A report out today in the New England Journal of Medicine and reported in The Independent shows nothing to be concerned about but press reports implying dangers of nutritional supplements that don’t exist if you actually read the study.
This was a ten year study of 23,000 reported adverse events to supplements, in other words 2,300 per annum in a population of 319 million, where maybe half take supplements. That means that, overall, one in 70,000 supplement takers has a reaction. In context, your annual chances of being killed in a road traffic accident are three times higher than this. But these weren’t for the large part, dietary or nutritional supplements.
The vast majority of adverse events were to weight loss, energy and sexual enhancement supplements. The most commonly reported symptoms were ‘palpitations, chest pain, or tachycardia’. We are talking about ‘natural’ stimulants which are neither allowed in the UK, nor would I ever recommend them. Too much caffeine, which many of these products contain, would do exactly the same thing.
A small number of adverse effects were recorded in relation to nutritional supplements. These reactions were:
‘mild-to-moderate allergic reactions’ to micro-nutrients(excluding iron, calcium and potassium). These accounted for 40% of adverse events to nutritional supplements. Now, any supplement can contain things a person could be allergic to such as wheat, milk, yeast, fish (oil). Good supplements exclude these, except for fish oil capsules. If you are allergic do check the label carefully.
swallowing problems accounted for 41% of adverse events. The most common implicated were calcium supplements which tend to be large and, in my opinion, unnecessary.
abdominal symptoms associated with iron and potassium supplements. There is no need to supplement potassium. There’s more than enough in food.
So, there is nothing at all serious by nature here. Meanwhile, the American Association of Poison Control has issued its 30th annual report. Yet again, not one single death from a supplement – for 30 years! The same is true in the UK.
Actually it was claimed that one person might have died from vitamin supplements in the year 2012, according to AAPCC's interpretation of information collected by the U.S. National Poison Data System. That single alleged "death" was supposedly due to "Other B-Vitamins." Since the AAPCC report specifically indicates no deaths from niacin (B-3) or pyridoxine (B-6), that leaves folic acid, thiamine (B-1), riboflavin (B-2), biotin, pantothenic acid, and cobalamin (B-12) as the remaining B-vitamins that could be implicated. However, the safety record of these vitamins is extraordinarily good; no fatalities have ever been confirmed for any of them. So this case remains a mystery. I cannot see how any of these vitamins would harm anyone let along kill them.
Since this study was in the US we have to compare this to the estimated over 100,000 deaths from adverse drug reactions, and millions of adverse reactions every year.
The overall verdict: Nutritional supplements remain remarkably safe. If you’re allergic to something check it’s not in the supplement you take. Don’t supplement calcium or potassium on its own. Potassium is unnecessary and calcium, without vitamin D, is close to useless. Don’t take too much iron, more than 20mg – although doctors prescribe four times this. It is unnecessary. Don’t swallow pills you cannot swallow.
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I take the supplements that Mcdougall warns about and have recommended Patricks antioxidant formulation to friends.
I recently had eye infection and stye were appearing. When I took this supplement (more than the recommended dose) it obliterated it almost overnight.
Matthew M, 23 Dec 2015
An Interesting talk on vitamins and supplements.
Matthew M, 23 Dec 2015
I read a free newsletter online fairly recently ( Dr John McDougall MAY 2010) which pointed out many harms.
What do you think about the studies here that he talks about showing harm is being done to those taking part.
Randomized Controlled Trials on Cancer
The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. A total of 29,133 male smokers were assigned to one of four regimens: alpha-tocopherol (vitamin E) alone, beta-carotene alone, both alpha-tocopherol and beta-carotene, or placebo.7 Findings: 18 percent more lung cancer and 8 percent more deaths in those taking the preparations with beta-carotene.
The Beta Carotene and Retinol Efficacy Trial. A total of 18,314 smokers, former smokers, and workers exposed to asbestos assigned to take beta-carotene and retinol (vitamin A) or placebo.8 Findings: 17 percent more deaths, 46 percent more lung cancer, and 26 percent more cardiovascular disease for those taking the supplement.
The Selenium and Vitamin E Cancer Prevention Trial (SELECT). A total of 35,533 men were assigned to one of four groups: selenium, vitamin E, selenium plus vitamin E, or placebo.15 Findings: 13 percent more prostate cancer for the vitamin E groups. No prevention of prostate cancer by any supplement intervention.
