To Be or Not to Be: On Vitamins?

In an editorial in the Journal of the American Medical Association, Dr. John Morley decries the over use of vitamin supplements in this country.  First of all, 53 percent of people in the United States take vitamin supplements, with 39 percent using multivitamins. Data is overwhelming that a healthy diet rich in fruits and vegetables is associated with increased longevity and improved quality of life.  However, this does not translate into the concept that taking vitamin supplements confers the same benefits as eating healthy foods.

In fact, some supplements have been shown to actually cause harm.

In a study of 56 clinical trials, there was strong evidence that antioxidants such as Vitamin E and beta-carotene increased mortality. This also was true for higher doses of vitamin A. Much has been written about the damaging effects of free radicals and that antioxidants can improve health by reducing free radicals. In reality, free radicals are essential for survival. They are part of the body’s defense against infection and cancer, and free radicals such as nitric oxide increase blood flow and improve activity in the nervous system.

Vitamin E has been promoted to slow functional decline in patients with early Alzheimer’s disease. However, the change was miniscule and vitamin E had no effect when given with memantine, a drug commonly given to Alzheimer’s patients. Another study of vitamin E in patients with mild cognitive impairment failed to show any effect.

Conversely, foods such as broccoli have been shown to reduce cancer risk, and olive oil and resveratrol, which can be found in red wine, have considerable data to support a reduction in first heart attack, mortality and risk for developing Alzheimer’s disease.

While most Americans would benefit by depending less on supplements and more on healthy diets, there are some beneficial supplements for certain persons. Vitamin B12 deficiency can be caused by pernicious anemia, bacterial overgrowth, and the use of drugs such as omeprazole that significantly reduce stomach acid. Vitamin B12 deficiency is a common, reversible cause of dementia and should be replaced when tests show low levels.

Vitamin D deficiency is common in older adults with exposure to direct sunlight less than 30 minutes daily – think northern Ohio in winter. If needed, supplementation with 1000 units of Vitamin D daily may reduce mortality and the risk of falls. Also, supplementation with calcium and vitamin D may help to reduce the risk of hip fracture in patients with low bone density, including those with osteopenia and osteoporosis.

Finally, older adults who are frail and/or malnourished have increased risk of delirium and cognitive impairment.  Adding food in the form of juice-based drinks would appear to be a better choice than vitamin supplementation as liquid caloric supplements given between meals actually may increase food intake during meals.

Reference: Morley JE Vitamins: The Good, the Bad, and the Ugly JAMDA March 2014