Anybody who took a basic science course in high school has heard the story about the ship from the Spanish Armada whose crew began dying from a strange, undiagnosed disease on a long Pacific voyage.
When they dropped anchor to bury the dead, one of the ailing sailors sated his hunger with a cactus fruit growing on the shore. His mates followed his lead and gathered up as much fruit as they could to take back to the ship. In two weeks, everyone on board was miraculously healed. A century later, scientists recognized that the men were suffering from scurvy due to an acute vitamin deficiency, caused by a waning supply of fruits and veggies on protracted trips at sea. By then, most ships had taken to carrying huge vats of lemons to deal with the problem — although they had no idea why that worked until 1928, when a Hungarian biochemist identified the cause of scurvy as a lack of vitamin C.
Today, we have a far greater understanding of what vitamins are, what they do and why vitamin deficiencies cause certain diseases. Vitamins, quite simply, are organic compounds critical for maintaining life. There are 13 essential vitamins: A, C, D, E, K and B1, 2, 3, 5, 6, 7, 9 and 12. A serious lack of any one of them can bring on a variety of conditions like scurvy, rickets, pellagra and night blindness. These are no longer a big problem in the United States but still plague the developing world. Vitamins are essential components in all aspects of the human operating system. They’re involved in everything from vision, skin, immunity, DNA production, cell division, nerve function, building and maintaining tissues, muscles, blood cells and more. Once ingested, vitamins act as helpers or catalysts. “Without them, there would be no metabolism,” explains Dr. Hal White, a biochemist who has done important research into the role of vitamins in chemical reactions. “Bacteria, fungi, plants, humans — everybody needs them.” Simply put, without vitamins, we could not survive.
Once upon a time — about four billion years ago — nobody got vitamins from an outside source; organisms were self-sustaining vitamin factories. But in the course of evolution, many species, including our own, lost that internal manufacturing capability. It’s speculated that this happened because as humans got more and more of their necessary vitamins from foods they hunted and gathered, they gradually lost the ability to make their own supply. As Darwin once postulated, why waste energy concocting a substance when it’s readily available all around you? Today, the only vitamins our bodies still make are D and K.
There is universal agreement in the health sciences that food is the best source of vitamins. Period! If you want to follow a diet that fulfills your daily needs, Drexel dietician Nydee Dardarian suggests that good go-to sources for vitamins are: apples, bananas, brown rice, yogurt, protein, skim milk, bright-colored produce (she keeps frozen veggies readily available to add to every meal) and nuts like almonds, pistachios and walnuts. Nuts have become the latest wonder food as new studies find that people who eat nuts every day live longer.
The big problem is that most of us have inadequate diets that don’t supply all of the nutrients our bodies require. As Dr. Ara DerMarderosian, professor of pharmacognosy and medicinal chemistry at the University of the Sciences, says: “If you have three square meals a day, you don’t need vitamins. But who has that ideal diet?”
No one I know has read, let alone can follow, the recommended diet from the National Institutes of Health’s Choose My Plate website (www.choosemyplate.gov ). We eat on the run, grazing on whatever is easy to grab. Obesity is an epidemic. Fad diets have us eliminating one food group after another. Eternal youth from a bottle is viewed by baby boomers as a birthright. No wonder the supplement industry has exploded into a $40 billion-plus money machine by hawking vitamins and minerals to an audience eager to buy into its sometimes-outlandish promises. Ever since Linus Pauling claimed in his 1970 bestseller, Vitamin C and the Common Cold, that vitamin C could cure the common cold, we have come to believe in the magic of pills to improve our health.
A recent National Health and Nutrition Examination Survey conducted by the Centers for Disease Control found that 40 percent of American men and women take a vitamin and mineral supplement. I am one of them because I can’t remember the last time I ate five portions of fruits and vegetables in one day. I take supplements to ensure that I am getting the vitamins I need. That’s why I was flabbergasted when, in the waning days of 2013, the prestigious Annals of Internal Medicine published an article damning vitamin supplements with the force of a rabbi condemning pork at a Bar Mitzvah. In a startling opinion piece, the authors — five respected physicians — stated that supplements and multivitamins are a total waste of money.
Their thesis was based on the findings of three different studies. The first was a meta-analysis of 27 earlier studies that found no evidence that multivitamins prevent cardiovascular disease or cancer nor did they prevent early mortality. The second study looked at people who’d had heart attacks to see if multivitamins protected them against another occurrence. Unfortunately, so many people dropped out of the study that the findings were ultimately considered inconclusive. The third study followed 6,000 doctors for 12 years. There was no improvement in the cognitive function of those who took vitamins versus a placebo. Based on this evidence, the authors advised the American public to flush their vitamins down the toilet and buy broccoli and bananas instead.
