Don’t Take Your Vitamins!

by Dr. Jonny Bowden · 35 comments

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Daniel Patrick Moynihan once said, “Everyone is entitled to their own opinion, but not to their own facts”.

But he didn’t live in the modern age of internet 3.0.

Thanks to Google founders Larry Page and Sergey Brin, we now have so many facts available to us that anyone with an agenda can carefully select a few facts that support his case, ignore those that don’t, and write an opinion piece masquerading as scientifically accurate and unbiased reporting.

To wit: the recent NY Times article Don’t Take Your Vitamins.

The author—Dr. Paul Offit– is the latest in a long line of vitamin naysayers going back at least to Dr. Victor Herbert and including the “non-practicing” psychiatrist Stephen Barrett, whose site Quackwatch is widely believed (including by me) to be wholly supported by front groups funded by Big Pharma.

But you don’t have to attribute any ill will or malicious motives to Dr. Offit—I certainly don’t–  to understand why he believes as he does. You simply have to understand that he’s been taught the Gospel according to Pharmaceutical medicine, and he buys it—hook, line, and sinker. And there are enough facts lying around—i.e. someone dies of iron poisoning, massive doses of selenium can kill you—for him to bolster a case for a position he already believes in and on which, for him, they jury is no longer out.

So let’s look at the facts Dr. Offit reports.

He mentions a twenty year old study on beta carotene given to smokers. Yes, that study did show a slightly increased risk of cancer in these folks, but the lesson taken from that is that people with highly diseased lungs should not take high doses of this particular antioxidant, especially not in the synthetic form used in the study.

To conclude from this that people should not take antioxidants is akin to saying that because a step aerobics class is a really bad idea for people with broken legs, people shouldn’t exercise.

The other studies Dr. Offit quotes are all epidemiological.

Epidemiological Studies vs. Randomized Controlled Clinical Trials

Epidemiology is the stepchild of serious scientific research. As I discussed in an article on the Huffington Post,  an epidemiological study bears exactly zero resemblance to a randomized controlled clinical trial. In a controlled clinical study, you do an experiment with matched groups of subjects in which one group gets the “treatment” and one gets a placebo.

Epidemiological studies, on the other hand, simply look at massive amounts of data from massive amounts of people and see what goes with what. People who take vitamins might also be people who exercise a lot, or who eat lots of vegetables, or, conversely, are very sick and believe they could get better by taking vitamins. One study from—of all places—the Journal of the American Dietetic Association, found that adults who use vitamins differ substantially in many ways from non-users, including in nutrient intake adequacy and dietary attitudes.

Epidemiology never—repeat, never—shows cause and effect, it shows associations, correlations.

We do not know why those associations are there, and in fact epidemiology is meant to generate hypotheses that can then be tested. (The hypothesis that vitamin E increases the risk of death doesn’t pass the smell test as a hypothesis, but no matter—it’s never been tested experimentally.)

Epidemiological studies were not meant to be the basis of public health policy or recommendations. After all, there’s a strong statistical association between television set ownership and diabetes prevalence. Should we assume televisions cause diabetes?

“Big T” Truth vs. “Little t” Truth

Dr. Ottis’ article illustrates the difference between what the great Gestalt philosopher Max Wertheimer called “big T” truth and “little t” truth.

Little t truths are verifiable facts which could not in any sense be said to be untrue”, but they miss the big picture. Big T truth is the “real” truth in that it contains context—it’s a fuller presentation of what’s really going on.  It’s true that during the 2004 campaign, Barrack Obama said the words, “….if we keep talking about the economy, we’re going to lose”. It’s also true that the full statement was this: “John McCain said, ‘If we keep talking about the economy, we’re going to lose”.

Dr. Ottis presents little t truths—the beta carotene experiment, for example—but none of the context.

Dr. Ottis believes that we should get all our vitamins from foods, ignoring the copious evidence that supplementation can make a big difference to a lot of people. Three examples follow.

  1. A well-controlled, large study conducted between 1983 and 1993 found that selenium supplementation (200 mcg a day) significantly diminished total cancer mortality by 52% compared to controls.
  2. The ARED and ARED-2 studies  both found that an antioxidant formula containing such antioxidants as zinc, vitamin E, vitamin C played a major role in helping people at high risk for developing age-related macular degeneration keep their remaining vision.
  3. And, since Dr. Ottis apparently considers epidemiological evidence good science, how about the epidemiological evidence that multivitamin use is associated with longer telomere length among women?  (Telomere length has long been considered a marker of biological aging.)

Dangerous and Irresponsible

The title of Dr. Ottiss’ article—“Don’t Take Your Vitamins”– is unfortunate, as it leaves confused readers with the idea that vitamins and supplements are dangerous substances that we take only because we are naive about their effects.

