5-Article Review by Dr Alex Vasquez

• For this video tutorial, I'm going to review 5 research articles which support the use of routine vitamin-mineral supplementation for health-promotion and disease prevention.

• I've chosen these articles from among several hundred articles as "representative examples" of peer-reviewed medical research which serve to answer the commonly asked question, "Why should people take vitamin and mineral supplements?"

• These articles discuss the use of multivitamin-multimineral supplementation in general rather than focusing on a particular disease or a specific nutrient. Also, this brief review does not include information about botanical medicines, pharmaceutical drugs, or the holistic and integrative clinical approaches that we use clinically with patients and which are detailed in my textbooks for doctors. This is simply a quick review of vitamin and mineral supplementation for general purposes of health promotion.
  
   

1)  Fletcher RH, Fairfield KM. [Harvard Medical School and Harvard School of Public Health] Vitamins for chronic disease prevention in adults: clinical applications. JAMA--Journal of the American Medical Association. 2002 Jun 19;287(23):3127-9 

• This is an important article not simply because it supports and encourages the use of vitamin supplementation by adults and by physicians, but because it comes from two powerful organizations within medicine: Harvard's Medical School and School of Public Health, and the article was published by the American Medical Association, an organization which has traditionally been opposed to accepting the importance of nutrition and the benefits of nutritional supplementation.

• "However, suboptimal intake of some vitamins, above levels causing classic vitamin deficiency, is a risk factor for chronic diseases and common in the general population, especially the elderly. ... Most people do not consume an optimal amount of all vitamins by diet alone. ...it appears prudent for all adults to take vitamin supplements. ... Physicians should...ensure that they are taking vitamins they should..."
   

2)  Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003 Nov;78(5):912-9

• Robert P Heaney MD, Creighton University, Omaha: Dr Heaney has numerous very respectable publications on vitamin D.

• "However, inadequate intakes of many nutrients are now recognized as contributing to several of the major chronic diseases that affect the populations of the industrialized nations. Often taking many years to manifest themselves, these disease outcomes should be thought of as long-latency deficiency diseases. Sometimes they come about by the same pathophysiologic mechanism that produces the index disease, but sometimes the mechanisms are completely different. ... Discerning the full role of nutrition in long-latency, multifactorial disorders is probably the principal challenge facing nutritional science today. The first component of this challenge is to recognize that inadequate intakes of specific nutrients may produce more than one disease, may produce diseases by more than one mechanism, and may require several years for the consequent morbidity to be sufficiently evident to be clinically recognizable as "disease." Because the intakes required to prevent many of the long-latency disorders are higher than those required to prevent the respective index diseases, recommendations based solely on preventing the index diseases are no longer biologically defensible."
   

3)  Ames BN, Elson-Schwab I, Silver EA. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms. Am J Clin Nutr. 2002 Apr;75(4):616-58.

• Bruce Ames PhD, one of the world's most respected researchers, developed the "Ames test" for determining the cancer-causing potential of chemicals.

• Dr Ames is currently a professor and researcher at University of California at Berkeley.

• This is a remarkably thorough review of the literature with 377 citations to other peer-reviewed biomedical publications.

• "About 50 human genetic dis-eases due to defective enzymes can be remedied or ameliorated by the administration of high doses of the vitamin component of the corresponding coenzyme, which at least partially restores enzymatic activity. Several single-nucleotide polymorphisms, in which the variant amino acid reduces coenzyme binding and thus enzymatic activity, are likely to be remediable by raising cellular concentrations of the cofactor through high-dose vitamin therapy."

 

4)  Ames BN. The metabolic tune-up: metabolic harmony and disease prevention. J Nutr. 2003 May;133(5 Suppl 1):1544S-8S

• "A metabolic tune-up is likely to have enormous health benefits, particularly for those with inadequate diets such as many of the poor and the elderly who need improvement the most, although it is currently not being addressed adequately by the medical community. The issues discussed here highlight the need to educate the public about the crucial importance of optimal nutrition and the potential health benefits of something as simple and affordable as a daily multivitamin/multimineral supplement. Tuning up metabolism to maximize the human health span will require scientists, clinicians and educators to abandon outdated paradigms of micronutrients merely preventing deficiency disease and explore more meaningful ways to prevent chronic disease and achieve optimal health through optimal nutrition."
  
   

5)  Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. [University of Oxford] Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Br J Psychiatry. 2002 Jul;181:22-8.

• Double-blind, placebo-controlled, randomized trial of nutritional supplements on 231 young adult prisoners

• Intervention included a simple vitamin-mineral supplement and a fatty acid supplement that contained GLA (generally from borage oil or evening primrose oil) and EPA and DHA from fish oil.

• "METHOD: Experimental, double-blind, placebo-controlled, randomized trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation. RESULTS: Compared with placebos, those receiving the active capsules committed an average of 26.3% fewer offences. Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks was an average 35.1% reduction of offences, whereas placebos remained within standard error. CONCLUSIONS: Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community."

 

Summary:

1) Mild vitamin deficiencies are common in the general population and contribute to the development of several different chronic diseases. Most adults should therefore take nutritional supplements containing vitamins and minerals. "Physicians should...ensure that [patients] are taking vitamins they should..."

2) Vitamin deficiencies--especially when mild--can result in "long-latency deficiency diseases" which can include osteoporosis, chronic pain, depression, heart disease, and cancer even while there is no evidence of acute or severe nutritional deficiency.

3) High-dose vitamin supplementation helps overcome genetic defects that result in altered enzyme structure. High-dose vitamin supplementation makes the defective enzyme work more effectively and efficiently.

4) Daily multivitamin-multimineral supplementation is an inexpensive way to help ensure that nutritional needs are met so that one's metabolism and physiology function optimally. "...highlight the need to educate the public about the crucial importance of optimal nutrition and the potential health benefits of something as simple and affordable as a daily multivitamin/multimineral supplement."

5) Nutritional supplementation with vitamins, minerals, and fatty acids has been shown to improve mood, intelligence, and psychosocial functioning. This is important to each of us as individuals and as members of society as a whole.

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