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Tuesday, December 17, 2013

Doctors: Stop Wasting Money On Vitamins


A group of doctors writes that people should “stop wasting money on vitamin and mineral supplements.” (shannonkringen/Flickr)

It might not be worth taking vitamins if you want to prevent chronic disease. That’s the message in an an editorial today in the Annals of Internal Medicine.

The editorial is a sweeping analysis of studies that focus on multivitamins. The authors looked at three studies that included hundreds of thousands of patients.

They determined that vitamins had “no clear evidence of beneficial effect” on the occurrence or progression of chronic disease, and in some cases could be harmful. For instance, smokers who took only beta carotene supplements increased their risk of lung cancer.

Dr. Lawrence Appel was one of the authors of the editorial and joins Here & Now’s Robin Young to discuss it.

Interview Highlights

On the studies’ focus on people with healthy diets

“These are the people that supplement manufactures are targeting. They are often people who are eating well and get enough nutrients. I mean, there are populations in the world, many in less developed countries, where vitamin supplements are important, really important. But not in the United States, Canada, other places where diets are basically okay, at least in terms of micronutrients. It’s not saying that our diets are perfect, you know, our diets can be improved, but the approach is not to take a pill.”

Are there no benefits to vitamins?

“Very equivocal. There have been studies that examine quality of life, and there really is not any evidence that it is any better than placebo. Evidence that supplements can improve joint function or symptoms is very weak too. So there really is not a compelling database for people to take these supplements, many of which can be expensive and divert people from doing what they really should do … [such as] being physical active. Take the money they use on supplements and spend it on a pair of sneakers, or gym club, or eating better foods.”

On some people’s belief that vitamins work

“The problem is we’re dealing with a product that has a mystique — how can vitamins not be beneficial? The term vitamin almost connotes value. So we’re taking on firmly held beliefs, but it’s held on shaky scientific evidence.”




From NPR and WBUR Boston, I'm Robin Young. It's HERE AND NOW.

And the FDA has confirmed what a lot of people suspected: Bacterial soap isn't any better at killing bacteria than regular soap. In fact, it's worse because long-term use can cause bacterial resistance and hormonal side effects. And the agency is now going to require manufacturers to prove the benefits of their antibacterial products. So there's that.

And there is more ammunition in the war over vitamins. An editorial out today in the Annals of Internal Medicine looked at three studies and concluded: case closed. Vitamins have no clear benefit for people who eat well. And they shouldn't be used for chronic disease prevention. The editorial ends with the words enough is enough. Dr. Lawrence Appel is professor of medicine and epidemiology at the Bloomberg School of Public Health at John Hopkins University and one of the authors of the editorial. Wow, Dr. Appel, pretty emphatic.

DR. LAWRENCE APPEL: We were just restating what these studies found, but it's not just these studies. I mean there's been really a long line of sort of disappointing results from trials. These statements have been made before by other people, but we just happened to have the opportunity to write an editorial and comment on it.

YOUNG: Well, the first study that you looked at out of the three was a meta-analysis of 27 studies. So there's, you know, tons of work here. But it sounds like these studies were looking specifically at the effect of vitamins on mortality, whether they can prevent stroke or a heart attack. And the conclusions were, they couldn't?

APPEL: Yes. They found that there was no benefit from taking multivitamins, you know, at least in populations such as those residing in the United States.

YOUNG: Well, that's what critics are responding to. There are people who have come forward to say, well, but you looked at people who were well-nourished. What about people don't have good diets?

APPEL: Yeah. But these are the people that supplement manufacturers are targeting. They're often people who are eating well and get enough nutrients. I mean there are populations in the world - many in less developed countries - where vitamin supplements, you know, are important - really important, but not in the United States, Canada, other places where diets are basically OK, at least in terms of micronutrients. It's not saying that the diets are perfect. You know, our diets can be improved, but the approach is not to take a pill.

YOUNG: Well, what about the other reasons people take vitamins, not necessarily to prevent death but to make them feel better while they're living, to, you know, lubricate the joints or make your skin better. Are there no benefits to vitamins?

