People are looking for a magic bullet to offset all their destructive habits and fix the resulting bad health.  One superficial solution for 70% of people in the USA is to take supplements of vitamins and mineral blends.  These concentrated mixtures enter our bodies by way of pills, nutrition bars, �health� drinks, and cereals.  �Vitamania� intoxicates the modern world.  Vitamin users are more likely to be female, older, better-educated, affluent, non-smokers, light-drinkers, frequent-exercisers, and to consume diets lower in fat and higher in fruits and vegetables.¹   Sounds like a nice group of people.  Unfortunately, some of these same people don�t like me much because of my stand on this matter. 

Nearly a decade ago, my syndicated radio show was threatened by people offended by my stand on supplements.  During my 2-hour broadcast all over the entire West Coast (USA) each Sunday evening, I tried to balance �negative� articles, like vitamin A causing a 1 in 57 chance of birth defects when taken by a pregnant woman, with �positive� ones, like folic acid supplementation taken before pregnancy reduces risk of serious birth defects.  However, this wasn�t enough for a group of �vitamin activists� from Los Angeles who worked to cause me to lose my sponsors.  They recorded my show and edited into one tape everything that could possibly be detrimental to supplement sales.  By the very next morning, the activists had called and left this anti-supplement message on the answering machines of health food stores up and down the West coast.  Unfortunately, many of these same businesses were my radio show sponsors, and a good percentage of their livelihood came from sales of vitamins and minerals.  Fortunately, I survived that battle.

The Best Vitamin and Mineral Sources

Vitamins are organic compounds that cannot be synthesized by the human body and therefore must be consumed to prevent serious illnesses.  Fruits and vegetables are the main sources and primary manufacturers of most vitamins (11 of 13 known vitamins are synthesized by plants � D comes from the sun�s actions on our skin and B₁₂ from bacteria).  Plants are also the most direct source for minerals � all of which originate in the ground and enter into living systems through the roots of plants � and then into animals.  Unfortunately, only 20% to 30% of the people living in Western populations consume the 5 or more servings recommended daily of fruits and vegetables.  The elderly, alcoholics, and those with chronic illnesses are also at higher risk of suffering real deficiencies.  But the solution is more plants, not pills.

Even your local supplement salesperson readily admits fruits and vegetables are the ideal sources of these essential nutrients�BUT, they add, �because of our depleted soils these sources are now inadequate and therefore supplements are necessary.� I will address this argument later.

Three Reasons I Do Not Recommend Supplements:

1)  They Provide No Bang for the Buck

When I lecture I am always asked, �Dr. McDougall, what do you think about taking supplements of vitamins and minerals?�  My response is, �How many of you know people who have lost 100 pounds taking supplements?  How about people who were able to stop blood pressure pills, diabetic, or pain medications?  Do you know anybody who has found complete relief of their inflammatory arthritis (rheumatoid arthritis), chest pains (angina), or headaches by investing in these potions?�

I never see a hand rise.

Compare this dismal response to the fact that I meet people every day, either in person or by e-mail, who have these very results and more by following a healthy low-fat, plant-based diet, and exercise � approaches that are cost-free.  Until I see the same with supplements I will not waste my time and effort.  Nor should you.

2)  Your Friends Don�t Have Deficiency Diseases

How many friends and relatives do you have with deficiency diseases?  Pellagra (niacin), Beriberi (vitamin B1), or Scurvy (vitamin C)?  Protein deficiency? Essential fat deficiency? 

The answer is, �none.�  Nearly a century ago vitamin supplements would have been heralded as miracles for curing these deficiency diseases.  Today in modern Western societies these diseases are essentially unknown, because of better nutrition for most people (more fruits and vegetables) and correction of deficiencies which had been created by manufacturing processes (such as the refining of rice). 

