White Coat Underground

Well, HuffPo does it again. No other mainstream news outlet brings the stupid on health news like Arianna. Take today’s vapid article on vitamin supplementation.

Let me remind all of you amateur biologists that vitamins, discovered over a hundred years ago, were found to be “vital” to health. What made them different from macronutrients such as fats, proteins, sugars, etc., is that they were only required in very small quantities. There has always been a fascination with vitamins, and even during this time of nutritional excess, people like their supplements.

Thankfully there are scientists out there who know how to ask a question and how to interpret an answer. In general, very little vitamin supplementation is needed for most Americans. Folic acid taken by women before and during pregnancy helps prevent a type of birth defect. Vitamin D deficiency is not uncommon in northern latitudes and may lead to problems such as osteoporosis. But in most cases, vitamin supplementation hasn’t been found to be all that beneficial. For example, the SELECT trial failed to show prostate cancer prevention with selenium, vitamin E, or both. The Women’s Health Initiative data failed to show any benefit of multivitamins on cancer, coronary disease, or mortality. Vitamin A supplements may actually worsen health.

There is nothing magical about the chemicals we call “vitamins”. Most are needed in small amounts so that the body functions properly, most will not have benefit if taken in larger amounts, and a typical American diet provides far in excess of what is needed. So why do people love this stuff? Look at what the idiot from HuffPo has to say:

I compare this kind of thinking [referring to a silly anecdote] to the individuals who won’t blink when some white coat gives them a pill for some ailment or a little extra stress but would NEVER take a vitamin. Too risky. I mean after all your meds could lead to three other pills to deal with your new side effects or your impulse to gamble or bloody urine. Makes sense to me.

The author, who obviously knows less about biology than my four-year old, sets ups a bizarre false dichotomy based on other false assumptions. The “white coat” obviously refers to folks like me, and the false assumption is that I’m handing out poisons that will require additional poisons to counteract them. The false dichotomy pits my poisons against unproven and disproved vitamin supplements which, while often harmless, are equally useless.

I can see how vitamins are confusing, an added expense, and a pain in the butt. However, none of us are getting the 39 essential vitamins and minerals we need in our food so, in my mind, they’re something we should rotate in and out of our diets. You can run down to Costco or to GNC when they are having a sale and go grab a bottle. Sorry, it’s not quite that easy.

More lies (or, more generously, dangerous ignorance). Most of us will get all of the essential nutrients we need, and more. And they are expensive. If you’re spending money on vitamins and it’s digging in to your budget, maybe it’s time to talk to your doctor (you know, the one in the white coat who is poisoning you but managed to pass biology)—what was I saying? Oh yeah, talk to your doctor to see whether you even need vitamin supplements. Are you a vegetarian? Do you have anemia? Are you trying to get pregnant? Getting chemotherapy? There are situations were certain vitamins are used and supported by evidence, but there aren’t many.

She goes on to give a bunch of paranoid and unscientific recommendations, none of which are based on science.

Better to buy a whole food vitamin since it’s a food already. There are tons of studies showing that the body can absorb these vitamins 20x greater then synthesized vitamins. So yes, the buy in bulk vitamin is cheaper, but you may be only get 1% of the nutrients if any at all. Talk about a waste of dough!

What the hell does that mean? To me it means that she likes to throw away money.

Not that it would matter to me but the FDA does not regulate the vitamin supplement industry (probably not enough money in it).

So, we should go out and buy expensive, useless vitamins—not medicine, like those evil FDAers want you to.

I realize it seems a little voodoo voodoo, but I am a real believer in vitamins helping us defend our health, sleep better, process stress, and just better over all body function. If you want to get crazy I’m all for natural Chinese herbs and teas.

Whoa, easy there, are you sure you don’t just want a Prozac? I mean tea can seem pretty scary, and it has been around for thousands of years. What do they know?

The part I highlighted pretty much says it all. It’s not about what is real, it’s about what the author believes. It’s religion. And just for good measure, she reminds us that herbs have been around longer than medicine so they must be better.

Let’s remember that blood letting has been around a long time, too. That doesn’t mean it’s good for all that ails you.

