For many years there has been a raging debate between conservative medical researchers and the complementary medical world around vitamin supplementation. The argument presented by conservative medicine is that we obtain all of the vitamins we need from a modern diet and we no longer see deficiency diseases to any great extent.

The second component of the argument is that the vast majority of randomised controlled clinical trials using vitamin supplementation have not demonstrated any clinical benefit, and in some cases, have even trended towards some degree of harm.

But, there is a strong argument against this position for the following reasons: 

 

  1. Less than 10% of modern society ingests 2-3 pieces of fruit per day and 3-5 servings of vegetables per day which is the recommended dosage of our major source of micro nutrients. Thus, the majority of people living in the modern world do not get an adequate amount of vitamins, minerals and trace metals from their diet.
  2.  Most of the randomised controlled clinical trials have a follow up period of 5 years or less. This may be adequate for strong synthetic drugs but for lifestyle interventions or natural supplements is not really long enough to show a significant clinical benefit. I make the analogy between a high performance motor car and a bicycle. A high performance motor car will get you from A to B very quickly but with the potential for an accident causing harm and possibly death and thus the need for seat belts, safety mechanisms within the car and very strong road rules to minimise harm. Lifestyle interventions and natural supplements are like a bicycle. It takes much longer to get from A to B but you also get some exercise along the way and the rules and safety precautions for the bicycle do not need to be anywhere near as rigid as for the high performance motor car. As we know too well in this society, the only issues arise when we combine the motorcar and the bicycle on the same road. Thus the concern about interactions between pharmaceuticals and some supplements. Randomised control trials are thus very important for drugs and medical procedures because of the stronger effects and stronger potential for harm but trends in clinical benefits and also improvements in surrogate markers are all that is necessary for natural supplements for all of the above reasons.
  3. All vitamins are not created equal. In Australia, natural supplements are made to pharmaceutical standards and thus what it says on the bottle is actually in the bottle and there are no contaminants. American supplements are made to food standards and thus there is a stronger potential for contaminants and for inaccurate dosing. This, of course, is not always the case but it is always better to source of vitamins that have been made to pharmaceutical grade.
  4. Vitamin supplements are just that i.e. supplements. Supplements are not strong enough to work against poor lifestyle habits. This has been shown clearly when comparing two major supplement studies performed in the United States. The first study, the Iowa women’s study showed no benefit and possibly a mild detriment from taking a multivitamin daily for a follow-up of 19 years. Iowa is typically a working class area with many people practising poor dietary habits. The nurses’ health study & the male physician’s trial from the more affluent Boston area has shown significant benefits from the long-term ingestion of a daily Multivitamins. Up to 10 years of taking a Multivitamin on a daily basis showed no actual benefit. In the physicians who took a Multivitamin for 10 years or more there was an 8% reduction in common cancers and cataracts and then when the data was analysed at 20 years there was a 44% reduction in cardiovascular disease. The observational data in the nurses at 15 years showed a 75% reduction in bowel cancer, 25% reduction in breast cancer and a 23% reduction in cardiovascular disease. A recent meta-analysis published in Mayo Clinic proceedings in January 2017 looking at Omega 3 supplementation showed no benefit in the trials up to 5 years but in the trials beyond 5 years an 18% reduction in cardiovascular disease.
  5. Many other supplements have been studied with significant benefits in surrogate markers. For example, taking natural vitamin E (D-alpha tocopherol) with vitamin C in 2 trials-IVUS, ASAP showed a 25% reduction in atherosclerosis seen using carotid Dopplers. There is also excellent work assessing a variety of surrogate markers with Bergamot polyphenolic fraction, ubiquinol, vitamin K 2 and kyolic age garlic.
  6. Any studies that have suggested no significant benefit or possibly harm have used poor quality, synthetic supplements or had too short a trial length or attempted to correct abnormalities in people with advanced disease i.e. too little too late.

 The problem with this entire debate is the difference of opinion between reductionist scientists and those who take a more global, open-minded view. I am reminded of the analogy of the 3 blind men at an elephant.

One man describes the tusks, another the trunk and another the tail but is it not better to look at the entire elephant. When you examine the long-term benefits for supplementation, in my view, these are very clear but do require a long-term commitment to swallowing pills or potions not recommended by mainstream medicine. At the worst, you are blowing your money but at the best you are gaining extra benefits to living a healthy lifestyle.

Fortunately, at this stage, it is your choice and does not require a regular prescription from a member of the medical profession.