February 16, 2009

Are you taking vitamin pills?

Are you a fool?


Palladian said...

I'm still going to take my Centrum Performance daily.

More fool me, I suppose.

Ann Althouse said...

LOL. "Performance." That took you in.

Jason (the commenter) said...

It's more fun to eat food.

blake said...

I can detect a distinct difference in certain things from when I take my vitamins and when I don't.

Placebo? Could be. What do I care? If it works, it works.

Absorption is a big issue, too. Not all vitamins and minerals are equal.

Bob said...

Well, I can say I've never had scurvy, rickets or any other vitamin-deficiency disease, so screw those scientists. I rarely get colds, either.

Ann Althouse said...

I've never had a vitamin deficiency disease, and I haven't had a cold since 5 years ago, when I had my first cold in 10 years, and I never take vitamins.

Ann Althouse said...

"Placebo? Could be. What do I care? If it works, it works."

You should care about science. And your money.

Bob said...

Ann Althouse said...

I've never had a vitamin deficiency disease, and I haven't had a cold since 5 years ago, when I had my first cold in 10 years, and I never take vitamins.

You should care about science. And your money.

You yourself labeled this post as bad science, so perhaps you're dubious about the claims in the article, too. There have just been far too many conflicting studies when it comes to diet and nutrition that I'm not going to take the latest study at face value.

And as for money, a year's supply of multivitamin typically costs less than $15 dollars at Wal-Mart, so money isn't an issue.

Palladian said...

"You should care about science. And your money."

I trust the science reporting in the New York Times only a little more than I trust their editorial stance.

The "science" on this issue is not a settled matter. Part of the article concerns "megadosing" vitamins. But the point of taking a multivitamin is not to "megadose" but to provide a balanced spectrum of vitamins and minerals. I happen to need a supplement. I will follow the advice of my physician and continue to take a multi-vitamin.

John Burgess said...

I suspect that many taking daily vitamins are taking them because they fear that their diet is not the precisely 'balanced diet' the doctors keep talking about. Thus, a daily dose to make sure you're getting what you should be getting is simple prudence, even if not entirely accurate.

I would never argue that my diet is perfectly balanced. Sometimes I notice that I'm short on potassium--a leg cramp or two in the night is a strong suggestion of just that. So I eat a banana every few days and don't worry about the cramp. I guess I'm foolish to do so, but hey, I like bananas anyway.

Swallowing a pill hardly taxes my abilities. Buying vitamin pills doesn't tax my budget far less than the occasional coffee I buy from a specialty shop.

I'm not going to OD on whatever is in a single, daily vitamin pill. I might if I go for megadoses of the vitamin du jour. So I don't do those.

blake said...

You should care about science. And your money.

There's a good chance science is not involved in this. The amount of money I spend is under my threshold of concern.

But you're missing my point: At some point I have to either trust my own experience or mistrust it.

reader_iam said...

I suspect a certain amount of benign neglect *balanced by* a certain amount of vigilance will ultimately win the day ... if we ever live long enough to see that proved out, or even studied seriously. (Personally, I don't expect to live that long.)

That said, it strikes me that there are potentially so many individual factors to take into account. The ideal--of course!--would be something to which Blake points: any given individual being aware enough of his or own individual physical/chemical/whatever/etc. to adjust, well, individually. But how to nurture or teach this, in these times and over the past several decades? It seems to me that enough dinking, conscious or not, goes on, and has gone on, at early ages to defeat a certain sense of awareness that might--might--otherwise kick in, innately and as a product of survival.

Anyway. I realize that quickie response likely reeks of bull. I don't mean it that way, and I sincerely think that's due to the "quickie" component.

Also, while I'm not obsessive about it, I am more vigilant about a lower level supplement for my son (though not daily). But that's primarily because he's primarily veg, so there are specific potential gaps to which it's appropriate to pay some specific attention ... although, OTOH, because he does and always has eaten more and a much larger variety of vegetables than is typical, there are other standard gaps about which other parents (such as all of my and my husband's collected siblings and most friends) worry but I do not.

Host with the Most said...

Fuck the "science" here and everyone who begins to take sides on this meaningless "debate".

What a load of crap - all on a a false premise:

In the past few years, several high-quality studies have failed to show that extra vitamins, at least in pill form, help prevent chronic disease or prolong life.