Now, turn your vision 180 degrees.  I�ll ask you the opposite question.  How many of your friends and relatives have diseases of �excess�? Like excess cholesterol, fat, sodium, and protein?  The answer is clearly, �most of them.�  The paradox of today�s living is that with all of our modern developments and technical advances we have developed another form of deadly malnutrition � properly labeled �overnutrition.�

An additional problem for those people caught up in vitamania is that the over-enthusiastic use of supplements can result in diseases of excess of these very vitamins and minerals.  For example, Vitamin A supplements increase the risk of hip fractures (osteoporosis) and birth defects.^2-4 Iron supplementation can cause a fatal liver disease called hemochromatosis.⁵ Magnesium supplementation has been found to increase the risk of heart attacks and sudden death especially among people with heart disease, and those who have recently undergone coronary artery bypass surgery.⁶  Zinc and iron supplements may also increase the risk of death from heart disease.^5,7

3) Nature (God) is Smarter than the Lab Technician

Vitamin manufactures do not improve upon nature�s design.  Vitamins and minerals are found in natural packages called fruits and vegetables.  These nutrient-rich foods have been under development for hundreds of millions of years.  Their interactions with living animals have been tested and proven correct over eons of successful living.   Possibly thinking they are smarter than Nature (God), lab technicians now take selected nutrients from their original environments, isolate and concentrate them, package them in capsules, and then sell them to us with claims that these �new and improved� potions are necessary for good health.  At best the results are medications, and at worst, they are poisons.

Manufacturing creates serious problems because nutrients do not work in isolation, but rather function properly, along with thousands of other substances that are found within the food, all in correct amounts and proportions.

Harmful Imbalances Cause Diseases

More Cancer with Beta-carotene Supplements

In concentrated, isolated, forms these vitamins and mineral supplements cause nutritional imbalances that can have serious consequences.   The classic example of this imbalance problem was seen with beta-carotene supplementation for cancer.  Two recent well-designed studies found an increase in lung cancer when smokers were given supplements of beta-carotene (a precursor of vitamin A).^8,9  These studies were performed because a reduced risk of several forms of cancer has been found in people with high intakes of beta-carotene � however, these findings simply reflected a diet high in plant foods.  Beta-carotene is a vitamin precursor (pro-vitamin) found only in plants.

Beta-carotene is one of over 600 substances classified as carotinoids found in yellow and orange fruits and vegetables. Inside our cells are receptors for carotinoids � these are the sites where carotinoids attach and function.  When the cell is flooded with beta-carotene by vitamin supplementation (pills), then there is overwhelming competition for these receptor sites that excludes their use by the other 599-plus carotinoids � creating a serious nutritional imbalance.

Supplements Cause More Heart Disease

Taking antioxidant vitamins which are supposed to help the heart seems to do the opposite because of imbalances created.  In the Heart Protection Study multiple vitamins (600 mg synthetic vitamin E, 250 mg vitamin C, and 20 mg beta-carotene daily) increased risk factors for heart disease (triglycerides, LDL-cholesterol, and total cholesterol.¹⁰  This same combination of antioxidant vitamins was found to interfere with the effectiveness of commonly prescribed cholesterol-lowering medications (statins like Mevacor, Lipitor, Zocor, etc.) by blunting the rise in HDL �good� cholesterol.¹¹  The bottom line may be reflected in one study of 1,862 male smokers with a history of heart attack.  Taking either vitamin E or beta-carotene, together or singly, resulted in a significantly increased risk of fatal coronary heart disease.¹²

Folic acid supplementation is supposed to be the newest answer for heart disease prevention.  However, after six months of supplementation in 636 heart patients with stents (stents are supports placed in the coronary arteries during angioplasty), the Folate After Coronary Intervention Trial found those taking folic acid had significantly more narrowing of the arteries compared to those taking placebo � the exact opposite of what investigators had expected to find.¹³  The experimental group received folic acid (1 mg), vitamin B6 (5 mg) and vitamin B12 (1 mg) IV immediately after angioplasty with a stent inserted, followed by daily oral doses of folate (1.2 mg), vitamin B6 (48 mg) and vitamin B12 (0.06 mg).

