Editor's Correspondence | Mar 12, 2012
Rainbow Vogt, PhD
Arch Intern Med. 2012;172(5):449-450. doi:10.1001/archinternmed.2011.1864
The recent article “Dietary Supplements and Mortality Rate in Older Women”1 reported increased mortality associated with use of vitamin supplements, and the message to fear supplements was echoed throughout major media outlets. In response to the study findings that were admittedly inconclusive by the authors because of the weak association between mortality and supplementation, Rita Redberg, MD, MSc,2 noted that the Dietary Supplement Health and Education Act “allows” Americans to spend in excess of $20 billion annually for dietary supplements, missing the irony that this is less than 10% of the amount spent on pharmaceuticals annually and less than 1% of the annual US health care expenditure.
Ironic still is that vitamin deficiency–related disease is so common that pharmaceuticals are now being formulated specifically for vitamin deficiencies.3
For example, a company called Cytochroma is currently developing a drug with the purpose of treating vitamin D deficiencies.
Glenville Jones, PhD, is a coinventor of this drug and also contributed to the 2010 Institute of Medicine report4 discouraging large doses of vitamin D by reporting that a blood concentration of 50 nmol/L of 25-hydroxyvitamin D (25[OH]D) (to convert to nanograms per milliliter, divide by 2.496) is sufficient for disease prevention.
In actuality, the concentration needed to prevent deficiency disease including osteoporosis, cancer, cardiovascular disease, and autoimmune diseases is 75 nmol/L of 25(OH)D,5 as recommended by the International Osteoporosis Foundation. Considering that millions of deaths have been attributed to pharmaceuticals6 and virtually none to vitamin supplementation,7 why would the research community risk confusing the American public with the message to fear supplementation?
Beyond having inconclusive results, this study1 collected data on neither nutritional status nor information on supplements used.
Nutritional status provides information about unique nutrient requirements and serves as an indicator of biochemical individuality.
Current US Department of Agriculture nutrient requirements do not account for biochemical individuality. Rather, they are set according to averages for a healthy population.
This approach ignores the unique interrelationship among individuals and their nutrient status, genome, methylome, intestinal microbiome, and surrounding environment.
As recommendations about vitamin intake improve in accuracy, they will reflect the wide variability in individual nutrient status and vitamin requirements.
They will also reflect current health status, which is unfortunately not healthy, on average.
This generation of children has the distinction of being the first in over 200 years to have shorter predicted lifespan than their parents.
If anything, we are not consuming enough vitamins, and those interested in preventing disease will benefit greatly from studying orthomolecular (vitamin) medicine.
Correspondence: Dr Vogt, Office of Research, University of California, Davis, 1 Shields Ave, Davis, CA 95616 (firstname.lastname@example.org).
Financial Disclosure: None reported.
1 Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr. Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. Arch Intern Med. 2011;171(18):1625-1633 PubMedCrossRef
2 Redberg R. Vitamin supplements: more cost than value. Arch Intern Med. 2011;171(18):1634-1635 CrossRef
3 Grant WB. An estimate of premature cancer mortality in the US due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002;94(6):1867-1875 PubMedCrossRef
4 Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2010
5 Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes.
Am J Clin Nutr. 2006;84(1):18-28 PubMed
6 Null G, Feldman M, Rasio D, Dean C. Death by Medicine. Mt Jackson, VA: Pratikos Books; 2011
7 Bronstein AC, Spyker DA, Cantilena LR, Green JL, Rumack BH, Giffin SL. Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS):
27th Annual Report (2010). Clin Toxicol. 2009;48979-1178 CrossRef