Alternative medicine is religion, and while I couldn’t care less where or whether you pray, when you give advice that can hurt my patients, I’m gonna take that hunk of stupid away from you and shake it in your face like a soiled newspaper.

Comments

#1 MikeMa
April 3, 2009

There are a lot of people pushing this from a lot of different angles.

Kids vitamins
Over 50 vitamins
Active
Not active
Women
Balanced
Extra x, y or z

All with the idea that you belong to one or more of these needy niches and must have what they’re selling or else…
#2 Diane
April 3, 2009

Wow, this is perfect timing. I’m reeling from my weekly “coffee chat” of friends that includes a couple of naturopaths. This morning, one was offering to give everyone B12 shots next week “for energy.” Everyone (except me) was really excited by that. She also said that “conventional medicine” is way behind in its knowledge about Vitamin D and recommended that everyone get 10,000 IUs daily. I’m tired of listening to all this crap. The group always consults these naturopaths for medical advice, which they are very willing to give. Sigh.
#3 Pete
April 3, 2009

Before making comments please read the literature, the recent work on vitamin d is not about osteoporosis, it is about cancer MS, hyper parathyroid, autoimmunity. Go to Medline and look up what has been published in the last 3 months. It is correct that people should not destabilise the carefully regulated systems of the body, so eat carrots not vitamin A. But the vitamin d3 in supplements is not the active form of D, the body will make the right amount for itself. More importantly you cannot get enough D from food, so either go out in the sun or take supplements or both. Also you can only make D when the sun is high enough in the sky (>45 degrees)
#4 Rev Matt
April 3, 2009

My wife takes a whole regime of vitamins and supplements (just started on Forward Nutrition because her mom is a True Believer in it). Her health has actually decreased since she started it but she refuses to consider there’s any relation between the two. I’ve tried many times to explain that there’s generally no need to supplement unless you have a specific medical condition that would benefit from it. To no avail.
#5 Diane
April 3, 2009

I realize that Vitamin D is recommended for all sorts of thnigs–I had never heard of that high a recommendation, but a quick glance at Wikipedia seems to show that 10,000 is not too high. I’ve gotten to the point where I routinely disbelieve everything this naturopath says.
#6 PalMD
April 3, 2009

A glance at the literature would suggest that vitamin D is the best thing since Nutella, but we’ve a long way to go before we have real evidence of significant connections to MS, etc.

For relative vitamin D deficiencies (not uncommon in northern latitudes, but we’re not talking rickets here) we typically give rather high doses for short periods of time.
#7 Pete
April 3, 2009

The body can make 10,000-20,000IU of D3 a day with enough skin exposed and it will do this day in and day out with no apparent regulation, or problems. Doctors often use doses of 100,000IU of D3 repeated every couple of weeks in cases of severe vitamin d deficiency.

You probably would not want to sustain an intake of 10,000IU for more than a few weeks, if you see the sun. However there are no reported cases of toxicity at 10,000IU and below. The advantage with a high starting dose is that D dissolves in fat so a low level of supplementation takes a very long time to raise the level in the blood. Remember what you are taking is a precursor D3 not the active form of D which is 1,25(OH)D.
#8 Pete
April 3, 2009

for real evidence connected to MS try

Monthly Ambient Sunlight, Infections and Relapse Rates in Multiple Sclerosis
Neuroepidemiology 2008;31:271–279 DOI: 10.1159/000166602
#9 Pete
April 3, 2009

Also try

Title: Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis
Author(s): Smolders, J; Menheere, P; Kessels, A, et al.
Source: MULTIPLE SCLEROSIS Volume: 14 Issue: 9 Pages: 1220-1224 Published: 2008

The question is: if the body only needs low levels of D why does it risk skin damage and cancer by fading out the skin. Your body risks significant damage to make D in significant amounts. Also most people are now much whiter than their parents so the risk is even greater. If you take about 5000IU D3 a day (I do) your skin fades less in the winter and you are less likely to burn in the spring.
#10 Egaeus
April 3, 2009

I keep multivitamins around as a weight control mechanism. No, seriously.

