
More Evidence Against Vitamin Use - J3L2404
http://well.blogs.nytimes.com/2011/10/11/more-evidence-against-vitamin-use/?ref=todayspaper
======
tokenadult
Good-quality commentary on the recent study announced in the article submitted
here by a regular contributor to the Science-Based Medicine group blog:

[http://www.sciencebasedmedicine.org/index.php/vitamins-
and-m...](http://www.sciencebasedmedicine.org/index.php/vitamins-and-
mortality/)

And since it has been a while since this link has been posted in an HN
comment, and since commenters here have mentioned that they haven't even read
the fine submitted article, much less the underlying study publication, I'll
repost here a link to a classic article by Peter Norvig (LISP hacker who is
now Google's director of research) on how to interpret scientific studies and
analyze study designs.

<http://norvig.com/experiment-design.html>

Suffice it to say that studies of human nutrition are HARD. A faultless study
design would have to have dictatorial power to observe patient behavior over
the long term, measuring exactly absolutely everything that a patient eats.
The study design of the study reported in the submitted article is basically
the best kind of study design for a longitudinal study that will pass
institutional review for study of human subjects and not bankrupt the
researchers with its expense. The researchers have made best current efforts
to reduce flaws in the study design to the utmost extent possible, and
acknowledge what they don't know (because they can't infer it from the study
design) in their publications and comments to the press.

~~~
scott_s
I encourage everyone to read the conclusions. (And they're actual conclusions!
Not just a summary! Yes, that makes me so excited as to warrant three
exclamation marks!)

------
joshklein
It's worth noting that they're describing the effects of high doses of
vitamins. Given the average modern diet (at least, for Americans like me),
vitamins may be necessary to achieve "normal" doses.

I take a fiber supplement (which, I know, is not a vitamin) because I try to
avoid refined carbohydrates, which tends to mean I have to avoid carbohydrates
altogether except when making a home-cooked meal. Since the average adult male
around my age/weight needs ~28g of fiber a day, and I probably consume 15g or
less, the 6g supplement seems prudent. Anecdotally, my ... er, system ...
seems to work better that way.

~~~
tjr
Also important is that they are not describing the effects of high doses of
all vitamins. Superfluous amounts of Vitamin E seem to be mainly what they are
seeing negative results from, and you'd probably only be getting that much
Vitamin E if you were taking Vitamin E-specific supplements on purpose.

~~~
alperakgun
This type health news confuse people; everything we think will make us healthy
is later claimed as an unhealthy exercise in some other research, should we
distrust health news in mainstream media totally?

------
kalleboo
I haven't read the original study, but might they not be mixing together cause
and effect here? Instead of taking vitamins causing people to get sick, it
might be people with riskier genetics/lifestyles are more likely to take
vitamins to hedge against that?

Reminds me of a news article that interpreted statistics to say "People who
drink low fat milk are fatter! Clearly this means that low fat milk makes you
fat!" instead of the obvious conclusion that people who are fat would drink
low fat milk to try to get slimmer.

~~~
kijin
I'm also suspecting this. Too many people seem to think that they can get away
with an unhealthy diet if they take vitamin and mineral supplements.

------
drzaiusapelord
I'm sick of this hand-wavey selective nonsense. Yes, healthy people with good
diets probably shouldn't be taking any vitamins, but the people I know who are
this healthy are a small minority, including myself.

Lets look at these cases specfically. Should women over the age of 50 take
iron? Probably not, but why are they taking iron? Because they've been told
their whole lives they're low on iron by their doctors, who were right to tell
them so, but now know not to recommend iron pills past a certain age. Were
they wrong for doing so?

Look at how foods are enriched with vitamins. Folic acid is everywhere because
it helps pregnant women, but in men it can cause cancer, but it also might
fight a different cancer, yet we still take it in. Its nearly impossible to
buy bread from the store that doesn't have folic acid. Hell, half the things
in the grocery store are enriched with folic acid. How about we pull that
stuff and just tell pregnant women to take supplements and stop feeding men a
carcinogen? I prefer the freedom to make my own decisions than having the
government dictate folic acid supplementation via food and the other hand
having the NYTimes telling me not to take anything.

For the record I take fiber, fish oil, and vitamin D + tryptophan. The latter
being more or less a cure for my SAD (after several failed SSRIs). This
combination makes me feel like a million dollars. With a little
supplementation as well as good sleep, etc I'm about 10x as creative and have
more energy. Quitting these would be foolish. If anything, we should be
encouraging responsible and informed supplementation and pulling government
mandated supplementation for things that harm us, folic acid especially.

Heck, I'm a big government kind of guy, and even I have a problem with folic
acid in our food. The government, even under the best of circumstances, is
biased towards pregnant women and families (population growth/family is seen
as important) but really not interested in helping you achieve longevity or be
happy. You're going to have to work those out on your own, hence my
recommendation to look into potential supplements and lifestyle changes, as
well as avoiding government supplementation that might hurt you (folic acid)
but help others (pregnant women).

