By Edward Pullen, MD. Check out drpullen.com, a medical blog for the informed patient.

I’ve been asked, “What vitamins should I take?” by many patients over the years. I’ve usually answered that a store-brand multiple vitamin is a good choice for most people, but recent evidence suggests that maybe the best answer to the question is that most people who have a reasonably healthy diet are best taking no vitamins at all. I know that answering the question, “What vitamin should I take?” with the answer that most vitamin supplements may cause more harm than good is not likely to be the answer patients want to hear, but as more evidence becomes available, it is clear that we just cannot get the healthy nutrients of a balanced diet in a pill, and that attempts to do so may actually be detrimental to our health.

In the nearly 30 years I’ve been practicing medicine, there has been one miracle vitamin/mineral/supplement after another in vogue, and almost none of them have stood the test of time. The only way to get the full benefit of nutritious foods is to eat them.  Bummer.  It’s so much easier to just buy vitamins or supplements and eat junk. Sorry, but that just doesn’t give the benefits of a nutritious diet.

In the last couple of weeks, two new studies show that there may be more harm than good from taking several vitamins.  A large study, published in the Archives of Internal Medicine, where 38,000 women were followed for 17 years showed slightly higher death rates in women taking multiple vitamins than in women not taking them. Specifically, taking multiple vitamins, vitamin B6, iron, copper, zinc and magnesium were all associated with statistically significantly higher death rates.  Only calcium seemed to be associated with slightly lower death rates in this study of older women.

An NIH study released recently showed that Vitamin E is associated with higher rates of prostate cancer.  Over the years, Vitamin C, Vitamin E, beta carotene, saw palmetto, multiple antioxidant regimens, and nearly every vitamin with a letter or number has been in fashion for reduction of one health condition or another. One by one, they have almost all been shown to be useless or worse.

Who else remembers the theory that the whole trick to avoiding atherosclerosis was to ingest the right ratio of saturated to polyunsaturated oils?  I remember a resident physician in Boston who, when I was a student, urged everyone to drink corn oil every day so that we could eat all the meat we want because our ratios of fat consumption would be in balance, and that would make eating animal fat OK.  Most of us laughed at him, but that theory had lots of followers 30 years ago. Beta-carotene and vitamin E as antioxidants have been clearly shown to be more harmful than good.

So what’s a person to do? Here are my suggestions:

1. First and most important, try to eat a healthy diet.  Avoid fad diets, eat more fruits and vegetables, eat less meat and exercise more.  Don’t think you can rely on vitamins, mineral supplements, or gimmicks to substitute for healthy eating. See previous posts on Anti-inflammatory Foods, Foods High in Fiber, and Anti-aging Diet.
2. Be skeptical of whatever vitamin or supplement craze is in fashion at any given time.
3. Don’t think that more is better regarding vitamins.  It has long been known that high doses of vitamins A, E and B6 can be toxic.  There is little evidence to support high doses of any of the other vitamins either.
4. Keep in mind special conditions where supplementation with specific vitamins is important.  Examples of these include many causes of malabsorption like gastric bypass surgery, some medication use and celiac disease.
5. Understand that this is a long-term issue.  Eating well this month is good, but eating well for a lifetime is the key.
6. Avoid vitamin regimens that have been clearly shown to do more harm than good.  These would include:

• Beta-carotene supplements
• Vitamin E supplements in most people
• Iron supplements in men and postmenopausal women
• High-dose supplements with nearly every vitamin.  Currently, vitamin D is in vogue, and currently, most of the data looks positive.  Time will tell whether this works out or not.
• I’d avoid even a daily multiple vitamin at this time if you eat a reasonably healthy diet and have no specific reasons to take the vitamin.

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Dr Pullen Lives the Mediterranean Diet

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