Dr. John Day, Cardiologist

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Should I Take Vitamins and Supplements?

With recent articles like “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements” appearing in prestigious medical journals, many people are now reconsidering their daily vitamins and other supplements.  Yet, half of all Americans still take vitamins and supplements.

When you look at who is taking supplements in the U.S., it is generally women, older Americans, and those who are more educated and better off financially.  Should you still take your vitamins and supplements?

My Vitamin and Supplement Disclosure

Before we get too far into this article, I should disclose that I do take vitamins and supplements.  In the past, I used to take a multivitamin and fish oil.  However, given the potential risks of each individual component in the multivitamin, I try to get all of the nutrients I need from real food and I now only take the following:

1. I take a vitamin D supplement from November 1 through March 31 as I live in Salt Lake City which is too far north (above the 37th latitude) for natural vitamin D from the sun during the winter months.  While I do get some vitamin D from fish and eggs, I have tested my levels in the winter and they are low from fish and eggs alone.

2. I take iodine, in the form of whole kelp, several days a week as I rarely eat dairy, my salt is not iodized, and I cannot get enough iodine in my diet from eating wild salmon and strawberries several times a week.

3. I take a biologically active sublingual form of vitamin B12 weekly to ensure that I am getting enough of this vitamin as I generally only eat meat on the weekends (wild salmon) and may only have eggs once a week.  It is very possible that I am getting enough vitamin B12 from the fish and eggs alone.  At some point in the near future I will test myself to see if this is indeed the case.

The Concern with Vitamins and Supplements

Why are prestigious medical journals attacking the powerful 30 billion dollar supplement industry?  It is because most vitamins and supplements have not been shown to prevent chronic disease or premature death.  Moreover, vitamins and supplements may potentially even increase your risk of certain diseases, cancer, or premature death.

Clearly, there is a role for vitamins and supplements when people have known deficiencies.  Also, while people may be eating all of the right foods they may not be fully absorbing key nutrients in their gut.

Potential Risks of Specific Vitamins and Supplements

It seems like each year there is a new study documenting the potential dangerous effects of certain vitamins and supplements.  Here is a review of the life-threatening potential risks of the most popular vitamins and supplements.

1. Vitamin A and Beta-Carotene Supplements

It seems like a paradox, and one that will play out over and over in this article, a diet high in vitamin A and beta-carotene from real foods (fruits and vegetables) decreases the risk of cancer.  However, in well designed clinical trials, vitamin A/beta-carotene supplements had the opposite effect.  When taken as a supplement the risk of cancer was increased!

Fortunately, it is very easy to get all the vitamin A we need from a diet high in fruits and vegetables (here is a list of the vitamin A containing foods).  Clearly we do not understand the myriad of effects of the thousands of different molecules in real food versus an isolated single molecule in a supplement.  Thus far, scientists have not been able to replicate the health benefits of real food in a supplement form.

2. Vitamin E Supplements

Unfortunately, there is an increasing body of data that vitamin E supplements may increase the risk of cancer.  Other studies have shown that vitamin E supplements may cause premature death.  We don’t yet know what dose of vitamin E increases our risk of cancer or premature death.  As vitamin E is in most multivitamins, this does cause me some concern.

Vitamin E is an important antioxidant and can prevent many chronic diseases when eaten in the form of real food. Fortunately, for those eating a healthy diet with plenty of nuts, seeds, fruits, and vegetables it should be easy to get all of the vitamin E your body needs from real food.  To learn which foods contain vitamin E, here is an excellent reference.

3. Selenium Supplements

Once again, while selenium is a powerful antioxidant and can help to decrease your risk of heart disease and cancer, taking too much of this through supplements may increase the risk of cancer.  Selenium is an easy nutrient to get from real foods.  Just one Brazil nut each day is all you need to get enough of this important mineral in a real food form.

4. Folic Acid Supplements

In an effort to reduce the risk of neural tube defects and other folate deficiencies, folic acid is now regularly supplemented in refined grains and processed foods.  If you eat processed foods and also take a multivitamin you are probably getting too much folic acid.

While high dietary intake of folic acid has been consistently associated with lower cardiovascular disease and cancer, taking it in the supplement form has shown no benefit in preventing heart disease or cancer. Even worse, research is emerging that folic acid supplementation may increase the risk of cancer and cause premature death.

Once again, it is easy to get enough folate in your diet particularly if you eat your greens and legumes each day.  To see which foods contain folate, here is an excellent reference.