I’ve found that sometimes, even after having eaten more than enough food, I was still hungry. I would then drink something to see if that was the problem. Nope. So I thought that perhaps I was slightly deficient in some vitamin, and my body was telling me to eat more in order to get it, so I took a vitamin. It worked.

I know it’s an anecdote (I prefer to call it an n=1 experiment), but I have found that when I have that “I’m still hungry” sensation, it is quite often alleviated by a multivitamin. I know that improving my diet would be the best option, but the vitamin trick works in a pinch.
#11 Kim
April 3, 2009

I do think a lot of doctors hold a big assumption that patients’ diets are adequate and culturally normative when that isn’t necessarily so. It doesn’t really matter to me how well the typical American diet meets people’s needs if *my* diet has a big hole in it. This isn’t really an idle concern: several young “convenience food vegetarians” of my acquaintance have experienced B12 deficiency. Personally I keep an eye on the vitamins typically added to fortified grain products because I don’t eat wheat.

I also think that doctors who haven’t kept up with the literature are a little too quick to dismiss beneficial supplementation (e.g. vitamin D: it’s funny when any doctor in Canada would tell me to take 1000IU through the winter but yet a local practitioner is still holding a hard line that anything over 400IU is excessive), and this can lead patients to just not tell the doctor what they’re up to. Vitamin D seems pretty harmless (and cheap) in the quantities any sane person will consume, but it seems like K2 might be next up on deck here and that one is much more worrisome.
#12 Denice Walter
April 3, 2009

And it’s not just *vitamins*,but all of these oh-so-magical *phyto-chemicals* being merchandised as “cures”,either individually(e.g. resveratrol,isoflavones,carotenes,etc.), or as “green” or “red” products, which are basically powdered vegetables and/or fruits.(“And you can put them in a *smoothie*!Mmmmm”)At $40 per 500grams/225 grams, depending on color.I have a money-saving suggestion(if you believe in this stuff):go to your local supermarket (mine is the A&P)and buy frozen broccoli florets (@ $2.39 per 20 oz.)and frozen red raspberries (@$2.99 per 12 oz.).Resveratrol? California Merlot.You might say,”But the products sold on the website are *concentrated* vegetables and fruits!” Here’s where the magic(al thinking)of homeopathy comes in :the phyto-nutrients in the frozen vegetables/fruits are *naturally* in a diffuse solution *already* (i.e.*natural* water in the food)-therefore,the powder is not as “strong” by the very fact of its greater concentration. Just defrost,”shake”,and serve with wine.
#13 Badger3k
April 4, 2009

I occasionally take a multi-vitamin, not because I think it really helps anything, but my diet is pretty bad and I’m not sure I’m getting everything I would get if I ate a balanced diet.

I do have a question for this nutjob – if the vitamin industry isn’t regulated (and this is due to legislation preventing that, thanks to the multi-billion dollar vitamin/supplement industry, and woo merchants like the author), then what is the difference between the amount of actual product among the padding in the cheap or expensive. I’ve read a lot of analyses on bodybuilding supplements that revealed the huge discrepancies in quality, regardless of the price (almost put irr- urk). Does the author think that the more expensive something is, that it is automatically better?

I guess when you give up critical thinking, it affects your whole life.
#14 Ian Connell
April 4, 2009

Imagine if all the money wasted on vitamin supplements was donated to supply food to those in need. Now there is a real way to improve health. The naivety of this author is stunning. That she seems to equate the fact that something has been used for thousands of years to the belief it must be good for you is just dum. In every other facet of our lives science has brought change that has not only brought convenience but a healthier, longer more diverse life. Whether it be transportation, housing, vaccination, clean water or antibiotics, science is responsible for most if not all of the real improvements in our lives. To believe that some man/woman living in a cave made a health breakthrough that hasn’t been improved on over centuries defies all logic and the proof of virtually every other facet of our lives. Vitamins are required in minute quantities and when these are exceeded their function is no longer as intended of a vitamin and to assume what they do must be good for you is incredibly naieve. As science turns to the study of vitamins we are starting to see proof of the fact that this is a dangerous assumption. It is hard to fight a long held belief system as proof is generally of little interest to those that want to believe. Not knowing and having an open mind is stressful to many and a blind trusting belief is far easier to manage. IanMD
#15 Art
April 4, 2009

According to some studies the average American diet is short of RDA on various vitamins and minerals. The RDA is also going upon some vitamins so even some of those your ‘getting enough of’ you might not be ‘getting enough of’. Calcium, magnesium, B-12 and vitamin-D lead the list.

