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One more reason to think twice before taking supplements
Posted: 10 October 2011 03:35 PM   [ Ignore ]
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Most studies have shown little or no benefit to daily vitamin use for most people unless there is a documented vitamin deficiency but here’s a study that should raise an eyebrow for anyone who says “whats the harm”. Granted its only one study but it still has to give one pause.

Here’s a link to the abstract

Of course this is a retrospective study and there could be lots of confounding variables. For example women who took iron supplements had the greatest increase in mortality but the possibility exists that these women may have been taking iron because of an undiagnosed condition that was causing anemia like uterine or colon cancer. In this case the iron supplements would simply be a marker for a condition that increased the risk of death and not actually the cause of the increased mortality.

Its an interesting study. It proves nothing but gives a lot to think about

Edited to change from moderator blue..

[ Edited: 12 October 2011 03:54 PM by Occam. ]
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Posted: 10 October 2011 04:04 PM   [ Ignore ]   [ # 1 ]
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Wow, it’s lucky that I’m an Older Male.  However, since I’m of Northern European ancestry, have low pigmentation, and have had a number of skin cancers removed, I slather myself with SPF 50 when I go out (I know.  Anything above 30 is supposed to be a waste, but the material wears off over a short time so I like the idea of staying in the 30+ range for much longer).  Since I’m not getting much in the way of UV conversion to vitamin D, I’ll continue taking supplements.

Occam

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Posted: 10 October 2011 05:30 PM   [ Ignore ]   [ # 2 ]
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Oh goodness, more vitamin confusion!  smile

Well I’m going to keep taking my iron pill on my doctor’s advice, as it’s constantly very low, especially because the Red Cross drains me so often (I’m type “O” universal donor, so the Red Cross stalks me.) Reading the excerpt about iron supplements is particularly disturbing, however, I am not concerned that my anemia is caused by a grave medical condition. I’m fairly sure it’s due to the Red Cross vampires combined with being a woman, which of course women lose more iron due to periods. (When I stop donating blood the iron levels go up, but so does my guilt for not donating.)

And I take a vitamin D in winter, again on my doctor’s advice. It appears very low on the bloodwork and I get very little sun. Then again my doctor probably wouldn’t recommend a supplement if these readings were near normal. The readings on the bloodwork were more like, “Whoa…”

She’s a science-based gal and I’m going to trust her to keep up with current research. If her recommendations change I am sure she will alert me to stop taking the iron and vitamin D at my next physical, when we discuss diet and medications. She takes the worries out of these things for me.


What about - on a separate thought regarding the iron - isn’t having too much iron just plain dangerous? There is a genetic condition that causes too much iron absorption/storage. However men are more prone to die from it because they do not lose iron through periods like woman. I forget the name, which is terrible. A co-worker’s husband just died from it at a very young age. He had a stroke and a coma due to it a couple of years ago, and was rehabilitating for a couple years. They were looking forward to rebuilding their life and then he suddenly passed. Very sad. But the “iron risks” mentioned reminded me of that condition. I wonder if taking iron supplements by persons who are NOT anemic could contribute to effects like this but on a smaller scale in people who are not genetically predisposed?

Also, iron is dangerous in higher doses which is one of the reasons kids must be kept away from chewy vitamins? I recall eating a handful of Flintstones vitamins as a child when no one was looking (they were SO TASTY.) Then I saw the warning on the back of the bottle and was certain I was going to die, but more afraid of my mother than death, so I never told anyone - ha. I guess I was lucky I did not get sick? Who knows. Maybe it impaired my development for life and I never knew my full potential.  wink

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Posted: 10 October 2011 06:19 PM   [ Ignore ]   [ # 3 ]
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You’re right. I wouldn’t stop taking iron if there is a good reason to be on it and for the reasons mentioned above no one should alter their routine based on this study.