To summarize the research on vitamins and heart disease prevention, the U.S Preventive Services Task Force (USPSTF) published a report July 1, 2003 concluding,  ��that the evidence is insufficient for or against supplements of vitamins A, C, or E; multivitamins with folic acid; or antioxidant combinations for the prevention of cancer or cardiovascular disease.� ¹⁴

Elderly Harmed by Vitamin E

A study of elderly persons found vitamin E supplementation (200 mg) resulted in more severe and frequent upper respiratory infections.¹⁵  Those taking the vitamins had longer total illness duration, more symptoms, and a higher frequency of fever and restrictive activity.  Investigators suspected an imbalance created by long-term supplementation was the root cause.  This finding becomes even more relevant when you realize 50% of the elderly take vitamin and mineral supplements that usually include vitamin E.  Also important to the elderly and others is the observation that in high doses vitamin E antagonizes the functions of other fat-soluble vitamins resulting in bone loss, reduced liver storage of vitamin A, and blood clotting problems.¹⁶

Mineral Imbalances Cause Disease

Imbalance problems are also created with mineral supplementation.¹⁷ For example, intestinal absorption of copper is inhibited by zinc.¹⁸  The intestinal competition of zinc with copper, iron, lead, calcium and cadmium may accentuate nutritional deficiencies or toxicities from these environmental metals.¹⁹   Vitamins also influence mineral activity; for example, ascorbic acid (vitamin C) strongly promotes iron absorption.²⁰

Considering the complexity of interactions of the body with our nutrients, unless you believe some man or woman sitting in a laboratory is smarter than Nature (God), then you would be prudent to take your vitamins and minerals only in their natural packages � whole grains, vegetables, and fruits.

When Supplements Benefit

Vitamins and minerals can be used as medications to cause effects � this is different than supplementation to promote natural health.   Realize that all medications have adverse effects accompanying their intended, positive effects.

Vitamin C will not prevent common colds but may provide a modest benefit in reducing the duration of symptoms of colds.²¹

Vitamin D may delay loss of bone in elderly, but sunlight is the right source of this vitamin.²²

Folic acid lowers homocysteine, but there is no evidence yet from controlled studies that this translates into reduced cardiovascular disease or cancer.²³

Folic acid will prevent birth (neural tube) defects.²³

Vitamin B12 should be taken when following a strict vegan diet � like the McDougall diet � if followed for more than three years or if pregnant or nursing.

Iodine supplementation prevents thyroid disease in areas of the world where iodine deficiency is endemic.²⁴

Iron supplementation is used for treating iron deficiency diseases, like anemia (most of the time iron deficiency is due to other correctable causes, like bleeding, dairy products, etc.)

Sometimes I Use Supplements as Medicines

I have used vitamins as medicines � hoping to cause more good than harm in my patients.  For example, I have taught for years that high cholesterol levels can be lowered with 2 grams of Vitamin C, 400 mg of Vitamin E, and/or 500 to 3000 mg of Niacin daily.  The literature supports this reduction in risk factors for heart disease by using these supplements.  (See my September 2002 and February 2003 Newsletters.)

The �Depleted Soils� Sales Pitch

The sales pitch is: �You must take supplements because of the poor condition of the soils � depleted soils � our plants are now grown in.�  First understand that minerals are from soils and vitamins are synthesized by plants.  If a plant is going to bear roots, seeds, flowers, and/or fruits fit for sale in your market, then it is going to have to produce all the necessary �vitamins� for its own survival. 

Mineral deficiency is theoretically possible � but highly unlikely to affect anyone living in a modern society.  The classic example of a mineral deficiency is iodine deficiency, which has caused goiters in underdeveloped parts of the world today, such as in Africa prior to the recent introduction of iodized salt.²²  (There are also some rare cases of selenium deficiency and possibly zinc deficiency in underdeveloped countries.)  These deficiencies occur because of the limited supply of foods for these people.  They eat only foods grown in their local region, and the soil in their neighborhood may well be deficient in one of these minerals. 

However, the risk of you suffering from vitamin or mineral deficiency caused by depleted soils is so incredibly small that a single case would make national headlines.  This is simply because you eat foods grown from a wide variety of soils: corn grown in Nebraska soils, grapes from Chili, bananas from Panama, etc.  In the unlikely chance that one food was low in a mineral, your next bite would likely contain an abundant supply.

