The end of the Vitamin Debate? Don't bet on it! Part:2

According to an analysis of data that the National Health and Nutrition Examination Survey (NHANES) collected in 2003–2006, multivitamins were taken by 33% of Americans over the age of one year.  The National Institutes of Health reports that during the year 2012, U.S. consumers spent 5.4 billion dollars on multivitamins.  The reasons that people take multivitamins include “insurance” against nutritional deficiencies and to prevent certain chronic diseases. This widespread consumption of multivitamins, however, has occurred since their introduction in the 1940’s with very little scientific data to support their benefits.
 
Last week, we looked at two recent studies that supported the use of multivitamins. The first found that vitamin deficiency occurs at a surprisingly high rate in our industrialized society.  The second presented evidence indicating that thousands of cases of cancer could be prevented each year by taking multivitamins.

Countering the idea that taking multivitamins is beneficial or life-saving, several studies published in the Annals of Internal Medicine about a year ago drew opposing conclusions. A brief synopsis of the findings from those studies follows:

1. Compiling the results of 3 major trials of multivitamin supplements and 24 trials of single or paired vitamins involving more than 400,000 participants showed no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer.
    
2. A second study looked at the effect that taking multi-vitamins had on mental functioning in an aging population.  After following almost 6,000 male physicians over the age of 65 for 12 years, no differences in regard to mental performance or verbal memory in those who took or did not take multi-vitamins was found.
    
3. A third study evaluated the possibility that taking a multi-vitamin would prevent a second heart attack in 1,700 men and women who had sustained an initial heart attack. This study, admittedly limited by a high rate of dropouts, found no difference in recurrent heart attack rates whether subject took a multi-vitamin or a placebo.

Findings from a number of other studies have determined that, in a generally healthy population who are consuming a well-balanced diet, there are no additional health benefits to be derived from taking multi-vitamin supplements.  Ironically, this is the very population of Americans (healthy, well-fed, etc.) that appear to be taking the lion’s share of these supplements.

Obviously, not everyone in this country falls into the “generally healthy and well-fed” category.  In fact, as last week’s Health Tip pointed out, up to one-third of Americans may be deficient in one or more vitamins. In these people, there is a definite role for improved nutrition and/or vitamin supplementation. There are other instances in which specific vitamin supplementation plays an important role in the maintaining health:

• Calcium and vitamin D supplements in post-menopausal women to reduce the risk of fracture.
   
• Folic acid in women who are considering becoming pregnant in order to reduce the risk of neural tube defects in their newborn.
   
• Vitamin B12 supplements in vegans who may not receive adequate intake since natural food sources of vitamin B12 are limited to animal foods. Vitamin B12 supplementation may also be necessary due to impaired absorption in the elderly.
    
• Iron supplementation for pregnant women since the amount of iron needed for making hemoglobin (the protein in red blood cells that carries oxygen to other cells) may not be provided by diet alone.
     
• The American Academy of Pediatrics advises that individuals who have anorexia, follow fad diets, have chronic disease, consume a vegetarian diet, or participate in dietary programs for managing obesity might benefit from multivitamin supplementation. 

While the debate regarding the benefits of vitamin supplementation will no doubt continue, few would argue that there is a better way to get enough vitamins than by eating a balanced diet with a variety of fruits, vegetables, fortified dairy foods, legumes (dried beans), lentils, and whole grains. The most appropriate role for vitamin supplements appears to be in circumstances in which the diet fails to provide adequate amounts of vitamins or a medical condition causes the need for additional supplementation.

The end of the Vitamin Debate? Don't bet on it! Part:1

According to an analysis of data that the National Health and Nutrition Examination Survey (NHANES) collected in 2003–2006, multivitamins were taken by 33% of Americans over the age of one year.  The National Institutes of Health reports that during the year 2012, U.S. consumers spent 5.4 billion dollars on multivitamins.  The reasons that people take multivitamins include “insurance” against nutritional deficiencies and to prevent certain chronic diseases. This widespread consumption of multivitamins, however, has occurred since their introduction in the 1940’s with very little scientific data to support their benefits.

Clearly, an adequate supply of vitamins is necessary for maintaining optimal health. A few of their important functions include boosting the immune system, strengthening bones, facilitating wound healing, and obtaining energy from food.  Without adequate vitamin intake, vitamin deficiency disorders can develop. Examples of these are anemia (low blood count) due to a lack of adequate vitamin B12 intake and osteoporosis (bone thinning) from inadequate vitamin D intake.  Recently, publications touting the importance of taking multivitamins as well as those indicating that taking vitamins is unnecessary have appeared. Let’s look at some of this information as we consider both sides of the vitamin debate.

