Once-upon-a-time, when a patient said they were taking a vitamin, most doctors would simply shrug their shoulders and say, “well, I guess its OK, it couldn’t hurt.” There was little research to judge the affect of vitamin supplements, so there was no reason to take a stand. That is no longer true.
Now we have published data on many vitamins and we can say that for most people they do not work. More importantly, there is increasing research that says manufactured, chemically synthesized nutriment compounds in a pill, can be deadly.
For this reason, I am likely to ask my patients if they are taking a vitamin and, if so, which fabricated additive and how much. Therefore, I asked Bill, while he was in the office receiving chemotherapy for Hodgkin’s disease, what alternative therapies he was using.
When he informed me that he swallowed a multivitamin (MVI), large doses of Vitamins C and E, as well as a B complex preparation, I advised him to stop.
To my astonishment he responded, “Well, you only want me to do that because you make a lot of money on chemotherapy, and vitamins might put you out of business.”
Bill’s response, he lack of trust in my advice, disturbs me at several levels. He fails to understand and does not wish to learn the present state of science regarding nutrition. In addition, there is a major problem regarding his perception of my motivations and therefore the veracity of my guidance.
Let us be clear; in the absence of malnutrition, malabsorption and a few uncommon medical conditions, there is absolutely no reason to take a multivitamin. They do not prevent or fix anything. Originally developed for starving populations and hungry soldiers during the Second World War, they have no place in a society with access to a broad range of foods.
More importantly, there is increasing data that people taking a multivitamin may become less healthy.
Antioxidants such as Vitamin E, beta-carotene and probably high doses of Vitamin A, are harmful. Supplemental doses of Vitamin C are useless and ultra-high dose Vitamin C, whether oral or IV, cannot be supported. Excessive amounts of folic acid and B vitamins seem to do nothing. Only vitamin D, with calcium, is of some benefit in women, and even that data is shakier than we would like.
I can accept that Bill has not learned this information, the 27-billion-dollar-a-year American vitamin industry goes to great trouble to confuse good nutrition with artificially formulated tablets in pretty bottles. Most people do not understand that vitamins are critical and fabulous, but only in their natural form. Our bodies have spent millions of years learning how to gain value from an orange, apple or sweet potato.
To think that a chemist in a lab is smarter than eons of evolution and can make super-nutrition in a pellet, is hubris, but I understand Bill’s confusion. Nonetheless, what does it say about our doctor-patient relationship if he does not trust me?
In New Jersey, our oncology practice is presently treating over 150,000 patients. A dozen people in my family have had cancer. What kind of a monster would I have to be to deliberately ignore affective therapy, in order to make money? Is it likely that the more that 35,000 members of the American Society for Clinical Oncology (ASCO), the dominant clinical cancer organization in the world, could keep the secret, if vitamins really worked?
Is it not more likely that if anyone had the cure, they would rush to the highest mountain, shout out the news and become the most famous (and rich) individual in health history?
So, if Bill does not trust my recommendations or motivation, why is he coming to see me at all? I would surmise he feels trapped between getting state-of-the-science care and a distrust of that science. As he watched the tumors grow, as he did his own research of his choices, he was limited to few alternatives. However, like anyone else in that position, he is not happy with how that decision process ended; sitting in an office with an IV dripping chemo into his arm.
I can empathize with his anger, fear and confusion; the feeling of being trapped. Nonetheless, I have difficulty understanding why he does not see me as friend, as someone who has his back, rather than as a leach feeding off his suffering.
During our brief conversation in the chemo suite, which I finished by giving him a written review about the risks of vitamin supplements, I did not have time to dig deeper into his concerns. If we are to continue together, I will need to understand his incentives, goals and how he makes decisions. Otherwise, I am afraid his health will suffer because of mistakes, by him or me, born of poor communication.
Curing his cancer requires not only that he understand me, but that I trust him.
James C. Salwitz, MD is a medical oncologist in private practice for 25 years, and a clinical professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.
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“I know of no evidence that vitamins increase beneficial immune function in otherwise healthy people.” Since when is a person with cancer considered a healthy person? Yes, a revitalized healthy immune system is a good idea, and if vitamin supplements can contribute to revitalizing a healthy immune system, that sounds like a good idea. It is not possible to get all our nutrients and vitamins through our meals.
And I agree that doctors (particularly medical oncologists) have historically not known much about diet and nutrition in the treatment of illness or keeping their patients healthy. Just as much as medical oncologists have historically not known much about treating all the side effects inflicted upon their patients with the toxic drugs they are being given.
Another issue is the difference between taking a daily type supplement or taking high doses of vitamins or other supplements? A daily type supplement would be fine, but taking “higher” doses of vitamins or other supplements during treatment may actually have an adverse effect on the cancer treatment itself.
