Post on Merck site on multivitamins includes outmoded views, CRN says

23-Aug-2017 - Last updated on 24-Aug-2017 at 17:00 GMT

A commentary from a doctor associated with the pharmaceutical giant Merck trots outs some tired criticisms of vitamins and other supplements that are mixed in with generally sound advice, an expert from CRN says.

Old habits die hard, especially when it comes to offhand criticisms of the effects of multivitamins and other supplements. Dr. Larry E. Johnson, MD, wrote a commentary on the portal Merck Manual Consumer Version titled “Striking the Right Balance with Vitamins—5 Things You Should Know.” While his commentary includes much information that Andrea Wong, PhD, of the Council for Responsible Nutrition said is sound advice, it does contain some timeworn criticisms that have been disproved by recent research. Dr. Johnson’s points can be summarized as follows:

Vitamin deficiencies are rare in the United States
Some diets or conditions might make a vitamin supplement necessary
Vitamin needs change over time
Tell your doctor about what vitamins you take
Vitamins are no substitute for diet and exercise.

Disagreement on the existence of nutrient gaps

As his first point, and one might say an underlying theme, Johnson makes the statement that vitamins are unnecessary for most people who are leading a healthy lifestyle.

“Taking vitamin supplements or a daily multivitamin isn’t the silver bullet many people believe. For most generally healthy people, a daily multivitamin has not been shown to provide health benefits,” Dr. Johnson wrote. Johnson cites the almost complete absence of scurvy—a vitamin C deficiency disease—in the US population to bolster his view.

“Most people eating a healthy, balanced diet get all the vitamins they need without having to take any additional supplements. What’s more, vitamins have not been shown to have an impact on most short-term illnesses,” he wrote.

While Wong, vice president of scientific and regulatory affairs for CRN, said that she “generally [agrees] with much of what Dr. Johnson has to say in the five things consumers should think about in regard to vitamins," she doesn't agree with Dr. Johnson's statement on nutrition gaps. "There is compelling evidence that comes from various government bodies that Americans continue to fall short in a number of key nutrients,” Wong told NutraIngredients-USA.

Official dietary guidelines recognize ‘underconsumed’ nutrients

Among the evidence that has come forward on the subject recently is a study that looks an NHANES data from the 2009-2012 period. While this is not the sort of double-blind, placebo controlled study that might resonate with a physician like Dr. Johnson, who is an associate professor of geriatrics at the University of Arkansas for Medicine, it does include data from more than 10,000 subjects. The authors found that the use of what they called MVMS (multivitamin and mineral supplements) could virtually eliminate nutrient shortfalls.

Lead author Jeffrey Blumberg PhD, who is the lead scientist of the Antioxidants Research Laboratory at Tufts University, said the data help support the idea that the use of MVMS can be an important support for overall health. Widespread micronutrient fortification in food has in fact helped eliminate certain deficiency diseases like rickets and beriberi. But Americans still consistently come up short in the kind of full-spectrum micronutrient intake that could support optimum health, he said.

“Food fortification —particularly vitamin D in milk and vitamin A in reduced fat milk; iodine in salt; B vitamins, now including folic acid, and iron in refined flour —has been one of the huge public health wins in the US this past century," Blumberg said.

"In spite of this past success, due partly to changes in our current dietary pattern, there are now 11 “underconsumed”or shortfall micronutrients —vitamins A, C, D, E, K, folate and choline and the essential minerals calcium, iron, magnesium, and potassium —recognized in the Dietary Guidelines for Americans 2015-2020. Multivitamin/multi-mineral supplements can help fill many, but not all, of these gaps as illustrated in our recent study of the latest NHANES dataset from 2009-2012,” he added.

Magic pill notion is outmoded

Another question that seems to underpin Dr. Johnson’s point of view is how he views the role of a dietary supplement in supporting health. He seems to believe that these are being used by consumers in lieu of other health lifestyle choices, something that no one in the industry advocates, and an idea that recent research does not support.

“If you want to decrease your risk of long-term health issues like heart disease and cancer, don’t look in the supplements aisle at the grocery store. Start in the produce aisle—eat a healthy, varied diet heavy in fresh fruits and vegetables and whole grains. Find a workable exercise regimen, avoid excessive alcohol consumption, and don’t smoke. There’s no magic pill that will make you a healthier person,” he wrote.

Wong said this is an outmoded idea. Dr. Johnson might seem to think multivitamins are being marketed as a space-age magic meals in a pill—the stuff of “cheesy science fiction,” as he puts it. But Wong said research conducted by CRN on consumers’ attitudes toward multivitamins shows that they are not looking at these supplements in that way.

“We conducted a survey a couple of years ago on consumers’ attitudes toward multivitamins. We found the vast majority believed they could be used to fill in nutrient gaps. They are not looking at these supplements to replace healthy lifestyle habits. The notion that they are looking for a magic bullet was not borne out by our research,” she said.