Listen up, idiots (and that includes law-related jerks): There are more reasons to take vitamins than the two that the Sister-Fucking New York Times set up as it's premise.

SHIT! How stupid are you people to let the discussion be defined by a paper who's editors and publishers are publicly sworn enemies of our democratic republic style of government?

You want to know why the country is polarized on so many different issues? Because of shit like this. Why improve our society and country when you can find worthless things like this to aid in feeling superior and arguing about?

"Hey, at least I'm on the right side of the vitamin issue! Take that, less smart person on the wrong side!"

Stupid is as stupid DOES. Sure proved it with this post.

jdeeripper said...

Ann Althouse said...I've never had a vitamin deficiency disease, and I haven't had a cold since 5 years ago, when I had my first cold in 10 years, and I never take vitamins.

Well you're just Little Miss Perfect aren't you.

NYTimes - "Ever since the Nobel Prize-winning biochemist Linus Pauling first promoted “megadoses” of essential nutrients 40 years ago,"

Linus Pauling recommended megadoses of Vitamin C, not all the so called essential nutrients.

In January, an editorial in The Journal of the National Cancer Institute noted that most trials had shown no cancer benefits from vitamins — with a few exceptions, like a finding that calcium appeared to lower the recurrence of precancerous colon polyps by 15 percent.

Since when is calcium a vitamin?

The body can only absorb so much of anything so taking megadoses is not really useful.

But there are at least two nutrients people do consume in sufficient amounts.

One is enzymes and the other is probiotics.

Enzyme supplements are vital to breaking down food and making it useful to the body.

Probiotics are needed to wage warfare against the bad bacteria, yeast etc that are constantly colonizing your body.

Get more enzymes and probiotics and you'll be much better off than taking vitamin megasupplements.

jdeeripper said...

I meant to write - But there are at least two nutrients people DO NOT consume in sufficient amounts.

blake said...

HwtM is cranky!

Ann Althouse said...I've never had a vitamin deficiency disease

Yay for never having rickets!

Assuming you lack some the same vitality you had 40 years ago, though, how much of what you perceive as aging might be due to a vitamin (or mineral or other nutritional) deficiency?

chickenlittle said...

Are you taking vitamin pills?

Yes. I take niacin (vitamin B3) daily. It normalizes my cholesterol levels.

Are you a fool?

Well I refuse to register for the NYT, so I guess I won't know their opinion. My physician and and RN wife don't think so (at least in this matter :)

Donna B. said...

The average normal healthy person probably does not need extra vitamins.

That does not mean that vitamins aren't necessary for others. For instance, those who succumbed to societal pressure to lose weight and had gastric bypass surgery suffer more from malnutrition than they ever would have from any weight-related health risk.

Their bodies no longer absorb calories from food which causes weight loss, sometimes extreme weight loss, depending on how much of the small intestine one's doctor left in place.

It also means that vitamins, minerals, and other nutrients are also absorbed in lesser amounts.

Those who had the lesser alteration of vertical banded gastroplasty also suffer from malnutrition, though not as severely. Their small intestine is still intact to absorb vitamins and minerals from whatever small amount of food they are able to eat.

Screwing with the body's metabolism results often in those with the banded gastroplasty gaining whatever weight they initially lost back, plus a few pounds.

Those who had the gastric bypass may remain skinny, but they die 20 years sooner.

The doctors who do these surgeries do not routinely inform their patients that vitamins (by injection for those who have had bypasses) are mandatory.

Being overweight is not as much an eating disorder as being underweight is, unless the fatness is induced by weight loss surgery.

OK... off my soapbox here, but the main point is that vitamins are necessary and the lack thereof is devastating.

Blood tests can show if you need more vitamins and minerals than you are getting, specifically B12, Iron, Calcium, and Sodium.

As for not getting a cold, you're just lucky and you should give thanks for that, not a nod to adequate vitamin intake. Since 1998, every MRI I've had (for a brain tumor) has also shown an abnormal sphenoid sinus fluid level which accounts neatly for my thrice yearly sinus/cold/bronchitis problems. One leads to another, ya know?

I was damned healthy before I decided my weight wasn't healthy and had surgery to "cure" that.

I'm sorry if I've offended anyone, but the arrogance of the innately skinny and healthy just generally pisses me off.

