The nutritional supplement industry took a few body blows this month from conventional medicine, with several reports published in the Annals of Internal Medicine regarding the effectiveness of daily vitamins and minerals. An accompanying editorial urged physicians to discourage their patients from taking supplements altogether. Moreover, the editorial suggested the government should stop funding research in this area.
As if it’s over…proven…the end.
In reality, mega-medicine has been waffling over nutritional supplements for as long as I can recall. For a few years, you’d see nothing but hostile articles in conventional medical journals, then a glimmer of hope (“antioxidants prevent heart disease”), and then more bashing before another glimmer (“vitamin D prevents cancer”). These sea changes aren’t necessarily a bad state of affairs. They show that even conventional physicians are willing to shift perspective if presented with evidence.
Keep in mind that 30 years ago acupuncturists and midwives were arrested in Illinois for practicing medicine without a license. Now they’re ensconced in virtually every medical center. As recently as five years ago, fibromyalgia wasn’t recognized as a condition and antibiotics were routinely recommended for all cases of bronchitis. Things can and do change.
But the general hostility from conventional medicine toward nutritional supplements and the indifference of most physicians to learning anything about nutritional medicine merits some thought.
Personally, I see it as a control issue
If you’re reading about supplements, discussing them with non-MD caregivers (like chiropractors, naturopaths, and nutritionists), and making your own choices you’re taking charge of your health and well-being. Sad to say, that’s generally not encouraged in conventional physician settings.
If you review the historical arc of American medicine, you’ll see an unwavering attitude that pretty much states “we’ll handle everything.” This has meant the politically controlled suppression by state licensing of homeopaths, chiropractors, naturopaths, and other alternative healers that exists to this day. (These practitioners are not permitted to have hospital admission privileges or to be taught pharmacology in order to write prescriptions. Most are still forbidden from practicing in many states.) It has also meant generally discouraging and disparaging your attempts at self-care by reading books on health, following a specific diet that you’ve found works best for you, and taking nutritional supplements and herbs.
Enter “vitamins are useless” articles like the one above. The more you’re presented with official-sounding data that erodes your confidence in self-care, the more you’ll relinquish yourself to the seriously dysfunctional US health care system. And that means the more you’ll rely on surgery, prescription drugs, and health insurance.
For decades, the FDA (Food and Drug Administration) has been salivating to take control of the supplement industry, making access available only by doctor’s prescription.
What the supplements study failed to report
The Annals study did not mention that surveys show regular supplement users consistently report their overall health status as “excellent” or “very good.” To me, this means they’re using supplements as part of a broader healthful lifestyle that includes a good diet, regular exercise, and stress reduction. When a person starts a supplement program, it’s often as part of an overall resolution to get healthier. And if you accomplish that very admirable goal, you won’t need doctors as often (good for you, bad for physician income).
People also use supplements to treat specific health problems before resorting to prescription drugs. Here the overall evidence is quite strong. Physician Alan Gaby’s textbook Nutritional Medicine, a million-word cat-crusher of a tome, details 400 medical conditions treatable by vitamins and herbs and backed by 15,000 references from the medical literature.
Should you, as the Annals editorial suggests, simply stop taking supplements? I wouldn’t recommend it for my patients and I guarantee that within a year some further studies will appear somewhere in world medical literature that show supplements are beneficial and that this particular US study was flawed.
Less than a year ago, for example, a huge study reported a lower cancer incidence among men taking supplements. Two years ago, early all-cause mortality (medical-speak for early death) was lower among supplement users. Neither of these studies was mentioned in this recent Annals flurry or in the accompanying editorial. Being selective with your data, as these researchers appear to have done, is called “cherry picking.” Pharmaceutical companies routinely cherry-pick the clinical studies they submit to the FDA when trying to get approval for a new drug, choosing the good while pushing the bad toward the back of someone’s desk drawer.
My advice on supplements…and OTC drugs too
Use common sense when choosing supplements. I can assure you most are not magic bullets, but many are plenty helpful, and even more so when used with the self-care mentioned above. How do you decipher beneficial supplements from the over-hyped and potentially dangerous? If your own doctor isn’t as well-informed about supplements as you’d like, consult a chiropractor, naturopath or clinical nutritionist.
A real doozy of a nutritional supplement scare article appeared in Sunday’s New York Times. If you read “Spike in Harm to Liver Is Tied to Dietary Aids” uncritically, you might run screaming from your supplements. In actual fact, the number of reported cases of serious liver damage is extremely small (845 cases from 2004 to 2012, with a notable increase from 2010 to 2012) considering the number of pills Americans swallow every year.
Almost hidden in the article was the acknowledgement that investigators had focused on cases where a drug or supplement could be blamed with a high degree of certainty. Drug? DRUG? Why, then, is the article not entitled “Spike in Harm to Liver Is Tied to Drugs”?
Acetaminophen (Tylenol) has surpassed viral hepatitis as the number one reason people require liver transplants. Yes, you read that correctly. The NYT piece mentions DILIN, an acronym for “drug-induced liver injury network,” where liver specialists report causes of liver failure. If you link to the website, you’ll discover the reported enemies to your liver–in addition to Tylenol–are almost all prescription drugs.
No thanks to the New York Times for smart, fair, and accurate reporting.
David Edelberg, MD