Outside of this average some groups, like vegetarians and people living off fast-food are not meeting the minimums. I think, outside simply eating better, supplementation makes sense. The cost and down side are low and the benefits substantial if not particularly impressive.

One of my old drinking buddies worked for years at the local mental health screening and admissions unit. As a matter of course they used to give fish oil and “B-50″, a B-complex mega dose, to the drunks and derelicts that were brought in by police. Many of these people were violent and/or suicidal enough to require restraints.

He remarked that just giving the fish oil and B-complex was often enough to see huge differences in behavior and lucidity in just a couple of hours. It didn’t work all the time but the center considered it, according to the in-house MD and psych, safe, cheap and effective enough to use with the majority of clients.
#16 J Todd DeShong
April 4, 2009

I may be a dork, but I love a show on Discovery Health, I believe. It is called Dr. G, Medical Examiner. She had a case where a seemingly healthy woman in her early 50′s who did not drink, had never done drugs nor smoked cigarettes died in her sleep. Dr. Garavaglia conducted a thorough autopsy which revealed nothing. After several in depth interviews with the husband, he finally said his wife took over 40 pills per day of different supplements. (The husband did not take them, but was so de-sensitized, did not think it was important enough to mention earlier.) Come to find out, his wife had died from DHEA supplementation.
JTD
#17 Dianne
April 4, 2009

Let’s remember that blood letting has been around a long time, too. That doesn’t mean it’s good for all that ails you.

Unless, of course, all that ails you is P vera. Then it can be quite helpful. Along with hydroxyurea and aspirin.

Vitamin supplementation in the absence of a deficiency is generally a waste of time–or worse. Some vitamins are toxic in high doses. Vitamin A can be teratogenic. Iron supplementation can kill a person with sickle cell anemia or hemochromatosis. On the other hand, it’s handy to have some folinic acid around if you’re going to give high dose methotrexate. Like any other therapeutic intervention, the risks and benefits of vitamin supplementation should be carefully considered before starting supplements.

Incidentally, I’m not the same person as the Diane (one n) who has also posted on this thread.
#18 Skwrr
April 5, 2009

True story: I was in a health-food store once and saw a bottle of supplements that had “1000% RDA of Vitamin C!” It cost about $50, $45 of which is- literally- flushed away.
#19 antipodean
April 5, 2009

Dianne

Everything is toxic at high enough doses. sCAM will never advertise this of course. Possibly because it doesn’t fit into their dichotmous (good/bad or natural/bad) understanding of the universe.
#20 Kim
April 5, 2009

@Dianne: Yeah, it sometimes creeps me out how freely people supplement with iron and how much it was advertised in years past (I still remember those damn “iron-poor blood” ads). I do know women who are constantly deficient even with supplementation, but I’m the opposite (constantly more than sufficient without supplementation) and I’m also a female of reproductive age. Most women thoughtlessly popping a multi with 100% RDA of iron have no idea of their status…to say nothing of guys taking the same vitamin as a female family member and just assuming there can’t be anything in there that might hurt them.
#21 oderb
April 6, 2009

The author’s – and many commenter’s – ignorance about the benefits of vitamin and mineral supplements is all too common among doctors and the medical establishment.

Whether it’s from ideology, lack of information – drug reps don’t tout vitamins nor are there vitamin ads in medical journals- peer pressure or outdated beliefs, it’s time you studied up before continuing to publish these falsehoods. You mention a handful of studies as proof that vitamin supplementation doesn’t work.

