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.