Research Position Paper – Anthony Matias

The Placebo Effect of Multivitamins

For the past couple of years there have been numerous studies and speculations that raise the question whether or not multivitamins provide the great health benefits that everyone assumes. Many people in this country take their health for granted and think they are invulnerable because our lives are by far easier than those of people in third world countries that can’t even access clean water. But the truth is Americans aren’t as invulnerable as they think when it comes to their health, according to the Center of Disease Control and Prevention, one million people died a year from cancer and heart disease alone. With all of these vitamin supplements on the shelves of almost every pharmacy and grocery store it tells the customers that the pills must work in positive ways. But recent studies have shown that dietary supplements do nothing at all and in some cases they can actually cause harm to one’s health, which goes against the common logic of pretty much everyone.

It is quite ironic that people are taking these pills to improve their health when in reality those same pills are hurting people and discouraging good health habits. People who take vitamin supplements may be more likely to take risks with their health and that taking vitamins may give an illusory sense of invulnerability that leads the pill-poppers to exercise less and to eat more than they should. The idea of taking a multivitamin everyday to improve health or be a safety net for the lack of vitamins you take in during the day affects the consumer both mentally and physically. The even more ironic thing is the sale of multivitamins has gone up despite the news that they might be doing more harm than good. Wen-Bin Chiou of Taiwan’s Sun Yat-Sen University said “the literature of the prevalence of dietary supplement use, seemed to show that use of dietary supplements is increasing, but it does not appear to be correlated with improved public health.”

With sales on the rise and no positive results how does this twenty-eight million dollar a year industry keep customers from abandoning their beloved multivitamins? First off, with the growing fear of getting sick, many people will do anything to stay on top of their health even if there is no statistical evidence that it works. People are just looking for something that will keep them healthy like a life saver, like these “miracle pills.” The obvious advancement of technology is all about getting things done quick and easy, that is just what these pills are, they are a fast and efficient way to stay healthy without having to second guess yourself. Society can alter one’s mind, even when they are unsure whether it is right or wrong. But if one thing is for certain is that, multivitamins do not fall under any of the five major food groups nor are they a part of a normal “well-balanced diet.”

Dietary supplements don’t fall under the recommended food choices and they have little proof that they even make consumers healthier than their current state. It is believed that many people fall into this trap that they can replace a normal healthy diet with a tiny pill. Yes, multivitamins are often self-prescribed over the counter diet supplements containing lipid soluble vitamins such as A, D, E, K and many more. But, if they were as successful as many of us think we are, why would the government push for a healthy diet. In 2011, the United States Department of Agriculture decided to publish a new nutrition guide” which depicts a plate and glass divided into the five food groups. The nutrition guidelines for MyPlate are divided into sections, thity percent grains, thirty percent vegetables, twenty percent fruits, twenty percent protein, ten dairy. It also gives many healthy alternatives such a skim milk and whole grains.” The funny thing about this new nutritional guide doesn’t say anything about dietary supplements.

Most people take multivitamins voluntarily, they are rarely prescribed to a patient by a doctor unless the individual is allergic to certain food products such as dairy. If someone is lactose intolerant than the doctors would prescribe them with a calcium supplement. The majority of doctors will recommend a well-balanced diet, but may people don’t know what a healthy diet consists of. A healthy diet is the food we eat in the course of a twenty four hour, one week, or one month, etc. period. One doctor who supports a well balanced diet is Albert Levy, MD, a primary care physician in New York, and he said “I have already asked my patients to stop their vitamin supplements four to five years ago, with the exception of those with a deficiency of vitamin D, pregnant patients who should get folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend a vitamin B complex.” A good diet is a nutritional lifestyle that promotes good health. A good diet must include several food groups because one single group cannot provide everything a human needs for good health. Also to consume enough vital amino acids to provide cellular replenishment and transport proteins. Which can be found in animal based proteins and some plant-based proteins. A combination of other plants, with the exception of rice and beans, may also provide essential amino acids. And a major role is to consume essential quantities of vitamins and certain minerals from food as directed by the Dietary Guidelines for Americans.

It is clearly evident that nature has provided the fact that many vitamins and minerals work together and need one for the other to work. Vitamin supplements, on the other hand, don’t always balance the need of certain vitamins. But people continue to neglect the recommended well-balanced diet which will provide the proper amount of vitamins and minerals needed on a day-to-day basis. This could be a result from the laziness and gullibility of the citizens in this country because people nowadays will do anything that is a shortcut.

