How did we get to our attitude of dependence on nutrition supplements? Do we hear only what we want to hear and ignore the evidence?  Marketing is so clever; first the marketers find out what we want to hear and then design slick subtle pieces that help us fail to recognize that they, the marketers are targeting our desires, which ultimately entice us to buy something which gives the appearance, rather than the reality, of what we think we want. They know that it is a lot easier to pop a pill than to cook and eat whole fruits and vegetables. I have even seen a TV ad where a harried shopper tried to fill a cart with broccoli and other veggies, only to put them back when she found a wondrous supplement. The only conclusion one could draw is that in its tiny capsules, it had all that was in that abandoned cart of fresh veggies. The marketers know our weakness and will promise anything that sells. At a quick glance, I found promises of strength, agility, memory, heart health, sexual prowess, eye health, enhanced energy, muscle building, and mood health; if I’d spend a few more moments I’d easily find many other lures. Today, with a heart frustrated after reading about some of the latest scams using supplemented food, I want to focus on nutritional supplements.

Marketing ‘health’ remedies, supplements, liniments and the like is not a new idea. My grandchildren will be surprised, that the actual ‘snake oil salesmen’ were before my time; although new versions of the ‘snake oil salesmen’ are alive and well today. I want to briefly mention, however, the snake oil salesman of the Wild West. They were part entertainment and part wild and crazy promises of healing, health, and whatever you wanted to hear. It’s really nice that there are lyrics posted to a Steve Earle song “Snake Oil,” …. A couple of the lines are:

If you ain't impressed yet, just tell me what you wanna hear

I can heal the sick, I can mend the lame

And the blind shall see again, it's all the same

If we stand back and take a long look, it looks pretty silly to get sucked into a deal with a Flim-Flam Vitamin Salesman. I hope that the general public doesn’t have the idea, however, that we stepped into our ‘vulnerable to the marketers’ position by ourselves or that we never learned from our ancestors that snake oil or vitamin preparations were a scam. I can’t pass a chance, to review a favorite comedy segment made during my young girlhood (1952), where Lucile Ball in I Love Lucy, is supposed to be selling a nutrition supplement. The clip is called the “Vitameatvegamin episode” – I think it’s worth watching, simply because it’s still a great laugh.

Certainly ‘hot on the heels’ of the discovery that vitamins and minerals were involved in keeping a body healthy, companies that clearly understood marketing and the public’s desire to have easy solutions to health needs, were ready to make supplements appear necessary or at least helpful.

Prior to the 1930’s, vitamins were obtained solely by eating food; think of it, thousands of years without supplements. Although vitamin preparations began to be available in the 1930’s, humans have recognized the value of eating certain foods to stay healthy for a very long time.  Most of us think of the British, learning in the mid-1750’s about limes solving the scurvy problem for sailors, but the Chinese identified beriberi as early as 2697 B.C. The Egyptians identified night blindness by 1500 B.C.; and would feed liver to cure night blindness.   I don’t really know when Jeremiah was written but it says in Jeremiah 14:6 of the Old Testament “and the wild asses did stand in high places, their eyes did fail because there was no grass.” The point is, that we humans have known for millennia that food was not just for energy or pleasure, but was involved in keeping our bodies healthy. What we’ve only known for decades (about 7 ½), a relatively short period compared with the entire history of mankind, is that there are some vitamins and minerals that are essential to life, that cannot be made by our bodies and must be consumed.

We did not make the leap from eating foods to taking nutrition supplements and having supplements added to our foods without some extensive marketing and what we have called elsewhere “mis-education by advertising”. The American Medical Association offered one recommendation that really stands out. In 2002 they published the following words in the Journal of the American Medical Association (JAMA):

“It appears prudent for all adults to take vitamin supplements.

Researchers hope JAMA's endorsement will encourage more people to reap health benefits of a daily multivitamin.”

“Health experts are increasingly worried that most American adults do not consume healthy amounts of vitamins in their diet, although they may be getting enough to ward off such vitamin-deficiency disorders as scurvy, beriberi and pellagra.

Almost 80 percent of Americans do not eat at least five helpings of fruits and vegetables a day, the recommended minimum amount believed to provide sufficient essential nutrients. Humans do not make their own vitamins, except for some vitamin D, and they must get them from an outside source to prevent metabolic disorders.”

Until last year, another organization, The American Dietetic Association was also very pro-supplementation. The relatively new (December 2009) position of the American Dietetic Association on nutrient supplementation tries to guide the public toward eating “a wide variety of foods in your daily diet.” Their 12-page position paper still, however, leans toward solving nutrition problems of those who eat inadequate diets by recommending supplements.

What is leading us away from the supplement mindset?

There seems to be a constant flow of research articles that report that vitamin supplements are not beneficial and many are shown to be harmful or, in the very least, it is said that more research is necessary to provide stronger evidence that supplements are harmful. That evidence appears to be trickling into the journals. The scope of this post is far too small to list all the articles that have led to the conclusion that we should get our nutrients from food, and not from supplements, but I will list a few key studies that highlight why medical doctors and dietitians are moving away from relying on supplements.

The ATBC Study conducted in Finland ended in 1993. It was stopped after learning that giving beta carotene to smokers, actually increased cancer and death rates, when the study was designed to show how much it would help smokers.  This was a seminal study that seemed to really initiate the concept that nutrients could be harmful (when given in excess as supplements) as well as beneficial (when taken in foods). I can’t speak for all schools of public health nutrition, but the professors at the UCLA School of Public Health, where I studied for my Masters in Public Health Nutrition were way ahead of the curve in their thinking on this issue. We students were clearly taught that supplements could be toxic and taking doses of supplements could be dangerous.

