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Whoa!  Lay Off the Vitamins!
Posted: 13 April 2014 09:04 AM   [ Ignore ]   [ # 406 ]
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VYAZMA - 12 April 2014 05:21 PM
macgyver - 09 April 2014 02:10 PM

Perhaps you will show me where the FDA says that supplements and vitamins are not a drug first.

From the FDA’s website, under the Q&A section in FDA/Food/Supplements.

What is a dietary supplement?
Congress defined the term “dietary supplement” in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a “dietary ingredient” intended to supplement the diet. The “dietary ingredients” in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of “foods,” not drugs, and requires that every supplement be labeled a dietary supplement.

There you go Macgyver. The FDA considers them under the umbrella of foods-NOT drugs.  Who wouldn’t think that?
Drugs are things designed to cure illnesses, treat symptoms, and relieve people of ailments.
Foods are things people eat to supply their bodies with nutrients and calories and vitamins.

You and Mckenzie keep getting this mixed up.

It isn’t that the FDA considers them as foods and not drugs. That decision was imposed on them by laws passed by Congress. The FDA wanted them to be classed as drugs. They lost that round. Supplements are not actually foods. They are mostly synthesized in a laboratory as appearing to be what is found in foods. No one knows whether they act on the body the same way as those elements act if taken as food. You are in dangerous territory if you depend on the FDA to tell you everything you need to know without looking beneath the surface and at what role politics plays in what they do or say. What the FDA can or can’t say or do is controlled by legislators, not scientists, and much of it is uninformed and harmful.

Lois

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Posted: 13 April 2014 11:49 AM   [ Ignore ]   [ # 407 ]
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Lois - 13 April 2014 09:04 AM

It isn’t that the FDA considers them as foods and not drugs. That decision was imposed on them by laws passed by Congress. The FDA wanted them to be classed as drugs. They lost that round. Supplements are not actually foods. They are mostly synthesized in a laboratory as appearing to be what is found in foods. No one knows whether they act on the body the same way as those elements act if taken as food. You are in dangerous territory if you depend on the FDA to tell you everything you need to know without looking beneath the surface and at what role politics plays in what they do or say. What the FDA can or can’t say or do is controlled by legislators, not scientists, and much of it is uninformed and harmful.

Lois

I know exactly what was behind DSHEA.
The law specifically states that supplements cannot make claims that drugs can make. IE they cannot claim to cure, treat, diagnose, or otherwise alleviate illnesses or symptoms of illnesses. I know that many supplements are bending these laws. Vitamin, herbal, enzyme, protein supplements
etc.

I’m not interested in these products. Weight loss, muscle builders, testosterone builders, sex drive herbs, urinary supplements and the hundreds
of other quack-jobs out there. Just because there are alot of bad apples doesn’t mean the whole bushel is rotten!

I’m also not interested in people making claims that vitamins can cure, treat, diagnose or otherwise relieve ailments.

Part of DSHEA and the FDA states that supplements must label ingredients and must have scientific consensus behind these ingredients.
If a reputable company such as Pfizer, who makes Centrum Multi-vitamins, labels their products and lists amounts of the ingredients, then I would like someone to show me that the Iron for example, in these tablets is fake iron and will not be metabolized in the human body.
Can someone show me that the Iodine is fake? The Vitamin A? etc etc etc…

Is somebody here trying to make the claim that these tablets which claim to have these vitamins are fake and contain no vitamins that will actually
be absorbed and metabolized by the body?
Consider that they are under the scrutiny of the FDA, the private watchdogs, the buying public, and these tablets regularly are tested for ingredients and function.

*So..once again, first show proof that the human body doesn’t need vitamin A, D, iron, iodine or potassium for example.
*If you can’t show this, the next step is to show that a particular product lies about the ingredients and amounts.
*If you can do this great, it should be banned, fined etc.
*For the ones that are found to contain these compounds and amounts correctly, you must next show that the ingredients for some reason cannot be absorbed and utilized by the human body.

After that, simple vitamin supplements which contain amounts of vitamins which are safe and equal to or less than the amounts found in a normal serving of food should be absolutely fine and treated as food.  Which is exactly what the FDA says they are.