Have you ever gone to vitasearch. com and looked at just one week’s abstracts and seen the impressive research – not sponsored by vitamin companies -collected from research centers around the world? Yes of course some of these studies are small, some are preliminary, some are observational, some study poputations in other countries, etc but the weight of evidence of the hundreds of studies in their database would disabuse any truly unbiased observer of the enormous preventative and even curative benefits of specific vitamins and minerals, singly and in various combinations.

Just in the last three weeks !!!! abstracts showed the following: (I excerpted from each abstract)

” in subjects under 55 years of age, mortality decreased by 17% among those who received the supplement (HR=0.83), while it increased 14% among those over 55 years of age. The authors conclude, “The beneficial effects of selenium, vitamin E, and beta-carotene on mortality were still evident up to 10 years after the cessation of supplementation and were consistently greater in younger participants.” (Can you imagine the worldwide headlines were a patent medicine shown to reduce mortality by 17% with daily intake – at little cost and with no side effects?)

These results suggest that supplementation with calcium may improve insulin sensitivity in type 2 diabetics.”

“supplementation with multiple micronutrients (in children) was associated with small but significantly greater improvements in height, weight, hemoglobin, serum zinc, serum retinol, and motor development.”

“the results of this study suggest through increasing HRV, magnesium supplementation may benefit patients with heart failure.”

“In a randomized, double-blind, placebo-controlled trial involving 670 women in their first trimester of pregnancy, supplementation with 1200 mg/d calcium (n=334) was found to be associated with an average 11% lower blood lead levels ”

“the results of this study suggest that even a low dose (1.5 mg/d) vitamin K2 may “accelerate the degree of OC gamma-carboxylation,” thereby improving bone health in postmenopausal women.”

“in a randomized, double-blind, controlled trial involving 650 singleton live births, supplementation with multiple micronutrients (1-1.5 times the RDA for vitamins A, B6, B12, C, folic acid, iron, zinc, and other micronutrients) from 3 to 24 months of age was found to improve growth. Infants who received multiple micronutrient supplements regularly (more than the 79% median compliance) were found to have significantly greater growth in length, by 24 months of age. Considering how common micronutrient deficiencies are, even in middle-income countries, these results are significant. Strategies that promote compliance through effective delivery of micronutrient interventions are needed.”

“These results suggest that nutritional supplementation with omega-3 fatty acids and antioxidants may reduce the risk of mortality in survivors of ischemic stroke.”

I haven’t even bothered to excerpt at least a half dozen studies showing benefits for Vitamin D supplementation published during this short period, as you have acknowledged – though in a very limited way – vitamin d.

I have no illusion that bringing these studies or this database will change your mind.
Your belief system is too rigid and too conditioned for you to dispassionately consider that you might be wrong about vitamins. After all it would be quite embarrassing to have to renounce a worldview held with such tenacity.

I post in the hope that maybe one or more of your readers may be a bit more openminded.
#22 Jeff Engle
April 6, 2009

PalMD states:
“If you’re spending money on vitamins and it’s digging in to your budget, maybe it’s time to talk to your doctor (you know, the one in the white coat who is poisoning you but managed to pass biology)—what was I saying? Oh yeah, talk to your doctor to see whether you even need vitamin supplements.”

He seems to assume all doctors share his prejudices. I would refer him to the Life…Supplemented Survey which can be read here:

http://www.lifesupplemented.org/supplements/healthcare_professionals_impact_study.htm

For example he may be surprised to discover that 72% of cardiologists surveyed recommend supplements to their patients.
#23 Dianne
April 6, 2009

oderb: The references would be more useful (and more convincing) if you provided citations and, ideally, links to the articles.
#24 catgirl
April 6, 2009

Most are needed in small amounts so that the body functions properly, most will not have benefit if taken in larger amounts

I think this is the biggest problem. Many people think that since some is good, more must be better.
#25 PalMD
April 6, 2009

I hope Jeff realizes what most of my readers know: who endorses a claim does not add to its validity—only evidence can do that.

Evidence is not, as oderb would have it, a mention of a few studies in support of your idea. It is the sum total of the good evidence available.
#26 Jeff
April 6, 2009

A few of the comments have mentioned Vitamin D. The most authoritative source of information on Vit. D is the website of the Vitamin D Council:

http://www.vitamindcouncil.org/

Did you know that the Canadian Pediatric Society recommends that pregnant women should take 2,000 IU’s vitamin D daily to reduce the risk of autism and other adverse health conditions in their children?
#27 PalMD
April 6, 2009

Oh, Jeff, you’re in so far over your head.

