The vitamin question
Proffered as pills, vitamins always "felt so fake" to Josephine Lee, who hails from Europe, where dietary supplements weren't given much credence. Lee rarely dosed her children with vitamins, despite their pediatrician's urging.
Instead, Lee fed her family a diet rich in fresh fruits and vegetables, to which the 61-year-old Medford resident credits her robust constitution. She believes in vitamins, Lee says — when they come from food.
"The fruits and vegetables, they have everything we need," Lee says.
Somewhat smugly, Lee read a recent newspaper story debunking the long-held notion that vitamins safeguard human health. Long-term trials conducted by the National Institutes of Health showed that vitamin C, vitamin E and selenium supplements didn't reduce the risk of certain cancers among more than 50,000 participants, the Los Angeles Times reported in December. Other recent studies proclaimed vitamin and mineral supplements ineffective at staving off stroke and cardiovascular disease, according to the Times.
"I kind of laughed," Lee says. "It's all coming out because that's not the way it's supposed to be."
But the study, some health care providers and supplement experts say, didn't show what it was supposed to.
"The NIH study you have to take apart very carefully," says Dr. Alan Kadish, a naturopathic physician practicing in Medford. "Are you getting a quality product or are you getting junk?
"We don't use anything they've tested, and I was thrilled."
Kadish is among several local purveyors of vitamin supplements who decried NIH's failure to test supplements of varying qualities against each other.
"Not all vitamins are created equally," says Edward Kruse, manager of Healthway Nutrition Center in Medford. "You get what you pay for."
Vitamin supplements derived from real food are preferred over synthetic versions, which don't react in the body like nutrients delivered by nature, Kruse says. Sales of these "whole-food" formulas have more than tripled within the past six months to constitute about 25 percent of the store's total business, he says. While high-quality supplements may cost twice as much as low-grade counterparts, Kruse adds, customers can take a smaller dose and still reap the benefits of increased energy, improved mental function and digestion and better sleep.
"They can notice a difference faster with these products."
Verifiable therapeutic results are the best reason for taking vitamin supplements, says naturopathic physician Dr. Lissa McNiel, whose patients often prefer vitamins as an alternative to prescription medications. Yet patients who practice self-diagnosis will justify taking any supplement — sometimes bags' and bags' worth that they lug into McNiel's Medford office.
"My goal is to really minimize those," McNiel says. "People may be taking things they don't necessarily need."
The doctor asks patients to consider numerous variables before they decide to pop a vitamin pill, including whether the body can even metabolize and use it.
"Coated tablets are best left unpurchased," McNiel says, explaining that they contain the most binders, like gums and waxes, holding them together. Capsules, liquids or powders are the preferred forms for vitamin supplementation, she adds.
"There's some things I definitely don't want in my supplement," she says.
Mercury contamination is of particular concern with fish oil, McNiel says. Manufacturers that go to the source for their fish oil — as opposed to those who purchase from one of a just a few large distributors — are more vigilant, generally speaking, about safeguarding their product from contamination, she says. Consumers should be able to call any supplement company's customer-service department and obtain a copy of its quality-control specifications, she adds.
"If the company doesn't want to give you that information, that's a red flag."
The U.S. Food and Drug Administration will hold makers of dietary supplements to stricter disclosure standards and more accurate labeling beginning next year. The new law will take some of the guesswork out of choosing quality products, McNiel says. But she still encourages patients to approach supplements with caution, asking themselves why they want to use it and who recommended it (a doctor, friend or television advertisement?). Perhaps, more importantly, is the supplement a substitute for making healthy dietary changes? she asks.
"If you can't think of a really good reason why you're taking the supplement ... probably take the money and buy higher-quality food."
With supplements a mainstay of their business, retailers like Kruse reinforce many customers' belief that the modern lifestyle makes it impossible to get all the nutrients humans need regardless of "how good you eat."
"Not many people can find organic spinach, organic blueberries, organic kale," he says, listing some of the foods contained in Healthway's higher-end vitamin supplements.
Long before the term "organic" surfaced in the American vernacular, the government in the 1940s established its recommended daily allowance (RDA) for each vitamin. Those RDAs are still the standard
(see correction below) although the nation's food supply has suffered in quality over the past few decades, says Christy Morrell, a registered dietitian practicing in Medford.
"Most Americans are malnourished," Morrell says.
Yet major dietary deficiencies, evident in diseases like beriberi (thiamine deficiency) and pellagra (niacin deficiency), are no longer seen in the U.S., leading nutrition experts to promote "optimum daily allowances," Morrell says. Higher than RDAs, optimum daily allowances for vitamins prevent "subclinical deficiencies," like reduced concentration and energy levels, she says.
"So many studies have shown that they (vitamins) do make a difference."
Even experts, however, can come up short. Noting that on some days she's too busy to munch a single vegetable, Morrell says most people don't eat well enough to get all the nutrients they need. For that reason, a high-quality multivitamin is the first supplement Morrell recommends for patients who want to take just one pill a day.
McNiel, too, is skeptical of patients' claims that their diets are so pure they have no need for supplements. And for those who admit their diets aren't up to snuff, she also prescribes a high-quality multivitamin, but she counts B-complex, vitamin-D and fish-oil supplements at the top of her list.
The B group's eight vitamins are used in virtually all cellular pathways, keeping the brain and nerves healthy, McNiel says. Vitamin D, according to some "promising" research, may prevent certain cancers and autoimmune disorders, the physician adds. And fish oil, found in cold-water, fatty fish, of which most Americans don't eat nearly enough, is a critical component of cardiovascular health, according to the American Heart Association.
"There's just landslides of research out there, I feel," McNiel says, adding that part of her job is distinguishing the good research from the bad.
"Conflicting studies happen all the time."
Correction: The latest government guidelines use "dietary reference intakes" or DRIs to describe nutrient values.