Back into my cave now...

blake said...

Actually, Donna B, I appreciate the little rants because one doesn't hear about the negative effects of the various weight loss surgeries, and this makes them all too appealing to people.

Donna B. said...

Thanks blake.

Though I was over 40 and old enough and smart enough to know better... the desirability of being skinny was just too much to overcome.

At 18, I was maybe 10 lbs overweight. At 38, after three children and the death of their father, I was 100 lbs overweight.

Yet, even at that weight, I was not 'undesirable' as I had frequent dates and at least two offers of marriage which I turned down, before I accepted the third. (Married 19 years now)

What disturbs me the most is the acceptance of weight loss surgery for teenagers. The unimportant things to me that I've suffered would be devastating to teenagers.

Hair loss. Imagine that as a teenager.

Loss of teeth because of daily vomiting... of course one does not have to have surgery to experience anorexia... but why induce it?

Weight loss surgery is touted as a cure for type II diabetes, yet one hears little about how the surgery induces HYPOGLYCEMIA, which is just as dangerous as hyperglycemia.

Social pressure (as well as so-called medico/scientific) to be skinny is not really all that healthy for most.

Of course, if you weigh 600 lbs, something's got to give... but what if you weigh only 300 lbs. At 300 lbs., one may not be attractive, but it's likely that walking is not a problem, fitting into most cars (even a coach class airplane seat) is not a problem... why such a negative social response other than a dislike for fat people?

George said...

my father (a physician) used to say vitamin and mineral supplements
ended up coming out as expensive urine-

two years ago, my family doctor tested me for vitamin D deficiency; I was severely so-

I took megadoses to catch up and now take vitamin D daily-

I hardly ever go out into the sun (not afraid of melanoma; just stay in reading these damn blogs and working on my photography www.gefillmore.smugmug.com (strictly amateur; don't care if I sell or not)) -

anyway, at work, I had been experiencing debilitating fatigue in the afternoons; after I got going on the vitamin D, I hardly ever lack energy for work (sometimes 14-16 hours a day)-

I am no scientist; I do believe vitamin D has worked for me; I would suggest all get checked for the deficiency, especially if you don't get out into the sun on a regular basis-

Michael H said...

I take a glass of red wine, or two fingers of cask-strength Scotch or a good bourbon every evening.

I'm quite healthy, thank you.

Pogo said...

The NYTimes article is answering a very narrow question with a very broad conclusion.

'But are vitamins worth it?', they ask. What does that mean?
'...lower the risk for heart disease and certain cancers' is the main issue they seem to be addressing.

There are other issues. Vitamin E is pretty doubtful.

But there is quite clearly considerable risk associated with Vitamin D deficiency, including osteoporosis, colon cancer, and death: "The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population. (source"

And multivitamins are still advised in the elderly or chronic illness: "However, some older adults, specifically homebound elderly, the frail, or those with chronic disease may be at nutritional risk, and could benefit from some form of supplementation. In fact, deficiencies in vitamins and minerals have been found in almost a third of elderly people. This can result from a failure to eat regular balanced meals; from interactions that occur with multiple medication use; or problems with the body's ability to make or use nutrients. What's more, different medications interfere with nutrient absorption. Those taking corticosteroids, anticonvulsants, thyroid hormone, antibiotics, laxatives or diuretics may benefit from some form of supplementation."
Cleveland Clinic

Crimso said...

"and I never take vitamins."

Maybe not in pill form.

Megadoses of some vitamins are undoubtedly safe and not helpful. For others it may be helpful. For still others large doses may cause problems that are not immediately obvious. There's a reason why until recent years the amount of folic acid in supplements was limited by law (and there's also a good reason why that's no longer the case).

Pogo said...

The most the NYTimes should have said was that there are no clear benefits to the recent vitamin fads such as Vitamin C and E.