Vitamin D is an entirely different issue and a big pet peeve of mine these days. Lots of TV docs and real life docs are advising people to have their Vit D levels checked and if they are low they are then supplementing them. The problem is that there is zero scientific evidence to support this approach. The whole vitamin D fad started about a year or so ago. Several studies showed a possible link between Vit D intake and reduced levels of cardiovascular disease and cancers, but heres the problem. NONE of the studies measured vitamin D levels and then looked at the effect of supplementing those patients until their vitamin D was in the “normal” range. Despite this many in the media and many physicians jumped to the conclusion that patients should be doing this. As the study above points out you have to be very careful about jumping to conclusions. There are just so many things wrong with this approach. No one has proven causation between Vit D and these diseases. There is only a suggested association. Recalling ones intake and measuring ones level are very different things. In addition, no one really knows what the optimal levels should be even if you assumed causation. And here’s a real shocker. I’ve been measuring Vit D levels on patients from time to time when they absolutely insist and can’t be dissuaded ( many were brainwashed by Oz). I’ve probably measured them in about 20 patients over the past year. Guess how many were normal…One. One person out of 20 had a “normal” Vitamin D level. This is not only my experience. Talking to a few other physicians I have found that they have noticed the same thing. So either we have an epidemic of vitamin deficiency in an otherwise healthy population who are feeling fine or there is something wrong with the test or its definition of normal. This is a concern because Vitamin D is a fat soluble vitamin and as such it can not be readily excreted if a patient gets too much. So the large doses I see physicians recommending to patients over long periods may lead to liver toxicity in some of these patients.

The only responsible current recommendation with regards to Vitamin D is to advise patient to get 800-1000iu daily ( and no more than 2,000iu at most). This is the same amount you would get if you took 2 tablet of most popular calcium supplements every day. Measuring and supplementing to get the patent into the “normal range” has no role at this time and may be harmful.

Take a look at this web site for a fair and balanced summary of the subject:
http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D

[ Edited: 10 October 2011 06:26 PM by macgyver ]
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Posted: 10 October 2011 06:20 PM   [ Ignore ]   [ # 4 ]
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Occam. - 10 October 2011 04:04 PM

Wow, it’s lucky that I’m an Older Male.  However, since I’m of Northern European ancestry, have low pigmentation, and have had a number of skin cancers removed, I slather myself with SPF 50 when I go out (I know.  Anything above 30 is supposed to be a waste, but the material wears off over a short time so I like the idea of staying in the 30+ range for much longer).  Since I’m not getting much in the way of UV conversion to vitamin D, I’ll continue taking supplements.

As we’ve discussed in another thread, I think for many people Vit. D is the one supplement most likely to be useful. But in any case best to check with your doctor for a blood analysis.

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Posted: 10 October 2011 06:23 PM   [ Ignore ]   [ # 5 ]
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macgyver - 10 October 2011 06:19 PM

The only responsible current recommendation with regards to Vitamin D is to advise patient to get 800-1000iu daily ( and no more than 2,000iu at most). This is the same amount you would get if you took 2 tablet of most popular calcium supplements every day. Measuring and supplementing to get the patent into the “normal range” has no role at this time and may be harmful.

Dunno about the last sentence but I agree with the rest of it. 800-2000 iu/day is what most competent health sites I’ve seen suggest. FWIW I take a little under 2000/day (most days 2000, some days less) and have had my blood checked and am spot on the range suggested in the recent large study.

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Posted: 10 October 2011 06:28 PM   [ Ignore ]   [ # 6 ]
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dougsmith - 10 October 2011 06:23 PM
macgyver - 10 October 2011 06:19 PM

The only responsible current recommendation with regards to Vitamin D is to advise patient to get 800-1000iu daily ( and no more than 2,000iu at most). This is the same amount you would get if you took 2 tablet of most popular calcium supplements every day. Measuring and supplementing to get the patent into the “normal range” has no role at this time and may be harmful.

Dunno about the last sentence but I agree with the rest of it. 800-2000 iu/day is what most competent health sites I’ve seen suggest. FWIW I take a little under 2000/day (most days 2000, some days less) and have had my blood checked and am spot on the range suggested in the recent large study.

