I was appalled by the article that appeared in the Atlantic Jul 19 2013: The Vitamin Myth: Why We Think We Need Supplements. Not surprisingly, Atlantic did not publish my toothy critique–which I’ll now copy below:
Atlantic did not print an even-handed article. The Author, Paul Offit, spends most of it building up then vigorously tearing down Linus Pauling–as if that alone would make his bizarre case against vitamins. Then he hand-picked studies that supported his conclusions and completely failed to mention anything to the contrary. To suggest that the benefits of vitamins are a complete myth and to unabashedly suggest that no-one should take vitamins goes *way* too far. This guy and his wobbly conclusion are both puntable. Shame on you Atlantic! How about some balance?
I’d have to look into it, but if the half dozen headline worthy anti-vitamin studies I have investigated in the last 10 years are any clue, I’d expect to see that many of the studies that supposedly “invalidated” the benefits of vitamins were using synthetic forms (ineffective or toxic). In these cases, all we really learn is that the cheap synthetic forms don’t work.
Another common flaw in the anti-vitamin studies has been by their design. If you survey people who take vitamins, many will already be sicker and therefore more prone to the downstream problems that were mistakenly attributed to the vitamins than the general population. Some vitamin takers had cancer (and chemotherapy) or heart disease, or perhaps they have a family history (genetic predisposition) of cancer, heart disease, or some other serious disease. Before anyone can make a reasonable conclusion about the benefits or detriments of vitamins, these kinds of “inclusion criteria” have to be checked out. For these kinds of reasons, it’s impressive but potentially meaningless that a study surveyed tens of thousands of people with a big university name behind it.
What’s worse is that we live in a world where we also have to dig into backgrounds of the scientists (and editorial boards which may have modified the conclusions of) the negative vitamin studies. I would be surprised if we did not see that many or most were essentially in the pocket of drug companies–who have a well established yet little known stake in keeping the population chronically sick, and not looking any further than the latest expensive drug for answers.
There is plenty of evidence showing benefits of various vitamins, and reams of evidence showing the detriments of vitamin deficiencies. Does that mean that we should open the floodgates of unlimited vitamins? Not at all, and I frequently and publicly harangue colleagues and supplement manufacturers who behave as if “mega-dosing” vitamins was the pathway to health. Likewise, I routinely take patients off of unnecessary supplements and steer my patients away from synthetic forms of the more chemically complex vitamins. The problems with synthetic vitamins that are close but not quite identical to their natural forms are obvious, and predicable, and it’s foolish to think that we are presently able to synthetically duplicate nature’s complexity. To be of optimal benefit, any supplement (vitamins, minerals, amino acids, etc.) must be a natural form, and then applied with sensitivity to the needs of the individual. I believe that multiple vitamins and minerals have their place too, but for the reasons mentioned above, you can pretty much forget about the synthetic Centrum you get at Costco.
With recent advances in genetic testing, we are able to test individual genetics—including the “nutri-genomics” of enzymes that process and use vitamins in critical biochemical processes. In this way we are getting much better at determining what doses and which forms of activated vitamins will promote health and prevent disease in an individuals.
We learned that giving pregnant mothers the vitamin folic acid (a vitamin found in greens and other “foliage” can reduce the incidence of serious neural tube defects like spinabifida. So now it is standard practice to give pregnant mothers 400-800mcg of supplemental folic acid (along with a host of other vitamins and minerals) in a prenatal multivitamin. With the advent of the prenatal vitamin, we saw a dramatic reduction in neural tube defects. A limitation of the prenatal vitamin is that it is a “one size fits all” approach that does not take into account individual genetics or dietary intake. At the population level, prenatal vitamins clearly have significant benefits. That said, I seriously doubt that it is completely without risks to some individuals.
It turns out that just as serious as a folic acid deficiency is a pair of genetic variations in a key enzyme that handles folic acid (Methylenetetrahydrofolatereductase—or MTHFR). These variations (C667T and A1298T) are common, and it turns out that about half of the population will inherit one or more “bad” copies of the MTHFR gene from their parents. (you can check out my other post dedicated to MTHFR) The variations lead to either less efficient or more fragile versions of the MTHFR enzyme. One solution is simply to give people with genetic hits on this enzyme more folic acid. Another more innovative solution is to leapfrog over the faulty enzyme by giving an “activated” form of folic acid: Methyl-Folate. In this little nutrigenomic story we can hear the knell of “one size fits all” multivitamin. It won’t be long before we can all have our own specially formulated vitamins based not only on our genetics but also responsive to functional measurements of our various vitamin and metabolite levels—including vitamin C and other measures of our antioxidant capacity.
