The skeptical cardiologist recently received an email from Al Lewis, who continues to do great work on his blog and with his company, Quizzify. The email quizzed me about supplements, a topic I’ve written about extensively.
The linked article is well worth reading and should be required reading for all employers and employees. If there are any CEOs or HR officers in my readership take note and consider changing your approach to employee wellness.
Six Things Employees Should Know
The vast majority of your employees take nutritional supplements, whose consumption just reached an all-time high. That increase means someone, somewhere – maybe even your very own wellness vendor – is telling them this is a good idea.
Or maybe they are thinking: “Hey, what harm can they do?”
Plenty, as it turns out.
Here are six things employees should know about nutritional supplements.
1. Virtually all the benefits of supplements with virtually none of the risk can be achieved by taking a regular multivitamin
There is plenty of evidence for the health benefits of virtually all vitamins and minerals and even a couple of supplements, so much evidence that we have room to highlight only a few.
Examples include fish oil for menopausal women with dry eye or possibly people at high risk of heart attack. Or folic acid for pregnant women and iron for pregnant women who are anemic. Or Vitamin D for people who have dark skin, live in cloudy climates, avoid all sun exposure and/or don’t each much dairy. And of course, Vitamin B12 for vegans. (Vitamin B12 is found only in animal products.)
Women likely benefit from small combined extra amounts of calcium and Vitamin D…but as noted below, don’t overdo it.
The 10% of the population who drink to excess really should be taking daily multivitamins. This is partly because alcohol interferes with absorption, and partly because they aren’t getting enough calories from real foods.
With these exceptions, most people should be getting enough vitamins in a balanced diet, but a few cents a day of an “insurance” multivitamin pays for itself just in the psychological benefit of not worrying about that. However, the story changes when we talk about megavitamins, and especially when we talk about other supplements.
2. Almost every megavitamin which once showed “promise” in fighting cancer, heart disease, etc. doesn’t. Quite the opposite, they may cause harm.
Niacin, once thought to have magical properties against heart attacks, has been completely debunked. Vitamin E supplements could prevent cancer in some women but cause it in others, depending on genes. Men who are concerned about prostate cancer (meaning all of us) should specifically avoid Vitamin E supplements, which likely increase the odds of it. Vitamin D in large quantities is the latest to be debunked, just last month. Taking too much may cause osteoporosis, rather than prevent it.
And monitor your own wellness vendors. Interactive Health, for example, tests every employee for anemia. This is contrary to the advice of clinical guidelines, which oppose anemia screening except for pregnant women, where evidence is mixed. Employees who then take iron supplements risk stomach pain, nausea, vomiting and serious long-term complications.
The good news? It is possible large amounts of Vitamin C do offer modest benefits with respect to common colds, and that those possible benefits outweigh the possible harms. But just large amounts, like 200-400 mg., not massive amounts — and not so large that you need pills.
3. If you have to go to GNC to obtain a supplement, or order it through the mail, it has no value and may cause harm.
CVS and Whole Foods want to make money too, and fancy supplements are expensive high-margin items. So if a supplement has even the slightest inkling of value, they’ll stock it.
As a random example we picked because we like the name, consider horny goatweed, as a treatment for erectile dysfunction (ED). Along with the name, it also has a great back story, something about Mongolian herders observing goats getting aroused after grazing on it.
It is actually proven to work, and not just on goats. It also works on rats. For the rest of us, there is zero evidence. Plus, ED is one of those conditions where, if something worked, we’d know about it by now.
At least the likelihood of harm is pretty low to other than your wallet.
4. There is no such thing as FDA approval for supplements
It’s also not entirely clear that these pills contain the ingredients they claim to contain in the quantities they profess to contain. These supplements turn out to be much harder to manufacture to specs than regular synthetically derived pills.
5. They may interact with “real” drugs you are taking
Just because supplements are derived from natural sources doesn’t mean they don’t act like real drugs inside your body. And, like real drugs, they can interact with other drugs. For instance, if you are taking Vitamin E and Advil or Advil PM or a baby aspirin, your risk of bleeding profusely in an accident goes way, way up, because all are blood thinners. The risk isn’t just accidents — small everyday bruises may become big bruises.
Make sure you list supplements when describing to your doctor what you take…though it’s questionable whether (aside from the basics, like that blood-thinning example) the doctor would be aware of these interactions. There are too many to track, and some interactions simply aren’t studied.
It all comes back to this: a one-a-day multivitamin/mineral supplement is more than enough for most people. Not just for the benefits, but for avoidance of the risk of interaction, side effects and unknown long-term impacts.
6. One other “supplement” benefits almost every body system and has no side effects
You guessed it – exercise, the key to health and longevity. If there were a dietary supplement that provided even a small fraction of the benefits of exercise, we’d know about it by now.
I agree with Al on most everything above except I don’t recommend a multivitamin to my patients. I think a good, balanced diet provides all the vitamins, minerals and unknown nutrients for the vast majority of individuals.
After reviewing the literature I wouldn’t recommend supplementing Vitamin C to prevent colds. I agree with the conclusions from a recent review which admitted there may be a slight benefit from Vitamin C supplements in reducing the severity and duration of the common cold
the practical significance of these findings is not very convincing. It does not seem reasonable to ingest additional vitamin C outside of dietary intake throughout the year if the only benefit is the potential for a slightly shortened cold duration and lessened symptoms.
The National Institutes of Health recommend daily intake of 90 mg of vitamin C for males and 75 mg for females with a focus on getting those amounts from dietary sources, namely, fruits and vegetables. Citrus fruits are a great source of vitamin C. A medium orange has 70 mg of vitamin C, and a medium grapefruit has 78 mg of vitamin C. The National Institutes of Health suggests that consuming 5 varied servings of fruits and vegetables daily can provide more than 200 mg of vitamin C. Supplementation may be needed for those specific patients with marginal vitamin C status such as the elderly and chronic smokers, but the majority of the population should focus on getting vitamin C from their diet.
N.B. I have no connection, financial or otherwise, with Quizzify but I did try to get my hospital to consider switching to them from the rather silly wellness vendor we currently have.
This promotional material appears at the end of Al’s article.
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