Competency: Nutritional Supplements
Two reports this week about vitamins and extra risk for early mortality. This is sort of a surprise and takes some thinking what it might mean. First, in the very prestigious Archives of Internal Medicine is a report following 38,000 plus women in the Iowa Women’s Health Study asking them about what supplements and vitamins they took. Of the fifteen items that were surveyed, 14 were found to be associated with higher mortality. They women were 61 years old when the study started and upon ending 18 years later, more than half had died. This is a big study. Iron was found to be the strongest risk on the list. Now, I’m a bit suspicious that 14 of 15 were found to be problematic. That is a problem itself.
In fact, the only one thought to be beneficial was calcium, and that has been shown in other studies to be problematic and not helpful. The study is apparently pretty well designed and regarded in its methodology except for one detail, and that is that they asked the women to remember what they had taken in the past. No one measured blood levels and reported on personalized details. If I have a family member with an iron deficiency anemia, I still think they should be on iron. (Once I know why they are low on iron.)
A second study was released in JAMA about prostate cancer and Vitamin E and selenium. Again, a pretty big study (SELECT Trial) and well designed with good placebo control. This one seems more rigorous in design because it was randomized. It only lasted 3 years but had 35,000 men. That’s big. What they found was that Vit E (400 IU) did NOT protect from prostate cancer, and in fact had about a 17% increased risk. That translates into 16 extra cases for every 10,000 men. 400 IU a day isn’t much. It’s the size of most E supplements in the grocery store. Most multivitamins only carry a fifth of that amount. But that’s a big jump and very disconcerting.
Both of these studies have the power of standardized large studies on their side, well executed and carefully thought out. Both suffer from a couple of fallacies that should be understood. We should more sophisticated than what they expect. We should all be past the era when we think any one supplement taken out of context and given in high dose would be beneficial. At no time in human evolution have we ever had isolated vitamins given to us in huge doses. Most of my functional medicine colleagues have long since given up on pure alpha-E and are instead focusing on gamma – delta E as that is where the action seems to be moving. We probably need the mix. And where do we get the very best balance of that mix? When we eat a diet rich in whole, organically raised foods. If your grandma recognized it as a food, it probably is. If was raised in your garden, it qualifies.
WWW. What Will Work for Me? I don’t take Vit E any more. I did for about 5 years back in the 90s. I’m pretty convinced that I do better with 9 servings a day of vegetables and a few fruits for fun. If I can find convincing evidence that our body naturally had high doses of a vitamin in it, like with D, I’ll change my mind. But then D isn’t a vitamin, it’s a hormone, and our bodies naturally make it when we have sunshine. Which we don’t for the next six months. So, trash the E. Start your D.