5. Magnesium, Zinc, Copper, and Iron Supplements

Magnesium, zinc, copper, and iron are considered a “must have” in most multivitamins.  However, some data have linked these minerals, when taken as a supplement, to an increased risk of premature death.

The data implicating these minerals as potentially dangerous is tenuous at best.  Correlation does not mean causation.  It is possible that “sicker” people gravitated to supplements as a way to start feeling better.

Regardless, it does cause some pause for concern.  Especially that in most cases, these minerals can be easily obtained as part of a healthy balanced diet of real foods.  Follow these links to find out what foods contain magnesium, zinc, copper, and iron.

6. Calcium Supplements

While calcium supplements are commonly taken by older women as a means to prevent osteoporosis, could it be possible that calcium is actually causing harm?  Yes, according to this study.  Calcium supplements increase the risk of a heart attack by 31% in this study.

There are certainly other ways to ensure healthy bones.  For example, daily exercise, including strength training, and plenty of vitamins K and D as well as calcium through a healthy diet and lifestyle can do wonders for our bone health.  For a list of foods high in vitamins K, D, and calcium click on these links.

7. Fish Oil Supplements

A few years ago cardiologists were enthusiastic about giving fish oil supplements to most cardiac patients.  I even took fish oil supplements for a period of time.  As fish has long been known to be very heart healthy, it was just typical human thinking to think that we could get all of the benefits of fish in a simple little fish oil pill.  Indeed, early studies even supported the health benefit of a fish oil pill.

Now, there are more and more studies coming out about the potential cancer risk of fish oil supplements.  Once again, we can get all of the cardiovascular benefits from fish by eating real fish at least twice weekly as recommended by the American Heart Association.  For me, I generally have wild salmon each Saturday and Sunday.

Should I Take a Vitamin D Supplement in the Winter?

Low vitamin D levels have been linked to most chronic diseases and even premature death.  Certainly, the best way to get vitamin D is in a sun-smart way so that your risk of skin cancer is not increased.

Unfortunately, if you live above the 37th latitude in the Northern Hemisphere (north of Los Angeles) or below the 37th latitude in the Southern Hemisphere, much of the year it will be difficult for you to get the vitamin D your body needs from the sun.  Here is a map to see where the 37th latitude runs in the U.S.

Fortunately, there are now great apps for smart phones that can even calculate your daily vitamin D intake from the sun and food.  Here is the free iPhone app that I have started using.  For a list of foods high in vitamin D you can click on this link.

Who is Regulating the 30 Billion Dollar Vitamin and Supplement Industry?

Would it surprise you to hear that the answer is no one?  While prescription medications are highly regulated by the FDA, no one is making sure our supplements are free of contaminants or even contain the amount of the supplement listed on the label.  To make sure you are even taking what you think you are taking, make sure that any vitamins or supplements you take are USP or GMP certified.

Vitamin and Supplement Use in China’s Longevity Village

From our research of the centenarians in China’s Longevity Village (links to a video and news report) it was readily apparent that none of them took any vitamins or supplements.  They obtained all of their needed nutrients from their food, water, and sunlight.  The same can be true for us.

Should I Take Vitamins and Supplements?

Returning back now to our original question, should I take vitamins and supplements.  The simple answer is, it depends.  If you have a documented nutritional deficiency, that cannot be corrected with real foods, then you would be a good candidate for vitamins or supplements.

Here are my four thoughts on vitamins and supplements.

1. Vitamins and supplements are very helpful if you have a documented deficiency.

If you have been tested and are low in certain vitamins or minerals, that cannot be corrected by eating real foods, then vitamins and supplements can be very beneficial.  Work with your physician and get tested to make sure you do not have any vitamin or mineral deficiencies.

2. Vitamins and supplements are like pharmaceutical medications.

They have potential benefits and possible risks.  Make sure you discuss the risks and benefits of any vitamins or supplements with your physician before you start taking them.

3. Vitamins and supplements may be contaminated or not even contain what they claim to contain.

There are many reports of people harmed by tainted vitamins or supplements.  Make sure that if you do choose to take vitamins or supplements that they are USP or GMP certified.

4. Supplements cannot replace the nutrients that we can get from real foods.

With a healthy diet it is possible for most people to get all the nutrients that they need from real food sources.  The World’s Healthiest Foods website is a reference that I frequently check to make sure I am getting all of my key nutrients from food.