A study published last month in the Journal of the American College of Nutrition, looked at nutrient intake from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2008. Of the U.S. adults surveyed, over 40% were found to have inadequate intakes of vitamin A, vitamin C, vitamin D, vitamin E, calcium, and magnesium.  From this study, no conclusions were drawn regarding the effect of vitamin deficiency on health, nor was it determined that standard multi-vitamin supplementation would have corrected these deficiencies.  Nevertheless, this study suggests that there may be a role for vitamin supplementation in American adults with sub-standard diets to bring vitamin levels up to healthy levels.

Results from the Physicians’ Health Study II (PHS II), published last month in the journal Postgraduate Medicine, suggest that multivitamin and mineral (MVM) supplementation may play an important role in cancer prevention. In this study, healthy middle-aged and older men (mean age 64 years) were randomized to taking daily multivitamin and mineral (MVM) supplementation or a placebo and followed for an average of 11 years.  Men taking MVMs experienced a statistically significant 8% reduction in incidence of in all types of cancer.  This translates to a reduction of 68,000 cancers per year that could potentially be prevented with multivitamin use.

These studies point out that not only is vitamin deficiency a significant problem in this country, but that taking multivitamins may provide a protective effect against the development of cancer. Next week, we’ll look at the flip side of the coin regarding the vitamin debate.

The Decision to Decline Immunizations

Today’s Health Tip originally ran in 2012 following the release of a statement from the Centers for Disease Control (CDC) regarding the responsibilities of parents who decline to have their children immunized.  The importance of this statement has been underscored by the recent outbreak of measles linked to an amusement park in California. Not surprisingly, a majority of those infected with measles had not received the vaccine.  With an increase in preventable cases of illness including measles and pertussis (Whooping Cough) this information deserves a second look.

The decision to postpone or decline childhood immunizations has important implications for the child, his or her family, and others in the community.  Recently, the Centers for Disease Control, along with the American Academy of Family Physicians and American Academy of Pediatrics, released a statement outlining the responsibilities of parents who decline to have their child vaccinated.  Today’s Health Tip summarizes some of the most important points from that statement.

Special considerations when an unimmunized child gets sick:  When seeking medical attention for a sick child, it is essential that the health care profession learn of the child’s vaccination status.  This applies whether the child is seen in the doctor’s office, an emergency department, or if the child is traveling in an ambulance. This is because vaccine-preventable diseases will need to be considered as a possible cause for the child’s illness.  Also, the child may need to be isolated to avoid spreading the disease to others. For example, an infant who is not yet old enough to be vaccinated or someone with a weakened immune system could be at risk of contracting the child’s illness.

With an outbreak of a vaccine-preventable disease in the community:  At the time of enrollment, a child’s school or child care facility should be informed about the child’s immunization status.  Should a vaccine-preventable disease strike in the community, it may be necessary to remove an unvaccinated child from school or daycare.  With some vaccine-preventable diseases, it may not be too late to receive protection by being vaccinated.

When an unimmunized child is exposed to a vaccine-preventable disease:  In this situation, the caregivers of the unimmunized child need to know the signs and symptoms of that disease. Medical attention should be sought at the first sign that the child has contracted the disease.  In some cases, a medication may be available to treat the illness, such as the use of an anti-viral medication following exposure to influenza.

When traveling with an unimmunized child:  Even though many vaccine-preventable diseases have become rare in the United States, they may still occur in foreign countries. For example, India, Nigeria and Pakistan continue to have polio outbreaks. Should an unimmunized child become ill with a vaccine-preventable disease, his or her parents should take measures to avoid spreading the disease to others. This could mean cancelling further travel until a doctor determines that the child is no longer contagious. Also, be aware that prior to admission into some countries, immunization against certain diseases, such as Yellow Fever, may be required.

A few of the vaccine-preventable diseases that continue to cause infections in the U.S. include pertussis (whooping cough), hepatitis B, mumps, measles, and Haemophilis influenzae type B (Hib) meningitis. Before deciding to forgo immunizing their children, parents should consider the following facts regarding these vaccine-preventable diseases:

• Cases of whooping cough have been on the rise in the U.S. because of reduced immunization rates, due in part to parental concern regarding the safety of the vaccine. Prior to pertussis immunization, however, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.
• Approximately 20% of people who contract measles require hospitalization due to complications such as pneumonia.  Before measles immunization, an average of 450 measles-associated deaths occurred each year.
• Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases.
• Before Hib vaccine became available, Hib meningitis killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.
• Of the 2 billion persons worldwide who have been infected with hepatitis B, around 350 million become life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants and children. Parents or caregivers should make the decision to postpone or decline immunizations for their children only after being fully informed of the risks and responsibilities.  For more information on childhood vaccines visit the immunization section of the CDC website at www.cdc.gov/vaccines.