Brandon Barrett's List: Neg/pos effects

• Citing studies that show that the antioxidants and vitamins B6, B12 and folic  acid in multivitamins not only don't prevent disease, but that folic acid may  actually cause cancer, Harvard Medical School researchers argued against taking  a daily multivitamin in the March issue of their Harvard Men's Health Watch  newsletter.

• The Council for Responsible Nutrition questioned the research the newsletter  cited and called the multivitamin cautions "premature."

• Stating that an estimated 35 percent of U.S. adults take multivitamins  regularly, Harvard researchers presented a history of multivitamin research in  their newsletter article titled, "Multivitamins and your health: A reappraisal."  They began with antioxidant research, citing studies showing that antioxidant  supplements not only don't protect against heart disease or cancer, but "in some  cases, they may actually do more harm than good."

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• They next tackled research on the "three Bs": B6, B12 and folic acid, and  concluded that recent randomized clinical trials show that B-vitamin supplements  don't prevent heart disease. They also cited one U.S. study showing that people  who took folic acid had more colorectal adenomas and more prostate cancers than  those who took a placebo. However, the researchers cautioned, the study involved  only people who were at high risk for colorectal cancer, and who took 1,000 mcg  of folic acid, two and a half times the recommended daily allowance.

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• Parents of our patients often ask whether we recommend multivitamins for their  children. In most situations, the answer is no. This takes a lot  of them by surprise.

• The explanation is actually somewhat complicated. Foods that are rich in  vitamins are definitely a good thing, and many scientific studies have proven  the benefits of a diet abundant in fruits, vegetables, whole grains, fish, lean  meats, and low-fat milk. But the vitamins themselves, when taken in pill or  liquid form, can actually be harmful.
• Our bodies use nutrients most effectively when we consume them directly from  natural food sources. The healthful advantages of these nutrients depend on  their food “packaging” to provide their full benefit. Researchers have not been  able to find any benefit from most vitamins when they are taken in pill form  rather than in their natural state. None of the major medical associations,  including the American Academy of Pediatrics, The American Medical Association,  The American Institute of Nutrition, The American Society for Clinical  Nutrition, or The American Dietetic Association, recommend routine use of  multivitamins.
  

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• In addition, many vitamins can actually be harmful if taken in excess. Too much  Vitamin A, for example, can cause birth defects, liver abnormalities, reduced  bone mineral density, and brain disorders. Too much vitamin B6 can result in  nerve damage to the arms and legs. Toxicity from these vitamins occurs almost  exclusively as a result of taking vitamin supplements. Supplements of some  vitamins and minerals can also block the body’s ability to absorb other  essential nutrients from foods.

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• Many parents give their children vitamins because they believe they are  helping to prevent diseases. However, this is unlikely to be true. For years  many people believed in the benefits of extra Vitamin C, particularly in  fighting colds. But in every careful scientific study of the effectiveness of  taking vitamin C supplements, no benefit whatsoever has been found. Medical  researchers have also studied whether adults taking multivitamin supplements are  protected from cancer. But shockingly, many of these studies found that taking  vitamin supplements actually increased the risk of getting cancer or dying from  it. A recent study performed at the National Cancer Institute found that men who  took more than seven multivitamins per week significantly increased their risk  of prostate cancer. Several studies of adults taking extra vitamin E,  beta-carotene, and vitamin A have shown an increased risk of developing cancer  and an increased rate of death from all causes, without showing any overall  health benefit.

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• Background: Multivitamin supplements are used by millions of Americans  because of their potential health benefits, but the relationship  between multivitamin use and prostate cancer is unclear.

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• Methods: We prospectively investigated the association between multivitamin  use and risk of prostate cancer (localized, advanced, and fatal)  in 295344 men enrolled in the National Institutes of Health  (NIH)–AARP Diet and Health Study who were cancer free at  enrollment in 1995 and 1996.

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• These results suggest that regular multivitamin use is not associated  with the risk of early or localized prostate cancer. The possibility  that men taking high levels of multivitamins along with other  supplements have increased risk of advanced and fatal prostate  cancers is of concern and merits further evaluation.

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• Previous epidemiologic studies have suggested that multivitamin  supplement use may be associated with more rapid prostate cancer  progression.

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• This large study was confirmatory of previous reports of an  association between multivitamin use and advanced prostate cancer. It  also found potential associations of various individual vitamins  and mineral supplements with prostate cancer that should be  investigated further.

• Despite the perceived health benefits of multivitamin supplements,  the risks associated with their use need to be explored further.

• Differences between heavy users of multivitamins and nonusers that  may not be controlled for in a study of this type may obscure the  true relationship between multivitamin use and prostate cancer.

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• Higher costs of particular   brands don’t necessarily mean higher quality. Generic brands are   often indistinguishable from brand name supplements, but have lower prices.   A year’s supply may cost as little as $30.