More Heart Disease
MRC/BHF Heart Protection Study. A total of 20,536 adults with coronary disease, other occlusive arterial disease, or diabetes were allocated to receive antioxidant vitamin supplementation (vitamin E, vitamin C, and beta-carotene daily) or placebo.16 Findings: Increased vitamin concentrations in the subjects’ blood, but no reductions in vascular disease, cancer, or death.
Alpha-tocopherol Beta-carotene Cancer Prevention Study. A total of 1862 male smokers who had had a previous myocardial infarction were assigned to dietary supplements of alpha-tocopherol, beta-carotene, both, or placebo.17 Findings: There were 75% more deaths from fatal coronary artery disease in the beta-carotene groups and a slight increase in the alpha-tocopherol groups.
The HOPE-TOO trial. A total of 9541 patients were assigned to vitamin E or placebo.18 Findings: No difference in cancer or cardiovascular deaths. Patients in the vitamin E group had a higher risk of heart failure.
Folate After Coronary Intervention Trial. A total of 636 patients with heart artery stents were assigned to receive folic acid, vitamin B6, and vitamin B12 or placebo.19 Findings: Greater restenosis (artery closure) and repeat heart surgery for those taking the supplement with folic acid.
The NORVIT Trial. A total of 3749 men and women who had had an acute myocardial infarction within seven days were assigned to be in one of four groups: folic acid, vitamin B12, and vitamin B6; folic acid and vitamin B12; vitamin B6; or placebo.20 Findings: Homocysteine decreased by 27 percent, but the risk of heart attack, stroke, and cancer was increased by 20 to 30 percent in the groups with the folic acid supplement.
Women’s Antioxidant and Folic Acid Cardiovascular Study. 5442 women with either a history of CVD or 3 or more coronary risk factors were assigned to receive folic acid, vitamin B6, and vitamin B12, or placebo.21 Findings: Homocysteine decreased by 19 percent, but the risk of heart attacks, strokes, heart surgery, and death was not reduced.
More Kidney Damage in Diabetics
The Diabetic Intervention with Vitamins to Improve Nephropathy Trial. A total of 238 participants who had type-1 or -2 diabetes and a clinical diagnosis of diabetic nephropathy (kidney disease) were assigned to folic acid, vitamin B6, and vitamin B12, or placebo.22 Findings: The vitamin group had worse kidney function and twice as many vascular events.
More Fractures in Elderly
High Dose Oral Vitamin D Trial. A total of 2256 community-dwelling women, aged 70 years or older, were assigned to receive 500,000 IU of Vitamin D (cholecalciferol) or placebo.23 Findings: Women taking the vitamin D had more falls and fractures.
More Severe Respiratory Infections
A Randomized Trial on Vitamin E and Infections. A total of 652 non-institutionalized elderly were assigned multivitamin-minerals, 200 mg of vitamin E, both, or placebo.24 Findings: No change in frequency of respiratory infections, but the severity was worse in those taking vitamin E.
Matthew M, 23 Dec 2015
Why do they not consider the increase in deaths within certain vitamin studies this could easily be seen as harmful.
Matthew M, 23 Dec 2015
If heart disease, cancer, and overall death have been reported/discovered in those taking isolated concentrated nutrients.
That should surely be seen as harmful.
Two highly respected Cochrane Reviews published in 2008 concluded, “Beta-carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality (death).”
Cochrane Collaboration no higher authority than them.
Patrick Holford, 17 Oct 2015
Matthew - this is rather 'off topic'. I'd be grateful if you could post off topic questions on Facebook - that's the main medium I'm using for such questions.
Potassium works in conjunction with sodium in maintaining water balance and proper nerve and muscle impulses. Most of the potassium in the body is inside the cells. The more sodium (salt) is eaten the more potassium is required,. Most people achieve 2000mg. WHO recommend 3,510mg for an adult, but you may not need this much if you are healthy and have a low sodium intake, below that of potassium. Fruit, vegetables and whole grains are rich in potassium. Bananas are quite good but they are high in sugar/calories. Best food sources, listed in order of mg per calorie are watercress (329mg), endive (316mg), cabbage (251mg), celery (285mg), parsley (540mg), courgettes (248mg), radishes (231mg), cauliflower (355mg), mushrooms (371mg), pumpkin (339mg), molasses (2925mg). The amounts in () are what you get in 100g.
Matthew M, 17 Oct 2015
You did talk about a lot of issues here, including potassium. I don't use Facesuck.
Matthew M, 16 Oct 2015
Why is the daily requirement set as 4000-5000mg for Potassium by WHO. That would require a decent amount of bananas