Response to New York Times Article: Vitamins: More May Be Too Many, 4/29/03
Gina Kolata, in her recent article in the New York Times (Vitamins: More May Be Too Many, April 29th, 2003), makes several valid points regarding the necessity of a nutritious diet and the possibility of consuming an unhealthy amount of certain vitamins. However, her article is not congruent with the significant literature that exists regarding the benefits of nutritional supplements.
First, it is obvious that nutritional supplements do not mitigate the need for a healthy diet. A nutritional supplement cannot completely reverse the damage caused by a diet high in saturated fats or a sedentary lifestyle. Further, there are certain vitamins that can cause harm if taken in abundance and the consumer should be aware of these dangers.
However, most consumers do not take nutritional supplements to avoid deficiency – an adequate diet will provide the levels of most nutrients to avoid deficiency. Consumers take vitamins to promote their health and prevent disease. The RDI levels of vitamins and minerals are based on amounts necessary to prevent deficiency. The paradigm regarding nutritional supplements has changed and scientists and consumers realize that levels above the RDI are needed to promote health and prevent disease.
Ms. Kolata mentioned a classic example of folic acid supplementation in her article. Folic acid supplementation significantly reduces the probability of fetal birth defects. In 1996, the FDA mandated the fortification of certain foods (flours, grains). Thus the FDA realized that a significant percentage of the population do not get the amount of this vitamin necessary to prevent neural tube defects – fortification was mandated and supplementation was recommended. In addition, most physicians recommend up to 1 mg of folic acid to women planning a pregnancy – well above the RDA for this group. How many neural tube defects could have been prevented with folic acid supplementation if it was recommended after the first randomized control trial showed benefit?
The same paradigm shift holds true for many other nutritional supplements including calcium and omega-3 fatty acids. The benefit of calcium supplementation, at doses higher than generally consumed in our diet, is well established and is accepted by the FDA and the scientific community. There is extensive research that omega-3 fatty acid supplementation can decrease the risk of a heart attack and lower triglycerides levels. In addition, the omega-3 fatty acids decrease the risk of sudden cardiac death and may be beneficial against strokes and hypertension. New research shows that its anti-inflammatory properties may be beneficial in other disease states such as arthritis. The American Heart Association recommends intake of one gram of omega-3 fatty acids per day, preferably from food. Most people do not consume fish at adequate levels to achieve these benefits.
Finally, I must take exception to your comments on vitamin E. Vitamin E has been shown to be effective in rigorous clinical trials, both through its antioxidant properties and other mechanisms, for conditions such as Alzheimer’s and macular degeneration. The results for vitamin E and selenium in observational studies and the ATBC study have been so promising, that the National Cancer Institute, initiated the largest clinical study ever for evaluating th