[ Edited: 13 April 2014 11:55 AM by VYAZMA ]
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Posted: 13 April 2014 03:53 PM   [ Ignore ]   [ # 408 ]
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I don’t think the two Ms are claiming that the supplements are evil, Vy, just that no one needs them because all of Americans get adequate amounts of all the supplements in our diets so we’re wasting money by taking them.  After all, we have to recognize the value of the fast food industry in their efforts to provide low fat, low calorie, high quality foods which supply all our nutritional needs to everyone.  LOL

Of course, the response to this is:  Americans should work to eat an adequate diet rather than the junk foods.  And that’s true, just as is:  Americans should all be atheistic, liberal, humanists who care for and respect each other. 

Occam

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Posted: 13 April 2014 07:22 PM   [ Ignore ]   [ # 409 ]
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Vyazma,

The evidence was a systematic review of 107 other systematic reviews and 74 meta-analyses, involving hundres of studies with thousands of people, which found that “despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable.” That’s the evidence I provide which you can interpret in whatever way you like. The questions you ask are totally irrelevant to the paper I posted, so I have no idea why you keep bringing them up. Read it for yourself and do whatever you like with the information.

Occam,

While I agree we all tend to interpret the evidence in the light most favorable to our preconceptions, it’s not a simple matter of picking and choosing one paper over another in this case. The review I cited is a systematic review of hundreds of studies, so it is as close as we are likley to get to an impartial assessment of the preponderance of the evidence. It requires a pretty strong commitment to a belief to dismiss evidence at this level.

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Posted: 13 April 2014 07:39 PM   [ Ignore ]   [ # 410 ]
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VYAZMA - 13 April 2014 11:49 AM
Lois - 13 April 2014 09:04 AM

It isn’t that the FDA considers them as foods and not drugs. That decision was imposed on them by laws passed by Congress. The FDA wanted them to be classed as drugs. They lost that round. Supplements are not actually foods. They are mostly synthesized in a laboratory as appearing to be what is found in foods. No one knows whether they act on the body the same way as those elements act if taken as food. You are in dangerous territory if you depend on the FDA to tell you everything you need to know without looking beneath the surface and at what role politics plays in what they do or say. What the FDA can or can’t say or do is controlled by legislators, not scientists, and much of it is uninformed and harmful.

Lois

I know exactly what was behind DSHEA.
The law specifically states that supplements cannot make claims that drugs can make. IE they cannot claim to cure, treat, diagnose, or otherwise alleviate illnesses or symptoms of illnesses. I know that many supplements are bending these laws. Vitamin, herbal, enzyme, protein supplements
etc.

I’m not interested in these products. Weight loss, muscle builders, testosterone builders, sex drive herbs, urinary supplements and the hundreds
of other quack-jobs out there. Just because there are alot of bad apples doesn’t mean the whole bushel is rotten!

I’m also not interested in people making claims that vitamins can cure, treat, diagnose or otherwise relieve ailments.

Part of DSHEA and the FDA states that supplements must label ingredients and must have Oscientific consensus behind these ingredients.
If a reputable company such as Pfizer, who makes Centrum Multi-vitamins, labels their products and lists amounts of the ingredients, then I would like someone to show me that the Iron for example, in these tablets is fake iron and will not be metabolized in the human body.
Can someone show me that the Iodine is fake? The Vitamin A? etc etc etc…

Is somebody here trying to make the claim that these tablets which claim to have these vitamins are fake and contain no vitamins that will actually
be absorbed and metabolized by the body?
Consider that they are under the scrutiny of the FDA, the private watchdogs, the buying public, and these tablets regularly are tested for ingredients and function.

*So..once again, first show proof that the human body doesn’t need vitamin A, D, iron, iodine or potassium for example.
*If you can’t show this, the next step is to show that a particular product lies about the ingredients and amounts.
*If you can do this great, it should be banned, fined etc.
*For the ones that are found to contain these compounds and amounts correctly, you must next show that the ingredients for some reason cannot be absorbed and utilized by the human body.

After that, simple vitamin supplements which contain amounts of vitamins which are safe and equal to or less than the amounts found in a normal serving of food should be absolutely fine and treated as food.  Which is exactly what the FDA says they are.

It’s up to the vitamin makers to show that their vitamins are effective and that their vitamin pills have in them what they claim. It is also up to them to show that vitamins have a positive effect on the human body, especially on those who have no diagnosed deficiency, and that they do no harm.

It is not up to the skeptics to prove anything. I would have thought you knew this. The burden of proof is on the claimant, not the people to whom the claims are being made—and not even the FDA.

