Vitamin and mineral supplementation

Nutritional insurance?

Adverse reactions to vitamins and minerals are not as rare as one might imagine. Between 1983 through 2004 the American Journal of Emergency Medicine has recorded a surprising number of adverse event reports regarding these compounds from poison control centers. A total of 1.3 million reports, 175,268 requiring hospital treatment, and 139 resulting in death occurred as a result of these “benign” supplements. Interestingly, the report jumped 62% after the passage of the Dietary Supplement Health and Education Act of 1993 (DSHEA). This act provided for a legal loophole to appear regarding linking questionable products to unsubstantiated health claims.

This is important because vitamins and minerals are regulated under this act, the same one that regulates the broad realm of substances sold under the aegis of the supplement industry with labels claiming the products in question “support”, “aid”, and “maintain” the general health of the body. That these products are produced without rigorous standards of quality control, not to mention an obligation to prove efficacy, is conveniently left out of the national discussion.

This is in sharp contrast to what is assumed by the public at large who believe these products are safe and effective. Vitamin and mineral supplements are a large part of the total supplement industry representing about one third of the 21.2 billion dollar product sale output (2005).

According to Hurley ((Natural Causes) in 1991 the National Maternal-Infant Health survey interviewed 8,285 mothers of preschool children and found that 54.4 % said they gave their children a daily vitamin and mineral supplement. Between 1999 and 2000 the National Health and Nutritional Examination Surveys conducted a survey among 4,862 Americans and found 35% regularly took a multivitamin.

These findings are consistent with the impression that there seems to be an accepted national consensus that vitamin and mineral supplementation is a valid, scientifically accepted recommendation. Indeed, the general message from supplement advocates, producers, and industry trade organizations has been to strongly support their frequent use, even in healthy populations as “nutritional insurance”. Again, Hurley reports that:

“Jeffery Blumberg, PhD, professor of nutrition at Tufts University in Boston, stated in a recent article that remains on the sites of webMD and fox news: ‘Most people need a multivitamin as ‘insurance’. Everybody needs to eat more healthfully. While you’re trying to get there, take supplements.’ Chris Rosenblum, PhD, a spokesman for the American Diabetic Association and associate dean of Health and Human Services at Georgia State University in Atlanta, was quotes on the Web site of a Blue Cross insurer as saying: ‘ A well-formulated vitamin and mineral pill for seniors is the best bet. It’s an insurance policy.’ A 2004 article on the Web site of the Harvard School of Public Health was headlined ‘Dietary Insurance: A daily multivitamin’ and concluded by calling multivitamins ‘about the least expensive insurance you can buy.’ An article in the Spring 2005 issue of the free newsletter distributed by CVS used the same ‘nutritional insurance’ line, as does an article on the Web site of Centrum, maker of one of the most popular multivitamins on the market.” These observations are a brief illustration of how pervasive the concept of vitamin supplementation has become, at least here in the states.

With this level of public familiarity and comfort for vitamin and mineral supplementation, it is not hard to understand how taking a daily pill just seems to make intuitive sense. However, this supposed “institutional” support for regular vitamin and mineral supplementation is actually a thin veneer of opinion and unsupported advocacy. Though, the masses make an illusory link to some type of official medical recommendation or government guarantee- the fact is there is none.

Again Hurley notes: “… no major medical group or government agency actually recommends the routine use of multivitamins for otherwise healthy children or adults, with only a few particular exceptions.” In 2005, the US Surgeon General Richard H Carmona had one vitamin recommendation: “That every woman of child bearing age take a folic acid supplement.” The American Diabetic Association states, in a position paper that: “there is little scientific evidence of benefit to the average person from a low dose multivitamin or multivitamin-mineral supplement.” In 2006 the National Institute of Health (NIH) stated that: “the state of evidence is insufficient to recommend either for or against the use of multivitamin/multimineral [supplements] by the American Public.”

Benjamin Caballero, MD, PhD, director of the Center for Human Nutrition at John Hopkins University in Baltimore and a member of the Food and Nutrition Board at the National Academy of Sciences notes: “Most of the vitamin supplements consumed in the US are unnecessary, but don’t rely on my opinion. Look at the 2005 Dietary Guidelines for Americans. They don’t recommend any vitamin supplement for the healthy population consuming a variety of foods.” These guidelines represent a continuing effort to stay abreast of the latest science based information.

In a “no brainer” so hard for many to accept they state “Nutrient needs should be met primarily through consuming foods.” Robert M Russell, director and senior scientist of the Lean Mayor USDA Human Nutrition Research Center on Aging at Tufts University in Boston adds: “Instead of paying attention to their diet and a mixed variety of foods that they should be eating, people think they’re getting everything they need from a multivitamin, which is not the case. If you’re just depending on a multivitamin, you’re missing out on many, many, many benefits that come from eating a variety of foods.”

Even the health oriented consumer seems convinced and assumes that supplementation “just in case” is generally assumed to be the way to go. But they don’t consider the surprising number of adverse events (that may even be higher if properly regulated), the fact that supplementation often contains far more concentrations of vitamins and minerals than found in food , and that as a whole human consumption today of these substances is the highest in the history of humanity itself! (The improved health, longevity, and quality of life observed in the past century is linked to improved science based medicine, hygiene technology, biologicals (antibiotics and vaccines), refrigeration, improved food distribution, among others- not vitamin and mineral supplementation.)

Though many concerns regarding these supplements are ignored by many here in the US, some European countries have signaled a far more prudent approach. In 2004, the Danish Veterinary and Food Administration refused an application from Kellog’s to fortify Corn Flakes, Rice Krispies, Special K, and fifteen other brands.

As Hurley states: “Danish health authorities… concluded, after reviewing the safe upper limits for vitamins and minerals that had previously been established by the European Community Scientific Committee on Food, that the amounts that Kellog’s wanted to add would bring some citizens, particularly children, over the safe limits.”

They went on to add that any deficiencies in a general diet should be addressed by specifically fortifying for that item- not supplementing “just in case.” The Dutch authorities went on to state that advising supplementation for people (in this case referring to cereal supplementation, but valid in general) on poor diets completely misses the point. There is no evidence that supplementation is the solution. The focus needs to be on consuming a better diet. Would that more people take heed!

Ref: Hurley D. Natural Causes. Broadway Books.New York 2006