The report got tremendous attention in the media and was quickly heralded as the new gospel. I was highly suspicious — and confused. If vitamins are so critical to our well-being and most people have diets with nutritional holes, why shouldn’tsomeone want to swallow a daily multivitamin to fill the gap? Gladys Block, a professor of nutrition at University of California Berkeley, supported my skepticism. “Most Americans,” she says, “don’t have a healthy diet and don’t get the vitamins and minerals they need.” She noted that the men in the doctors’ study were well-fed physicians with no health problems, so their lack of cognitive improvement wasn’t particularly significant. It’s not as if they transitioned from a nutritional wasteland to a new regimen of nourishment where a change could really be measured. And as for the conclusion that multivitamins don’t prevent cancer and heart attacks, that’s not even part of argument for taking them. The primary reason is to maintain general health and wellness — and no institution is funding the study of anything that vague. Frank Duffy, a registered dietician at Temple Hospital, had another concern when he read the report. “For public health, you want to get nutrients to people who need them,” he says, “and the fallout will be that the people who think they don’t need vitamins may be the very ones who do.”
DerMarderosian says that quite honestly, we really don’t know what conditions vitamins might improve and what, if any, boost they provide. “We can prove that too much of a particular supplement is a problem, but it’s nearly impossible to prove what specific vitamins help.” Or as biochemist White told me, “a daily vitamin shouldn’t hurt you. The question is, will it help — and how?” We may not know that answer yet, but there is no denying that vitamins and minerals are vitally important to our overall health; otherwise, we wouldn’t fortify so much of our food.
I called Carol Haggans, a consultant with the NIH office of dietary supplements, for some guidance. She said, “People will take a multivitamin to help fill nutritional gaps in their diet and that’s fine, although it’s preferable to get the vitamins you need from food. That way, you also get other things like fiber that don’t come from a pill.” Haggans worries that vitamin hype, combined with our “more is better culture,” will encourage people to overload on vitamins, which can be dangerous. In large doses, for example, vitamin A can cause birth defects, B6 can cause neuropathy, D can cause calcification and iron can be fatal. On the other hand, there are categories of people who should take vitamins. White says vegetarians need B12 because the primary source of that vitamin for humans is beef, which they eschew. For people on statins, he recommends coenzyme Q, and for pregnant women, folic acid. Everybody in the Northeast, where we get limited sunlight for the long months of winter, should be taking vitamin D. And Haggans supports the use of calcium and vitamin D supplements for bone health and fracture prevention. That’s especially important for teens who are building bone and postmenopausal women who are losing it.
If you do decide to take a daily multivitamin, look for a brand that’s approved by an organization like Consumer Lab, NSF International or U.S. Pharmacopeia. They test for proper manufacturing practices and give a seal of approval, which you can find on the bottle or look up on the Internet. Some of the brands that carry the U.S. Pharmacopeia seal are Nature Made, Kirkland (sold at Costco)and Berkley & Jensen (sold at BJ’s). To be safe, read labels. Many supplements add herbals, botanicals, amino acids and enzymes that may not be good for you. “Be very careful of supplements with the words ‘Mega’ or ‘Super,’ ” cautions Temple dietician Frank Bruni. You want only a standard multivitamin that provides the RDA (recommended daily allowance) or DV (daily value) established by government agencies. Nothing else is necessary for healthy people. It’s also worthwhile to choose a vitamin targeted to your age and gender, as the amounts we need vary over the course of our lives.
There are also some good government websites should you want to explore the controversy in greater depth. Two that I liked were ods.od.nih.gov/factsheets/list-VitaminsMinerals andods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx#Brands
Despite the hoopla created by the report trashing supplementary vitamins, the “to take or not to take” question has not really been resolved. Even the NIH Office of Dietary Supplements straddles the fence. One of its fact sheets states: “Based on current research, it’s not possible to recommend for or against the use of multivitamin–minerals to stay healthy longer.” Given their uncertainty, I have opted to continue to pop my daily vitamin. I side with DerMarderosian. “Taking vitamins is a form of long-term insurance,” he says. “In a perfect world, we’d get everything we need from food — but who lives in a perfect world? So I turn to vitamins because I’m not taking any chances.”o
Carol Saline is the mahoff for all things medical at Inside and the Special Sections of the Jewish Exponent. This article originally appeared in Inside Magazine, a Jewish Exponent publication.