About five years after the 2002 published words of JAMA there began to be more reports of vitamin supplements actually being harmful. In 2007 JAMA published a review saying: Our systematic review contains a number of findings. Beta carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality. There is no evidence that vitamin C may increase longevity. Increasing the chance of death – not increasing longevity is not what vitamin marketers want to hear – they know the public wants to hear about living longer, healthier lives by popping in a nutritional supplement.

In a third JAMA article, published in 2008 the following words were published: “Combined folic acid, vitamin B₆, and vitamin B₁₂ treatment had no significant effect on overall risk of total invasive cancer or breast cancer among women during the folic acid fortification era.” So widespread promises of treating cancer with folic acid fortification were smashed. It now appears that folic acid supplements may actually increase the risk of cancer.

I continue to read recommendations by some nutritionists that vitamin supplements should be provided for those who do not eat a healthy diet. The assumption is that a vitamin tablet, can indeed; provide the nutrients that are being missed when someone consumes an inadequate diet. Prevention Magazine quotes Miriam E. Nelson, PhD, Director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention at Tufts University’s Friedman School of Nutrition science and Policy as having said; “The multivitamin as insurance policy is an old wives’ tale, and we need to debunk it.” Short and Sweet!  Taking a multivitamin to provide the hundreds/thousands of nutrients found in whole foods is truly an old wives’ tale.

It seems as though we are going back in time to when the great diseases like beriberi, scurvy, and pellagra were a major concern. When we discovered the single nutrient that cured each major nutritional deficiency, we somehow got the idea that special single nutrients were the only treatment necessary to keep people from each specific disease and therefore, keep them healthy. I personally believe that there is a fairly wide margin between not having a serious deficiency disease and health. Many of the trace nutrients, phytonutrients, and antioxidants, are yet to be discovered. Of those that are discovered, we do not know the mode of activity for many; we don’t know if they react with other nutrients, accomplishing biological functions in combination with other nutrients, not merely by themselves.

For these reasons, some years ago, I began to abandon the concepts of nutritionism, of teaching or writing about specific nutrients. I changed my focus to trying to help the public identify ways of incorporating improved eating patterns, including eating whole unprocessed foods.

Last year, 2009 JAMA published a research study that shows that it’s possible to have too much of a good thing. The researchers examined clinical trials where almost 7 thousand patients were given combinations of folic acid, vitamin B12, vitamin B6 in an effort to reduce homocysteine, an amino acid in the blood linked to heart disease. Norway does not supplement with folic acid, as the U.S. does, it therefore, seems to be ideal to discover if the supplemented nutrients could make a difference.  Unfortunately, those who received the folic acid plus the vitamin B12 were 21% more likely to be diagnosed with cancer and 38% more likely to die of cancer. The researchers concluded that it is safest to get your nutrients from food, and that high-dose supplements shouldn’t be relied on to prevent chronic disease.

Folic acid, one of the B vitamins, has been long known to reduce a protein, homocysteine, which has been linked with heart and blood vessel disease.  So you can, of course, see where the logic would take this one.  If we can reduce the homocysteine in the blood with supplements of folic acid, then hopefully the risk of heart disease, stroke or cancer would also be reduced. A very large-scale analysis published in the October issue of the Archives of Internal Medicine showed that supplements containing folic acid didn’t reduce the risk for cardiovascular disease, death or cancer, even when given at high doses. Even though those taking the folic acid supplements saw a 25% reduction in homocysteine, the subjects were just as likely to have a heart attack or stroke as those receiving a placebo.

Jeffrey A. Tice, M.D., one of the researchers of the folic acid study suggested that consumers be cautious about high-dose supplements. He used vitamin E and beta carotene as examples of vitamins that at one time were believed to have a strong scientific rationale for long-term health benefits of high dose supplementation, but are now known to be harmful. He also cautioned the public to be wary of the current enthusiasm for vitamin D and omega-3 fatty acids until large randomized studies are completed. His advice is not so jazzy, but he suggests that; “The best way to optimize your health is to exercise regularly, eat a nutritious diet, avoid smoking and maintain a healthy weight.”

Another example reported in the Journal of Nutrition by Tufts University is found in a U.S. study that linked high blood levels of the mineral selenium to increased levels of non-HDL cholesterol – the more selenium, the more bad stuff and no benefit to the “good” HDL cholesterol). Heads up! Why would any of us want to take selenium supplements to raise our “bad” LDL cholesterol?

Science continues to discover more about vitamins, minerals, antioxidants, and phytonutrients. The first step is that science makes an observation that eating a certain food, or group of foods, is related to having better health, or lower risk of certain diseases. The second step is that frequently the researchers say, “Oh, this food has nutrient X, therefore it is nutrient X that matters.” This is an interesting step in the process, because it is often a marker nutrient that the researchers already know how to identify and measure. Thus, in studies they can easily learn how much is in the food. It is often just a guess, letting that one nutrient stand for the entire food or group of foods. It is truly a blind guess from thousands of possibilities, but it sounds scientific. Then that one single nutrient is exclaimed to be the entire story of why the people who eat the food or group of foods don’t have certain diseases as often. Where things ‘fall apart’ is that foods contain hundreds of nutrients, and we have just barely learned enough to realize that we can’t always ‘guess’ which of the nutrients is causing the improved health; or if it is, in fact, a combination of many of the nutrients working together.

My personal opinion (albeit backed by some very strong research) is that the marvelous human body can sustain life for quite a while, when not optimally nourished; but if the best possible health is what you desire, it is time to abandon dependence on supplements and dedicate the necessary effort to nourish yourselves and your families with real whole foods. We should recognize that none of us will get what’s necessary for the desired best possible health from the food processors, who continue to provide highly-processed impoverished food-like substances with a few limited nutrients added to try to grab our attention and make us believe the food-like substances are really healthy.

An idea for Americans - a Chinese snack food truck.