The medical profession has always been very reluctant to acknowledge that vitamins are useful for anything except treating vitamin deficiency diseases, even when confronted with evidence to the contrary. This negativism toward vitamins begins in medical school, where doctors-in-training are indoctrinated with phrases like “Vitamins end up in the toilet,” “Anyone eating a healthy diet doesn’t need vitamins,” and the vaguely jingoistic “Vitamins are for people in developing countries, not us Americans.”
Even the self-styled physician quack-busters (i.e., opposing all forms of alternative medicine) Stephen Barrett and Victor Herbert, authors of The Vitamin Pushers, once warned the one-third of Americans taking multiple vitamins daily that they were being duped, that instead of waiting to urinate out their vitamins they should consider flushing their money directly down the drain.
During my medical training, not once did I ever hear one good thing about vitamins. In fact, we were all but schooled to eye-roll and sneer when a patient started listing her daily supplements. We weren’t smart enough back then to notice that the patient was well into her 80s and had never been sick in her life. We just shook our heads in disbelief, muttering, “How can people waste their money on vitamins?”
In the 1990s studies began appearing that linked vitamins, especially antioxidants, to heart disease prevention, and an utterly false urban myth started that had to do with cardiologists taking antioxidants but deliberately not telling their patients about them. This was followed by several equivocal antioxidant studies, giving any actual cardiologist taking antioxidants reason to stop.
I’m giving you this history as the backdrop to an article that appeared in the November 14, 2012, issue of the Archives of Internal Medicine entitled “Multivitamins in the Prevention of Cancer in Men.” Your first question is probably “Why only men?” The answer being that in 1997, when the study began, investigators wanted to track a huge population of subjects who would reliably complete the detailed health-oriented paperwork and may have concluded their best bet would be practicing physicians, who fill out forms the way most of you breathe. They likely chose men because there were more male than female doctors back then, though this is changing.
Importantly, there is no reason why this study’s conclusions wouldn’t apply equally to women.
Investigators sent query letters describing the study to more than 250,000 physicians and managed to attract just over 14,000 subjects. This tells us that most physicians don’t open their mail, are sick to death of paperwork, and/or are incurious about vitamins. I would hope (but genuinely doubt) that most of the refusals were based on a reluctance to be randomly assigned a placebo. Personally, I wouldn’t have participated, since I’d never replace my supplement regimen with a tray of dummy pills for the edification of anyone, much less the skeptical medical profession.
The study lasted 11 years until the “placebo code” was broken, research lingo for finally seeing which subjects had been taking an actual multivitamin and which had taken a sugar pill. The conclusion is in the article’s title, “Multiple Vitamins in the Prevention of Cancer in Men.”
Yes, vitamins prevent cancer
The difference between the vitamin users and non-users was a small but definitely statistically significant reduction in cancer rates. All cancers. All.
And you’d think that would end it, right? But no. Old thinking dies very hard. A few pages later, an accompanying editorial asks, “Is It Too Soon to Tell Men That Vitamins Prevent Cancer?” and at that title, even before I read the opening paragraph, I rolled my eyes and said aloud, “The Lord giveth, the Lord taketh away.”
Indeed the authors–one a specialist in health outcomes at Memorial Sloan-Kettering Cancer Center (whose income depends on people getting cancer), the other of all things an emergency room doctor–list numerous previous vitamin studies that failed to prove vitamins did anything, and then go on to criticize the current study for its vagueness. “Preventing cancer” was too broad a goal, since each cancer is its own unique disease. Likewise, multivitamins, containing as they do a large variety of separate ingredients, cut too wide a swathe to be considered useful for research. They conclude with the predictable “more studies are needed” before physicians start making multivitamin recommendations.
Yes, old habits die hard. The reason today’s prenatal vitamins contain extra folic acid is that the addition of this single B vitamin prevents the birth defect spinal bifida and its rarer companion, anencephaly (partial absence of the brain at birth). To give you a sense of the scope of physician resistance to vitamins, the first controlled study proving folic acid could prevent spina bifida and anencephaly appeared in 1983, and although other studies from around the world followed in short order it wasn’t until 1992 that the US Public Health Service officially recommended that women who could get pregnant take extra folic acid.
For nine years, physicians were engaged in handwringing, asking “Should we recommend folic acid?” while nutritionally oriented doctors were banging on the door: “Add the folic acid! Add the folic acid!” Even then, folic acid, like multivitamins, was known to be perfectly harmless. In the meantime thousands of babies were needlessly born with a serious and often fatal birth defect. Today (thank heaven), spina bifida is a real rarity except in developing countries among the malnourished.
And so it will go with cancer prevention.
There are numerous good multiple vitamin brands and an equal number of good reasons if you’re not already taking one to start. Take it regularly, not “when I remember.” Remember that, like tires and paint, with nutritional supplements you really do get what you pay for. There are numerous cheap-o brands I wouldn’t bother with. When it comes to your health and longevity, best not to go the “this price is too good to be true” route.
Multiplex is a potent formula in capsule form, which I prefer. Take two every morning or better yet, one twice a day; the big bottle lasts for four months.
David Edelberg, MD