Another huge question that has been raised over the past couple of years is how reliable and honest are supplement companies are. The big companies that run the supplement market spent years fighting the FDA to have multivitamins regulated as a general food product rather than a drug. This huge debate ended with the Dietary Supplement Health and Education Act of 1994 which states, ” Dietary supplements as products taken by mouth that contain “dietary ingredients” for the intent of supplementing the diet. The act deems vitamin supplements food items, not drugs, and they can take the form of tablets, capsules, liquids or powders. The FDA requires vitamin supplement labels to provide a descriptive name that indicates the item is a supplement, as well as a manufacturer, packer or distributor name and place of business, the ingredients list and net contents. A supplement facts panel must appear on the label, which identifies each ingredient contained in the product.” Which means the FDA is responsible for the product safety before marketing but doesn’t have to approve, test or analyze the supplement before it is mass produced. If these pills are supposed to help improve people’s lives than why did they fight so hard to keep the FDA from being able to test and approve their vitamins before they go on the market?

A big advantage that multivitamin companies in persuading their customers is that they can put disclaimers on their products because they aren’t evaluated by the FDA. Which means the FDA doesn’t really to support the manufacturers’ health claims of what the supplement may do for the consumer’s body. For example, the label of a B-complex vitamin supplement may claim to improve your energy, help you think clearly and boost metabolism. Statements of this sort are claims made by the manufacturer, but not tested and confirmed by the FDA. Dr. Tod Cooperman of ConsumerLab conducted tests on a number of dietary supplements to see if the ingredients on the labels matched what was actually in the pill and Cooperman concluded, “there are plenty of rip-offs out there. About one out of every five products Cooperman’s researchers tested failed to pass basic quality standards that include having too much or not enough of the amounts claimed on the package — and sometimes none at all. Others contain dangerous levels of lead or other potentially dangerous ingredients.” So, if this one study found numerous flaws then there is a possibility that there are many more faulty labels out there. Since the FDA doesn’t test the supplements before they go on the market companies are able to manipulate what is on their labels so, they can attract people to buy what they are selling.

It is suspicious that companies that pride themselves on making pills that help people and are supposed to improve health, neglect testing their products tested to see if they are even safe for the consumer. The high concentration of certain vitamins and minerals that many people feel make them feel better or help prevent disease can actually put them at a higher risk of contracting certain diseases or cancers. Many people believe that extra vitamins are just peed out when they aren’t used but this is a huge misunderstanding, it is true that vitamins A and C get peed out because they are water-soluble vitamins but all of the other vitamins such as vitamin B get stored in the fat of the body and can actually cause harm. Many people have acquired the education on multivitamins and think that they are making themselves healthier, without realizing they might be potentially creating problems for themselves in the future.

The human body has various regulatory mechanisms to handle excess vitamin intake, as it does with most other nutrients. Vitamins are safe when you get them in food, but in pill form, they can act more like a drug, with the potential for unexpected and sometimes dangerous effects. If you are routinely taking huge doses of vitamins everyday it could pose a threat to your health. For instance, too much vitamin C or zinc could cause nausea, diarrhea, and stomach cramps. Too much selenium could lead to problems including hair loss, gastrointestinal upset, fatigue, and mild nerve damage. Usually most people aren’t getting these huge doses. But, if you eat a fortified cereal at breakfast, grab an energy bar between meals, have enriched pasta for dinner, and take a daily multivitamin, you could easily be over the recommended daily intake of a host of nutrients. “If left untreated, vitamin overdose whether from gummy or regular vitamins can cause serious and potentially permanent damage to the body. As vitamins affect multiple areas of the body, overdose dangers include impaired sensations, irregular heart rhythms, mental changes, weight loss, convulsions and kidney damage. If a vitamin overdose is suspected, contact emergency medical services or a poison control center immediately. Emergency medical treatment might include washing the stomach, breathing assistance, intravenous fluids and medicine to reverse the overdose effects.” When it comes to vitamins and minerals, more is not necessarily better.

There are many studies on the effects of multivitamins and a good number of them have not been so bright. A majority of tests done to show the supplements chances of lowering the risk of cancer and heart disease have concluded most of the time they make no difference and some cases they surprisingly increase someone’s chance of contracting a disease. A big study that has recently come around is the study on beta-carotene pills. These tests are done to see whether the antioxidant could prevent lung cancer, but researchers instead detected surprising increases in lung cancer and deaths among male smokers who took the supplement. When the results first came out everyone thought it was a fluke and couldn’t believe that the pill that those people were taking to make them “healthier” ended their like but there’s a real possibility that in some circumstances, antioxidant pills could actually promote cancer in women as well as in men. Other studies have raised concerns that taking high doses of folic acid could raise the risk of colon cancer. Still others suggest a connection between high doses of some vitamins and heart disease.

With about forty percent of American adults taking multivitamins without any scientific evidence, there has to be some kind of beneficial value to these pills. Regan Bailey, a nutritional epidemiologist in the Office of Dietary Supplements at the U.S. National Institutes of Health did a study on why people in the U.S. take multivitamins. She collected data on nearly twelve thousand adults who took part in the 2007 to 2010 U.S. National Health and Nutrition Examination Survey. “She found that forty five percent of those taking a multivitamin did so because they believed it would improve their health, and thirty three percent did so because they thought it would maintain their health. Only twenty three percent said their decision was based on advice from their doctor. When they recommend supplements, doctors are most likely to recommend calcium for bone health (twenty four percent) or to improve overall health (eighteen percent), or fish oil for heart health (twelve percent) or to supplement diet (eleven percent),” Bailey said. But a majority of the people who took this survey had three things in common; they all already had a healthy well-balanced diet, they all moderately workout on a regular basis and they all didn’t smoke. So, the already healthy people take vitamins to try make themselves healthier even though they don’t need to waste the money.

