What Vitamins Should I Take, Doctor?

To the Editor:

Willett and Stampfer (December 20 issue)¹ state: ìgiven the greater likelihood of benefit than harmÖa daily multivitamin makes senseÖ..especially important for the elderlyÖvitamin E supplements are reasonable for most older Americans.î Thorough review of the literature suggests this is bad advice, more likely to harm than benefit.

A CDC study indicates mortality among those who take supplements is identical to those who donít². Supplements help some, harm others, have no effect on most².

A supplement of the triad of vitamin B₁₂, B₆, and folate beneficially lowers high homocysteine, but multivitamin supplements also contain redox agents which can damage this triad when dissolved in the stomach, where the redox agents such as vitamin C and/or iron can quickly convert ~half the B₁₂ to anti-B₁₂, and destroy ~20% of the folate². Additionally, the 4 mcg RDA of B₁₂ recommended is grossly inadequate for the elderly whose gastric atrophy has progressed to loss of intrinsic factor³. In them, there is only diffusion absorption, of ~1% of any crystalline B₁₂ dose. They need daily supplements of 25-100 mcg of B₁₂³.

They claim a ìnonsignificant increaseî in hemorrhagic stroke in the Alpha-Tocopherol Beta Carotene Trial. In fact, the trial reported ìa significant 50% increase in mortality from hemorrhagic stroke.î α-tocopherol can also harm⁴ by expressing latent autoimmune disorders and neoplasms, and by displacing γ-tocopherol, which traps both NO_x and O⁺free radicals⁴.

New evidence re efficacy and safety of supplements is published weekly, and immediately put by our co-author⁵, Dr. Barrett, on his website, www.quackwatch.com.

1. Willett, W.C., Stampfer, M.J. What Vitamins Should I be Taking, Doctor? N Eng J Med 2001; 345: 1819-24.

2. Herbert, V. Introduction. American Institute of Nutrition (AIN) Symposium on "Prooxidant Effects of Antioxidant Vitamins." J Nutr 1996;126(Suppl 4):1197S-1200S.

3. Herbert, V. Vitamin B₁₂. Present Knowledge in Nutrition, Seventh Ed. (Eds: Ziegler, E.E., Filer, L.J., Jr.) ILSI Press, Washington, D.C., 1996, pp 191-205.

4. Herbert, V. Destroying immune homeostasis in normal adults with antioxidant supplements. Am J Clin Nutr 1997; 65: 1901.

5. Barrett, S., Herbert, V. The Vitamin Pushers: How the "Health Food" Industry Is Selling America a Bill of Goods. Amherst, NY: Prometheus Books, 1994. 536 pages.

V.H. CV #842L.Herbert V. Letter to the Editor: What Vitamins Should I Take, Doctor? Submitted to NEJM on 01/08/02.