I would like to take a moment to provide my personal opinion regarding this new study and some important points that we should consider when interpreting its conclusion. The generalized consensus from the study is that vitamin and mineral supplements seemed to provide no benefits in preventing cardiovascular disease or early death.
1. I can agree with the general concept that popping a simple multivitamin or basic dose of a supplement will not magically extend your lifespan and prevent cardiovascular disease. Supplements are certainly advertised and marketed to a very high extent and often touted as a fix for many issues and consumers often spend more money on them than is necessary.
2. Food should be the primary source of our nutrients and the priority of a healthy lifestyle. A wholesome diet rich in fruits and veggies will provide most, if not all of the micronutrients necessary for optimal health and prevention of any nutrient deficiencies. They also provide nutrients that we often cannot get from a pill alone including polyphenols and fiber.
3. Numerous studies have found that diets such as the Mediterranean Diet have significantly reduced the risk of cardiovascular disease and all-cause mortality.₄,₅,₆
4. In addition to a healthy diet, exercise is paramount for optimal well-being and is the closest you can get to consuming a "panacea miracle pill." Exercise has been proven time and time again to reduce all-cause and cardiovascular-related death, diabetes mellitus, cancer, osteoporosis, cognitive decline, and much more.₇ Exercise and proper nutrition are like two wheels on a bicycle: you need both working in order to progress forward.
With all that said, I do feel as though this new study is getting misinterpreted and falsely portraying that all supplements are useless and a complete waste of money.
1. This study was a meta-analysis comparing a variety of studies on specific supplements (folic acid, B-vitamins, multivitamins, vitamins C, D, β-carotene, calcium, selenium, antioxidant mixtures and niacin) and looking at their effects on cardiovascular disease outcomes and all-cause mortality. It did NOT state that all of these supplements are useless for any purpose. Headlines that are extrapolating the results of this study and proclaiming that all supplements are a waste of money are incorrectly interpreting this study. Each vitamin and mineral has specific roles in the body and may positively benefit individuals who are deficient or have a specific health condition. Just because a vitamin does not improve heart health or length of life, does not mean that it has no beneficial impacts on another aspect of health or quality of life.
2. Each person is unique and has specific vitamin and nutritional needs based on their diet, lifestyle, genetics, and more. We need to have a personalized approach to nutrition and supplements and understand that certain individuals have a greater need and benefit from certain supplements. Meta-analyses are great at providing a high sample size analysis of a large number of studies to help us see overall trends and effects. But we must remember that within each individual study, there is a wide range of outcomes, with some subjects noting a negligible effect or possibly negative effect due to a supplement, but others experiencing a highly beneficial impact. Also, the authors of the study are allowed to pick and choose the studies to include in the meta-analysis, thereby introducing the potential for bias.
3. There are many vitamin and mineral deficiencies in the US. This has been well-documented in a variety of studies. Here is a chart which displays the Prevalence of inadequacy (% of population below Estimated Average Requirement - EAR) for “underconsumed nutrients” identified in 2015–2020 Dietary Guidelines for Americans from food only and food + multi-vitamin/multi-mineral supplements (MVMS) among adults age 19 years and older reporting taking a MVMS. NHANES 2009–2012.₈
Here are some other deficiencies and their subsequent reduction thanks to supplementation:₈
4. "Adequate" ≠ Optimal
All too often, a blood test indicating that a value is within the "reference range" or a vitamin/mineral meets the RDA (Recommended Dietary Allowance), then that is optimal. This is incorrect. We must look beyond the reference ranges and RDA and determine what is truly optimal. ₉
5. Another important takeaway from this is that the dosages used in supplement studies are often low. A study comparing the effects of 400iu of Vitamin D3 may very well have much less of a positive impact in comparison to 5000iu. We cannot state that a particular supplement is useless when a study is not using optimal dosing. Of course "optimal" may very well vary from supplement to supplement and also from person to person so once again, an individualized approach must be taken and ideally blood tests can confirm that the serum level is rising to the appropriate value.
6. We cannot discredit the hundreds of thousands of studies which have found an immense number of different benefits due to many different supplements. Every day, many new studies are released which find positive outcomes due to supplementation of different vitamins, minerals, and herbs. A simple search on PubMed or Medical News Today or ErgoLog of a particular supplement will show research articles which have documented the power of different supplements. I encourage you to also visit Examine.com which provides an unbiased source of supplement information including a summary of effects of supplements and their level of evidence based on documented clinical studies.
In conclusion, I hope my post helps to provide a different look at supplements and understand their role in our health. I do not discredit the findings of the "Supplemental Vitamins and Minerals for CVD Prevention and Treatment" study and agree with its advice to focus on healthy dietary patterns and increased consumption of fruits and veggies. I just wanted to provide a rebuttal to the generalized news spreading the idea that all supplements are useless. I believe that proper nutrition and exercise are the cornerstones of a healthy lifestyle and supplements are only a complementary component of an optimal health plan and should be customized to each individual's needs.
- Joe Zucchi
1. Jenkins DJA, Spence JD, et al. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. JACC: Journal of the American College of Cardiology. http://www.onlinejacc.org/content/71/22/2570. Published May 28, 2018. Accessed May 31, 2018.
2. Study: Vitamin Supplements Don't Provide Health Benefits. U.S. News & World Report. https://www.usnews.com/news/health-care-news/articles/2018-05-29/study-vitamin-supplements-dont-provide-health-benefits. Accessed May 31, 2018.
3. Wehner M. Scientists studying vitamin supplements warn that they're a huge waste of money. BGR. http://bgr.com/2018/05/29/do-vitamins-work-supplement-effectiveness-health/. Published May 29, 2018. Accessed May 31, 2018.
4. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet | NEJM. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1200303. Accessed May 31, 2018.
5. Bo S, Ponzo V, et al. Predictive role of the Mediterranean diet on mortality in individuals at low cardiovascular risk: a 12-year follow-up population-based cohort study. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830057/. Published 2016. Accessed May 31, 2018.
6. Knoops KT, de LC. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/15383513. Published September 22, 2004. Accessed May 31, 2018.
7. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/. Published March 14, 2006. Accessed May 31, 2018.
8. Blumberg J, Frei B, Fulgoni V, Weaver C, Zeisel S. Impact of Frequency of Multi-Vitamin/Multi-Mineral Supplement Intake on Nutritional Adequacy and Nutrient Deficiencies in U.S. Adults. MDPI. http://www.mdpi.com/2072-6643/9/8/849/htm. Published August 9, 2017. Accessed May 31, 2018.
9. Functional Medicine Methods And Ideas. Integrated Healthcare Solutions. http://www.drcafferyintegrativehealth.com/functional-medicine-methods-and-ideas/. Accessed May 31, 2018.
10. Tello M. Vitamin D: What's the "right" level? Harvard Health Blog. https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893. Published October 3, 2017. Accessed May 31, 2018.www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893
11. McDonnell SL, Baggerly C, French CB, et al. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study. PLOS Medicine. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152441. Accessed May 31, 2018.
12. Disease Incidence Prevention Chart. GrassrootsHealth. https://grassrootshealth.net/document/disease-incidence-prevention-chart-in-ngml/. Accessed May 31, 2018.