I’m sure that Offit, is right in one area. We do need to come to a better understanding of the role of oxidation in health and disease. Dumping ten or hundreds of grams of vitamin-C into our bodies is not going to fix everything that ails us. Oxidation is essentially “molecular rusting” and occurs whenever electrons are stolen, and it happens a lot inside our cellular powerhouses in normal metabolism.
Science has always progressed forward with steps and falls. It’s a process of developing greater understanding of the nitty gritty details—details that seem to require bold and revolutionary thinkers to uncover for us. In order for science to progress, we need unbiased observers to carefully observe what’s happening, then we need to question our assumptions and apply a greater degree of sophistication to develop better theories to explain what’s happening.
Take dietary fat for example. In the late seventies, the idea that dietary fat was bad for us was popularized. Then we subdivided fats and learned that it was saturated fats that were bad for us and that unsaturated fats were good for us. Now we’ve learned that some saturated fats (Lauric acid 12:0) are really good for us in that they raise the level of the “good” HDL cholesterol.
What about those unsaturated fats? Well, it turns out to be complicated too. Arachiadonic acid (polyunsaturated omega-6 fatty acid 20:4) in high doses (e.g. from corn fed beef) is bad for us, but we absolutely need some of it to have a normal inflammatory response to infection and injury. Then there is the debacles of trans fats (made by hydrogenating corn and soybean oils to increase shelf life) and the problems with oxidized fats (made by heating unsaturated fats) which can upend the benefits of “good fats” like olive oil and make it into a health hazard. Now we know that fats made from feeding the animals corn rather than grass makes for a different fat profile—with attendant health detriments. Another problem with dietary fats has nothing to do with the fats themselves, but with some fat-soluble chemical hitch-hikers: persistent organic pollutants (POPs). The list of POPs includes hundreds of nasty man-made chemicals like DDT (pesticide), PCBs (industrial chemical), Dioxin and the like. We banned or severely restricted many these “legacy” POP chemicals in the 70s & 80s, but because of their persistence in the environment and transmission in the food-chain. Want proof? They can all still be found in the cord blood of our newborns.
How did the anti-fat craze get started? Some believe it was Senator George McGovern’s Select Committee on Nutrition and Human Needs held a hearing in 1976 on over-nutrition. McGovern staffer Nick Mottern, a labor reporter with basically zero nutrition training, got most of his material from a Harvard nutritionist and anti-fat crusader, Mark Hegsted. Mottern’s report myopically suggested that every American should eat by the American Heart Association’s recommendation for men at high risk of heart disease—and so we did. Unfortunately, as American’s obediently cut out the fat, they did not increase dietary intake of fruits, vegetables, and legumes. Instead, Americans consumed more carbohydrates: wheat, corn, potatoes, rice, sugar–and lets not forget the #1 source of calories in Americans today: corn syrup. What did we get for our low-fat obedience? Obesity, diabetes, and heart disease rates have all soared.
What’s the lesson here? Science progresses slowly, and extremist statements (including Pauling’s “Vitamin C is a panacea” and Offit’s “the benefits of vitamins are a myth”) are rarely, if ever, correct. While we wait for genetics and nutritional and functional lab testing to individually direct our diets and supplementation My advice, to everyone, is to eat a varied diet of fresh fruits, vegetables, legumes, nuts and seeds, and (limited) animal products—provided the animal was more or less naturally raised. Limit refined sweeteners, processed foods, grains (especially wheat and corn), and to avoid artificial sweeteners and other artificial ingredients altogether. If you’ve got a personal or family history of a specific disease, check with a nutritionist, naturopathic doctor, or functional medicine practitioner to see if certain nutrients has been shown to reduce the incidence, recurrence or severity of that condition and then find foods or high quality supplements to supply that nutrient.
Dr. T.R. Morris is a licensed naturopathic medical doctor (ND). He is currently serving as faculty and consultant to the Institute for Functional Medicine (IFM). The IFM mission is to revolutionize medicine by teaching the latest genetic, nutritional, hormonal and other biochemically-based integrative medicine techniques to MDs and other practitioners looking for new tools to prevent and treat chronic disease. In the past, T.R. served as the medical director of a large integrative clinic and taught (genetics, physiology, biochemistry, microbiology, cellular & molecular biology) for 10 years for various medical programs in the Puget Sound. He sees patients in person (or long-distance via Skype consultations) from his home office in Seattle.
Contact Dr. Morris