A series of articles published on Dec. 17 in a prestigious medical journal, The Annals of Internal Medicine, received a lot of press because of an editorial entitled, "Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements."
It's safe to say that many reporters and commentators did not actually read the studies, because the data published actually revealed the opposite, at least for heart disease and for cancer in men.
So I'm going to tell you what the results of the lead study reveal, which is very different from what's been reported.
In this study, 1,708 people who had already suffered a heart attack were given either a high dose multivitamin and mineral or a placebo and were followed for about 4.5 years. Most of them were white men between the ages of 59 and 72 with high cholesterol and high blood pressure.
Because many of the people were taking statin drugs, and extensive research has shown that statin drugs substantially reduce the risk of a second heart attack, it's important to look at the data in people not taking statins.
There were 236 people not taking statins who received a placebo pill instead of the multivitamin and mineral. Over the study period, 35 percent of them experienced a second cardiac event (heart attack, stroke, death or cardiac surgery), a frequency that would be expected in this high risk group.
Of the 224 people not taking statins who received the multivitamin, only 23 percent experienced a second cardiac event. That's a 34 percent reduction of cardiovascular risk associated with the multivitamin compared to the placebo, enough to reach a high level of statistical significance, which makes it unlikely that this effect is simply due to chance.
Although the study was not designed to test the effects of statins, it is possible to measure the effect of statins in this population. There were 619 people taking statins who received no multivitamin; 27 percent of them experienced a cardiac event during the study period. In other words, the effect of the multivitamin was at least as good as the effect of the statins.
The combination of a statin and the multivitamin produced no additive benefit, however. Of the 629 people who were taking statins and also received the multivitamin, 28 percent experienced a cardiac event during the study period.
This is not the first time that statins and vitamins have been shown to interact in an unfavorable way. I reviewed how vitamin E and statins interfere with each other in an earlier blogcalled "Mixing Medications and Vitamins: When It Hurts, When It Helps."
How could anyone conclude from this study that vitamins showed no benefit in preventing heart attacks?
By pooling all the results, lumping the effects in statin users and statin non-users together, so that the apparent benefits of the multivitamin and mineral shrunk and failed to be statistically significant.
This is the approach you might take if that was the result you wanted to report. The authors of this study made their bias clear when they cautioned against the use of vitamins as a substitute for statins, even though the vitamin effect was actually greater than the statin effect.
It's important for you to know that the vitamin and mineral pill used in this study was not an ordinary multivitamin. Here is its daily content:
Vitamin A (fish liver oil and beta-carotene) 25,000 IU
Vitamin C (calcium, magnesium and potassium ascorbate) 1200 mg
Vitamin D3 100 IU
Vitamin E (d-alpha tocopherol) 400 IU
Vitamin B3 (niacin and niacinamide) 200 mg
Vitamin B6 50 mg
Folic acid 800 mcg
Vitamin B12 100 mcg
Biotin 300 mcg
Pantothenic acid 400 mg
Calcium 500 mg
Iodine 150 mcg
Magnesium 500 mg
Zinc 20 mg
Selenium 200 mcg
Copper 2 mg
Manganese 20 mg
Chromium (as polynicotinate) 200 mcg
Molybdenum 150 mcg
Potassium 99 mg
Choline 150 mg
PABA 50 mg
Boron 2 mg
Vanadium 39 mcg
Citrus bioflavonoids 100 mg
This study leaves many questions unanswered:
What are the critical nutrients in this combination?
Would a different multivitamin have produced the same results?
Would this supplement work as well for people who never had a heart attack, or for younger people?
These questions are important to answer, but the irresponsible reporting and the biased presentation prevented these important questions from even being asked.
Scientific truth always lies in the details. For people to understand the true meaning of a scientific study, the details have to be made known.
Now I'd like to hear from you:
Do you take vitamins or other supplements?
Have you noticed any immediate or long-term affects?
What you think of the recent media coverage about vitamins?
Please let me know your thoughts by posting a comment below.
Leo Galland, MD
Leo Galland, MD is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.
References and Further Reading
"Oral High-Dose Multivitamins and Minerals After Myocardial Infarction. A Randomized Trial" Lamas GA, Boineau R, Goertz C, et al. Annals of Internal Medicine, 159: 797-805 (2013).
"Enough is Enough. Stop Wasting Money on Vitamin and Mineral Supplements" Guallar E, Stranges S, Mulrow C, et al. Annals of Internal Medicine, 159: 850-851 (2013)
This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician--patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.