Healthcare

Vitamin E, multivitamins, B vitamins…this week, they’re all over the news. Again. And as Rick opines in this week’s podcast, sometimes we think we talk too much about ‘nutritional supplements,’ but we also feel that there’s got to be some voice of sanity. So this week’s blog will cover three studies, two from JAMA and one from Archives of Internal Medicine. Let’s start with the negative studies first. Older women may be at higher risk of death if they take multivitamins, iron, or a couple of other supplements. That’s the Archives study, and it looked at women enrolled in the Iowa Women’s Health Study beginning in 1986. Almost 42,000 women aged 55 to 69 years! These participants were surveyed using questionnaires (notoriously poor means of gathering data, btw) at baseline, 1997 and 2004. Predictably the number responding at each follow-up declined, but here’s what they found: multivitamins, B6, folic acid, iron, magnesium, zinc and copper were all associated with an increased risk of death. Interestingly, calcium supplements were associated with a decreased risk, and that is counter to other studies we’ve previously discussed linking calcium supplements with greater heart disease and heart attack risk. Hmmmmm. Rick is quick to point out that like all observational studies that rely on surveys, there’s much we don’t know about other conditions these women may have had and causes of death. A study in JAMA concludes that vitamin E does indeed increase the risk of prostate cancer. That’s according to a study of almost 36,000 men begun about a decade ago and representing an average of 7 years of follow-up. While the increased risk was fairly modest, it wasn’t seen with selenium supplements or a combination of selenium and vitamin E. So what’s so dangerous about E? It’s hard to say, but danger with regard to cancer promotion also seems to be true in cigarette smokers and lung cancer incidence. Such results appear to shoot the theory of antioxidants and cancer risk reduction in the foot. The one positive study this week with regard to supplements was the folic acid/folate study, also in JAMA, and language acquisition in offspring of women who took these B vitamins. Women who were studied took folate before, during or after pregnancy or didn’t take the supplement at all. While we’ve known for some time that spina bifida is reduced in children whose mothers use folate, now we know that delays in language acquisition are also reduced. As I opine in the podcast, this supports the addition of folate to some prepared foods in this country. What Rick and I conclude is that vitamins and supplements, like almost all of medicine, clearly cannot be viewed with a one size fits all approach, and in this case it sure seems like a lifespan kind of issue. At some points in the lifespan vitamins and supplements may have a beneficial effect, while at others they’re not only not helpful, they can be harmful. Now to fall back to that old refrain, what’s needed now is more research. And that’s great job security for someone. The remaining study for this week was in NEJM, and was also good news: the relationship between Barrett’s esophagitis, an inflammation of the esophagus sometimes seen in people with gastroesophageal reflux or GERD (aka, heartburn) and esophageal cancer isn’t as robust as we once thought. Until next week, y’all live well.