Millions of people will read it and decide that their omega-3’s, for example, are doing them no good and may even be harming them, despite literally thousands of studies showing the exact opposite.

In fact, just recently the Bellagio Report—which I wrote about in my blog clearly concluded that too much consumption of omega-6 and not enough consumption of omega-3 was one of the two major health issues of our time. Yet according to Dr. Ottis we shouldn’t take our “vitamins” and that would, for most people certainly include omega-3’s.

It would also include multiple vitamins, which for many people is the primary way they get the 400-800 mcg of folic acid they need to protect against neural tube birth defects. And with survey after survey showing widespread vitamin D deficiency, and with vitamin D fortified foods one of the poorest ways to get vitamin D, the message that we should not “take our vitamins” is irresponsible to say the least.

Selective Reporting at Its Worst

I mentioned earlier that Dr. Ottis was selective in his reporting of the facts, leaving the reader with the impression that vitamins were dangerous and the studies he quoted were just mere examples of the widespread dangers he warns us against. Let’s look at a few other facts he neglected to mention:

There was not even one death caused by a dietary supplement in 2008, according to the most recent information collected by the U.S. National Poison Data System.

The new 174-page annual report of the American Association of Poison Control Centers, published in the journal Clinical Toxicology shows…

  • zero deaths from multiple vitamins
  • zero deaths from any of the B vitamins
  • zero deaths from vitamins A, C, D, or E
  • zero deaths from any other vitamin

Contrast that with…

If I were to write an article quoting those studies, and a few other cases of people being clearly harmed by a prescription drug, with the title, “Don’t Take Your Prescription Drugs!”, would the NY Times publish it?

I doubt it.

It would be terrible science.

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{ 35 comments… read them below or add one }

George

In the book “The Complete Guide To Herbal Medicines” by Charles W. Fetrow, Pharm.D. and Juan R. Avila, Pharm.D., it is alleged “Co-Q!0 can damage heart tissue during intense exercise.”

Your response?

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Dr. Jonny Bowden

Did they give a research citation for this statement? Let me guess. No.

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Nick Ritchie

I take my vitamins daily, and the question is, which ones do you think are the best ones to take? It’s true, there are so many deaths yearly from prescription drugs, yet somehow, vitamins have to be locked down… I smell a rat in the ‘system’ – but we already know there’s powers at be that are tampering with people’s health… Nice post, thanks! :)

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Mark

LOVE your work! Thanks Jonny!!

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Suzanne

Jonny,

I think you should but put it in a book form and publish it like my nutritionist friend, Tom Petrie did. This was based on the ridiculous article that Reader’s Digest did a couple of years ago.

http://www.amazon.com/Anti-Vitamin-Baloney-Tom-Petrie/dp/1605946621/ref=sr_1_3?ie=UTF8&qid=1371550973&sr=8-3&keywords=tom+petrie

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Brenda

Well done, again. Thanks for saying it all so well.

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Brian

Great post! I love this line: To conclude from this that people should not take antioxidants is akin to saying that because a step aerobics class is a really bad idea for people with broken legs, people shouldn’t exercise.

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K.Gopal Rao

Dear Jonny,
I was waiting for this after seeing the NYT article. What I dont follow is, firstly, how NYT editors can publish such a piece with the title it has. Does NYT not hv seriously savvy editors who can at least point out that there is a counter-view, and preferably not give credence to such BS? Secondly, why dont you submit this to NYT and demand that they publish it as a rebuttal?
K.G. Rao

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LB

Excellent, enjoyed reading and totally agree with your article

Thank you

Lisya

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Perry

Will they ever stop???

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Marvin Lewis

Well put, but more globally, “Lies, Damn lies, and statistics.” UK Prime Minister Disraeli.

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Eno Nsima-Obot MD

Thank you for such a well researched and well written article. As a physician who so believes in Ultra- Prevention I find myself uncertain of when to and when not to recommend supplementation to a population of patients who have come to depend on pharmaceutical drugs. You’re article has strengthened my resolve to continue to preach the benefits of supplementation and I will be referring to the studies you have highlighted that show this to be the case. Great work and thanks again!!

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Dawn

With the real food and holistic health movements heating up over the past few years, the food, health, and pharmaceutical industries are fighting to protect their profits. It seems we’re at the 3rd stage of Ghandi’s quote:

“First they ignore you, then they laugh at you, then they fight you, then you win.” ~Mahatma Gandhi

More and more consumers, organic farmers, and manufacturers are going to great lengths to protect our people and our planet, rather than making money at the expense of both. They’re making ripples, and even waves of progress in recent years, despite the fact that many large, well known food, health, and pharmaceutical companies have been using their tremendous resources to distort the facts and maintain the status quo. A perfect example is the tug of war over GMOs.