Vitamin D is an emerging issue because its deficiency has farther-reaching effects than anyone ever considered, including autism and maybe even the origin of obesity:
"Common obesity and the metabolic syndrome may therefore result from an anomalous adaptive winter response. The stimulus for the winter response is proposed to be a fall in vitamin D. The synthesis of vitamin D is dependent upon the absorption of radiation in the ultraviolet-B range of sunlight. At ground level at mid-latitudes, UV-B radiation falls in the autumn and becomes negligible in winter. It has previously been proposed that vitamin D evolved in primitive organisms as a UV-B sensitive photoreceptor with the function of signaling changes in sunlight intensity. It is here proposed that a fall in vitamin D in the form of circulating calcidiol is the stimulus for the winter response, which consists of an accumulation of fat mass (obesity) and the induction of a winter metabolism (the metabolic syndrome). Vitamin D deficiency can account for the secular trends in the prevalence of obesity and for individual differences in its onset and severity. It may be possible to reverse the increasing prevalence of obesity by improving vitamin D status."

What they wrote is simply untrue for the elderly.
The rest is unclear.
There's a lot of that in medicine.

Pogo said...

And vitamin V is not for daily use.

Darcy said...

Interesting, Pogo. Thanks for that.

bearbee said...

I will continue to take vitamins and minerals.

Unless you grow, pick and eat, fresh fruits and veggies lose most of their nutritional value from harvest to the time that they are consumed.

Why are vitamin fortified foods considered beneficial but taking vitamins with food questionable?

You should care about science.

Science is imperfect.

The USDA keeps changing its food pyramid

Here is the latest of the USDA food pyramids verison 2005.

Prior verison

And prior to that there was a 7 food group pyramid.

al said...

I suppose if I ate a truly balanced diet I would skip my daily vitamins. Since I don't I take some. Our whole house does. We rarely have more than a sniffle in the house.

Most doctors are testing for Vitamin D deficiency as part of regular visits. According to my wife the doctors office where she works at are seeing a lot of very low D levels. And lots of overweight people.

Ann Althouse said...

"I suspect that many taking daily vitamins are taking them because they fear that their diet is not the precisely 'balanced diet' the doctors keep talking about. Thus, a daily dose to make sure you're getting what you should be getting is simple prudence, even if not entirely accurate."

What on earth makes you assume that the balance in the pill is correct? We should eat real food and get nutrition from that. You don't know all the subtle complexities of the things in real food. A few of these things are isolated and extracted and named with a letter -- C, E, B -- and touted as important. What are all those things that don't have letters, that you are getting none of while you get extra of the isolated, extracted thing? And how does that get you to balance? The idea that taking the pill is being safe is not very scientific.

ricpic said...

The only substance there is total agreement about concerning its beneficial effects is, or are, Omega 3 fatty acids.
I hope Pogo will back me up on this.
Anyway, it's what I take, 4 grams daily.

Pogo said...

" We should eat real food and get nutrition from that. "

I agree.
There are people, mainly the sick and elderly who cannot do so. For them a multivitamin makes sense.

The problem with most medical science is that deep research into it cause ennui and therapeutic nihilism ("nothing works and we're all going to die anyway so screw it").

At this point, I see little harm to taking some supplements; for many it's a modern talisman warding away illness. If cost is no issue, I see little point arguing about it with my patients. They won't listen to me anyway.

I just point out the possible risks of doing so, including expense, and let them decide.

Science has a role in the decision, but medicine pretends to know alot more than it actually does, so be very careful in accepting the reported "facts". Most people notice how faddish medicine is, and the "truth" seems to vary every few years.

It's a little silly to treat as sacrosanct that which is unsettled and amorphous. Like economists, get a few doctors in a room and you'll never reach a conclusion.

Tibore said...

Pogo's right. I think we need to concentrate on what the studies are saying, as well as the scope of the article. For starters, they're talking about "megadosing" on vitamin supplements, not ingesting the recommended daily allowance in either food or pill form. Two, they're discussing the effect strictly in the context of megadosing's effect on cancer and heart disease. The three studies mentioned in the article did not establish any prohibitive effect from megadosing. Presuming those studies indicate a trend, then it's safe to conclude that megadosing has no preventative effect on cancer and heart disease.

But, this doesn't mean that supplements shouldn't be taken at all. The knowledge generated by the studies concern themselves with excess vitamin intake, and do so in the context of the studied diseases only. So there's no knowledge to be gleaned from this on whether non-"mega" dosing should not be done in general or not. It only addresses specific cases.