. . . the Food and Drug Administration doesn’t regulate dietary supplements as drugs — they aren’t tested for safety and efficacy before they’re sold. Many aren’t made according to minimal standards of manufacturing (the F.D.A. has even found some of the facilities where supplements are made to be contaminated with rodent feces and urine). And many are mislabeled, accidentally or intentionally. They often aren’t what they say they are. For example:

In 2003, researchers tested “ayurvedic” remedies from health food stores throughout Boston. They found that 20 percent contained potentially harmful levels of lead, mercury or arsenic.

In 2008, two products were pulled off the market because they were found to contain around 200 times more selenium (an element that some believe can help prevent cancer) than their labels said. People who ingested these products developed hair loss, muscle cramps, diarrhea, joint pain, fatigue and blisters.

Last summer, vitamins and minerals made by Purity First Health Products in Farmingdale, N.Y., were found to contain two powerful anabolic steroids. Some of the women who took them developed masculinizing symptoms like lower voices and fewer menstrual periods.

Last month, researchers in Ontario found that popular herbal products like those labeled St. John’s wort and ginkgo biloba often contained completely different herbs or contaminants, some of which could be quite dangerous.

The F.D.A. estimates that approximately 50,000 adverse reactions to dietary supplements occur every year. And yet few consumers know this..


http://www.nytimes.com/2013/12/15/opinion/sunday/skip-the-supplements.html?_r=0

Lois

[ Edited: 13 April 2014 07:48 PM by Lois ]
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Posted: 14 April 2014 03:34 AM   [ Ignore ]   [ # 411 ]
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Lois - 13 April 2014 08:50 AM
TimB - 12 April 2014 07:31 AM

Well, I didn’t pressure my PCP to prescribe Vit. D.  As I said, I questioned it.  I did, OTOH, lobby for him to allow me to try fish oil for a few months to address my cholesterol (instead of immediately starting Lipitor or some equivalent).  He basically said that the fish oil would not help in a significant way, but went along with my wishes, for the time being, as I stressed my concerns about statins potential effects on the liver. 

So you would be skeptical of my PCP’s stance on Vit. D in my case, but I imagine that you would not be skeptical of his stance on the fish oil.

BTW, the vit D was a 3 month prescription.

Did you need a prescription for something that is widely available over the counter for a lot less money?

As for fish oil, he was probably being honest in saying it would probably not help in any significant way but that he sees no harm in it. What else could he say? He probably knows that his patients will take things whether he advises against it or not. The only thing he can do is pass on the information he has. What you do with it is up to you.  He only has so much influence over what his patients do despite his advice. But if I were your doctor I wouldn’t have given you a prescription for Vitamin D. I would have told you that what you get over the counter will be as helpful or as harmful as what you would get with a prescription; it would just cost more.

Lois

I agree with what you suggest about the fish oil and my PCP’s stance.  Re: the Vit D: I didn’t ask for it. I was a bit skeptical.  I haven’t shopped around, but my guess is that for the 14 capsules of 50,000 IU would have cost me more, over the counter, than the prescription, which my insurance paid for (resulting in me paying $0.00 for it out of pocket).  I apologize for probably unnecessarily contributing in a small way to the national cost of healthcare.  But I am paying something for the healthcare insurance and my PCP must have thought it was important that I take the Vit D. But as I said, he also must have thought it important that I start a statin medication.  I wasn’t as concerned about the possible negative effects of Vit D as I was about those of a statin.

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Posted: 14 April 2014 04:54 AM   [ Ignore ]   [ # 412 ]
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TimB - 14 April 2014 03:34 AM
Lois - 13 April 2014 08:50 AM
TimB - 12 April 2014 07:31 AM

Well, I didn’t pressure my PCP to prescribe Vit. D.  As I said, I questioned it.  I did, OTOH, lobby for him to allow me to try fish oil for a few months to address my cholesterol (instead of immediately starting Lipitor or some equivalent).  He basically said that the fish oil would not help in a significant way, but went along with my wishes, for the time being, as I stressed my concerns about statins potential effects on the liver. 

So you would be skeptical of my PCP’s stance on Vit. D in my case, but I imagine that you would not be skeptical of his stance on the fish oil.

BTW, the vit D was a 3 month prescription.

Did you need a prescription for something that is widely available over the counter for a lot less money?

As for fish oil, he was probably being honest in saying it would probably not help in any significant way but that he sees no harm in it. What else could he say? He probably knows that his patients will take things whether he advises against it or not. The only thing he can do is pass on the information he has. What you do with it is up to you.  He only has so much influence over what his patients do despite his advice. But if I were your doctor I wouldn’t have given you a prescription for Vitamin D. I would have told you that what you get over the counter will be as helpful or as harmful as what you would get with a prescription; it would just cost more.

