Vitamins As A Health Care Intervention – Understanding Potential Risks And Benefits

[HuckleB]

Vitamins and Mortality
http://www.sciencebasedmedicine.org/index.php/vitamins-and-mortality/


"...

Today vitamins have a deserved reputation for being an important part of overall health. However, their reputation has gone beyond the science and taken on almost mythical proportions. Perhaps it is due to aggressive marketing from the supplement industry, perhaps recent generations have grown up being told by their parents thousands of times how important it is to take their vitamins, or eat vitamin-rich food. Culture also plays a role – Popeye eating spinach to make himself super strong is an example this pervasive message.

...


Based upon the totality of evidence the best current recommendation is to have a well-rounded diet with sufficient fruits and vegetables, which should be able to provide most people with all the micronutrients they require. There is no evidence to support routine supplementation. There is also reason to avoid taking megadoses of vitamins, as this can cause toxicity, and even short of toxicity the evidence becomes more compelling at higher doses of the risks of supplementation.

But there are also many situations in which targeted supplementation is evidence-based and appropriate. There is increasing evidence to support the use of vitamin D supplementation for many populations. Many elderly have borderline or low B12 levels, which correlates with dementia. Pregnant women should take prenanatal vitamins. (To give just a few examples.)

Vitamins are just like any other health care intervention – they have potential risks and benefits and it is best to follow the evidence. For most people the best advice is to ask your primary health care provider which supplements, if any, you should take. Recommendations should be based upon specific health conditions and blood tests to measure levels of vitamins, so that specific deficiencies can be appropriately targeted."


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A good review of the current state of the science. Alas, with supplement companies pushing every little preliminary study they can in order to sell their wares, this is not common knowledge, by any means.

[cutlassmama]

1. A lot of people don't eat right though so these supplements can benefit them

[HuckleB]

2. From the OP:

"For most people the best advice is to ask your primary health care provider which supplements, if any, you should take."

[MedicalAdmin]

12. Sadly, many primary care providers have little to no training ...

... or education in the use or therapeutic application of supplements.


However, this is a great post and an approach that we use at our clinic. Because a subset of people who practice under our roof and with the direct supervision of our medical staff are those who self prescribe vitamins, we ask all new patients to bring in any vitamins or supplements they take or have taken recently.

Our winner so far was a man who hauled in 7 - 30 gallon coolers full of bottles. The doc sorted things out, handed him 4 of the bottles and told him to stop taking the rest.

2 rules of thumb; free medical advice is worth every penny you pay for it, a doctor who treats them-self, has a fool for a patient.



Normally I have some issue with much of what the OP posts, but this one is spot on.

[HuckleB]

15. Actually, they are very well versed in the actual science of supplements.

Most people don't them, and they know to limit what's given to those who do.

If only the "alt med" folks would be as ethical, science based and well trained.

[MedicalAdmin]

16. Sadly that is not our experience.

I can't tell you how many times we have had to send the latest (not to mention the basic, everyone should know) research to other docs who are sharing care for a patient. They simply don't know and they simply were never taught.

Is this completely true? Of course not and many docs have made the effort to come up to speed, but far too many simply don't know and don't want to. I suspect this is mostly because (largely due to interference by and inefficiencies caused by) insurance companies and the lack of time that engenders in a schedule.

I have found that the Canadian doctors we consult with tend to be more up on the research and I suspect this is because they have more time for about the same pay as US docs.

[HuckleB]

17. The "latest" in a long list of self-selected preliminary studies does not equal good information.

Unfortunately, the alt med community doesn't understand that.

You're not teaching MDs anything. You're just making them shake their heads, and wonder how such practices came to be, when the practitioners supposedly doing the informing know nothing about the scientific process.

[MedicalAdmin]

18. And again you make unsubstantiated assertions.

Toodles. And I'll say goodbye for our MD staff too.

You are a positional obsessive and it isn't worth my time anymore. I have a conference to set up for some of those head shaking MDs so they can get CE credits from one of our MDs. Perhaps if you pulled your head out of your ... asinine obsession and looked around a bit you wouldn't come across as such a self absorbed *******. and that just make more people pay attention.

:puke:

[HuckleB]

19. As expected, you can't defend against my assertions.

What you don't understand is that I understand this very well. I have spent a great deal of time talking with supposed experts on supplements: Naturopaths, etc... I know what they do, and how they do it. I know many MDs who deal with these supposed experts and their usual push of selected preliminary studies. I also have many friends who bring these selected preliminary studies home, after seeing their naturopath, acupuncturist, etc..., in order to "prove" to others that said treatment is valid. Preliminary studies do not make any treatment valid, and they do not turn the supplement pushers into experts.