APPEL: Very equivocal. I mean, there have been studies that have examined quality of life. There really is not any, you know, evidence that it's any better than, you know, placebo - evidence that supplements can improve joint function or symptoms is very weak too. So there really is not a compelling database for people to take these supplements, many of which, you know, can be expensive and divert people from doing what they really should do.

YOUNG: Which is?

APPEL: Being physically active, take the money that they use on supplements and spend it on a pair of sneakers or a gym club or eating better foods.

YOUNG: Well, this is a huge multibillion-dollar industry. What are you hearing?

APPEL: Well, I've heard from people, individuals who expressed their own opinion that they perceive some benefit. The problem is that we're dealing with, you know, a product that has a mystique or a, you know, how could vitamins not be beneficial? The term vitamin almost connotes value. We're taking on firmly held beliefs, but it's based on shaky scientific evidence.

YOUNG: You mean the beliefs are?

APPEL: Yeah.

YOUNG: Dr. Lawrence Appel, professor of medicine at the Bloomberg School of Public Health at John Hopkins, also a co-author of an editorial in the Annals of Internal Medicine that looked at several studies and concluded taking vitamins to prevent chronic disease is not worth it. Dr. Appel, thank you.

APPEL: A pleasure to be on your program.

YOUNG: So Dr. Appel told us he's going into the witness protection program now. We, however, welcome your thoughts. Go to hereandnow.org. Love to hear what you think about this. You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.

Please follow our community rules when engaging in comment discussion on this site.
  • ssxsolstice

    “Sweeping” indeed. Only men over the age of 65? I’ll need more diverse studies before I give up my gummy vites.

  • rambunctiousexplorer

    First, doctors have never been trained in nutrition. They are trained by drug companies (who greatly pay for their medical education through , at minimum, paying for their medical books). There is no money for drug companies via vitamins, supplements, or nutrition so the drug companies have been waging war on these and nutritious foods through campaigns, public relations and marketing to smear anything that might cut into their profits.

    Doctors are trained throughout their medical lives by drug companies or their “neutral” marketing companies and given false information. I’d never trust a doctors opinion about nutrition because it’s from faulty data provided by profiteers. Btw, I was one of the marketers who skewed information for docs and kno whereof I speak/ write

    • Stacy21629

      Contributions to doctors, med schools and med students are strictly regulated. They can’t legally give med students PENS with their logo on them.

  • Philip

    The link above does not go to the editorial. The correct link is: http://annals.org/article.aspx?articleid=1789253

  • Ham

    They keep attacking Vitamin D and i have a huge bottle of vitamin D, for 11$. I think it just pisses jews off that it’s there. i don’t use them, cause i don’t feel any benefit. let’s not diss the vitamins.. i tend to advance medicine and they seem to know my every move. They always talk about my LATEST discovery.

  • http://www.openeyesvideo.com/ Glenn C. Koenig

    I wish the doctor would clean his own house before jumping on vitamins! How many prescriptions are written in this country that not only do no good, but are actually harmful? Why does our medical care system cost 1.5 to 2 times that of any other developed country on the planet?
    This report, in my opinion, is just more bigotry from the Medical Industrial Complex, which has discriminated against all sorts of beneficial practices that they “don’t believe” in. Hogwash! The vitamin industry has tweaked their noses and they are just upset. Sure, probably a lot of people take vitamins that they don’t need, but the way to fix that is to make responsible nutritional information and care available widely at a reasonable cost. As long as this absurd ‘fight’ between doctors (and the big drug companies) and the vitamin makers continues, with all the propaganda flying back & forth, then good reliable information will continue to be hard to come by.

  • Amy

    I have been hearing news about this for quite some time, and am happy that there is developing empirical evidence in this area. My question is: What about when someone is deficient in a vitamin? My doctor tested my vitamin D levels, which indicated I was low. I took a vitamin D supplement for a short while and it put my levels back in the “normal” range. My doctor told me to take vitamin D regularly because it is safer than getting it from the sun. I was also short in Vitamin B12 at one point and those levels were regulated with supplements as well.

  • Jody Griggs

    This doctor, who I agree is clearly no nutritionist, said for us to use the money we spend on vitamins to eat proper diets. Problem is, most of us are not nutritionists either, and its very hard to ensure one is getting all the micronutrients, especially if one is not a fan of kale. I don’t think not buying a bottle of multi-vitamins would free up enough money for me to purchase this food, and it certainly wouldn’t free any time for me to figure how which foods have biotin or chromium or other trace elements I supposedly need (even according to these mainstream doctors).

    • Kate H.

      Here’s the thing, though: you don’t need to know exactly which foods have biotin or chromium (etc) in them. You just need to make sure your diet is made up of “whole foods” (think of them as food as close to its original form as possible), and lots of variety. The reason so many people are nutritionally deficient is because there is no variety in a diet frequently made up of processed foods.

      When I hear people say “well I’m not a fan of kale”, my only thought it: if you want to be healthy, you have to find a way to enjoy those kinds of foods, and excited about exploring the unknown. I used to dislike vegetables, mostly because I didn’t know how to prepare them to satisfy my taste buds, and because they didn’t “feel as satisfying as a cheeseburger”. But more importantly, I disliked being sick and unhealthy and overweight MORE, and vowed to change my ways (which I did).

      This idea that vegetables are somehow more expensive than processed foods is a fallacy. The true cost of process foods is hidden. You may pay $2 for a box of hamburger helper, while a bunch of organic kale is $3. but you will spend easily an extra $10 for that hamburger helper over time in costs related to diminished health due to an inadequate diet, when you consistently opt for the immediately cheaper meal option that comes from a box or a drive thru window.

  • Russ

    Since I have multiple blood work results proving significant improvements and effectiness of my supplement regimen, I’ll take that over the “editorial” opinion of any doctor, any day of the week. The media presentation of this editiorial as fact without presentation of any facts is abysmal reporting. Not only was it one sided and short sighted, it is a signifacant public disservice for balanced reporting. Who paid for most, if not all of those studies, compiled in this editorial opinion? Any conflict of interest? The unspoken truth is deafening.

    • Stacy21629

      Just because your blood levels have increased, does not mean that those increased levels translate into any increase in your overall body health or longevity. THAT is what these studies are looking at.
      If you want to know about conflict of interest (though i’m not sure what the benefit is for companies to promote a study DISCOURAGING people from buying something) – that sort of thing must be declared in the study itself. Pub Med my friend.

  • Russ

    Dr. Lawrence Appel, director of the Welch Center for Prevention, Epidemiology and Clinical Research website.
    My editorial of the report below Vs. today’s opinion against supplementation uselessness; Hypocritical.

    Atkinson MA, Melamed ML, Kumar J, Roy CN, Miller ER 3rd, Furth SL, Fadrowski JJ. Vitamin D, Race, and Risk for Anemia in Children. Journal of Pediatrics. 2013 Oct 8. [Epub ahead of print] PMID: 24112861. (PubMed link)

  • Russ

    Dr. Lawrence Appel, director of the Welch Center for Prevention, Epidemiology and Clinical Research website.

    My editorial opintion of their article below Vs. today’s professional opinion that supplements offer no value. Hypocritical.

    Atkinson MA, Melamed ML, Kumar J, Roy CN, Miller ER 3rd, Furth SL, Fadrowski JJ. Vitamin D, Race, and Risk for Anemia in Children. Journal of Pediatrics. 2013 Oct 8. [Epub ahead of print] PMID: 24112861. (PubMed link)

  • PC249

    This article is about SYNTHETIC vitamins.

    • Russ

      Yes, missing facts the public should know about but conveniently is left out.

  • Pete Wagner

    99% of doctors are in it for the money, and the other 1% aren’t in it for long.

    • Stacy21629

      Yes, $300,000 worth of educational debt. Money-grubbing doctors.

      • Pete Wagner

        Point taken. I guess it’s more about cash flow.

  • Anne

    What about prenatal vitamins?

    • Stacy21629

      See the difference there is that there IS actual, verifiable, repeatedly science behind prenatals (more specifically folic acid levels and iron). That is not what is being addressed here. This is looking at your standard “One-A-Day” type multivitamins for normal, non-pregnant adults.

  • caseyann

    What about menopausal women taking calcium and and vitamin D? Every ob gyn recommends this.

  • Kate H.

    Anyone who thinks vitamins will prevent “chronic” illness are misguided and likely nutritionally uneducated to begin with. This is not surprising, as most people either just don’t know or perhaps just refuse to consider how what you eat effects your health.

    I couldn’t agree more with Dr. Appel’s comment that people should spend the money they put towards vitamins and supplements towards a gym membership. Fitness, coupled with diet, is the number one proven method to combat general and chronic illness, and improve your overall health. However, I do also believe that occasionally including vitamins and supplements in your diet as just that – a SUPPLEMENT – helps your body to function at it’s best.

    For most of my life I was extremely unhealthy, eating a standard American diet of processed, convenience and fast foods and getting little physical activity. I can attest to the massive health benefits of exercise and switching to a plant-based diet, peppered with occasional supplements tailored to my personal needs based on lots of self-observation. I feel great, and I am sick so infrequently I often can’t remember the last time I came down with any kind of a cold. But I still attribute 80% of my overall good health to exercise. Just finding the time to take an hour long walk every day makes a HUGE difference.

  • V

    Many of us (including science) would agree that our bodies need vitamins and nutrients to thrive. And the majority of people do not eat food that has a wide range of these being that fast food and processed foods are a large part of many diets in North America- something that many people will not change. I agree that synthetic supplements are not the best and whole food vitamins are preferable, but I sure wish they wouldn’t make the blanket statement that “vitamins have no value” because whole food vitamins absolutely do. There are many factors to consider with chronic diseases…

  • Caroline

    I tend to agree with him. Our genetics play a large part with health, and our life expectancy, and a few pills isn’t going to cure us, or kill us. Most people in the USA want a pill for curing everything. Western medicine has promoted this idea, but it’s not been proven. I’d say watch out taking any medications, prescribed drugs, or suppliants. Also, don’t believe the doctor who tells you, “you must take this pill, or have this surgery.” They’ll also tell you that once you’re on a medication you can’t stop taking it. That’s not true either. At 66 years and having parents who lived into their 80s and 90s experience has proved the point.

    I’ve had my share for hoping vitamins will do me good, and second opinions about surgery too, but didn’t have it ~ turned out didn’t need it ;] and took anti-anxiety/depression medications, but I never stick with any strict regimen, and I always get off of any medication as quickly as I can. Eating healthy, and getting up off your duff, interacting with bright encouraging relatives and friends are our best medicine.

  • Skeptical in AL

    One wonders who funded these studies. Could it have been big pharma? I’m sure they don’t have a vested interest in the results

    • Stacy21629

      Your comment makes no sense. These studies and the scientist profiled here are encouraging people to NOT buy a product because they could find no benefit to them. What exactly is the “vested interest” of “big pharma”? Take off the tinfoil hat and read/listen critically.

  • Duxford

    I’m still trying to figure out what the point of the piece was? Surely there’s no magic bullet for health, but using a vitamins in conjunction with other healthy lifestyle choices seems sensible as opposed to not using them at all.

    • Stacy21629

      That’s exactly the point the speaker and the studies are trying to make – just because it SEEMS sensible does not mean it actually is. Rather than going on assumptions, they chose to evaluate it scientifically. Ever heard of “evidence based medicine”?

  • RindieC

    Hm, I clicked on Phillip’s link below and it took me straight to a drug ad…
    I am a nutritionist, and in the interest of full disclosure I will say I do recommend, dispense out of my office and, yes, profit from nutritional supplement sales including the occasional multivitamin. I had a very wise professor in school and she said one thing that has stuck with me through my years of practice. Nutrition cures nutrition deficiencies. Period. Food first, supplements second. If the populations in the study were truly “well nourished” then it would make sense that a multivitamin meant to supply the recommended daily intake would not greatly improve their lives, And chances are vitamins won’t prevent chronic disease as they are caused by multiple factors. However determining an individual’s needs either by lab testing or food diaries and using targeted supplementation to address actual deficiencies is more likely to be beneficial. But hard to assess in a meta study like this one. I would love to see the actual studies and exactly what they were taking.

  • jonathanpulliam

    American dietary practices hardly yield optimal nutrient absorption because humankind, until comparatively recently in the anthropological evolution sense, ate the way a hunter-gatherer eats, that is by gorging opportunistically on accessible game, berries, etc.; but at any given meal, their body is not being asked to break down and digest a veritable smorgasbord the way we routinely attempt to do today. We simply haven’t had sufficient human generations to adapt to a “post-invention of modern agriculture” diet.

  • Marcia

    I think the doctor has formed an opinion already and just doesn’t know what he’s talking about, in terms of vitamins and also nutrition. I hope this gets people talking about this. My vitamin regimin costs a lot of money and should be covered by my health insurance.

  • samuelpepys

    Dr. Appel seems woefully under-educated on the subject of food insecurity (hunger, we used to call it) in the United States. You don’t have to look to overseas or below the equator to find people whose diets are not “basically OK.” You have to look at the people you pass on the street holding paper cups with $0.47 in change in them, or those who serve you at Walmarts and Arby’s.

    It may be that vitamins and minerals in pill, tincture or powder forms don’t make people feel or think or move better, and if so it’s a shame we can’t hear the facts objectively. I’m not a biochemist: I don’t know. I’m willing to accept that the relief provided by turmeric, bromelian, and fish oil capsules from my arthritis pain (I can’t take NSAIDS) is psychosomatic: who cares, if it lets me walk, work at a desk, and sleep at night? but I can afford it. But when I see a similar interview with Dr. Appel about the toxic, expensive, often equally unhelpful medications Big Pharma pays doctors to prescribe, I’ll have more faith in his critique of vitamin and micro-nutrient supplements. He may not deserve my cynicism, but the medical profession has little credibility in critiques of non-pharmaceuticals. (And as I know from friends who are physicians, and from personal experience, little to no understanding of nutrition.)

  • Graham Chan

    So what do you do when you’re in the shape of your life, already have enough running shoes and a ridiculously organic and fresh diet. Would it not make sense to start using supplements/vitamins in conjunction, before you become sick? Or might this contradict the system of waiting for the cancer to occur and then using the medical system to “fix” it? I’ll go with the former, thank you.

  • dialyn

    Let’s see, doctors want to put half the population on statins (which have proven negative side effects) and some of them have decided the blood pressure measure for my age group is wrong. So who do I believe? Doctors pocketing money from the pharmaceutical companies? I don’t know that I believe anyone in the medical field right now. I was in the hospital for 8 days and released, finally (because I insisted) without a diagnosis but doctors eager to send me to do tests completely unrelated to what my problem was. I dutifully went forward for awhile but nothing they did was doing me any good and they seemed disinterested in addressing the original problem (they were real big on prescribing drugs that led to new problems that required other drugs to solve). Meanwhile, the hospital sent me a bill for $200,000 for 8 days during which nothing was accomplished, and very little done. What a great con this all is. My brother is still a true believer, but I’m completely cynical — too many doctors care more about buying their next BMW than they do their patients.

  • TJtruthandjustice

    Doctors hate vitamins because they don’t require prescriptions. This is a meta-analysis of MULTIVITAMIN studies, meaning 1) this is not original research and 2) it does not take into account studies of individual vitamin supplementation. The fact is that there is CONSIDERABLE evidence that vitamin E supplementation can reduce the risk of heart disease in healthy individuals. These physicians had a clear agenda, just as the physician panel that recently recommended that nearly everyone should be on powerful statin anti-cholesterol drugs. I honestly think that many (certainly not all) people become doctors for financial and status reasons. They tend to place a high value on high income. Prescriptions supplement their income. Vitamins and other non-presrcription supplements do not. The bias is most certainly in favor of income-producing products and against non-income-producing products.

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