lundi 29 avril 2019

VITAMIN AND MINERALS SUPPLEMENTED TAKEN INDISCRIMINATELY MAY HARM YOU


I am an Endocrinologist, a medical doctor whose specialty is studying and taking care of people with hormonal imbalances.
Very early on in my student days in London, I was taught: you correct the situation, when there is a deficiency, try to normalize the hormonal levels, do the same when there is an excess of hormones.
I am also a student of Medical History and I had read that when Konrad Roentgen discovered X-rays, it was thought of as a panacea and people were given radiation treatment for back aches, acne among other things.
Many of the hormones secreted by our bodies are potent and while we give them as a supplement or medication, we only give them people who are deficient in such hormones. There was a fashion at one time to give thyroid hormones to overweight women, trying to justify with the clinical observation that hypothyroid women when given thyroid hormones they were deficient in, lost weight. Giving excess thyroid hormones or testosterone or any hormones when you give to people who truly do not need them can only lead to health problems.
Cortisol is a good hormone and we know the myriad of side effects : hypertension, thin bones and thin skins, diabetes
These hormones or minerals have been judiciously used and benefited millions of people around the world, but only when taken appropriately.
The same applies to Vitamin and Mineral supplements.
There are medically indicated situations when these are necessary and beneficial: Folic acid supplement to prevent neural defects in the foetus. A new study,

Prenatal Vitamin Use Lowers Risk for Autism Spectrum Disorder in Vulnerable Families
Brings hope to many of the affected families of Autism Spectrum Disorder
When there is documented Vitamin D deficiency (the numbers would be in single digits) or calcium deficiency, supplementation is warranted. In my travels I have seen the benefits of sporadic vitamin supplementation when the population (country, isolated region) has been deprived of food or does not have sufficient food, or a population becomes too dependent on food cooked outside or in fast food restaurants. While we recognize that the American diet may be deficient in certain minerals, such as Calcium or Iodide, but we recommend that mineral replacement be natural and through food, not tablets.
Vitamin and Mineral industry in the USA is worth billions of dollars..

The big 5 spenders in Vitamins and supplements are
Top 5
ChinaUS$4,704m
UnitedStatesUS$4,630m
JapanUS$1,868m
BrazilUS$847m

I have always felt that this behemoth of an industry was built on the false promise that, if a little is good, more should be only better, so that you can take 500% of the required amount of the mineral in a tablet and “feel” better.
Of course, a broader spectrum of individual ingredient and its purported huge benefits also fill the store shelves:
Co Enzyme Q 10
Individual amino acids
I feel that these supplements (unless indicated as explained above) are not panaceas of health but a waste of money and in many cases may actually harm you. If I suspect a mineral deficiency, on clinical grounds, such as a young woman taking a very small amount of Thyroid hormone, may be due to Iodide deficiency, I ALWAYS recommend that the nutrient or mineral be obtained naturally through food. I was very reluctant to prescribe high dosages of vitamin D being advocated (almost every one had Vitamin D deficiency because the normal levels were artificially raised).
The new entry into this circus is PROBIOTICS. And you would see its prescription more and more as we learn the science of Microbiome. Microbiome is as diverse as a thick jungle and the Probiotics tablets are just like few leaves in that canopy, plus the fact that the probiotics do not reach where they are supposed to be effective.
Forbes magazine September 2018
Do You Buy Probiotics? New Study Says They May Not Work For You And May Even Be Harmful
Science Daily:
Probiotics are found in everything from chocolate and pickles to hand lotion and baby formula, and millions of people buy probiotic supplements to boost digestive health. But new research suggests they might not be as effective as we think. Through a series of experiments looking inside the human gut, researchers show that many people's digestive tracts prevent standard probiotics from successfully colonizing them. Furthermore, taking probiotics to counterbalance antibiotics could delay the return of normal gut bacteria and gut gene expression to their naïve state. The research publishes as two back-to-back papers on September 6 in the journal Cell.

So it was very gratifying for me to read an article published today , thousands and thousands of people and their habits and whether or not vitamin and mineral supplement did anything to their health or longevity?

Nutrients from food, not supplements, linked to lower risks of death, cancer

SUMMARY AND COMMENT | GENERAL MEDICINE

April 18, 2019
Dietary Supplements Aren't Associated with Lower Mortality
Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Chen F et al. Ann Intern Med 2019 Apr 9
But adequate intake of nutrients from food confers health benefits.
Many U.S. adults report taking dietary supplements, despite no evidence of benefit. In a prospective cohort study, investigators evaluated the effects of dietary supplements and nutrient intake from foods and supplements on mortality in ≥30,000 adults who participated in the U.S. National Health and Nutrition Examination Survey and were followed for ≥6 years.
Fifty percent of participants used dietary supplements. In analyses adjusted for demographics, habits, and comorbid conditions, use of dietary supplements was not associated with lower mortality. However, people who did not maintain at least adequate intake of vitamins A and K, magnesium, and zinc from foods (according to Institute of Medicine standards) had excess risk for death. Excessive calcium intake (≥1000 mg daily) from supplements was associated with significantly higher relative risk for cancer-related death (1.5 additional deaths per 1000 person-years). Excessive vitamin D intake (≥10 µg [400 IU] daily) from supplements in people without vitamin D deficiency was associated with significantly higher relative risk for death.