Researchers at Jefferson have provided genetic evidence that antioxidants can actually help to treat cancer. They are taking advantage of available drugs that reduce oxidative stress and autophagy that are important for driving tumor growth. While researchers at Johns Hopkins have shown epigenetics is proving orthodox oncology wrong about supplements.
I agree that a main issue within this essay is the suspicion and mistrust between the practitioner and the patient, brought on by the practitioner’s insistence that might makes right. I can agree on what the supplement industry does, about as much as I can agree on what the cancer drug industry does.
Thank you for this article. It is always better not to eat multivitamins if you are perfectly healthy. In fact, it is safer to wait for a doctor’s prescription. If we want to increase the nutriments in our body, we just have to adjust our foods. There is nothing better than natural vitamins. Whether we like or not, multivitamins are medicines. In order to avoid all the side effects of medicines, we need to eat them only when necessary.
I deal with mostly non-life threatening musculoskeletal conditions in my practice in Occupational Medicine. I am finding more patients are willing to use physical measures (ice, heat, wrapping, exercises, etc) and less eager to jump to pharmacological treatments. If I do use mediciations, I recommend OTC meds first and I am writing far fewer prescriptions than even a few years ago.
In doing DOT physicals, I encourage the drivers to intitiate lifestyle changes such as exercise and good eating habits to limit the need for BP or diabetes meds if possible, or at least give a better response to meds.
In years past, many would ask, “can’t I just take a pill for that?”, and now
they’re wanting to get away from the meds. I am hoping to see a trend toward lifestyle changes, and proper nutrition to obviate the need for extensive medications. I do not promote vitamins, but if asked, advise there is no evidence they are beneficial, and some can be harmful.
While I suspect many patients with malignancies would like to forgo the
toxicities of chemotherapy, at this point it is the best we can offer. But I see a backlash against Big Pharma, and to some degree the medical establishment for escalating healthcare costs. It will take all of us physicians to encourage the patients that right now, we are the only ones on their side.
Quite an interesting post.
Is the patient receiving chemotherapy for Hodgkins considered a “healthy person”? At this time his system is impaired and fighting a disease. Can the vitamins and supplements be tailored to taking those that boost his immune system and any other low or deficient levels in his bloodwork? Agreed that what you eat should be the first line of effort for helping the body but there are lots of variations on that idea. And personal eating habits weigh heavily into the mix.
I found that when I stopped taking a multi-vitamin I felt much better. This was after many years and through several cycles of chemo and radiation. I was happily surprised at this.
The problem I have with doctors saying multis have no benefit is that doctors have historically not known much about diet and nutrition in the treatment of illness or keeping healthy.
I agree that the supplement industry needs to have much more scrutiny and oversight as to quality – but it’ll be hard to prove cause and effect.
After this report came out I reevaluated my supplement intake and cut it in half, and I feel no different. But it’s difficult to know much without blood testing and I would like more evidence.
I am learning that eating less (a lot less) really contributes to health.
I think we all agree on the supplement industry ..
On the other hand: isn’t true that almost every drug carries a trade off?
Many of us take our pills without stopping to consider the risks and benefits.
Why should vitamins be any different?
Yes, and even as greedy and deceptive as the drug (and device) industries are, they are, at least, held to some set of standards. The standards are imperfect, as are the oversight and enforcement, but even modest standards are better than none.
I think we missed the big picture here. The major issue as I see it is the patient/doctor relationship and trust. If there is suspicion and mistrust between the practitioner and the patient how is healing supposed to occur?
I believe, trust in the physician’s intent to treat the said illness has to be present for healing to begin. Conversly, if the patient feels trapped and confused about his/her options but goes through with treatment what type of effect would the treatment have?
I believe the mind influences healing and if the patient is not convinced that the physician and health care team are acting in the best interest, it is doubtful that the treatment would be beneficial.
I agree the evidence to support routine vitamin use in people without confirmed vitamin deficiencies is lacking, and yet millions of people she’ll out hard earned funds to buy it. It’s sad and foolish.
That said, it may not be worth fighting with patients about it. (I don’t mean to imply you did, just that it’s an inclination many of us feel.) I try to educate my patients and support their informed choice, but in the end it is their choice to make, and I want to make sure our therapeutic bond is strong even if they aren’t making the same choice I would make.
Hopefully in time that reasonableness and bond and consistency will outshine the fly-by-night claims of the vitamin zealots.
