The Vitamin Wars

Tara Parker-Pope, a personal health columnist and reporter at the Wall Street Journal, snagged the front page of the March 20 Journal Report with an article titled “The Case Against Vitamins” (subscription required).

Parker-Pope is The Alt Health Voice of the WSJ. Irony intended. The WSJ is pretty pro-pharma — after all, they’re pro-business and pharmaceuticals make people a ton of money — so of course they aren’t going to bring a rabid alt advocate on board for anything like a regular gig.

Not that she’s overtly hostile. She’s somebody’s idea of the new mainstream. If you have a general physician who nods kindly when you discuss nutritional supplements, even though he/she would never actually suggest you take them, then that’s about the tenor of a Parker-Pope article. She’s grounding, because she reminds you that in many cases the science for alt stuff is on the thin side. But be sure to bring the umbrella if she’s invited to the picnic, if you catch my drift.

Anyway, this case against vitamins thing — first off, the headline was a bit of overhype. Reactionary, really. I mean, if you’re my age or older, you can remember a time when taking vitamins was something that normal people just didn’t do. Now it’s something that everyone does. We’re popping supplements like candy. So naturally, there are going to be some vitamin-bites-man stories, of which the March 20 piece is one.

I won’t list the studies rounded up in the article; if you follow this topic at all, you’ve heard about most of them, anyway. And really, the lesson is quite simple: the human body is mind-bogglingly complex, and our understanding of what’s going on at the biomolecular level is still embarrassingly crude. So no matter if you’re doing mainstream medicine or alt health, when you introduce a particular molecule at high concentrations, the best you can do as far as predicting what happens next is an educated guess.

In mainstream medicine, we call our bad guesses “side effects.” In alt health, we call it quackery.

But here’s what’s heartening: the letters to the editor that the paper published last Friday, in response to Parker-Pope’s article. Here’s one of them:

It is clear that eating a balanced diet rich in whole foods is the best way to obtain vitamins, minerals and other essential nutrients the body needs. Healthful diets appear to protect against the development of chronic diseases like heart disease and cancer. Yet when single isolated nutrients found in such diets are studied in reductionist clinical models, limited or negative effects are often seen, supporting the idea that taken out of their whole food context, dietary constituents don’t behave as predicted. Isolated nutrients don’t exist in a vacuum in human biology, and thus they can’t be meaningfully studied in this way. In whole foods, vitamins and minerals exist in a complex matrix along with many other supporting nutrients and potential health-promoting compounds. Metabolism has adapted to the presence of many interacting factors in the diet, a complexity that isn’t always reducible to pharmaceutical clinical methods of study.

In today’s world we have refined much of the phytonutrient diversity out of foods. As a result, we try to supplement with vitamins and minerals perceived to be missing, but with a poor understanding of their effects. The role of diet and dietary supplements in health is much more than the sum of the parts. That is to say, merely combining the results of clinical studies of single isolated nutrients will almost always present a flawed picture of the complex, multi-factorial role of diet in health, because it ignores the complexity of the synergistic whole food nutrient matrix that itself has multiple effects on health.

The role of nutrition research in the future will be to understand how food constituents interact biologically within the context of total dietary intake and human genomics. While the pharmaceutical clinical model will have a role in this pursuit, we are in need of scientifically sound innovative study designs to address the complex food/health interface.

David Barnes, Ph.D.
Director of Research
Standard Process
Palmyra, Wis.

So okay. Standard Process is a supplement manufacturer. But compare his tone to that of this letter from a “pharmaceutical consultant:”

Your analytical report is to be applauded. Vitamins fall into the category of “nutritional supplements,” for which unbelievable claims are often made regarding their salutary effects. When the makers of such products use the term “clinically tested,” or an equivalent statement, they should be required to state information about the studies, such as the number of participants, or whether they randomized, double-blind, placebo-controlled investigations with statistical analyses. In addition to the reliability of the clinical studies that are performed, quality control on the actual material in the bottle should, in my view, be equivalent to that for over-the-counter drugs.

Charles G. Smith, Ph.D.
Pharmaceutical Consultant

Yeah, I bet that’s your view, dude.

Note how vitamin guy’s letter is self-reflective, unlike Mr. Pharma Consultant, who wants to rah rah rah bad vitamin stories while people are dropping dead, daily, from prescription drugs. An estimated 9 million Americans abuse prescription drugs. Prescription drugs kill about 125,ooo of us annually.

So don’t sneer at my supplements, pharma-boy, until you show the grace to admit to the demons in your own closet.

We’ll get there — we’ll get to the place where we really do understand how the body works, and how to use nutrition in more sophisticated ways to heal disease and promote health. We’ll get there. But we have a ways to go, yet.

Placebo Power

There’s been a rash of studies lately that purport to poke holes in popular notions about using supplements to treat various health conditions.

Here’s the latest: an AP report, headlined “Supplements do little for arthritis, study finds” in the Globe & Mail, which says that glucosamine and chondroitin sulfate don’t seem to have much effect on arthritis symptoms.

The article reports the findings of a study by the National Institutes of Health that was published in today’s New England Journal of Medicine. But when you dig into it a bit, some interesting things come to light. One is that well over half of the subjects did get better–including those who were given a placebo:

Sixty per cent who took the placebos had reduced pain compared with 64 per cent who took glucosamine, 65 per cent who took chondroitin and 67 per cent who took the combo pills.

And get this — of the people who took the prescription drug Celebrex? 70 percent reported less pain. Note that the article sums up the spread between the placebo and supplement results as “These differences were so small that they could have occurred by chance alone.” Presumably we could say the same thing about Celebrex vs. glucosamine and chondroitin, then, right?

(No word on whether the subjects taking glucosamine and chondroitin encountered any Celebrex-style side effects.)

The subtext of the argument that traditional medicine likes to mount against alternatives is that alternatives are witchdoctory. Closer to magic than science. But you know what? Traditional medicine is completely dependent on faith, excuse me, “magic,” as well. Publish a few studies that say Celebrex doesn’t work, and that 70 percent figure would start dipping closer to 60 percent.

Me? I just keep my eye out for that perfect placebo. That would be: something that goes well with a nice red wine.