Doug there is no study that i am aware of that links a particular level with better outcomes for either cardiovascular health or cancer and there certainly is no double blind prospective study showing that supplementation to a specific level is helpful or even safe. Check the link i gave above. It gives a good summary of the research

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Posted: 10 October 2011 06:32 PM   [ Ignore ]   [ # 7 ]
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I wrote about this one today, and this is how I see the situation:

It is not possible to demonstrate from such a study that these supplements cause an increased risk of death. But if untargeted supplementation truly had a beneficial effect on older women, it would be very unlikely to see the pattern of results shown in this study. And considering that several other similar studies have also failed to find a beneficial effect from such supplement use, it seems pretty clear that unless there is a specific deficiency or risk factor that suggests supplementation is needed, the non-specific use of single or multiple vitamin and mineral supplements is not likely helpful and may very well be harmful.

In a commentary on this study, a pair of nutritional experts remarked that the results
“add to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful….
Dietary supplementation has shifted from preventing deficiency to trying to promote wellness and prevent disease….Until recently, the available data regarding the adverse effects of dietary supplements has been limited and grossly underreported. We think the paradigm ‘the more the better’ is wrong….
We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population…”

The bottom line is that supplements, like any other medical intervention, need to be used to treat an identifiable problem for which there is a plausible mechanism and/or convincing research evidence they are safe and effective. Untargeted use of anything “just in case” is usually a bad idea.

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Posted: 10 October 2011 06:36 PM   [ Ignore ]   [ # 8 ]
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macgyver - 10 October 2011 06:28 PM

Doug there is no study that i am aware of that links a particular level with better outcomes for either cardiovascular health or cancer and there certainly is no double blind prospective study showing that supplementation to a specific level is helpful or even safe. Check the link i gave above. It gives a good summary of the research

The fullest study so far is the Institute of Medicine. I discussed the results a bit HERE (#95-96). The IoM discusses overall risk of death vs. Vit. D serum levels on pp. 433-434. They bottom around 50 nmol/L. (Slightly lower when younger, higher when older, but 50 is a good general target). That’s what I’m using as the guide.

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Posted: 10 October 2011 06:50 PM   [ Ignore ]   [ # 9 ]
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I ended up getting the smallest dose of vitamin D in the pharmacy aisle. My doctor was recommending a slightly higher dose, but there was so much varied opinion of what dose was proper… therefore I chose the smallest one.

I figure it was a happy medium between taking none at all and taking a larger dose, since no one can make up their minds! Now everyone is happy. If it’s beneficial, I had a little - hooray. If it turns out to be harmful down the road, at least I didn’t take too much - hooray.

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Posted: 10 October 2011 07:02 PM   [ Ignore ]   [ # 10 ]
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dougsmith - 10 October 2011 06:36 PM
macgyver - 10 October 2011 06:28 PM

Doug there is no study that i am aware of that links a particular level with better outcomes for either cardiovascular health or cancer and there certainly is no double blind prospective study showing that supplementation to a specific level is helpful or even safe. Check the link i gave above. It gives a good summary of the research

The fullest study so far is the Institute of Medicine. I discussed the results a bit HERE (#95-96). The IoM discusses overall risk of death vs. Vit. D serum levels on pp. 433-434. They bottom around 50 nmol/L. (Slightly lower when younger, higher when older, but 50 is a good general target). That’s what I’m using as the guide.

I took a quick look. I’ll have to work my way through the document to locate the study that this was based on. The devil is always in the details. This is the first publication i have seen that links level to mortality rate but once again this is an association not causation and there is not even one double blind prospective study done.

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Posted: 11 October 2011 04:17 AM   [ Ignore ]   [ # 11 ]
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macgyver - 10 October 2011 07:02 PM

I took a quick look. I’ll have to work my way through the document to locate the study that this was based on. The devil is always in the details. This is the first publication i have seen that links level to mortality rate but once again this is an association not causation and there is not even one double blind prospective study done.