Should normal people take vitamin supplements? I'll let Pogo be the authority in this thread, since he's a physician, but from what I know, normal people i.e. folks eating a balanced diet who have no metabolic disorders have no need to do so. Others? Well, that's what doctors are for: To advise the patient on their individual circumstance. The ultimate point I'm making is that the information generated from those studies is a lot more limited, a lot more case dependent and narrowly focused than any of the conclusions drawn in the article suggest.

Tibore said...

Ah. Pogo's put up some more info since I started composing.

Freeman Hunt said...

I take a quality multi vitamin and 3 grams of Omega 3 everyday. I am forgetful though. I suppose I am not particularly "in tune" with my own vague bodily sensations, so I couldn't tell you about feeling differently aside from more energy with the multi vitamin (probably due to the B vitamins in there), but I can definitely tell a difference in my skin. Remembering the multi = clearer skin. At the very least, vanity is motivating.

As others have already mentioned, the benefits of Omega 3 fatty acids seem to be fairly well-established.

People have mentioned the obvious flaws in the article, but there are also obvious flaws in the big study. What multis did the people take? Vitamins are not all the same. There's a world of difference in bioavailability between different forms of certain vitamins. Were many of the people who didn't take vitamins not taking them because they felt they ate balanced diets while those who did take vitamins felt their own diets were wanting? Correlation is not causation. For any definitive conclusions you'd have to do a real study to narrow down the variables and eliminate, as far as possible, any cohort effects.

Darcy said...

Oh, good point, Freeman. I also believe I have healthier, shinier hair from taking vitamins. Noticeably. Unless that's something I'm imagining. Ha ha.
I think I'll stick with the very minimal vitamins I take. ;-)

Pogo said...

Tibore, don't let the MD hold sway here; that's sort of my point. The data are available for all to review. I serve as a sifter of data for those wanting it.

Some cardiologists I work with exhort their patients to take six grams of fish oil every day. But if you do, you may lose your friends because of horrific flatulence, diarrhea, or fecal incontinence of oil. Yummo.

Shanna said...

Actually, Donna B, I appreciate the little rants because one doesn't hear about the negative effects of the various weight loss surgeries, and this makes them all too appealing to people.

I definitely agree with this. I did know that a lot of people gain the weight back. I had a sort of coworker who had the surgery and lost some weight, but he was still very heavy and then he died of a brain tumor. (not saying that’s because of vitamins or anything).

My mom gave me some fish oil, and I have been kind of taking it some days. Mostly, I have never stuck to a vitamin regime, but I do eat a banana if I feel like I need potassium, buy orange juice if I need Vitamin C, etc…

Triangle Man said...

The article also does not seem to mention the studies that show increases in risk for cancer among cigarette smokers who take supplements. Smokers who want to do something healthy for themselves would be better off forgetting about the vitamins and quitting smoking.

Smilin' Jack said...

What on earth makes you assume that the balance in the pill is correct? We should eat real food and get nutrition from that...The idea that taking the pill is being safe is not very scientific.

What on earth makes you assume that the balance in real food is correct? The plants and animals you eat don't like to be eaten--they have no interest in prolonging your life. Quite a few contain various poisons for that very reason, and they're certainly not going to optimize their nutritive content for your benefit. The idea that eating real food is being safe is not very scientific.

Crimso said...

I vaguely recall a study being done years ago to test whether large doses of antioxidants (I think it was E) would protect smokers from lung cancer. They stopped the trial early because the smokers getting the E were getting lung cancer at a higher rate than the control group. Sometimes more is not better.

Original Mike said...

My understanding is that it's hard to impossible to get enough vitamin D from food. It's sunlight that is "suppose" to provide vitamin D, but for northerners in the winter, it's hard to impossible to get enough of that. And if you slather on the sun screen, you don't get it in the summer, either.

But my main concern is expecting good science information from the New York Times for science. I'm sorry, but journalists are simply not qualified for this. If they studied and tried very hard, they could do it, but they don't.

Pseudolus said...

I have a condition that may, according to the doc, benefit from having at least the "100% RDA" of a couple vitamins/minerals. So I take a cheap multivitamin every day to help make sure I don't fall below those levels. Costs me something under a dime each. If this is a foolish act it's surely not the most foolish one I'll do all day.

Christy said...

Donna B, your news is distressing. My sister is having the surgery next month and I've not known how to respond. I want to be supportive but I so very much believe this isn't the answer. She personally knows 3 people who've had success with it. But I know that one never messes with a woman and her weight loss program, whatever that may be.