Provocative post. Vitamin supplements do not prevent or treat cancer. But there is another side to this story, and it, too, is important. I have addressed it in several prior posts:
I am all for people with heart failure using CoQ10, or anything else that will provide symptomatic reflief and possibly improve QOL, at what is a very low cost. Their disease is not curable, it will almost certainly result in premature death, and their options are few.
That’s a far cry from the supplements industry’s prevalent message that their dreck has strategic value in the health lives of the majority of Americans, who are not sick and certainly don’t have heart failure. What the majority of Americans suffer from most is a lack of will.
This is really a news to me. But my question is if some patient is found lacking in particular vitamin, how do you treat him? I don’t think it is possible to get all our nutrients and vitamins through our meals.
Not the meals most people are eating. Vitamins are a distraction from a truly healthy lifestyle. A plant based diet, devoid of processed foods continues to prove itself over and over again. Unlike vitamins, the health benefit is obvious.
Yes, I do agree with you on that most of us are eating unhealthy meals. But what is wrong with supplementing a particularly deficient vitamin/mineral/nutrient through external supplements? I think this a pretty useful book: What Your Doctor Doesn’t Know About Nutritional Medicine May Be Killing You
Jim Salwitz is right on. The jury is out only if you don’t read, or if you read and choose not to believe what you read.
The supplements industry is built on a lie. And, thanks to a complicit US Congress, they can dance right up to the edge of making curative claims without penalty. The industry’s criticisms of studies showing that their products don’t work are moronic beyond words: the studies didn’t use the right vitamins in the right formulation or the right dose; they use products in people who were too sick to benefit; they used the products in people who were not sick enough to benefit. So, basically, vitamins don’t help people who are already ill and they don’t help people who are healthy get healthier because, well, risk is not endlessly reducible and if you are healthy, you are healthy.
Here is the study that this very rich and deceptive industry ought to do: go to any major metropolitan area in America and recruit a sample of multiethnic, free living men and women, with a sample size large enough to make it generalizeable. Everyone gets a general medical exam, a treadmill fitness test, and is certified to be free of a major preventable (i.e., lifestyle) disease, such as diabetes, CVD, HTN, cancer, etc.
Assign half to a group that gets the treatment (i.e., the vitamin supplement). Assign half to a group that doesn’t get and then tell both groups to just go live their lives.
Do follow-up contacts and medical exams periodically and at years 1, 5, and 10, assess morbidity and mortality (model the study after MESA). I will bet my retirement savings that the vitamin (even let the clowns in the industry select the type/dose/formulation just so we use the “right ones”) will make ZERO difference to morbidity and mortality.
No lifestyle pursuit does more to promote a healthy immune system than exercise. And, finally, cancer cells, like other cells, require nutrients. No less an expert than James Watson, the co-discoverer of DNA’s structure, has slammed the promotion of antioxidants as a way to cure or prevent cancer. It is entirely possible that mega doses of vitamins promote cancer cell development rather than inhibit it. But, maybe we just need to study a different vitamin/formulation/dose.
I don’t know enough about e-cigs to comment.
At this point we have a significant amount of research that shows no benefit and possible harm. While I appreciate the concept that a healthy immune system is a good idea, I know of no evidence that vitamins increase beneficial immune function in otherwise healthy people. So, I think the jury has delivered its verdict. Will there be appeals? No doubt. Nonetheless it will take new evidence for the court to change its mind.
E-cigarettes contain nicotene. Nicotene is bad. Maybe e-cigs can be a bridge to wellness by helping people quit, but there is the risk they may be a “healthy” bridge to cigarette addiction and therefore a first step toward my office door.
Thanks for your reply James. Again, I understand how annoying the conservation must be to have to deal with. In this scenario, I come down on your side. I’ll back you up in the talk with the patient every time.*
That said, I have one question. You write:
“While I appreciate the concept that a healthy immune system is a good idea, I know of no evidence that vitamins increase beneficial immune function in otherwise healthy people”
Out of curiosity, do you provide any nutritional advice to your patients? Not implying that you should or shouldn’t, just curious.
Would you counsel other physicians to avoid doing so?
Aren’t there some things that we can safely recommend, because, well – they’re just common sense.
I think we all agree that the supplement industry needs a serious kick in the a**
* Well, almost every time.
Hold on. The jury is still out on this one
I get the frustration with the people who accuse you of less than honorable motivations as an oncologist. I’d be pissed too.
On the other hand, we need to remember that helping the immune system out (which is what the pro vitamin – pro supplement crowd are basically arguing is going on here) is NOT the same thing as curing a disease
We also need to remember that not not being able to prove a relationship is not the same thing as proving that a relationship does not exist ..
For example, as an oncologist would you recommend your patients smoke e-cigarettes? There’s no evidence they have any negative health effects. Not a shred. Cased closed, right?