Do Multivitamins Make the Grade:
The Role Vitamins Play in Your Health
by Susan Jenks

Four years after many doctors began advising consumers to take daily multivitamins for their health, unexpectedly poor results in several large vitamin studies appear to have dampened that view.

"There's definitely been a sea change" in some physicians' attitudes, said Dr. Rick Kellerman, president-elect of the American Academy of Family Physicians in Leawood, Kan. "I don't think spending money on these supplements is money well-spent."

Still, millions of Americans pop a multivitamin each day, spending $3.8 billion in 2004, more than half of total vitamin sales that year, according to the latest figures from Nutrition Business Journal.

And a 2005 survey by the industry group Council for Responsible Nutrition found 64 percent of U.S. adults use dietary supplements -- vitamins, herbs and botanicals, sports - nutrition supplements and the like -- in hopes of delaying the onset of cancers, heart disease or other potentially deadly illnesses.

Fort Lauderdale resident Shirley Olson said she takes multivitamins "off and on" -- not on a regular basis -- but relies on herbal and vitamin supplements to beat back colds and bolster her immune system.

Although many doctors object to the lack of rigorous scientific testing for many of these products, it doesn't bother Olson, who was visiting Brevard County recently with her husband, Gary, a computer contractor.

"If they don't work, people won't buy them," she said, while shopping at Nature's Market in Melbourne. "You research it, thoroughly, of course -- I always do -- and talk to a lot of people."

Judy Ivey also turns to multivitamins "as needed," usually two or three times a week.

"Your body tells you when," the 65-year-old Merritt Island resident said.

Few doctors, however, actively support vitamin use, at least not in healthy individuals who eat a well-balanced diet.

Most take a neutral stance, as long as consumers avoid the "alphabet effect" of indiscriminately taking megadoses of single vitamins from A to E, on their own.

"One multivitamin a day isn't going to hurt you," said Dr. Amarin Alexander, medical director for the hospitalist service at Parrish Medical Center in Titusville. "But you have to wonder if it's going to help you in any way."

Even the American Academy of Family Physicians' Kellerman said, "What I personally tell patients is, if you are taking a vitamin a day and you feel better, that's fine. There is no evidence of great damage, although there is no evidence of great good, either."

Little testing

Such lukewarm endorsement underscores what doctors say is a lack of scientific proof multivitamins work, because of regulatory standards that differ from those used to test individual drugs.

Although the U.S. Food and Drug Administration regulates vitamins, they do not go through three stages of clinical testing, as drugs do. Rather, they are regulated as dietary supplements to foods, under the Dietary Supplement Health and Education Act of 1994.

That means manufacturers of these products bear the full burden for their safety and quality, before entering the marketplace.

"Most vitamins do not need to be tested, even though you can overdose (on them), and they can cause harm," said Dr. Christopher Manion, a family practitioner on staff at Parrish. "That's the big difference between vitamins and pharmaceuticals."

However, the FDA does oversee manufacturers' claims in product labeling or packaging inserts for vitamins and other dietary supplements -- defined as products taken by mouth that contain dietary ingredients intended to supplement the diet.

And the Federal Trade Commission, another federal agency, regulates advertising of these products.

"Manufacturers are required to follow certain practices," said Andrew Shao, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition and an industry spokesman.

"The great majority of companies in this industry are responsible and create safe products," he stressed. "Multivitamins are the No. 1 supplement in this country. If they were terribly unsafe, I think, at this point, the FDA and we would know it."

Colleen Cramer, part owner of Nature's Market, said she relies only on "reputable companies" in recommending dietary supplements or taking them herself.

"I take a multivitamin and a lot of other things" to prevent heart disease, which runs in her family, she said.

Also, Cramer said, she encourages consumers "to know what they have" before stocking up on supplements that may or may not help.

"Don't say, 'I think I have osteoporosis,' " she said, referring to the bone-thinning disease. "Go to your doctor and find out first."

'Safety net'

In June 2002, two well-known physicians in the nutrition field argued in the Journal of the American Medical Association that "it appears prudent for all adults to take vitamin supplements."

They reasoned: Too little of certain vitamins carries an increased risk for several chronic diseases, so better to be safe than sorry.

The Nutrition Council's Shao also argues that vitamins provide nutritional insurance for poor dietary habits in today's fast-paced environment.

Because most people "don't weigh their food out for nutrient content," he said, "multivitamins are an insurance policy of sorts for reaching a RDA (recommended daily allowance) of nutrients," established by the Institute of Medicine -- an independent scientific advisory group -- as part of a healthy diet.

Harvard researchers agree -- at least, in part.

On the Harvard School of Public Health Web site, researchers state a "standard multivitamin supplement doesn't come close to making up for an unhealthy diet."

But a multivitamin, they said, does provide a "nutritional safety net," especially for five key vitamins -- folic acid, vitamin B-6, vitamin B-12, vitamin D and vitamin E -- either proven, or still under investigation, for their role in preventing certain diseases.

Scientists know, for example, insufficient folic acid in pregnant women can lead to neural tube birth defects, such as spina bifida, in their babies. And too little calcium, as we age, makes us more susceptible to osteoporosis and bone fractures.

In the elderly, poor nutrient absorption may make a multivitamin "not a bad idea," suggested Dr. Tim Laird, a Health First physician who is a family practitioner in Port St. John.

Children, "due to sometimes-questionable food choices and rapid growth," also might benefit, he said.

Heart health

In heart disease, no studies with any vitamin supplement -- with the exception of fish oil -- "show a reduction in mortality, myocardial infarction (heart attacks) or stroke," according to Dr. Arthur Crossman, a cardiologist at Halifax Medical Center and a spokesman for the Florida chapter of the American Heart Association.

That includes vitamin E, which fell out of favor last year, after researchers found no heart benefit in nearly 40,000 healthy women who took natural vitamin E supplements every day for nearly 10 years.

The surprise finding upended scientists' expectations from observational studies that the powerful antioxidant would reduce oxygen damage inside artery walls -- thus benefiting the heart.

"Maybe, the right trial has not been designed yet," Crossman suggested.

Nevertheless, it is a lack of "hard" research endpoints, such as these, he said, which confounds physicians, whereas, "from natural sources, like fruits and vegetables, we know vitamins offer tremendous benefit."

Dr. Tamer Ahmed, a kidney doctor who is the department chief of medicine at Wuesthoff Medical Center-Melbourne, puts these reservations more bluntly.

"Does the average person off the street need a multivitamin supplement," he asked. "I would say 9.9 out of 10 doctors would say 'no.' "

"Unless you live in a cardboard box, or have a drinking problem, you can get the vitamins you need from whatever you eat," he said, especially today, when so many foods are fortified, or vitamin-enriched.

Judy Slater, the mother of surfing champion Kelly Slater, indirectly shared a similar view.

Although she has taken multivitamins since childhood, she said, it's more a lifelong ritual than anything else.

"I do take one once in a while because I feel guilty," she said. "But I'm not all that sure it works."

Copyright 2006 FLORIDA TODAY (Brevard County, FL) All Rights Reserved

FLORIDA TODAY (Brevard County, Florida) May 9, 2006, BYLINE: SUSAN JENKS Contact Jenks at 242-3657 or sjenks@flatoday.net