A controversial but prominent advocate of immunizations in the United States is now becoming a vocal critic of nutrition. In advance of his new book, which advertisements and reviews suggest is a diatribe against acupuncture, chiropractic, supplements, etc., he wrote an editorial for the New York Times espousing the harms of vitamin supplements. In the editorial he “cherry picks” studies to support his contention, leaving out others that contradict his view, and even neglecting to mention data in the studies he chose, which complicate the question.
The first study he cites is an ancient one in the world of medical research. It was a 1994 investigation of male Finnish cigarette smokers. Back 15+ years ago, when this study was “new”, I often discussed it in my lectures to physicians. He wrote that those Finish male smokers who had taken beta carotene were more likely to die of lung cancer. That was true. Overlooked by those who read only the abstract, not the study itself, was that researchers discovered that smokers who had the highest blood levels of beta carotene at the beginning of the study were least likely to die of lung cancer, whether they took the supplement during the study or not. Doesn’t that then mean that beta carotene supplements cause cancer? No. My reading of the study then and supported by studies since then, was and is that male smokers should not take a synthetic beta carotene supplement by itself.
Beta carotene is “beta” because there is an alpha, gamma, delta, epsilon and zeta carotenes as well. There are different forms of beta carotene as well. Considerable science accumulated over the last two decades fleshes out our understanding (at least if we take the time to read enough). Just as taking too little is not good, taking too much is bad. The form is important, just as is the context (ie,. taking a balance of nutrients).
As you can tell, dietary studies are extremely prone to be as misleading as they are enlightening. Even when carefully done, nutritional research is notoriously unreliable. Design flaws are ubiquitous because we can’t control precisely what people eat for the decades required. Consequently, we need to think more broadly. One asset to understanding nutrition, as with so much else in medicine, is the study of evolutionary biology. Simply put, that is thinking carefully about how we got here.
We have learned that the leafy diets of our primate relatives are surprisingly nutrient-rich. Little 10 pound chimpanzees get about 600 mg of vitamin C a day in the leaves and other wild foods they consume. In addition to the relatively high levels of vitamins and minerals they contain, these leafy primate diets also have surprisingly high levels of protein. With their veggie diets, primates eat more protein for their size than we do. Concentrations of vitamins, minerals, antioxidants and polyphenols are much higher in the wild precursor plants our ancestors domesticated, than in the “healthy” veggies we consume, sometimes hundreds of times higher.
Adding to the unfavorable side of the ledger, our domesticated fruits and vegetables contain much higher sugar levels than their wild counterparts. Long before we reached today’s extreme of adding sugars like high fructose corn syrup to our foods, in a more subtle way ancient human farmers started the junk food craze when they began to breed crops more to their liking. Human agricultural practices, altering plants for more pleasing tastes, began squeezing the nutrients out of our diets from the very start.
There is ample reason to believe that our standard nutritional targets (MDR, RDA, etc.) are very wrong. However, for the sake of argument, assume that they are. The World Health Organization estimates that over 2 billion worldwide are nutritional deficient. This is not just a problem among the poor. With studies showing that 20-90% of Americans are deficient in any one individual vitamin or mineral, the odds are that every single one of us is deficient in at least two or three.
What to do?
A healthy diet is vitally important. Supplements can not replace a good diet for many reasons – nutrients we do not yet recognize, the benefit of consuming these nutrients together with other nutrients and the healthy pleasure of eating.
Supplementation is a good idea, however-
Quality makes a huge difference
Some of us need specific forms of nutrients
(e.g. the 20% of you who need methylfolate)
Take a balance of nutrients together
(1 reason for “multiple” vitamin supplements with minerals – e.g. MVM)
Generally, a modest level of supplementation, is wise:
That fills in gaps
Avoids the risks of super high, unbalancing dosing
Some individuals need more
More of us sometimes need more
What is not in the MVM can be as important as what is in it
Calcium blocks absorption
Avoid allergenic ingredients
My understanding of all of this is precisely why I began formulating my MVM. I think that taking a bad MVM might be worse than taking nothing at all. Maybe in that way I agree with Dr. Offit?