The precise amount of needed vitamin D is not clear, but clearly differs among ethnic groups and geography. The Canadian PAEdiatric Association makes a number of recommendation, many of which take into account the status of First Nations, especially Inuit who get little sun exposure and little dietary vitamin D.

The money quote you were probably looking for is this:

Consideration should be given to administering 2000 IU of vitamin D daily to pregnant and lactating women, especially during the winter months, to maintain vitamin D sufficiency. The effectiveness of this regimen and possible side effects should be checked with periodic assays for 25(OH)D and calcium (recommendation grade A).

“Autism” is not mentioned in their summary recommendations.
#28 Phoenix Woman
April 6, 2009

PalMD: I can actually see where paying $10 for a standard bottle of multivitamins every two months might be a useful fallback strategy if, say, you live in a place where there are no grocery stores and the gas station/”convenience store” is the only place you can get food aside from the local McDonald’s. This is an all too common situation faced by the urban and rural poor.

That being said, most of us (thankfully) aren’t in that situation. If we can spend hours at a time blogging or playing World of Warcraft, we can make the time to get off our butts and go to the grocery store or farmers’ market. Even better if you can make the trip by bike.
#29 Mike
April 6, 2009

oderb: Quantity of research is not the same as quality. Spend twenty minutes browsing the internet and you’ve just completed a “Study”.

In the eternal words of Inigo Montoya “You keep using that word. I do not think it means what you think it means.”

“drug reps don’t tout vitamins nor are there vitamin ads in medical journals”
This is because they are not drugs. Microsoft reps also don’t tout vitamins, does this seem odd? No of course not, because that’s not the business they are in. If Vitamins went through the rigorous and demanding trials needed by the FDA to varify efficacy, then you can be damn sure every drug company on the planet would be selling vitamins. They are cheaper to develop and produce than major drugs, and they would make a ton of money. The reason drug companies don’t tout them is because they can’t. The people who are currently making vitamins do not want the drug companies to muscle in on their action, so they don’t want anyone to do serious clinical trials, they just want “studies”.
#30 antipodean
April 6, 2009

Mike

There are plenty of large phase 3 vitamin trials out and published. They don’t work, are costly and may even be slightly harmful.
#31 Jeff
April 8, 2009

I stand corrected. You quoted the Canadian Paediatric Association more accurately than I did. Simpler, more pertinent (for Americans) information on dose levels for pregnant women and infants can be found on the Toxicity page of the Vitamin D council:

http://www.vitamindcouncil.org/vitaminDToxicity.shtml
#32 Jeff
April 8, 2009

Correction from previous post: I meant to type the Treatment page of the Vitamin D council website (not the Toxicity page):

http://www.vitamindcouncil.org/treatment.shtml
#33 Phoenix Woman
April 9, 2009

Ah, here’s the problem — and it’s similar to the one faced with antivax woo. Namely, that 1) the news that vitamin supplements are unnecessary for most people isn’t exactly publicized by the press (instead, we hear about obesity epidemics and the latest fad iterations of the Atkins Diet — yeah, you too can have stinky breath while you starve your neurons of brain fuel!), and 2) the websites from legitimate medical authorities are swamped by those from non-evidence-based groups with non-evidence-based products to pitch.

I Googled “vitamin study guide” to see how long it would take me to find a website that belonged to a reputable medical authority. It wasn’t until I got to the third page of Google results that I found one, from UC Berkeley: http://www.wellnessletter.com/html/ds/dsVitaminE.php The Mayo Clinic’s supplement site was three results even further down: http://www.mayoclinic.com/health/drug-information/DrugHerbIndex

How many people looking for info about vitamins will bother scrolling through pages of Google results to look for information from actual hospitals and colleges? If they’re like most folks, they’ll stop after reading the first five results on the first page — that is, if they didn’t simply hit the “I’m feeling lucky” button and just go to the most-cited result.