I am sorry to bring reality to your claims.

It's odd that you focus on my responses to BS about supplements by those who are pushing bad science. I get it, however. You work for a place that is pushing that same misunderstanding of how science works.

Instead of noting that, and responding to that, you resort to more personal attacks. I find that to be quite telling.

[MedicalAdmin]

20. And again you make assumptions without knowledge or data.

You have no clue about what we do, how we do it, or what research is used. You never asked you assumed.

And what i find truly funny is that Mr. Science expert made an unsubstantiated claim and then complains when I don't prove his negative claim about how our practice operates. Not some practice you heard about. Not heresay from doctors you "know." and you'll note that I haven't made a single claim about the vague assertions you have made about either science or supplements. But I have taken issue when you claimed we were unethical, stupid, annoying other doctors, etc when you make these claims based on a broad load of nothing but your own assumptions.

You are fucking hilarious dude. So much for a reasonable gathering and understanding of facts. I will leave you to stick to your emotional reactions and unsubstantiated accusations.

[HuckleB]

21. You say I don't know, and yet your response clarifies that I do know.

Such defensiveness tends to tell a good deal.

Again, I do know what the professions at your clinic do, and how they're trained. I know that MDs tend to use the consensus of evidence when it comes to supplement recommendations and that the professions at your clinic tend to use selected preliminary studies to justify their recommendations, yet you claim that your providers are the experts and the MDs don't know what they're doing.

Again, that is at odds with the training provided to the professions in question, as well as to the daily practice of said professions.

Oh, and I thought you were done with me.

[HuckleB]

22. BTW, your confession that you have issues with what the OP posts...

... is more evidence that you don't understand science well.

[SheilaT]

3. So true.

I am a little bothered by those who will promote some particular vitamin as a cure-all for what ails you.

A few months ago at my annual eye exam my doctor (because of a recent move across country, this is only the second time I've seen this guy) once again mentioned the incipient cataracts that have been observable for at least ten years now, and then told me I should start consuming heavy doses of Vitamin C. So when I got home I went to the internet, and found that there's no clear evidence that Vitamin C would make any difference.

So I'm just going to continue as I have for sixty-some years now, eating reasonably well, consuming meat, wine, bear, veggies and fruits (although probably not enough of those last two, I'll concede), and still not exercising enough (I'm being honest here) but I am still the healthiest person I know. I'm still doing head stands at my age, and that says something.

What it all comes down to in the end is that we all do die. From something. It's a real good idea not to smoke, to drink only in moderation, to eat a reasonable variety of fresh foods, and get some exercise. Your genetics also matter a lot, and possibly what you were exposed to as a child, and certainly exposure to toxic things at any time in your life. I think maybe in the end what matters the most is that you make the most of whatever you have, try to enjoy life, be good to others.

[laconicsax]

4. Recommended.

[HuckleB]

8. Thank you.

[hedgehog]

5. At the same time, the current levels were recommended a

century ago based upon preventing gross deficiency diseases: rickets, scurvy, pellagra, beri-beri, etc. Recent evidence suggests that people living in cloudy Northern areas (Great Lakes region) are short of Vitamin D, and that this shortage is associated with depression, some cancers, auto-immune disorders, etc. It sounds like quackery because of all the chronic illnesses involved, but Vitamin D is a hormone basic to many aspects of human physiology. Recently, doctors treating various members of my family coincidentally began treatment for Vitamin B deficiencies. The serum levels were well within "normal" limits, but there is evidence that deficiencies and/or inability to metabolize these vitamins is associated with various chronic diseases that run through the family.

To top it off, there is evidence that modern foods have lower nutrient levels than they did back in the 1940's!

http://www.time.com/time/health/article/0,8599,1880145,00.html

[HuckleB]

7. Which has nothing to do with the article in the OP.

[MedicalAdmin]

13. Our practice is in Minnesota.

And every single patient from here who we test for vit D levels comes up deficient. Lack of exposure to sunlight daily for most of the frosty year.... If only we could convince everyone to sunbath on a snowbank during the winter. 10 minutes should do it....


Yah - not gonna happen.

[xchrom]

6. Recommend

[HuckleB]

11. Thank you.

[Eddie Haskell]

9. America's corporate culture is like a cancer and it's killing us.

Don't eat anything with a label. Don't watch anything with a sponsor. Don't read anything from a syndicate. Turn off, tune out, and drop in. Eat local!

[HuckleB]

10. I generally agree with title line of your post, but...

And eating local is good, but there are pluses and minuses there, too. As for the rest, I'm not sure that's all that helpful.

[MedicalAdmin]

14. Good advice. n/t