“Do you take vitamins?”
“No,” I answer my patients.
“Why not? Aren’t they good for you?”
The nuanced answer to that remains no. A truthful answer might be “when it’s been shown you need them.”
Most Americans are not vitamin deficient. There is evidence that vitamins can be harmful, not helpful. And what generally gets forgotten is that the “advantage” of vitamins comes from studies of food, not supplements.
What we need to eat is what we’re evolutionary built to eat – food. Some of the facts and why Americans ignore them is what we’re deal with here.
The Journal of the American College of Cardiology is not where most Americans go to get their dietary advice. Recently, however, an important article chronicled 179 recent controlled clinical trials on vitamins and minerals.
All clinical trials have their troubles, but putting lots of them together may get us a more accurate view of what happens to human beings and their health. This study of studies looked at four of the most commonly used supplements, vitamin D, calcium, vitamin C, and multivitamins and asked the question do they improve health?
For overall mortality, no.
Myocardial infarction (heart attack) – no.
Stroke – the one exception – folic acid seems to cut back on the risk of stroke.
That was it. One supplement and one outcome. Other studies, like the Iowa Women’s Health Study, showed increased mortality for women 62-80 taking multivitamins. The increased death rates were small, but significant.
And what of that “super heart healthy supplement,” omega 3 fatty acids? We can take the advice of a part of the NIH, the National Center for Complementary and Integrative Health: “Research indicates that omega-3 supplements don’t reduce the risk of heath disease.” And continues, “However, people who eat seafood one to four times a week are less likely to die of heart disease.”
Okay, omega-3s don’t work to prevent heart disease, presumed “great effect.” Yet a recent review of the industry states that over 2 billion dollars was spent on omega 3s in the U.S. and that an increase of 6.6% a year in sales was expected each year for the next five years.
The total national market of vitamins and nutritional supplements is now reported to be about $36 billion.
What is that all that money doing for people?
The Magic of Drugs
Ask folks what they expect from doctors and you may hear desires for greater empathy, time, consideration of their many social and economic problems, and escalating costs. But often beyond these concerns that somewhere, somehow, there’s a drug out there that will make things better.
Drugs are what the public expects as the main treatment dispensed by physicians. Guidelines regarding medical care increasingly strait jacket physicians into pushing more heavily pharmaceutical therapies, even, as in the case of psychiatry, where combined treatments of talk and lifestyle are shown to be superior.
Pharmaceutical sales, including the now extraordinary profits of the middlemen Pharmacy Benefit Companies, are in excess of $450 billion a year.
With the advent of Information Technology and the rise of the physician and nurse as data base servants, dedicated to documentation before treatment, the importance of pharmaceuticals grows. Drugs are quick. They’re supposedly what people want. They fit guidelines. They get the government and insurance industries off your back. You’re “doing something.”
What are some of the results of these policies?
1. The denial of the doctor patient relationship’s importance in the placebo effect. If your doctor is typing all the time it’s harder to feel she understands you, is concerned about your life, and will provide advice that will help you. As placebo effects are often 30-40%, and in many medications represent the majority of overall “effectiveness” since overall utility of many treatments is only slightly better than placebo, this is a jarring and tragic waste for which no clinical trials are being done.
2. The placebo effect becomes transferred from human to pharmaceutical effects. Humans are not powerful, not their social relations or concerns, nor public health measures. What matters are the drugs. For many patients and providers, this is where the placebo effect now lies.
We can witness an overreliance on drugs as a stand in for formerly standard medical therapy in the present, extraordinarily messed up opioid epidemic.
3. Many drugs now take on the collective burden of “improving” health. Why spend time walking, or lots of money going to doctors who don’t look at you, when an over-the-counter item, like vitamins, is just an internet click away, and can be sent immediately by Amazon to your home.
4. Over-the-counter medications, unlike many FDA studied drugs, are generally considered “safe.” Vitamins, which were medical drugs a century ago, are considered to be particularly safe. The public is greatly unaware of how some vitamins, especially fat soluble ones, can accumulate in the body and eventually cause disease.
5.By pushing drugs through public advertising unlike much of the developed world, the American pharmaceutical and supplement industries have become so large and politically powerful they are virtually untouchable.
6. Drugs are easy, quick, and now carry the “miraculous” status of the placebo effect. The end result is to denigrate the importance of lifestyle.
Medical care, in all its present manifestations, might increase lifespan by 2-3 years. Compare that with the recent Healthy Habit study showing expected increases in lifespan of males of 12 years and females of 14 years.
Just because something is easy and heavily marketed doesn’t mean it’s good for you.
Virtually all of the advantages the public accords to vitamins occur through the use of food, not vitamins. Omega 3s do not change heart health, but the fish they come from do. Multiple healthy diets improve overall survival, while few supplements do the same. Those few that do aid health can easily and effectively be given through your diet.
However, cultural, political, and technological changes have pushed drugs like vitamins as the “way to health” instead of healthy eating. The lesson is simple: eat foods, diverse natural foods, before you think of going to the supplement counter.