vitamin companies and drug companies use "propaganda". The thing is that the drug companies are making false claims that something as simple as a multivitamin can be harmful. There is no evidence of that at all. On the other hand, there are medical conditions which are caused by not having enough of a vitamin in your diet. These really do exist while the dangers of a multivitamin don't.


I am simply asking for you to present evidence to substantiate the claim in the OP. You can't. Maybe you should delete the OP since you have made a claim which can't be substantiated. You may be discouraging someone who needs a supplement from doing so.


I know that my personal experience is nothing more than one example but...

As I stated in an earlier post, I take vitamins during the winter months and don't do so the rest of the year. I believe that it does help fight off colds and other illnesses. I have had blood tests twice in the last four months. All my organ functions are fine. I have no sign of any damage from taking vitamins. The only thing I do have is a vitamin D deficiency. My doctor has me taking 2000 mg. a day right now and I will have another blood test in a couple of months to see if it helped.

Maybe you should start looking into the risks of not taking vitamins. That is where the risk lies.

[etherealtruth]

35. Big Pharma does NOT want you to stop taking supplements

"Most people would be surprised to find out that the most popular, best-selling dietary supplements are made by the biggest pharmaceutical companies that also make prescription drugs. For example, commercial supplements you find in supermarkets and on pharmacy shelves are dominated by huge supplement companies such as Centrum®) and One-A-Day®. Who is the parent company of Centrum®? It's Pfizer®. And the parent company of One-A-Day® is a division of Bayer®. These companies also make over-the-counter medicines as well as supplements.

Most U.S. vitamin companies then buy the bulk ascorbic acid from this single facility. After that, marketing takes over. Each company makes its own labels."

http://www.examiner.com/article/who-makes-the-most-popular-dietary-supplements

[Bradical79]

60. I think the article argued that it's mostly just a waste of money.

Except one study mentioned where the risk of cancer was increased.

[Motown_Johnny]

65. That is not what the last line in the quote in the OP says.

I think is clear that the risk / benefit ratio for taking a multivitamin is totally one sided in favor of doing so. The idea that it can be harmful seems ridiculous to me. The only possible downside is the cost and the cost is also pretty low.

If you go to this site you can get multivitamins for less than $0.17 each ($9.99 for 60).

http://www.vitaminshoppe.com/search/controller?N=200789250&type=category

[proverbialwisdom]

30. I'm agnostic on the OP topic at the moment, personally, but if food tips are what you're looking for

MUST SEE: http://www.eattobeat.org


Google: william li and judah folkman
(HARVARD trained and affiliated, both)

http://www.nytimes.com/2008/01/16/us/16folkman.html?_r=0

Judah Folkman, Researcher, Dies at 74

By ANDREW POLLACK
Published: January 16, 2008

Dr. Judah Folkman, a path-breaking cancer researcher who faced years of skepticism before his ideas led to successful treatments, died Monday in Denver. He was 74.

<>

Dr. Folkman, a professor at Harvard and director of the vascular biology program at Children’s Hospital Boston, is considered the father of the idea that tumors can be kept in check by choking off the supply of blood they need to grow.

The approach is now embodied in several successful cancer drugs, most notably Avastin, by Genentech.

“His vision and ideas literally changed the course of modern medicine,” said Dr. William Li, a former student of Dr. Folkman’s, who is president of the Angiogenesis Foundation, an organization that promotes the promise of Dr. Folkman’s approach. Angiogenesis refers to the formation of new blood vessels.

<>

[proverbialwisdom]

31. RECOMMENDED.

http://www.democraticunderground.com/10024206715

[FarCenter]

36. What is your view of taking vitamins for age-related macular degeneration?

Vitamins to Prevent Vision Loss

http://consults.blogs.nytimes.com/2011/07/14/vitamins-to-prevent-vision-loss

My retinologist says I should take them. I also eat foods rich in lutein and zeaxanthin.

[bhikkhu]

37. As long as they're inexpensive, its no bother at all to take a multi-vitamin

I don't take them because I think they will keep me from getting sick or extend my life or anything else; I take vitamins because I don't always have a perfect diet and I get a lot of use out of my body and mind. Its just a little insurance against deficiencies of whatever sort, and there's no harm.

I've still seen no evidence that there is harm in routine supplements, and if anyone wanted a candidate for how they might be helpful (or at least harmless) I'd volunteer. At 50, after a lifetime of routine supplements, I am in very good shape, physically and mentally, fit and trim in mind and body, pretty much zero problems either way. If bad things were going to happen I would have expected them to happen already.

[proverbialwisdom]

41. Routine, maybe. What about non-routine, as in biomedical autism therapy under medical supervision?

Watch the November 2013 IACC webcast (below), where some members of the IACC confidently predict peer-reviewed studies WITHIN 5 YEARS which will scientifically establish the safety and efficacy of 'biomedical' clinical protocols for the treatment of children with autism. Also, read this entire interview transcript: http://www.ttbook.org/book/transcript/transcript-martha-herbert-autism-revolution .

http://videocast.nih.gov/summary.asp?Live=13225

2013 IACC Strategic Plan Update Workshop Agenda

Friday, November 15, 2013
8:30 a.m. to 5:00 p.m. Eastern

National Institutes of Health

Runtime: 07:33:03

Description: The workshop will feature discussions between IACC members and external subject matter and community experts regarding updates from the field and from the community that the committee may consider when developing the 2013 update of the IACC Strategic Plan.

RECOMMENDED: http://www.marthaherbert.org

[LeftyMom]

47. *facepalm*

[Bradical79]

58. non-routine use is addressed in the article.

It's bolded. The argument is against the sale of multivitamins for routine use as a general supplement, it is not against use in specific situations where scientific research backs specific usage of vitamins.

[Bradical79]

59. So, why dont they offer benefits?

Does the process of extracting these vitamins and putting them in a pill make it into a form that we basically piss away?