COMMENT

In this study, researchers went to great lengths to accurately calculate participants' vitamin and mineral intake (distinguishing nutrient sources) and to assess mortality outcomes. Findings mirror those of other large cohorts and a systematic review, supporting findings that adequate vitamin and mineral intake from foods leads to positive outcomes, with little or no additional benefit from supplements. Whether the excess mortality associated with calcium and vitamin D supplementation reflects residual confounding in this observational study is unclear, but clinicians might want to share these findings with patients who routinely take these supplements.

Commentary from Tufts University (long) for those who wants to know the nitty gritty of the research:

Adequate intake of certain nutrients is associated with a reduction in all-cause mortality when the nutrient source is foods, but not supplements, according to a new study. There was no association between dietary supplement use and a lower risk of death.
In addition, excess calcium intake was linked to an increased risk of cancer death, which the researchers found was associated with supplemental doses of calcium exceeding 1,000 mg/day. The study was published on April 9 in Annals of Internal Medicine.
"As potential benefits and harms of supplement use continue to be studied, some studies have found associations between excess nutrient intake and adverse outcomes, including increased risk of certain cancers," said Fang Fang Zhang, M.D., Ph.D., associate professor at the Friedman School of Nutrition Science and Policy at Tufts University and senior and corresponding author on the study. "It is important to understand the role that the nutrient and its source might play in health outcomes, particularly if the effect might not be beneficial."
The study used a nationally representative sample comprised of data from more than 27,000 U.S. adults ages 20 and older to evaluate the association between dietary supplement use and death from all causes, cardiovascular disease (CVD), and cancer. The researchers assessed whether adequate or excess nutrient intake was associated with death and whether intake from foodversus supplement sources had any effect on the associations.
For the association between nutrient intake and the risk of death, the researchers found:
·       Adequate intakes of vitamin K and magnesium were associated with a lower risk of death;
·       Adequate intakes of vitamin A, vitamin K, and zinc were associated with a lower risk of death from CVD; and
·       Excess intake of calcium was associated with higher risk of death from cancer.
When sources of nutrient intake (food vs. supplement) were evaluated, the researchers found:
·       The lower risk of death associated with adequate nutrient intakes of vitamin K and magnesium was limited to nutrients from foods, not from supplements;
·       The lower risk of death from CVD associated with adequate intakes of vitamin A, vitamin K, and zinc was limited to nutrients from foods, not from supplements; and
·       Calcium intake from supplement totals of at least 1,000 mg/day was associated with increased risk of death from cancer but there was no association for calcium intake from foods.
In addition, the researchers found that dietary supplements had no effect on the risk of death in individuals with low nutrient intake. Instead, the team found indications that use of vitamin D supplements by individuals with no sign of vitamin D deficiency may be associated with an increased risk of death from all causes including cancer. Further research on this potential connection is needed.
"Our results support the idea that, while supplement use contributes to an increased level of total nutrient intake, there are beneficial associations with nutrients from foods that aren't seen with supplements," said Zhang. "This study also confirms the importance of identifying the nutrient source when evaluating mortality outcomes."
The study used 24-hour diet recall data from six two-year cycles of the National Health and Nutrition Examination Survey, through 2010. For each nutrient, the daily supplement dose was calculated by combining the frequency with the product information for ingredient, amount of ingredient per serving, and ingredient unit. Dietary intake of nutrients from foods was assessed using 24-hour dietary recalls. Mortality outcomes were obtained for each participant through linkage to the National Death Index through December 31, 2011, using a probabilistic match.
The authors note some limitations, including the duration of dietary supplement use studied. In addition, prevalence and dosage of dietary supplement use was self-reported and so is subject to recall bias. Residual confounding may play a role in the observed associations.

MORAL OF THE STORY
DO NOT TAKE ANYTHING IF YOU ARE NOT DEFICIENT IN IT, BECAUSE OF THE PROMISE OF SOMETHING GOOD MIGHT HAPPEN, USUALLY JUST THE OPPOSITE MIGHT HAPPEN.
As Michael Pollan would say: EAT FOOD
As an example
9 iodine-rich food sources that can help prevent a deficiency.
·       Seaweed. ..
·       CodCod is a versatile white fish that is delicate in texture and has a mild flavor. ...
·       DairyDairy products are major sources of iodine, especially in American diets (12). ...
·       Iodized Salt. ...
·       Shrimp. ...
·       Tuna. ...
·       Eggs. ...
·       Prunes.

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