Being a girl engineer and always dieting, I naturally have a program that counts the calories, vitamins, calcium, etc. in the food I eat. It really doesn't take all that much food to get what we need. Of course, I've all my life eaten a vitamin C fruit daily, drank milk, eaten broccolli and cabbage, eaten tuna or salmon 2 or 3 times a week, tried to eat a tomato a day, and an apple a day. My trainer started me on a daily cup of green tea a couple of years ago. Now if I could just stop eating all those steaks and ice cream...

Original Mike said...

Christy - I'm shopping for a food scale for this purpose. Do you have any experience with any? Can you give me any shopping advice for a scale?

Christy said...

Original Mike, get one with a large enough base or cup to hold a serving of dried pasta, a chop, a chicken breast, soup, or anything else you might want to weigh. Don't buy one so large it cannot be left out or that cannot be easily gotten in and out of the cabinet. Whatever you find most convenient iow. I have an old low tech smallish one with which I do well enough. While I'd love a digital scale, I suspect attention to fractions of an ounce would drive me nuts. On the other hand, it's too easy to shift the line of site on an analog scale to decide that 5 oz burger is really 4 oz.

Original Mike said...

On the other hand, it's too easy to shift the line of site on an analog scale to decide that 5 oz burger is really 4 oz.


Thanks for the advice. I haven't bought the scale yet, but I did pick up a set of calibration weights from a surplus supply place (We scientists must calibrate our scales. It's part of the fun, after all.)

Freeman Hunt said...

Original Mike, don't just look at food scales; look at small scales intended for mail. The trays are bigger, and you can get some where the base stores in the tray and fits in a drawer easily with room to spare.

Original Mike said...

But small trays = less calories, right?

Thanks for the advice, Freeman.

Freeman Hunt said...

But small trays = less calories, right?

Heh. Small tray = "Argh! Pasta/salad/multiple servings of regular food/ingredients for a multi serving dish won't fit on here!"

Original Mike said...

No worries. As long as they fit in/on a bowl/plate that fits on the scale.

blake said...

Unless that's something I'm imagining.

Not from the pix, Darcy! Nice hair!

We should eat real food and get nutrition from that.

The stuff I'm reading recommends 9-13 servings of fruits and vegetables a day. 'specially the leafy-greens. How many people do that?

Joe said...

Sorry ricpic, but specific studies of Omega 3 haven't supported it's claims of benefits.

This is the problem--researchers see correlations in poorly controlled longitudinal studies, yet in controlled studies almost all the claims collapse.

In the end, simply eating a moderate diet from a variety of sources, coupled with specific regimens based on proper testing, seems to offer the best health benefit.

Joseph Hovsep said...

What on earth makes you assume that the balance in real food is correct?


Original Mike said...

I would posit that evolution assures that the food available on the African savannah over the last several thousand years is "balanced". That's not exactly easy to match from the offerings in your local supermarket.

Original Mike said...

That should have been "last several hundred thousand years".

blake said...

Actually, I'm not sure what it is about evolution that would suggest the food was "balanced". It would only need to be "adequate" for a fairly narrow definition of "adequate".

Or (more precisely) we would have adapted to be able to live off of it to an adequate degree to survive long enough to reproduce, and presumably raise offspring to self-sufficiency. (In other words, the parameters of "adequate" for evolutionary purposes could include precocious puberty, lengthened fertility or shortened development time.)

Never assume nature's goals are in line with your own.

jaed said...

9-13 servings of fruits and vegetables a day

Have you seen what the USDA's idea of "a serving" is? For most vegetables it's half a cup. Go out to the kitchen and look at how much half a cup is. For lettuce and raw greens, if I remember correctly, a cup. Eat a veggie omelet, a chicken caesar salad, and a reasonable serving of veggies at dinner, and you're already most or all of the way there.

Fish oil makes a visible difference to my skin, so I take that. A good multi is cheap (about twelve bucks a year) and is unlikely to harm me, so what the hell. I take calcium because my mother's doctor was adamant with her about my taking it, when she was diagnosed with osteoporosis (which my maternal grandmother also had) - this was ten years ago and the popular media has since had stories claiming calcium supplementation doesn't help, but again it's cheap and isn't going to hurt me.