As I was thinking about this week’s post, I thought I would write about the most common vitamins people are taking today. However, it occurred to me that such an approach only represents a small portion of what I wish people to understand about the world of vitamin supplements. The more important information to share is that, just like fad diets, fashion or music, the “in vogue” vitamins change every five or ten years. When I was in college in the 1980’s, Linus Pauling was spearheading the belief that taking vitamin C was essential for fighting off disease and having a healthy immune system. In the early 1990’s, when I was starting my residency in internal medicine, magnesium was the vitamin being touted as critical to increasing survival after heart attacks. In fact, every patient with a heart attack in my hospital received intravenous magnesium as part of their treatment protocol. The late 90’s ushered in vitamin E and B-carotene (vitamin A) as the vitamin supplements “du jour”.
So what happened to these vitamin fads and why don’t we continue to talk about them today? Well, over time we conducted multiple studies that found no or limited efficacy to taking these supplements, and in some cases actual harm. Specifically, we found no benefit to long term vitamin C supplementation in preventing infections and a lack of benefit of magnesium in improving survival after heart attacks. Even worse, we found B-carotene supplements increased the risk of lung cancer in smokers, while vitamin E provided no heart health protection and could provide harm in high doses.
Fast forward to the last ten years with fish oil (omega-3 fatty acids) and calcium taking center stage. For the most part, reviewing the scientific literature found similar findings to those “invaluable” vitamins of the past. Fish oil supplements, initially hailed as essential for good heart health, quickly became important in preventing everything from nervous system issues to eye problems. Unfortunately, over time we have found that the preponderance of evidence shows no benefit to fish oil supplements. However, a very important distinction is that a diet including several servings a week of foods rich in fish oils is still considered healthy. Foods rich in omega-3 fatty acids include salmon, sardines, tuna fish as well as soybeans, tofu and walnuts.
Calcium has also been a critical vitamin in the last decade touted as essential for bone health. Yet, over the last few years two camps regarding calcium supplement safety have been developing–those who believe it is safe and still important vs. those who feel the supplements may increase the risk of heart disease. As with most things in medicine, when two strongly opposite views are held on a question, it usually means any benefit or risk will be far less than the initial exaggerated claims. Given that we are to first do no harm, I have been recommending to my patients that they focus on getting calcium through their diets rather than supplements. Foods that are excellent sources of calcium include low fat dairy products such as yogurt, cheese and milk, leafy green vegetables, tofu and sardines.
Once again, as with last week’s post about the lack of benefit taking multivitamins, we should be cautious about assertions that any pill is going to have a significant benefit to our overall health. There is no substitute to a healthy well-balanced diet with lean proteins, fresh vegetables, fruit and whole grains. Over time, this approach continues to be associated with the best health outcomes, even if it is not as exciting to discuss as this year’s latest fad diet, super-vitamin or exaggerated claims about a newly found herb from South America.
Next week’s post: COPD: Breathing gets tougher in a polluted world
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