This article is so against the hacker ethos its not even funny. Sorry NYTimes,
this issue is a lot more complex than "Vitamins bad, mmm'kay?"

~~~
ap22213
I don't want to discredit your experiences, because if they work, they work,
but have you considered the possibility that you're achieving a placebo effect
with your supplements? In some studies, iirc, placebos have been shown to be
as effective or more effective than SSRIs.

~~~
tokenadult
_In some studies, iirc, placebos have been shown to be as effective or more
effective than SSRIs._

You wrote, "if I remember correctly," so I'll mention here some sources I have
checked recently for other Hacker News threads. In actual practice, placebos
only look effective when the statistical tests in a study are poor, and most
especially when the symptoms are self-reported by patients. Placebos are NOT
effective in treating actual disease states or improving "hard endpoints" such
as reduction of all-cause mortality or major morbidity from specific diseases
with verifiable physiological signs. See

[http://www.sciencebasedmedicine.org/index.php/placebo-
effect...](http://www.sciencebasedmedicine.org/index.php/placebo-effect-for-
pain/)

[http://www.sciencebasedmedicine.org/index.php/placebo-
effect...](http://www.sciencebasedmedicine.org/index.php/placebo-effects-
revisited/)

[http://www.sciencebasedmedicine.org/index.php/the-placebo-
ef...](http://www.sciencebasedmedicine.org/index.php/the-placebo-effect/)

[http://www.sciencebasedmedicine.org/index.php/placebo-
effect...](http://www.sciencebasedmedicine.org/index.php/placebo-effects-
without-deception-well-not-exactly/)

[http://www.sciencebasedmedicine.org/index.php/benedetti-
on-p...](http://www.sciencebasedmedicine.org/index.php/benedetti-on-placebos/)

Placebo effects are strongest for patient self-reported subjective symptoms
(classically, pain, but in more recent studies mood) and weakest for objective
clinical signs measured by experienced observers. Hard endpoints to look at in
the case of depression include preventing suicide and the patient returning to
normal daily life function (such as full-time employment if that is
appropriate for the patient's stage of life). Some hard endpoint studies
indeed do not support some brands of SSRIs as well as they support cognitive-
behavioral talk therapy for depression, but no properly designed study says
that placebos are "effective" for any indication for SSRIs. Thanks for
bringing up this issue, which is recurrent on HN, here.

~~~
onemoreact
There is a huge range of placebo effectiveness. Placebo's that cause side
effects work better than those that don't. Placebo's handed to you by people
in lab coats work better than people in normal attire etc.

Also, while placebo's have little effect on cancer or broken bones they do
show significant and measurable effects with increased immune response, reduce
pain, reduce signs of depression and a host of other things.

PS: This get's really complected there is even evidence that many anti
deprecation work on the side effect and only show up as better than 'placebo'
when the placebo's have no side effects.

------
mweimer
I listened to NPR talk about this study yesterday. They explained that men
taking a normal does of Vitamin E are NOT at a higher risk for prostate
cancer. Men taking what they described as a "mega dose" are. The conclusion is
don't take more than the recommended amount, vitamins can be harmful if you
take too much. Don't do that.

~~~
mattgreenrocks
Exactly. When starting any supplement, it's worth spending ten minutes to look
up what conventional (read: conservative, which is _exactly what you want_
here) medicine considers the maximum daily dose, side effects, overdose
symptoms, and toxicity levels.

------
ww
It's pretty hard to get the (now increased) recommended allowance for vitamin
D (600 IUs ... especially as an indoor-programmer-type). You need 10 glasses
of milk to get that without supplementing.
[http://www.docgurley.com/2008/05/18/the-greatest-drug-in-
the...](http://www.docgurley.com/2008/05/18/the-greatest-drug-in-the-world-
isfree/)
[http://www.sparkpeople.com/resource/nutrition_articles.asp?i...](http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1357)

------
zdw
So, when do I get to buy this new bestseller:

"The 4-hour 'giving you prostate cancer before your time' week"

------
J3L2404
This isn't rocket science, but I am glad the research is being done. It seems
obvious that eating whole foods is the best way to get your vitamins and
minerals. First of all we have millions of years of consumption of whole
foods, so our microbiotic gut systems are well tuned to them. Supplements are
fairly new evolutionarily. The specific form of compounds is extremely
important as noted here:

[http://www.sciencedaily.com/releases/2011/10/111011112501.ht...](http://www.sciencedaily.com/releases/2011/10/111011112501.htm)

Maybe I am hypersensitive, but I can literally feel that there is a man-made
substance in my body when I take vitamins. Just my two-cents.

------
velocicopter
No explanation is given why any supplement is unhealthy. That's the first
thing.

