Vitamins are not magic. We need good science and better sense.

The scientific literature is replete with the failure of vitamins to support diseases.  Yet, the industry is booming and people’s cabinets are filled with potentially harmful, poorly studied colorful bottles that make unsubstantiated magical claims.

This year, we witnessed Dr. Mehmet Oz, a celebrity doctor who frequently extols weight loss products, supplements and vitamins on his syndicated television show come under fire from regulatory committees for false claims and poor outcomes.

The vitamin D story is also instructive.   Patients with low vitamin D levels have higher rates of bad health outcomes. But supplementing vitamin D has not been shown to improve outcomes. Patients with low vitamin D levels are ill, often immobile, overweight, and frequently not outdoors playing. Replacement does not change these underlying factors.

After years of study, niacin was once thought to be the most powerful cure for coronary artery disease by most doctors.   It has been reformulated by pharmaceutical companies but has been found not only ineffective but harmful.

There are three clear challenges.  Patients and physicians desperately want to believe in a magical solution to disease that reveals itself in the form of a naturally occurring capsule.  There are those who take advantage of this need by presenting formulations of vitamins and supplements based on no proper double-blinded randomized controlled prospective studies published in peer reviewed journals.  Then, as with niacin, there is bad science which does not look at hard outcomes such as lives saved, but aims to correct laboratory abnormalities which do not necessarily correlate with intuitive outcomes.

There are important lessons in the niacin story.  First and foremost: Do no harm.  The list of complications from medications is long, ranging from abnormal electrolytes to liver and kidney damage, to muscle pain from statins.  We must remain vigilant in treating our patients, to keep the #1 goal: Primum non nocere.

Association is not causation.  Although high HDL is associated with lower cardiac events, and high HDL levels are associated with better outcomes, high HDL levels do not cause favorable outcomes.  Other more potent HDL-raising drugs have failed to improve outcomes.  HDL may be a risk marker but is not a risk factor. Niacin, like many other cholesterol-lowering drugs, is indeed able to change levels of cholesterol. The problem is that changing surrogate markers does not always change outcomes. Recall that the purpose of prevention of heart disease is not to lower cholesterol levels (or blood pressure for that matter) but to decrease future heart attacks, strokes, and death.

The problem with using drugs to prevent heart disease is that they can distract both patients and doctors from the obvious: That good health comes from making good choices. If patients on statins feel free to eat poorly and remain stationary then the drugs fail to confer significant long-term health benefits.

In the end, we need good science and good sense.  There is no magic but proper nutrition, proper exercise and properly studied medicines which save lives, not those which cosmetically correct laboratory abnormalities.

Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists. This article originally appeared in the Jewish Journal.

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  • John C. Key MD

    While this post seems to need a little editorial help, the message is clear: whole food nutrition and moderate activity reign supreme as preventives. The current craze for having everyone on a statin is clearly a victory only for Big Pharma. The ubiquitous daily aspirin will also likely be exposed as a false god.

    • Patient Kit

      Agreed that regular exercise and a healthy diet are key. It’s not complicated. I’m a bit of a gym rat who is addicted to swimming and I eat a fairly healthy diet. I haven’t given anything up completely that I love to eat or drink. Lime and agave “juice” is fruit and vegetable, yes? ;-) Total deprivation is counterproductive for me. Moderation rules. And the “bad” stuff only has treat status and a treat has to be deemed worthy by me, i.e. if I’m going to eat an occasional treat donut, it will come from my neighborhood mom & pop bakery that makes the best donuts in the world, not from Dunkin’s Donuts. Thankfully, said bakery is 20 blocks away from home.

      In my experience, many people will do almost anything to avoid this reality of regular exercise and healthy diet — hence all the gadgets, supplements and ideas people are willing to buy in the hope of losing weight and getting into shape without moving and without modifying their eating habits. Magical thinking weight loss is a huge industry. And it’s the American way to protect huge industries that make boatloads of money, even if all they are selling is illusions.

  • SteveCaley

    We should look carefully at the passion for vitamins, for historically they bridge between our cultural romance with nostrums of the 19th century, and the broad snarl that modern medicine has become caught up in, namely, the Lust for Product.
    There has always been a passion for the One Magic Thing – from Mary Shelley’s novel about the magic of electricity in medicine, to countless other Things of medical interest which can be marketed and purchased.
    Process is dull. Process is predictable. Process is too well known.
    During the late H1N1 scare, I was asked by many people on the sly what the doctor’s special secret was for avoiding flu. When I would tell them, wash your hands, they would become annoyed, as though a guru had turned them away for unworthiness. Wash your hands – how common, how well-known! And still, healthcare institutions still make this little ritual problematic in the placement of sinks and other sorts of things, for this humdrum habit. That works, by the way.
    We prefer something gadgety – something profound and hep, something New and Special, preferably with a scientific name.
    This is where research medicine and practical medicine often stand apart. One treats a malady in the real world, in a single patient, using a number of interventions at once – lose weight, quit smoking, take an aspirin a day. In research medicine, the gold standard is the variation of one variable, all others being held the same. People imagine that such behavior is the secret pathway – all they did is add exotropium b to the solution, and the outcomes changed by 45%! Changing one thing, adding on one magic elixir, that’s the ticket!
    We are habituated into substituting from the medicine that works, to the medicine we like. Regrettably, patient care has always been channeled by human nature, and it will take us some time to evolve to a more rational state. Until then, we will have our vitamins, and some of the most chemically-bewildering urinary streams in biology..

  • guest

    Personally, I would suggest that we as a profession lay off on the vitamin-bashing. Mainstream vitamin supplements are no more unproven or harmful (and in some cases, less so) than many of the interventions we prescribe.

    This relentless outcry against relatively harmless over-the-counter remedies that our patients like to employ, makes us look hypocritical and self-serving. We don’t even study nutrition in medical school; in what regard could we be considered experts on this subject?

  • QQQ

    “In the end, we need good science and good sense. There is no magic but proper nutrition, proper exercise and properly studied medicines which save lives, not those which cosmetically correct laboratory abnormalities.”
    —————————————————————————————————–

    “I trust no one, not even myself.”
    -Joseph Stalin-

  • Mark Feinholz

    Proper nutrition in our food culture often requires nutritional supplements. To suggest out of hand that vitamins are bad and should not be considered as one of the elements necessary to living a healthy life and preventing chronic disease is ridiculous – the medical world needs to wake up to the reality that big pharma is not always the answer.