OK, I’ll be interested to hear your thoughts. I know that a lot of large nutrition studies are epidemiological, such as the Nurses’ Study that revealed so much about cholesterol and saturated fats. They’ve been attacked for being epidemiological but IIRC from hearing a talk from the lead scientist at a CFI event several years back, the problem is that it’s just not feasible to do such a long baseline nutrition study in any more rigorous fashion. First it would be difficult to recruit for, second it would be difficult to double blind, and most importantly it would be way too expensive. Not sure in this case but I wouldn’t be surprised if some of the same issues came into play.

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Posted: 11 October 2011 07:42 AM   [ Ignore ]   [ # 12 ]
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dougsmith - 11 October 2011 04:17 AM
macgyver - 10 October 2011 07:02 PM

I took a quick look. I’ll have to work my way through the document to locate the study that this was based on. The devil is always in the details. This is the first publication i have seen that links level to mortality rate but once again this is an association not causation and there is not even one double blind prospective study done.

OK, I’ll be interested to hear your thoughts. I know that a lot of large nutrition studies are epidemiological, such as the Nurses’ Study that revealed so much about cholesterol and saturated fats. They’ve been attacked for being epidemiological but IIRC from hearing a talk from the lead scientist at a CFI event several years back, the problem is that it’s just not feasible to do such a long baseline nutrition study in any more rigorous fashion. First it would be difficult to recruit for, second it would be difficult to double blind, and most importantly it would be way too expensive. Not sure in this case but I wouldn’t be surprised if some of the same issues came into play.

I’ll try to read through it in the next few days. I think i finally found the article that the graph was taken from.

Cost and time are of course the biggest hurdles to any prospective randomized trial but they are not an excuse for making recommendations based on incomplete evidence. These sorts of studies are done all the time. Retrospective or epidemiological studies should only be the starting point, not the final word. There are certainly plenty of randomized trials done to examine the effects of vitamins and supplements so they can be done if someone is motivated to do them. Often they dispute the results of the original epidemiological work that examined the question so its difficult to get funding from the supplement industry which is all too happy to quote the one article that showed a benefit. Because of this we all need to be very cautious about putting too much faith in retrospective studies but especially physicians who are making recommendations to patients with the full weight of their MD behind them.

Maybe it will take 10-20 years to get an answer as to whether Vit D measurements and supplementation is helpful or harmful, but so what? I’m not really sure why there is such a rush to judgement on these issues. Why not just admit that there is insufficient evidence to recommend for or against the use and leave it at that. I think we are all becoming so preoccupied with the idea of avoiding death that we have become wiling to take steps that may in fact do us more harm than good just to be on the cutting edge.

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Posted: 11 October 2011 11:16 AM   [ Ignore ]   [ # 13 ]
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Maybe most of the source of this continuing hub-bub about science, meds, supplements and alt medicine is due to varying degrees of hypochondria!
I bet if a study was done, it could be shown that people who obsess or worry about vitamins, eating, and other supplements are likely to die in the same timely manner and with the same quality of life beforehand, as the people who just consume and go about their lives without worrying.

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Posted: 12 October 2011 06:33 AM   [ Ignore ]   [ # 14 ]
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I hate to to pile it on and beat a dead horse but for those who haven’t yet seen the headlines today by shear coincidence another study has been released that once again should make people think twice about the belief that a vitamin or supplement couldn’t do any harm. It seems that healthy men who took Vitamin E had a higher rate of prostate cancer than those who did not

And here’s the original JAMA article abstract: http://jama.ama-assn.org/content/306/14/1549.short

[ Edited: 12 October 2011 07:30 AM by macgyver ]
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Posted: 12 October 2011 09:21 AM   [ Ignore ]   [ # 15 ]
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Steve Novella’s typically levelheaded take ...

... Vitamins are just like any other health care intervention – they have potential risks and benefits and it is best to follow the evidence. For most people the best advice is to ask your primary health care provider which supplements, if any, you should take. Recommendations should be based upon specific health conditions and blood tests to measure levels of vitamins, so that specific deficiencies can be appropriately targeted.

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