The irony is that the food industry has capitalized on the whole vitamin trend. They advertise added vitamins, minerals, and fiber in order to sell their products. What they don’t state is that what they’re really doing is trying to replace all that’s been lost during processing. Unfortunately, nature can’t be picked apart and put back together like that. That which you take away can never truly be replaced.

With all that stated, I do believe that it is very possible to get too much of a good thing, and such is the case with vitamins as well. If you’re not careful, you can get too much. Some people think they can eat junk of they take fish oil or other supplements. It’s just not true.

The first step toward health is to eat real, pure food that our bodies actually recognize, the kind that’s been grown in healthy, organic soil that’s packed with the minerals and beneficial bacteria that support a healthy digestive system. These days, you can’t find much of it at your local supermarket. Thanks to a few hard working and determined people out there, that’s changing, one step at a time.

Thanks for sharing! Have a happy, healthy day.

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Dolly

Thank You

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Dianne Boulton

My university studies included a subject called science and the media. It only increased my scepticims of much of the reporting on health issues. The sheer volume of information, mainly press releases from academics and university PR departments, is enough to make the proper researching of facts difficult for them. The fact that much (not all) research is conducted with commercial ends in mind means their is pressure to get results that will give some commercial gain so as to keep funding for the university.

There is also the problem of “Theory Ladden Observation”. We learned that no one is able to make observations or measurements that aren’t influenced in some way by the researchers beliefs. We all look through glasses made of our own ideas and beliefs. Therefore it is very hard for anybody to be totally unbiased when it comes to a scientific “fact”.

For us lay people it is even harder to come to conclusions when a google search on most health topics will often bring up conflicting views or mainly the main stream (medical establishment) view at the top of any search list. Unfortunately my Science Technology and Society studies has made me cynical of a lot of claims and tends to make life less simple.

I like your site as I do see science as important and appreciate the rigour of your research and your ability to do some of the hard work for me.

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Tracy Kolenchuk

The truth about vitamins and research is so silly it’s sad. Let’s suppose, for example that multivitamins have an effect on your healthiness. There are, for example, according to NutriSearch Comparative Guide to Nutritional Supplements – over 1500 different multivitamin products on the market.

How many of those products have been tested for their effects on healthiness? Not one. Researchers have analyzed product composition, product mix and synergies, and product risks. They have created ODI (Optimal Daily Intakes) which are not recognized by government, to evaluate and compare products, production techniques and quality, because the RDA and DRI theories of vitamin nutrition are based on illness, not on healthiness.

But no one has studied their health effects in a scientific study. It’s a bit sad when you think about it. Millions of people take multivitamins every day – but there are no studies of the relationship between specific products and healthiness.

Many of these products are extremely high quality. Many are cheap and low quality. But even the best products, having been on the market for decades in some cases, have not been tested for healthiness.

We can understand why easily – there are no tests for healthiness. We have well defined clinical study methodologies for measuring illness and testing the effects of drugs on illness – but there is nothing, not a single theory, on how we might effectively measure healthiness. We don’t have any idea how we might measure healthiness (as opposed to illness) for such a clinical study.

So there are no clinical studies. We have no idea if some vitamins improve healthiness a bit, or a lot, or if some harm healthiness a bit, or a lot – because we don’t measure. If someone did design a clinical study to measure healthiness – and then tested several of the top products for their effect on healthiness, who would publish it? There are hundreds of ‘medical journals’, but no ‘healthiness journals’.

But that’s not all. None of the top multivitamin products have been tested against illness either. That is a shame as well.

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Chantelle

this is awesome… thanks so much for taking the time to write such a great rebuttal. Shame on the NY Times for posting such a sensational title knowing the state of health in this country!! Especially an article by someone who appears to have such disdain for the Alternative or Holistic Health movement.

Chantelle

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Gregory Anne Cox

Once again great reporting to give us the “T” truth about this article and taking supplements. And it’s hysterical to imagine an article in the NY Times with the title “Don’t Take Your Prescription Medications” but hey, the time will come I hope.

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J. Mammano

awesome response and soo needed–your explanation of epidemiology is so necessary for the lay person to understand what is going on—just outstanding!

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Etienne Juneau, PhD(c)

Jonny,

What a masterpiece!

My PhD is in Public Health, with a focus on epidemiology of physical activity. Your comments about RCTs vs. observational studies were dead on.

I also liked your comment about Quackwatch. I never understood why he trashed Linus Pauling so hard. Now I know.

Thanks for this great post, and keep up the good work.

