06 August 2005

Vitamin Pills Don't Protect Old People From Infections?

Infection rates in older people living at home are not helped by taking vitamin or mineral tablets, researchers have found.

The Aberdeen University study looked at the effects of daily multivitamins compared with dummy placebo tablets.

It found that taking supplements seemed to make no difference in infection rates between the groups.

The research, published in the British Medical Journal, covered 900 people aged over 65 who were living at home.

The study authors said: "Regular use of commonly available multivitamin and multimineral supplements is unlikely to reduce the number of self-reported infections or associated use of health services for people living at home.

[ BBC News Health, Aug 04 2005 ]

I have long suspected this. Aging weakens the immune system and no amount of vitamin supplements can prevent infections from occurring in elderly individuals with weakened immune systems.

Psychologically, I think taking vitamin supplements do indeed provide some sort of security. But not the one we expect.

12 reactions:

Doctor_Potato said...

Does this go for younger people too? Or maybe there aren't any studies yet in this segment of the population? There are so many ostensibly healthy young adults out there who are taking multivitamins anyway, thinking those things will make them nigh invincible...I'd love to be able to tell them that they'd definitely put the money to better use by paying for an inexpensive gym instead :)

may said...

unrelated to this post, but yes, you can add any of my posts to the grand rounds, if it passed your standards :) thanks

Robert said...

Why am I not surprised that Doc Emer jumps on just about every negative vitamin supplement news item that comes out?

This report is quite vague. What is the typical multivitamin that people over 65 take? What are the amounts of the various nutrients in these so called "typical multivitamins?" Lot's of assumptions here.

I would want to know specifically how much vitamin C was in these multis. I would venture a guess and say that the typical multi contains in the range of 50 to 500 mg of vitamin C. If you are wanting to protect the immune system that is pitifully little vitamin C. And of course, it's being taken at one time during the day. The half life of vitamin C in the blood stream is approximately 30 minutes under normal conditions (much less under stress). Therefor it is best if you divide the dosage up and take it through the day. So 250 mg in the morning and 250 at dinner is much better than 500 mg in the morning alone.

The great scientist Linus Pauling lived to be 94 years old. He was taking well over 10 grams (that's 10,000 mg) of vitamin C daily in divided doses (through the day).

And another thing that Doc Emer failed to point out is the conclusion of the authors of the report:
"There are specific medical reasons why people might need to take supplements," said Avenell.

Meanwhile, