Monday, February 3, 2014
The last nail in the coffin for multivitamins
How much money would the U.S. auto industry be making if every car they sold never started? How much could video game console makers charge if their products didn’t play any games? Well, in 2010 the U.S. dietary supplement industry sold $28 billion dollars in vitamins, minerals and other supplements that, as far as we can tell, benefited virtually no one.
Annals of Internal Medicine published 3 studies examining the effects of multivitamins. This is not the first investigation of a mysterious unexplored field. Lots of studies have already shown that in well-nourished people living in the Western Hemisphere, multivitamins are not helpful. Think of this more as sweeping away any traces of doubt.
One study explored the effects of a high-dose vitamin and mineral supplement on heart disease. About 1,700 patients who had a heart attack in the past were randomized to the supplement or a placebo. They were followed for four years to measure their rates of recurrent cardiovascular events. There was no difference in the occurrence of these events between the group receiving the supplement and the group receiving placebo.
Another study examined the effects of a multivitamin on cognitive decline. About 6,000 male physicians aged 65 and older were randomized to a multivitamin or placebo and given a battery of 5 tests of cognition and memory over 12 years of follow up. The 2 groups did the same.
The third study was a review of prior studies of vitamin and mineral supplements for the prevention of cancer or cardiovascular disease. The study conclusion was negative. There is no reason to take vitamins or minerals for cancer or cardiovascular disease prevention. And the review highlighted the harms of some vitamins. β-carotene and vitamin A increase lung cancer risk in smokers, and vitamin E increases the risk of prostate cancer.
An editorial in the same journal issue crystalized our current knowledge: In conclusion, β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.
Their conclusion: The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.
There are specific patient populations who are especially vulnerable to vitamin malabsorption, such as those who have had intestinal surgery and patients on long-term acid suppressing medications. They may be recommended specific vitamin supplements. Women in their child-bearing years should take folic acid. And it’s possible that vitamin D in the elderly prevents falls. But apart from those narrow groups, well-nourished people don’t benefit from supplements. (I don’t take any vitamins or minerals.)
Perhaps the latest studies and the barrage of resulting media coverage will make a difference. Then maybe we could save some of that $28 billion and spend it to buy some skepticism.
Multivitamins Found to Have Little Benefit (Wall Street Journal)
How do Americans waste $28 billion a year? On vitamins, doctors say (Los Angeles Times)
The Case Against Multivitamins Grows Stronger (Shots, NPR’s health news)
Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial (Annals of Internal Medicine article. Abstract available without subscription)
Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial (Annals of Internal Medicine article. Abstract available without subscription)
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 (Annals of Internal Medicine. Available without subscription.)
Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements (Annals of Internal Medicine editorial. Subscription required.)
A Reminder to Dump Your Multivitamin (my post from 2011 reviewing the known effects of various vitamin supplements)
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.