“I see that you’re taking a multivitamin. What are you taking it for?” I asked my 80-year-old patient.
“Oh, I’m taking it for my memory, joint pain and to improve my hearing,” she responded.
“OK. I see that you missed all the words on the memory test. We may need to find you a different vitamin,” I yelled back at my patient as she cupped her hand around her ear.
According to a recent survey done by the National Health and Nutrition Examination Survey (NHANES), more than half of adults in America take at least one dietary supplement. As a primary care physician, I see a multitude of patients who take supplements on a regular basis, and I often inquire why they are taking them.
The answers vary wildly with the same medication. Patient A can take a daily multivitamin for heart health and Patient B can take the same vitamin to decrease their risk of cancer.
However, are these supplements effective in preventing certain ailments? Are they more harmful than helpful? What more can healthcare physicians do to help patients make informed decisions about supplements?
Since 1994, dietary supplements have not needed the authorization of the FDA to be manufactured and sold. This is due to the Dietary Supplement Health and Education Act of 1994. This act left manufacturers to their own devices to evaluate the safety of their products, as well as the labeling on said products. New supplements developed after 1994 do not require approval by the FDA but must be reviewed before being marketed.
This can be frightening as a physician, with many of my patients taking multiple prescribed medications due to comorbidities and potentially having an increased chance of drug interactions because of intake of loosely regulated supplements. A large percentage of patients take supplements as a preventative measure. They desire to decrease their chances of memory loss, cancer, heart disease, bone fractures and a list of other conditions longer than the ingredients on a multivitamin bottle. However, the question remains — are these supplements effective at reducing the development of these conditions?
A recent article in the Journal of the American Medical Association (JAMA)reviewed the United States Preventive Services Task Force’s updated guidelines for community-dwelling nonpregnant adults taking beta carotene, vitamin E, multivitamins, single nutrients and paired nutrients for the prevention of cardiovascular disease and cancer. The USPSTF recommends against the use of beta carotene and vitamin E.
Beta carotene was noted in some studies to increase the risk of cardiovascular disease and lung cancer (in smokers). Vitamin E displayed no benefits in reducing cardiovascular disease and cancer. There was insufficient evidence to determine the benefits of multivitamins, single nutrients and paired nutrients.
One of the problems in assessing multivitamins is the vastly different amounts of multivitamins that are available with different ingredients. One generic brand of multivitamin may contain different amounts and different vitamins from another generic brand. Thus, it is hard to accurately assess the benefits of taking multivitamins and their possible effect on cardiovascular disease and cancer due to the variability in their production.
Other notable vitamins taken individually and in combination with others have shown minimal or insufficient results in preventing certain ailments. Various forms of vitamin B have been shown to be lacking benefit or having no effect on Alzheimer’s disease, cancer, decreasing fracture risks and cognitive function. Antioxidants such as vitamin A, E and C are also in line with vitamin B in not showing value in preventative treatments either.
Even vitamin D, which is commonly prescribed for fall prevention, has only been demonstrated to decrease the risk of falls in elderly individuals in institutional facilities and decrease hip fracture risks when taken with calcium. Overall, the data isn’t supportive of the benefits of taking supplements for preventative treatment.
Nevertheless, despite the research, patients continue to take these supplements. And who can blame them? Patients have been conditioned to take these medications from family members and the healthcare industry. “My grandmother told me to take this to not get cancer,” or “I read on the internet taking this will help to improve my overall health.” These are the statements that I hear regularly.
Most people want to have overall good health, will do what they can to improve it and will try their best to not be on any pharmacological medications. Consequently, they take supplements to help get an extra boost. However, the extra juice may not be worth the squeeze.
A large majority of the vitamins that individuals are attempting to supplement are already available in their diet. The various B vitamins are available in lean meats, grains, fish and nuts. The antioxidant vitamins (A, C and E) are plentiful in dairy products, fruits and vegetables. Vitamins and minerals are more bioavailable when taken via dietary measures and not pills.
Those who truly need supplementation may have dietary restrictions, chronic conditions such as alcoholism or live in food-deficient areas where vitamins aren’t readily available. Those who don’t fit into those categories can supplement vitamins and minerals easily through changing their dietary habits.
Patient autonomy over healthcare decisions is at the forefront today of many medical conversations. From COVID-19 vaccinations to abortion rights to medications, healthcare has always straddled the line between what the patient wants and what the physician thinks is best. Sometimes these two groups walk in accord, and other times they can pull each other in opposite directions.
As a physician, I believe it is the medical industry’s duty to properly educate patients to help them make the choice they feel comfortable with. This is evident in conversations regarding supplements in preventative medicine.
Open and non-judgmental conversations regarding risks and rewards, along with active listening, will develop a better relationship between physicians and patients. Healthcare physicians must provide accurate and up-to-date information on supplements. More research is needed over an extended time to provide sufficient data to show the benefit or detriment of supplements. This will be of great service in helping healthcare physicians share accurate information and inform patients.
In the end, this facilitates a better relationship between physicians and patients as we walk together on the road to better health.
References
www.aafp.org/pubs/afp/issues/2020/0301/p272.html
www.fda.gov/food/dietary-supplements
jamanetwork.com/journals/jama/fullarticle/2793446
Dr. Randy Hines II
Dr. Hines is a board-certified family medicine physician. He attended Prairie View A&M University for undergraduate and graduate school. After acquiring his master’s degree, he received his doctoral degree from the University of Louisville School of Medicine. He completed his family medicine residency training at Wellstar Atlanta Medical Center and today practices in Smyrna. He is a self-published author and the host of the medical podcast “On Call with Dr. Randy.”