• Jane Higdon, Ph.D.
  LPI Research  Associate

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• Although it hasn’t been  proven that a daily multivitamin supplement containing 100% of the Daily Value  of most vitamins and essential minerals will lead to better health for  well-nourished people, recent research indicates that several of the nutrients  found in standard multivitamin supplements play important roles in preventing  chronic diseases like heart disease, cancer, and osteoporosis. A daily  multivitamin supplement ensures an adequate intake of several micronutrients  that are not always present in the diet in optimal amounts:

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• Although one would expect  the Daily Values (DV) listed on supplement labels to reflect the latest intake  recommendations from the U.S. Institute of Medicine, most of them are actually  based on outdated recommendations made in 1968.

   

  The latest nutrient intake  recommendations from the Institute of Medicine are called Dietary Reference  Intakes (DRIs), which have been set for males and females throughout the  lifespan. They include the Recommended Dietary Allowance (RDA) as well as the  Adequate Intake (AI), which is established for a nutrient when there is  insufficient data to calculate an RDA. Supplement labels continue to display the  outdated DV. A comparison of the DVs and the DRIs for adults is shown in the  table below.

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• Supplements that contain more  than 100% of the DV for these micronutrients are not necessary for most  people.

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• Don’t worry about the  relatively small amounts of chloride, phosphorus, and potassium in multivitamin  supplements. Most people get plenty of chloride from salt, and phosphorus and  potassium are best obtained from diets rich in fruits, vegetables, and whole  grains.

• Trace elements like boron,  nickel, silicon, tin, and vanadium are not necessary since they may not even be  required by humans.
• Vitamin A in supplements may  come from retinol, beta-carotene, or both. Recent research suggests there may be  an association between higher retinol intakes (5,000 IU/day) and an increased  risk of osteoporosis in older men and women. However, vitamin A intakes from  beta-carotene have not been associated with an increased risk of osteoporosis.  Look for supplements containing no more than 2,500 IU of vitamin A or, if  unavailable, supplements containing 5,000 IU, of which at least 50% comes from  beta-carotene.
• Although the DV is 300 mcg,  the most recent recommended intake for biotin is 30 mcg/day.
• In March 2003, the   U.S. Food and Drug Administration proposed new regulations that would,   for the first time, establish standards to ensure that dietary supplements   are not adulterated with contaminants or impurities and are labeled accurately.   However, these regulations are not yet finalized or implemented.

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• The United States  Pharmacopeia (USP) has a voluntary testing program called the Dietary Supplement  Verification Program. The USP Dietary Supplement Verification mark shows that  the supplement has passed USP tests to ensure that it contains the ingredients  listed on the label, contains the amount of each ingredient listed on the label,  dissolves effectively, does not contain harmful contaminants, and was  manufactured using safe and sanitary procedures.

   

  Higher costs of particular  brands don’t necessarily mean higher quality. Generic brands are often  indistinguishable from brand name supplements, but have lower prices. A year’s  supply may cost as little as $30.

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• Higher costs of particular   brands don’t necessarily mean higher quality. Generic brands are   often indistinguishable from brand name supplements, but have lower prices.   A year’s supply may cost a

  • Cost Effectiveness
• Higher costs of particular   brands don’t necessarily mean higher quality. Generic brands are   often indistinguishable from brand name supplements, but have lower prices.   A year’s supply may cost as little as $30.

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• Healthy foods, such as whole grains, fruits and vegetables, are the best sources  of vitamins and minerals. But because it is sometimes hard to get all the  nutrients we need from foods, all adults should take one multivitamin per day.  
  

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• It is especially important for women who can become pregnant to get enough folic acid. Folic acid, a B vitamin, helps prevent  birth defects of the brain and spinal cord when taken before and very early in  pregnancy.

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• During pregnancy, a woman needs more of some nutrients, such as iron, calcium  and folic acid. For this reason, it is wise to start taking a multivitamin  before pregnancy.
  
• Read the label. The label tells you which vitamins and minerals  the multivitamin contains. It also tells you how to take the multivitamin safely  and how to store it.
  

• Avoid high doses. Some vitamins and minerals are toxic in  high doses for women and their developing babies. Examples are iron, chromium,  selenium and vitamin A. To avoid high doses, choose a multivitamin that contains  no more than 100 percent of the DV for each vitamin and mineral. Before taking  anything other than 100% of the DV, check with your health care provider.

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• Look for USP on the label. This means that the multivitamin  meets the standards of U.S. Pharmacopeia (USP). USP is an organization that sets  standards for content, quality, purity and safety. 

   

  Know about name brands and store brands. As you shop,  remember that name brands may be no better than store brands. In fact, the same  manufacturer may make both of them. Store brands often cost less than name  brands. The most important thing is to check the label to be sure you are  getting the vitamins and minerals you need. Although health care providers often  write prescriptions for prenatal vitamins, you can get some brands of these  vitamins at the drugstore without a prescription.

   

  Know about natural and synthetic vitamins. In multivitamins,  natural and synthetic vitamins have the same health benefit. Natural vitamins  cost more than synthetic vitamins.

   

  Avoid extras. Avoid multivitamins that contain herbs,  enzymes or amino acids. You don't need them and they add cost. Herbal remedies  can be toxic. Never take them if you are trying to get pregnant, are pregnant or  are breastfeeding. Many vitamin products contain extra ingredients such as herbs  that are not considered essential under federal guidelines. Medical scientists  do not know if these extra ingredients are safe and effective, especially during  pregnancy.

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