Still Perplexed? What to Do?

For anyone not willing to buy fully into my arguments � that is someone with an incurable case of vitamania � an appropriate response for his unsupported fears would be to take an inexpensive one-a-day, vitamin-mineral capsule � costing less than $20 a year.  Spend the money saved by not buying that shelf full of supplements on a better pair of walking shoes, a shopping trip to the farmers� market, or a healthy vacation.

References:

1)  Patterson RE.  Cancer-related behavior of vitamin supplement users.  Cancer Epidemiol Biomarkers Prev. 1998 Jan;7(1):79-81.

2)  Michaelsson K.  Serum retinol levels and the risk of fracture.  N Engl J Med. 2003 Jan 23;348(4):287-94. 

3)  Dolk HM.  Dietary vitamin A and teratogenic risk: European Teratology Society discussion paper.  Eur J Obstet Gynecol Reprod Biol. 1999 Mar;83(1):31-6. 

4)  Rothman KJ.  Teratogenicity of high vitamin A intake.  N Engl J Med. 1995 Nov 23;333(21):1369-73. 

5)  Schumann K.  Safety aspects of iron in food.  Ann Nutr Metab. 2001;45(3):91-101. 

6)  Galloe AM.  Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction.  BMJ. 1993 Sep 4;307(6904):585-7. 

7)  Black MR.  Zinc supplements and serum lipids in young adult white males.  Am J Clin Nutr. 1988 Jun;47(6):970-5.

8)  The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group.  N Engl J Med. 1994 Apr 14;330(15):1029-35.

9)  Omenn GS.  Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996 May 2;334(18):1150-5.

10)  MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial.  Lancet. 2002 Jul 6;360(9326):23-33.

11)  Brown BG.  Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.  N Engl J Med. 2001 Nov 29;345(22):1583-92.

12)  Rapola JM .  Randomised trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction.  Lancet. 1997 Jun 14;349(9067):1715-20.

13)  Lange H.   Folate After Coronary Intervention Trial� (FACIT). http://www.accitalia.it/congress_centre/meeting_int/detail.asp?acr_trial=FACIT

14)  U.S. Preventive Services Task Force.  Routine vitamin supplementation to prevent cancer and cardiovascular disease: recommendations and rationale.  Ann Intern Med. 2003 Jul 1;139(1):51-5.

15)  Graat JM.  Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial.
JAMA. 2002 Aug 14;288(6):715-21.

16)  Chandra  RK.  Graying of the immune system. Can nutrient supplements improve immunity in the elderly?  JAMA. 1997 May 7;277(17):1398-9.

17)  Roughead ZK.  Dietary copper primarily affects antioxidant capacity and dietary iron mainly affects iron status in a surface response study of female rats fed varying concentrations of iron, zinc and copper.  J Nutr. 1999 Jul;129(7):1368-76.

18)  Sandstead HH.  Requirements and toxicity of essential trace elements, illustrated by zinc and copper.  Am J Clin Nutr. 1995 Mar;61(3 Suppl):621S-624S.

19)  Abdel-Mageed AB. A review of the biochemical roles, toxicity and interactions of zinc, copper and iron: I. Zinc.  Vet Hum Toxicol. 1990 Feb;32(1):34-9.

20)  Sandstrom B.  Micronutrient interactions: effects on absorption and bioavailability. Br J Nutr. 2001 May;85 Suppl 2:S181-5.

21)  Douglas RM. Vitamin C for preventing and treating the common cold.Cochrane Database Syst Rev. 2000;(2):CD000980.

22)  Gennari C. Calcium and vitamin D nutrition and bone disease of the elderly. Public Health Nutr. 2001 Apr;4(2B):547-59.

23)  Bender DA.  Daily doses of multivitamin tablets. BMJ. 2002 Jul 27;325(7357):173-4.

24)  Kalk WJ.  Dietary iodine deficiency in South Africa. Surveys before the introduction of universal salt iodisation. S Afr Med J. 1998 Mar;88(3 Endocrinology):357-8.