There’s Vitamins and then There’s Vitamins

Note from Mike: I recently tweeted an NYT story that claims deleterious health effects from consuming too many vitamins with the note that I thought it likely people were gobbling too many pills. My wife decided the article merited a response.

This NYT article on vitamins contained a few scientific issues that I feel the need to respond to. Unfortunately, the NYT didn’t allow opinions to be expressed so you will have to endure my ranting and raving.

The article provides details about published studies, two of which are published in The New England Journal of Medicine, that claim deleterious effects from excessive vitamin consumption. These studies show that those that took Vitamin A or beta carotene (Vitamin K) supplements were more likely to die from lung cancer or heart disease compared to those who didn’t. The article also lists other studies showing a correlation between taking Vitamin A, E, beta carotene (Vitamin K), Vitamin C and selenium supplements and mortality. The author then goes on the say the link between mortality and the vitamins ingested are antioxidants.

I cannot agree with this conclusion as this conflates fat soluble vitamins and water soluble vitamins and minerals. Vitamins A, D, E and K are fat soluble meaning any excess taken in the diet is stored in the fat of an individual and the body can’t regulate these nearly as well as the water soluble ones. Selenium is water soluble, as are the Vitamins B and C. An excess of a water soluble vitamin or mineral is removed in the urine by the body. I can therefore see the disease and mortality states arising from fat soluble vitamins. But I am concerned that the studies showing consuming the water soluble vitamins plus Vitamin C and selenium came to the wrong conclusion. It may be a case of guilt by association with the fat soluble vitamins. Have any studies looked at water soluble vitamins in isolation?

I worry about this because there are benefits to high vitamin levels for certain conditions. The third paragraph claims:

Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better.

Up until I was diagnosed with multiple sclerosis (MS), I would have subscribed to the nutrition experts’ opinion as well. But after turning my research interests towards the genetic underpinnings of MS (I am a medical geneticist), I quickly uncovered how vital Vitamin D is in the management of the relapse-remitting disease. I even tried getting out in the sun in the summer and turned to tanning beds in the winter to maximize my body producing enough Vitamin D to manage my MS without resorting to Vitamin D supplements. After many flare ups over a two to three year period, the last of which put me in a wheelchair in the summer time, my Vitamin D level came back each time as below optimal levels. For this reason, I now take four times the FDA recommended level of Vitamin D in a supplement form to help manage my MS. Over the past year of doing this, I can report, my MS is well managed without any flare ups. For this reason, I think that the levels listed on the recommended daily allowance are not adequate for people with medical conditions needing additional supplements.

I consume a prescription strength dose of folate, vitamin B12 and Vitamin B6 for overcoming the chance of a miscarriage while I carry my second child. After three miscarriages, I was recently diagnosed as being a carrier of a gene known to be involved with miscarriages as well as migraines, cardiovascular disease and other disorders. To overcome this reduced gene function, more Vitamin B is needed to reduce homocysteine levels in the body. Since Vitamin B is a water soluble vitamin, I am also supplementing it with the consumption of spinach, which does not contain much Vitamin B12 or Vitamin B6, just folic acid (folate). Since my taste for spinach is waning, I rely on the supplement strength pill for these additional vitamins as I know my body can self regulate the concentration of these vitamins without much harm to the baby. Similarly, my husband also has the same genetic abnormality and suffers from migraines. To treat this disease, we buy an over the counter Vitamin B supplement for his symptom management at not much cost to us versus the prescription strength pill that I take.

This is why calling on the FDA to better regulate vitamin supplement sales makes me a bit nervous. If the FDA becomes involved in this fight, I worry that the ability to self regulate symptom management for diseases and disorders may be impaired. Tighter regulation of the fat soluble vitamins may be justified. But it is not obvious that tighter regulation of water soluble vitamins is.

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