Lois

I agree with what you suggest about the fish oil and my PCP’s stance.  Re: the Vit D: I didn’t ask for it. I was a bit skeptical.  I haven’t shopped around, but my guess is that for the 14 capsules of 50,000 IU would have cost me more, over the counter, than the prescription, which my insurance paid for (resulting in me paying $0.00 for it out of pocket).  I apologize for probably unnecessarily contributing in a small way to the national cost of healthcare.  But I am paying something for the healthcare insurance and my PCP must have thought it was important that I take the Vit D. But as I said, he also must have thought it important that I start a statin medication.  I wasn’t as concerned about the possible negative effects of Vit D as I was about those of a statin.

If you can get a prescription filled for no extra cost to you, then go with it. I don’t have a plan that pays for 100 % of my prescription costs. In fact, I’m not sure if my plan would pay for a vitamin supplement at all. But if you have such a plan, then go with it. Let us know what happens. My own doctor said there is no effective substitute for statins, but if you can get your cholesterol levels down with vitamins, I might try it myself because my body does not tolerate statins.

Lois

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Posted: 14 April 2014 05:24 AM   [ Ignore ]   [ # 413 ]
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mckenzievmd - 13 April 2014 07:22 PM

“despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable.”

What does this mean? Does this mean that we don’t need vitamin D?
What does “associations with a selection of outcomes are possible” mean?

McKenzie, explain what this means.  McKenzie please, I’d like McKenzie to explain it thank you.

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Posted: 14 April 2014 06:13 AM   [ Ignore ]   [ # 414 ]
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Lois - 14 April 2014 04:54 AM

My own doctor said there is no effective substitute for statins, but if you can get your cholesterol levels down with vitamins, I might try it myself because my body does not tolerate statins.

Lois

I’ll let you know what happens with my cholesterol levels. I am not overly optimistic. But even if my levels turn out to look better, it doesn’t necessarily follow that it would work for you.  I could just be an outlier.

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Posted: 14 April 2014 09:59 AM   [ Ignore ]   [ # 415 ]
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Vyazma,

The best thing, of course, would be for you to read the paper yourself (HERE‘s the link). I do understand, though, that it’s a dense scientific paper that requires some specific training in statistics and critical appraisal to understand, and just as I’m no expert in your field, I don’t expect everyone to be an epidemiologist, so I will try to convey the gist. I will admit, though, that based on the rest of this thread I am skeptical that you really want to understand what this paper is about, and I fear you are just looking for points to attack or fit into the previous fruitless debate. Still, here’s hoping we can leave that behind and do better from here on.

The paper reviewed the results of hundreds of studies looking at whether or not there was any relatonship between taking a Vitamin D supplement and one’s state of health. I understand you believe that taking the supplement is simply getting Vitamin D just like you would from food and that you don’t think it has anything to do with health. But you also seem to believe that you are in some way healthier or better off for taking it than you would be if you stopped, presumably because you aren’t convinced that your diet contains enough Vitamin D without adding the supplement to it. This paper is looking at exactly that question: Are people who take Vitamin D supplements any better off than if they didn’t take one?

The review examined both previous reviews of observational studies (studies where investigators just looked at people who did or did not take a supplement on their own) and experimental studies (where people were deliberately given a Vit D supplement or a placebo). It looked at what are called “outcomes,” meaning what happened to the people in the studies in terms of their health.  Becaue of what Vitamin D is know to do in the body, many of these outcomes were things Vit D might be expected to affect (either becuase people got too little in the diet and the supplement fixed that deficiency or because adding a supplement to the diet was better than not adding one regardless of how much Vit D was obtained from food). The outcomes included things like falls and broken bones in old people, cavities in children, cancer, and so on, all things Vit D might affect given what it does in the body.

The results found that taking a supplement didn’t clearly affect any of the outcomes looked at. In other words, for most people it didn’t seem to matter for their health if they took a Vit D supplment or not. There were a couple of outcomes that might have been affected, but the data wasn’t completely clear (this is the “probable association with selected outcomes”). It might be that if pregnant women take Vit D this affects the birth weight of their babies, that Vit D supplements might affect the risk of cavities in children, it might affect a certain important hormone that is an issue for people with kidney disease, and so on. So the overall conclusion was that despite hundreds of studies in thousands of people, it doesn’t seem like taking a Vit D supplement has any effect on health excpet possibly for a few specific things.

