Is your Pursuit of Health Making you Less Healthy? - Vitamins
Given the alluring title of my blog post, as you probably guessed, the answer is potentially YES.
Ranging from technology such as the Apple watch to our old “tried-and-true” yearly mammograms, doing too much for your health can sometimes lead to a false sense of disease and harm. Now, before you cancel your mammogram or smash your Apple watch (please give it to me before smashing it), I’m not at all saying that these things are bad. I’m a very firm believer in the value of yearly mammography. The issue is how we should interpret and digest those results.
In this blog series, I will be taking on various “healthy” choices to determine their health benefits and/or risks. First up in the series: Vitamins.
Over half of Americans take some form of multivitamin or supplement because they believe it is “the healthy thing to do.”
The medical journal JAMA recently published a recommendation statement from the US Preventative Task Force (USPTF) regarding vitamin, mineral and multivitamin supplementation. The USPTF is an independent agency that evaluates all of the best available evidence and issues guidelines. For example, the USPTF issues guidance on how often to do mammograms, colonoscopies and prostate cancer testing among other issues. The USPTF is generally highly regarded and the vast majority of physicians in the US choose to follow their issued guidelines.
Their recent recommendation on supplements and vitamins created quite a stir. In fact, the recommendation made headlines and was discussed on mainstream media shows like The Today Show. Their review of the most up-to-date literature actually found that “the harms of beta carotene supplementation outweigh the benefits for prevention of cardiovascular disease or cancer.” Additionally, they found it more harmful than helpful to supplement with vitamin E.
Beta carotene was found to increase the risk of developing lung cancer when used with or without vitamin A among smokers. This was a risk that was increased past their baseline smoking risk. Two other studies showed an increased risk of hip fracture associated with vitamin A supplementation. Additionally, two trials showed increased risk of hemorrhagic stroke with vitamin E supplementation.
While this data came as quite a surprise to most, it was also quite surprising to see the lack of benefit found from taking more common vitamins or supplements such as B12, vitamin D or vitamin C. Their research did not demonstrate any net benefit for usage of essentially any vitamin or multivitamin. Additionally, we know clinically that supplemental vitamin D and C usage can increase risk of kidney stones. More and more studies are calling into question the validity and helpfulness of the commonly recommended calcium and vitamin D for bone health or fatigue.
So what is my recommendation?
Generally, I say, “if you feel like it is helping you or you prefer to take it, then go ahead.”
This advice applies only if it is not harmful. As a general rule, I would recommend against the use of vitamin A, E, or vitamin K as I feel their net effect is harmful. For folks with very low vitamin D levels, I still do recommend the conservative use of vitamin D as long as the risk factor for high calcium levels or kidney stones is also not present. Vitamin C and zinc products have not clearly been demonstrated to help bolster immunity so I’m rather indifferent on those but generally recommend against vitamin C usage as it can increase kidney stone formation. Zinc at high doses can have some gastrointestinal toxicities and can also inhibit proper copper absorption.
The vitamin and mineral supplementation industry is a 37-billion-dollar per year industry in the United States and is projected to double over the next 6 years. So to say there is a financial incentive involved would be a vast understatement. Unfortunately, I’ve come across various outfits/clinics/profiteering companies that will test your blood for every trace element and mineral under the sun. They then provide a fancy report that shows bar graphs with the “levels.” Some will be in the “green” which makes us feel warm and fuzzy, but inevitably, some will fall in the ominous “red” category. Many of these ultra-trace elements/minerals (the human requirement for these is extremely small) are often tested. Things like chromium, selenium, arsenic and so on. These ultra-trace minerals typically have minimal physiologic function and deficiencies in these minerals have generally no consequences. Furthermore, serum testing of these minerals is often fraught with inaccuracies and do not necessarily reflect the true tissue concentrations.
The bottom line here is: Be cautious of the extensive vitamin/mineral testing. Often it is inaccurate, unnecessary, and potentially harmful especially to the pocketbook. When faced with the “troubling news” that your chromium levels are too low (read sarcasm), those same companies or clinics will happily supply you with a useless bottle of chromium supplementation for the low price of $50/bottle.
Vitamin B12 deficiency is definitely an exception. We know that vitamin B12 deficiency can cause serious medical issues. However, B12 deficiency is also relatively rare. So before I could recommend B12 supplementation, I would first like to establish a good reason for taking it. As a general rule, blindly taking B12 supplementation is not recommended by me, but also not condemned as I don’t feel it to be harmful.
A diet with lots of fruits and veggies along with a daily cardiovascular exercise regimen will likely help quite a bit more than the expensive vitamins and supplements. If you must take something though, a daily men’s or woman’s once-a-day multivitamin should be more than enough to do the trick.
Charles Opperman, MD, FACP