Multivitamins aren’t always bad news though, certain multivitamins and dietary supplements help make the lives of certain people easier. Doctors will rarely tell a patient to take a multivitamin or eating a healthy diet but there are some cases where it is almost mandatory that the patient does take one. For instance, a patient is lactose intolerant and has a hard time breaking down and digesting dairy products. Dairy products are a main source of the essential mineral, calcium. So the doctor would have to prescribe a calcium tablet so that patient can get an adequate amount of calcium into their diet. The same could go for those with a deficiency of vitamin D, pregnant patients who should get folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend a vitamin B complex.  Another benefit is that vitamin D protects against a long list of ills: Men with adequate levels of D have about half the risk of heart attack as men who are deficient. And getting enough D appears to lower the risk of at least half a dozen cancers. Vitamin D is the sunshine vitamin. You make it when sunlight hits your skin. Yet thanks to sunscreen and workaholic or TV addict habits, most people don’t make enough. Even with no scientific evidence yet, there is still some hope for the evolution of multivitamins. Fish oil pills are a good example of a supplement that does more good than harm.  Evidence from a number of studies has shown that the one-two punch of lengthened telomeres and reduced inflammation could potentially decrease the risk for other major diseases associated with aging like heart disease, Type 2 diabetes, arthritis, and Alzheimer’s disease, study authors say. Plus, Omega-3 supplementation reduced oxidative stress, caused by excessive free radicals in the blood, by about 15 percent.  So, while omega-3s won’t prevent wrinkles or other physical signs of aging, they could help you live a longer, happier life.

The development and idea of dietary supplements seems to have everyone who takes on under a placebo effect. A placebo effect is the measurable, observable, or felt improvement in health or behavior not accounted to a medication or invasive treatment that has been administered. The placebo effect is not mind over matter; it is not mind-body medicine. The placebo effect has become a term for a positive change in health not attributable to medication or treatment. In this case the multivitamin is the placebo, and the people believe that the pill is making them lose weight or improving their health or fighting off cancer are the ones being tricked. Since there is no evidence that multivitamins really work, all the consumers just take the word of the big companies, friends or doctors just because it seems to be common sense. Why would those companies sell pills that will improve one’s health if in reality they don’t do anything at all. American’s are so gullible feel so invincible that they don’t think anything is a lie or that anything can hurt them. As long as the people believe in these products, they will never go out of business.

There are many reasons why people take dietary supplements, whether it is to improve their health or to get extra vitamins and minerals in their diets when they may or may not need them. Supplements give the impression that they increase ones health and certainly not diminish their health based on their nutritional facts alone.  The consumers of these products are blinded by what they see and hear rather than doing the research to find the facts.  Consumers put so much trust into the manufacturers of multivitamins that they neglect to see the true biological science behind certain supplements.  People like to be told that they are healthy and that they are fine and will do anything to keep it that way. The fear of being unhealthy and sick drives people into choosing supplements to give them a safety net in case they aren’t eating enough. But in reality it could be a false confidence that could cause consumers into buying the products and not getting any positive side effects.

Works Cited:

Anderson, Jon. “Lab finds false claims on supplement labels.” 22 Dec. 2011. Web. 23 Apr. 2013.                           <http://www.armytimes.com/article/20111222/OFFDUTY03/112220302/Lab-finds-false-claims-on-supplement-labels>

Freeman, David. “Vitamin risks? Study ties supplements to bad health decisions.”CBS News, 23 Nov. 2011. Web. 23 Apr. 2013.                                                    <http://www.cbsnews.com/8301-504763_162-57330261-10391704/vitamin-risks-study-ties-supplements-to-bad-health-decisions/>

Reinburg, Steven. “Why Do Millions of Americans Take Multivitamins?” WebMD News,       4 Feb. 2011. Web. 23 Apr. 2013.                                                 <http://www.webmd.com/vitamins-and-supplements/news/20130204/with-benefits-unproven-why-do-millions-of-americans-take-multivitamins>

Richardson, Kevin. “Multi-Vitamins & Vitamin Supplements Do More Harm Than Good.” 25 May. 2011. Web 23 Apr.2013. <http://www.naturallyintense.net/blog/diet/nutrition/multi-vitamins-vitamin-supplements-do-more-harm-than-good/>

Walding, Aureau. “Are Vitamins Regulated by the FDA?” 12 May. 2011. Web. 24 Apr. 2013 < http://www.livestrong.com/article/440306-are-vitamins-regulated-by-the-fda/ >