Secondly, the context in which this occurs is that various government agencies
and professional guilds want to prohibit the sale of supplements, or impose
ridiculous 'standards' on their manufacture and testing.

However, it's very important that people remain free to choose which non-
prescription chemicals to put in their bodies. Medics and pharmacists don't
always get it right, they are difficult to consult, and they are as subject to
whim and fashion in their thinking as other professions.

Meanwhile, only a handful of people die annually from vitamin overdose,
whereas hundreds of thousands people die who take prescription drugs (yet we
don't say that there's no justification for prescription drugs).

~~~
danparsonson
I hope you're trolling but on the assumption that you're not:

> No explanation is given why any supplement is unhealthy. That's the first
> thing.

An extreme example to illustrate the point: if you eat a random plant and drop
dead, I'm not going to look for an explanation, I'm going to avoid eating that
plant until I can prove that your death was caused by another factor.
Likewise, if taking vitamin supplements appears to result in a negative effect
on overall health rather than the expected positive, the smart thing to do is
stop taking them until you can demonstrate otherwise, is it not?

> Secondly, the context in which this occurs is that various government
> agencies and professional guilds want to prohibit the sale of supplements,
> or impose ridiculous 'standards' on their manufacture and testing.

Source for this?

> However, it's very important that people remain free to choose which non-
> prescription chemicals to put in their bodies.

Indeed, it's also important that people are well educated in the effects of
those non-prescription chemicals and are in full possession of the known facts
about their effects. Such is the aim of studies like this.

> Medics and pharmacists don't always get it right, they are difficult to
> consult, and they are as subject to whim and fashion in their thinking as
> other professions.

Maybe so, but they know a lot more about the human body than those who don't
study it, since that is by definition their job. Besides, the great thing
about science is that anyone can dive in and have a go at proving or
disproving something so if you disagree with the conclusions in this article,
run some research of your own and prove them wrong.

> Meanwhile, only a handful of people die annually from vitamin overdose,
> whereas hundreds of thousands people die who take prescription drugs (yet we
> don't say that there's no justification for prescription drugs).

Sources for either of those statements?

Your issue with prescription drug-taking is entirely separate; you might as
well argue that thousands of people die driving yet we don't say there's no
justification for driving.

~~~
velocicopter
>An extreme example to illustrate the point: if you eat a random plant and
drop dead, I'm not going to look for an explanation, I'm going to avoid eating
that plant until I can prove that your death was caused by another factor.

Even if the plant extended my life? Isn't trying to understand why I died the
same thing as looking for an explanation?

Any studies which merely correlate supplementation with early death and then
‘conclude’ that supplements are bad can be refuted by saying that the relevant
people in spite of supplementatation and not because of it.

>> Secondly, the context in which this occurs is that various government
agencies and professional guilds want to prohibit the sale of supplements, or
impose ridiculous 'standards' on their manufacture and testing.

>Source for this?

[http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformat...](http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/DietarySupplements/ucm257563.htm)

>> However, it's very important that people remain free to choose which non-
prescription chemicals to put in their bodies.

>Indeed, it's also important that people are well educated in the effects of
those non-prescription chemicals and are in full possession of the known facts
about their effects. Such is the aim of studies like this.

Like I said, the article gave no explanation for why any supplement or
supplements in general are bad. So there's no scientific or educational value.

Since the freedom to take supplements is presently at risk, the article can
only do harm.

>Maybe so, but they know a lot more about the human body than those who don't
study it, since that is by definition their job.

Yes, doctors do know more about the body than most people but that doesn't
make them infallible. Part of recognising our fallibility means not relying on
any one source of expertise. If doctors and government took that seriously
then they wouldn't be trying to restrict non-prescription items. The
government's job is to protect our freedoms. Doctors can learn from ordinary
people's experiences of supplementation.

>the great thing about science is that anyone can dive in and have a go at
proving or disproving something

But he can't if the relevant supplements are banned!

Note also that, generally speaking, science thrives in an atmosphere of
freedom and toleration.

>if you disagree with the conclusions in this article, run some research of
your own and prove them wrong.

There's nothing to test from this article: it doesn't assert anything. It
merely insinuates that supplements are bad. Science is about searching for
explanations. It's not about counting studies or weighing evidence or anything
like that.

>> Meanwhile, only a handful of people die annually from vitamin overdose,
whereas hundreds of thousands people die who take prescription drugs (yet we
don't say that there's no justification for prescription drugs).

>Sources for either of those statements?

[http://en.wikipedia.org/wiki/Vitamin_poisoning#Comparative_s...](http://en.wikipedia.org/wiki/Vitamin_poisoning#Comparative_safety_statistics)

> Your issue with prescription drug-taking is entirely separate; you might as
> well argue that thousands of people die driving yet we don't say there's no
> justification for driving

I don't have an issue with prescription drugs, but note the car driving
argument is precisely what is being put forward with regard to supplements.