Here’s a project for you, PalMD, should you choose to accept it: Find — or create — a site on vitamins that laypeople can understand, and get the other science and medical bloggers to promote the hell out of it. Link to it, put it in their blogrolls, you name it. Let’s see if we can at least get one evidence-based site on vitamin supplements into the top five Google results.
#34 Eddie Vos
August 17, 2009

PalMD, you state” “a typical American diet provides far in excess [sic] of what is needed.[sic]” On what do you base that statement and I’d refer you to NHANES for what the typical American diet actually is. Also, how do you know what the typical American needs of the known about 10 micronutrients one can be low in [even accepting low RDA/DV values], a situation that can be worse depending upon one’s genetics [think the MTHFR enzyme] and that are unknown to patient and doctor.

Your statement is based on belief not on published science but please correct me.

For example, what if arterial decline [heart disease] is CAUSED by higher than minimal amounts of homocysteine, is the average American still getting more than enough [your words] of what is needed? [only a high-dose multi B-vitamin lowers homocysteine maximally.]
http://www.health-heart.org/why.htm [how homocysteine degrades structure, and arteries].

I’m with Harvard’s top nutritionist Walter Willett’s food pyramid on that: “multivitamins for most”, and that is science, not belief based [and 30 times cheaper than Plavix]. Kind regards, vos{at}health-heart.org
#35 PalMD
August 17, 2009

You do know that for the last decade or so we’ve been supplementing basic foodstuffs with folate in the US, right?
#36 PalMD
August 17, 2009

BTW, love the Web 1.0. Sweet antique, man.
#37 Eddie Vos
August 17, 2009

Dear PalMD, Re your comment 35: that has nothing to do with your strong statement about the typical American diet containing “FAR in excess” of “what is needed”. Since you’re an internist, it is clearly not supported by anything in my copies of Harrison’s Principles of Internal Medicine or in NHANES, so what is your source for such a bold statement?

To answer your question about folate [why folate?], yes I knew and clearly you did not click on the link I provided which has at the end links to what that did to American health. Unfortunately they did not put ‘what is needed’ since it did not lower NTD’s as much as it could as per the trials, but it did lower mean U.S. homocysteine by 10-15%**) [and the rate of stroke DEATH decline went up [less deaths] by a factor 8, found the CDC. A truly small step but better [and at $0.01/year, cheaper] than statin [that increase hemorrhagic stroke, as per the SPARCL and HPS trials].

**) The simple fact homocysteine went down proves that the American diet does not supply the 4 B vitamins in amounts needed to lower it to minimal, and no scientist believes that above minimal Hcy represents a health benefit. Heart disease is effectively not reported at Hcy <7µM, to name one epidemic.

If that Web 1.0 comment was addressed to me .. I don’t get it.
#38 Eddie Vos
August 17, 2009

The sentence that was cut off reads “Heart disease is effectively not reported at Hcy below 7 micromoles/litre, to name one epidemic.”
#39 Eddie Vos
August 23, 2009

Hello palMD, we’re still waiting for the data on which you base your statement to patients and blog readers that the “typical American diet” contains “FAR in excess of what is needed”. Instead, you answered with a question to me which did nothing to explain your global statement.

In the current issue of AJCN from one of the most knowledgeable guys in the US about current low bitamin B intakes intakes and the DNA damage that causes, Bruce Ames, just about vitamin K: http://www.ncbi.nlm.nih.gov/pubmed/19692494 [I can get you full text if you send me an email to vos{at}health-heart.org
#40 Eddie Vos
August 23, 2009

Hello palMD, we’re still waiting for the data on which you base your statement to patients and blog readers that the “typical American diet” contains “FAR in excess of what is needed”. Instead, you answered with a question to me which did nothing to explain your global statement.

In the current issue of AJCN from one of the most knowledgeable guys in the US about current low vitamin B intakes intakes and the DNA damage that causes, Bruce Ames, just about vitamin K: http://www.ncbi.nlm.nih.gov/pubmed/19692494 [I can get you full text if you send me an email to vos{at}health-heart.org