Sure, you get Vit D from a Vit D supplement, and the body uses Vit D, but so what? If it doesn’t have any measurable effect on health whether you take it or not, what is the point of taking it?

Put another way, the body needs water, and you get water from drinking a glass of water. But if drinking one extra glass of water a day has no effect on your health, why make a point of doing it? It’s the same with Vit D.

Now the issue not addressed in this study was is there any harm to taking a Vit D supplement even if it doesn’t do anything useful. At this point, it seems unlikley that there is any harm for most people at reasonable doses. But as I’ve said before we thought the same thing in the past about other vitamins and turned out to be wrong in some cases. Vit E supplements can actually icnrease the risk of strokes in some people, for example. So for most people, the evidence suggests that taking a Vit D supplement is probably doing nothing good or bad, but as always in science more research will give us more iformation about who might benefit and who might be harmed. The devil is in the details.

Anyway, as I’ve said many times, I’m not telling you what to do or not to do. I just put the paper out there because I think reviewing the scientific evidence and using it to guide our choices is the best way to approach these things.

[ Edited: 14 April 2014 10:02 AM by mckenzievmd ]
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Posted: 15 April 2014 05:26 AM   [ Ignore ]   [ # 416 ]
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mckenzievmd - 14 April 2014 09:59 AM

Vyazma,


Anyway, as I’ve said many times, I’m not telling you what to do or not to do. I just put the paper out there because I think reviewing the scientific evidence and using it to guide our choices is the best way to approach these things.

What kinds of actions will be taken as a result of this scientific paper you cited?

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Posted: 15 April 2014 05:42 AM   [ Ignore ]   [ # 417 ]
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VYAZMA - 15 April 2014 05:26 AM

What kinds of actions will be taken as a result of this scientific paper you cited?

The ideal action would be for physicians to stop recommending Vit D supplements to their patients except in the rare circumstance where there is a proven need or benefit. Additionally one would hope that the information would trickle down to patients allowing them to make decisions about their own Vit D consumption based on good science rather than the rumor, hearsay, flawed reasoning, and pseudoscientific claims that permeate much of the discussion about vitamins and supplements.

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Posted: 15 April 2014 12:08 PM   [ Ignore ]   [ # 418 ]
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As macgyver said, the value of systematic reviews is they give an overview of the balance of the evidence which doctors and everyone else can use to guid their choices. If the evidence seems pretty clear that there is no difference in health for most people beteen taking and not taking a Vit D supplement, presumably octors will tell their patients this and they can make a fully informed choice about what to do. Conversly, if the evidence had shown strong reason to believe Vit D supplements had benefits in some circumstances, doctors and publich health officials might encourage people in those circumstances to take them. Ideally, policy and patient education should be driven by research evidence as far as is possible.

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Posted: 15 April 2014 03:19 PM   [ Ignore ]   [ # 419 ]
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Without going into the details of this report(I went and skimmed it) and the scope of what it covers, what previous reports or studies
does this report supersede?

For example, back in 2009 Doug Smith posted a thread about studies that said Vitamin D supplements were recommended.
He cited 3 different sources.(search: “Vitamin D”; pg. 3 or 4 I think.)

This study here above supersedes these past studies beyond a shadow of doubt or debate?

Also it is important to note that this study only covers Vitamin D and not other vitamin supplements or vitamins.

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Posted: 15 April 2014 04:02 PM   [ Ignore ]   [ # 420 ]
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This study reviews all of the previous studies, which is part of the definition of a systematic review, so it is the most current summary of the evidence. And since for every medical question there is almost always disagreement between individual studies, reviews such as this are useful in giving us an overview of what the reearch as a whole says. You can find positive and negative studies on any subject, so such overviews help us decide if the evidence is stronger for or against something. Of course, new research is always ongoing, so in a couple of years if there are a significant number of additional studies, another review will have to be done.

And other reviews exist that look at subsets of the larger question, and those reviews might answer specific questions not asked in this one.

And of course your’e correct this only addresses Vit D supplementation, and each single supplement, as well as combinations such as mutivitamins, have to be addressed separately. There have been a few other such systematic reviews cited in this thread such as

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

as well as a number of reviews and primary articles I have collected elsewhere

The devil is in the details, and it’s a complex subject for sure!

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