Alternative medicine - Supplements do little but increase death risk

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Alternative medicine – Supplements do little but increase death risk

I’VE BEEN ACCUSED of being anti-alternative medicine in this column, but the truth is I’m really pro-science. Maybe pro-data is a better description.

Like most doctors, I subscribe to the credo that if you think an alternative treatment works, prove it.

It is maddening that prescription pharmaceuticals are subject to intense scrutiny and testing, while manufacturers of alternative treatments can market vitamins and supplements with outrageous claims of benefit without a shred of evidence to back them up.

When patients ask me whether they should take supplements, my standard reply is that they make for expensive urine but they are generally harmless. But new data suggests that supplements may not be so benign.

First, a little background. Supplements are almost like a religion in this country. About half of American adults take mineral and/or vitamin supplements on a regular basis. The supplement industry is big business, with annual sales more than $20 billion.

During the Clinton administration, the National Institute for Health created the National Center for Complementary and Alternative Medicine (NCCAM). The intent was to bring science to alternative treatments that “are not generally considered part of conventional medicine.” It was hoped that some of the alternative treatments, when subjected to scientific scrutiny, would prove effective. What could be better than relatively inexpensive,

safe, natural remedies for fighting illness and maintaining health?

Unfortunately, in the 20 years of NCCAM’s existence, the majority of studies have shown no benefit or even harm from most alternative remedies. Studies of St. John’s wort, echinacea, saw palmetto and other natural products have shown no benefit. Despite this, Americans continue to believe that “alternative” means “better.” Even though most supplements are manufactured in large factories and are packaged in pills and capsules, they are still viewed as being “natural.”

Ineffectiveness of supplements is tolerable, but now two large studies are suggesting that supplements may be harmful for healthy adults.

The first study looked at nearly 39,000 older women (mean age of 62) in Iowa between 1986 and 2004. The design of the study was quite simple; women self-reported their supplement usage on a regular basis, and they were followed for several decades to see if they lived or died. With one notable exception — all of the mineral supplements were associated with a higher death rate. Multivitamins increased the death rate by 2.4 percent, vitamin B6 increased the risk by 4.1 percent, folic acid by 5.9 percent, magnesium by 3.6 percent, zinc by 3 percent and copper by a whopping 18 percent. Iron increased the risk of death by 3.9 percent, but low doses of iron cause a low risk of death, while higher doses of iron increased the risk.

It is important to remember that these were women past menopause; younger women may need iron to treat anemia. The only supplement that improved mortality was calcium, which reduced the risk of dying by 3.8 percent.

The authors of the study suggest that healthy adults should eat real food, including fruits and vegetables to get their nutrients and not rely on supplements. There is a caveat that some people need supplementation for medical reasons. Some adults can’t absorb B12, iron or other nutrients because of disease, but the vast majority of women will not benefit from supplements.

A different study also was published last week that looked at vitamin E and selenium supplementation in men. The intent of the study was to show that these supplements would prevent prostate cancer. Unfortunately, not only did vitamin E not prevent prostate cancer, it was associated with a higher risk of prostate cancer.

The study enrolled more than 35,000 men in the United States, Canada and Puerto Rico who were older than 50. They were given selenium, vitamin E, a combination of the two or a look-alike placebo. With roughly the same number of men in each group, there were 529 cases of prostate cancer in the placebo group, 620 cases in the vitamin E group, 575 in the selenium group, and 555 in the group that took both selenium and vitamin E.

The increased risk of prostate cancer in the selenium was small enough that it could be written off to chance. But the risk from vitamin E was highly statistically significant with nearly 100 more cases of cancer in the vitamin E group compared with the placebo group. This is a rather disturbing finding that should prompt all men to stop taking vitamin E.

Both of these studies are eye-opening. While doctors have been willing to look the other way and make jokes about expensive urine in the past, it is clear that it is time to declare, when it comes to supplements, the Emperor has no clothes.

It is time to reassess whether we should condone the poisoning of America with supplements that go beyond worthless to harmful. It may even be time for the FDA and other government agencies to get in the act.

But then again it’s an election year — that probably won’t happen any time soon.

Dr. Bill Elliott is assistant physician in chief for Kaiser Permanente’s Novato office and Petaluma. His column appears every third Monday.

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