Etienne

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Patrick

The more people that take their vitamins (supplements); maybe less doctor visits. No wonder the FDA approves over 20,000 prescription drugs and not one nutritional supplement…

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Laura Garth

I just learned recently that although you can use Food Stamps to buy soda pop, ice cream, and candy, you can’t use them to purchase vitamins and supplements. How does someone work one’s way out of dependence on aid while not feeling healthy?

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Lori

I just recently found out that I have early stage endometrial cancer. A few days ago I met with the gynecologic oncologist that will hopefully be performing my hysterectomy. I have the utmost respect for him as a surgeon, but was dismayed to discover that he is adamantly anti-supplement – when he saw the list of what I was taking, he told me to quit taking everything – they could be causing my cancer to get worse! I’m not taking weird stuff – multivitamin, extra vitamin D, extra vitamin C. fish oil, COQ-10, alpha lipoic acid and chromium (for prediabetes), etc. I really don’t want to stop everything – what do I do? Find another doctor? Lie to him? Maybe I should print out your article and give it to him.

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Dr. Jonny Bowden

Print out the article and give it to him.

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Eric

There is an interesting article (at http://www.supplements-and-health.com/vitamin-benefits.html ) convincingly deflating Offit’s anti-supplement claims including his Pauling-bashing “evidence”, and describes the big picture of the situation.

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Rob

Is “Dr. Ottis” a different doctor that you’re talking about or is that a typo?

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Dr. Jonny Bowden

typo.. so sorry!

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Sarah

Truly very informative and really helpful blog post. Really looking forward to read more. Thanks for sharing with us.

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David Ardinger

Love your work and info but you name the author differently through this piece. Is it Dr Offit or Dr Ottis?

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Dr. Jonny Bowden

Dr. Offit. Sorry about the typo!

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David Ardinger

I’ve heard the “vitamin supplements are worthless ” meme before. As you pointed out in your Cholesterol video, Scurvy was once a deadly mystery disease. We now know it is simple vitamin c supplementation that totally eradicates this once deadly plague. Likewise with Rickets, Beri Beri and other diseases, all eradicated with simple vitamin supplements. I have studied nutrition since the mid 80s, and have always wondered how many of the incurable diseases we face today are simple deficiencies of micro nutrients? I’m glad you and others are finally lending real medical credibility to what I have always known through my research.

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Dr. Jonny Bowden

Thanks for your nice post, David.

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Robin Baker, D.C., D.I.C.C.P.

Thank you so much for your well written critique on the recent “article” discouraging the general public from taking multivitamins. As a provider it is frustrating to see misleading information put out in the media. This article has been pretty much disassembled and discredited by knowledgeable health professionals such as yourself. Dr. Offit is a well known schill for the pharmaceutical industry. Healthcare providers know this, unfortunately the lay public may not know this yet. As many have pointed out, the quality of the product is key and I like to tell my patients it is inexpensive “insurance” and very safe. I know many people who have rid themselves of serious and life threatening conditions through nutritional supplementation and dietary changes. I look forward to future posts from you!

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Ed Alderman

Dear Dr. Bowden,

I enjoyed this article and agreed with most of it. I believe it is important to take supplements, but I also think that the best vitamins and the easiest for us to assimilate are found in the foods we eat. The older one gets the harder it is for certain foods or vitamins to get digested well. Death comes to everyone eventually, the “fountain of youth” has been pursued by all cultures and generations, and yet the Lord I believe desires that we take care of our bodies, minds, and souls properly. With that being said, I take issue with the ADEDS study that you sited. This study was funded by the US government and Bausch and Lomb, therefore they had to come up with something positive. I have some problems not much with the way that it was conducted, but with the conclusions.
1. Zinc was reduced from 80 mg to 25 mg from ARED to ARED 2. This was probably still too much zinc to be giving some people, but they did not say why.
2. Giving this formula to people prior them developing AMD(age related macular degeneration) did not prevent drusen formation or other signs of AMD.
3. Everyone in this study lost their vision to AMD.
4. Over 70 % of the people who participated using the ARED formula lost their vision at the same rate as those using the plecebo.
5. The ARED formula sold by Bausch and Lomb and by other pharmaceutical companies is very expensive, but people will do it if they are told that it will “save” their vision.

In general, there are some good things that came from this study. One being the use of the carotids(lutein, zeozananithein, beta catotenes). As an eye care practioner for many years I found AMD one of the most difficult conditions to deal with. I also found it very difficult to recommend the ARED formula to elderly people because of the high amount of zinc, the cost, and the shear fact that it provided little benefit to the actual condition that it was intended for. There were other vitamins and supplements that were cheaper and more beneficial. The bottomline was to treat people like you would want to be treated. Each of us are unique and made in His image. God bless.

Ed Alderman

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Dr. Jonny Bowden

Thanks for your thoughts, Ed.

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