Tag Archive for: multivitamin

Nothing to Fear from the Multivitamin Study

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If you’re concerned about taking your multivitamin, I think you can lower the concern. Is it still possible that there may be individuals who may have a unique set of genes and covariates that may increase the risk? Sure, it’s possible, but this study brought us no closer to finding out if that’s true. Here’s why.

The Issues with the Study

The problems lie in what the researchers didn’t do.

While the researchers used 13 different covariates, they didn’t break the data down by macronutrient or micronutrient. They used the Healthy Eating Index, but that ranks the quality of the diet from 0 to 100; that’s not the same as breaking the subjects’ diets down by intake of vegetables or antioxidants. It’s possible that someone who ate more vegetables could have higher antioxidant levels, which could contribute to getting too much of a nutrient by taking a multivitamin. The same would be true if they also were taking a complete multivitamin-multimineral and getting too much calcium or iron. That might have given valuable information to the people most at risk if there were such a relationship.

The researchers also did not give any explanation for mechanisms through which a multivitamin could increase mortality. That’s not unusual, because they didn’t examine any nutrient factors—but still, what was the point of saying there may be an increase in mortality, but nothing more than that?

The most likely explanation is that the results happened by chance because they tested multivitamin intake only twice early in the studies. Think of what you were eating 20 years ago. Has that changed? It’s reasonable to expect that some peoples’ habits changed, just as their dietary intake may have changed. We don’t know because they couldn’t go back and do the questionnaires every year or two, or even every five years. They suggest that this was a problem due to the latency of the data, and they were correct in my opinion.

The Bottom Line

This study illustrates the problem with going back to analyze data collected decades ago: you’re limited by the data you have rather than actually planning the study from the beginning. It’s an interesting observation after chunking lots of numbers, but it’s not meaningful in the real world due to the lack of ability to do an adequate analysis of the data.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2024;7(6):e2418729.

Will Taking a Multivitamin Increase Your Risk of Death?

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Close to a month ago, the health headlines were full of warnings about multivitamins. A long-time researcher even did a video to explain the study. This headline was based on a study that demonstrated an increase in Hazard Ratio if a person took a multivitamin every day, compared to occasionally or never. On the face of it, this seemed to be a compelling study. Data were combined from three large studies that totaled over 390,000 participants. The data were taken from health and nutrition questionnaires first given more than 20 years ago, with the mean follow up time of about 21 years. The questionnaires asked about a variety of demographic data as well as health and nutrition habits; the nutrition data were the old-style FFQ form.

After analyzing the data, researchers found a 4% increase in mortality risk in those participants who took a multivitamin every day compared to those who did not. Should you be worried? Aside from the number of covariates they considered, and you know how those combinations can add up, there were at least two problems. I’ll cover those on Saturday.

The Winners of the Challenge

Everyone who responded to the 4th of July challenge did an amazing job—no one had fewer than 20 vegetables and fruits. Where it got a little murky was in the herbs and spices; I’ll take the blame for that as I didn’t explain it as well as I should. For the overall total, I’m going to declare a tie between RE and KB; they each had close to 60 foods that qualified! For vegetables alone, VK topped the list with 23 and MW topped the fruit list with 13. Great job, everybody!

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2024;7(6):e2418729.

2018’s Worst Most-Read Paper

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In March of last year, the Journal of the American Medical Association published a viewpoint written by two experts in public health titled “Vitamin and Mineral Supplements. What Clinicians Need to Know”; it was one of the nutrition papers most read and most shared last year. The only problem is that clinicians really won’t find out much by reading it.

I’m going to pick one recommendation because everything after it won’t matter. The authors recommend that all clinicians recommend that patients get their nutrients from food. I absolutely agree with that. They go on to advise clinicians to tell their patients there’s no need to take any dietary supplements if they eat a healthy diet. That’s plain wrong.

We already know that over 90% of all adults do not get enough servings of vegetables, fruit, and whole grains every day—and it’s proven that food contains less nutrition than in the past—yet the authors did not recommend doing a nutrition analysis for the patient. With little to no information about the patient’s diet, clinicians are to tell their patients to eat a healthy diet, don’t take any supplements, and go on their way.

These are exceptional researchers; they know how poor the American diet is because they’ve done much of that research. To publish this opinion was incomplete in my opinion and thus it ranks as one of the worst papers of 2018. With almost a quarter million reads and shares passed along through social media and news feeds, millions read what they wrote, and it will influence millions. My opinion is that millions will be less healthy because they accepted these recommendations and dropped their nutrition insurance: their multivitamin and omega 3s and so on.

That doesn’t mean you take every dietary supplement that comes along. The rule is simple: know what supplements you take and more important, exactly why you’re taking them. And work on eating a healthier diet in 2019 as well.

What are you prepared to do today?

        Dr. Chet

Life Expectancy Is More Than Living Longer

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What’s more important to you: living longer or living better with the years you have? Think about it as you read this Memo and I’ll come back to that later.

The Upside of the Study

There were three important lifestyle variables that clearly stood out (1). The more exercise you get, the better off you are. Of those who got perfect 5s, they averaged over an hour per day of exercise. Second, the lower the BMI, the better; researchers didn’t track who might have lost weight over the years to get in the lowest BMI category, but it’s clear that carrying fewer pounds helps.

Finally, the Alternate Healthy Eating Index (AHEI) is a score of the quality of the diet, not the quantity. The highest quintile was below 60 out of 100 possible points. That means you don’t have to eat perfectly; just eat your vegetables and fruit and fewer refined carbohydrates and sugars, and you’ll see benefits.

The Downside of the Study

The subjects were overwhelmingly white and they were nurses and doctors for the most part. Whether that translates to other races and professions, we just don’t know.

The biggest issue for me is the Food Frequency Questionnaire used in the original studies as well as the AHEI scores. Trying to remember what you’ve eaten in so many categories over a year never made sense to me; there’s just too much potential for error. There were also differences in AHEI scores between the Nurses Study (all women) and the Health Professionals Follow-Up Study (all men). The men had an AHEI of 59 while the women in the nurses study had an AHEI of 37.5 in the groups assigned a 5. That makes no sense to me. I know the FFQ were slightly different, but the way the data are extracted to arrive at the AHEI score should have accounted for that. Are men so much better with the quality of their diet? Not buying it.

Supplements

Here’s something I found interesting. The use of a baby aspirin went up as the overall scores went up. In contrast, multivitamin use went up as the overall scores went down. To me, that means that healthcare professionals in all professions know that taking a baby aspirin is good for you. It also means that the poorer the diet, the more people try to compensate with supplements. The goal should be to complement a good diet with a multi, not try to make up for a poor one.

Amount of Time Living with Disease

I asked you a question at the beginning of this memo: what’s more important to you: living longer or living better? Right now, the average number of years spent living with some form of disease is almost 12 years (2). Not every condition is as debilitating as others, but would you rather live longer no matter what your health is or would you rather live well right up to the day you check out? Only you can answer that one. The study didn’t examine quality of life so we don’t know how the subjects did.

Here’s my guess: I would wager that the more healthy lifestyle variables you can add to your life, the longer and better you will live. Eat less. Eat better. Move more. It all starts with those six words.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.
2. https://ourworldindata.org/life-expectancy.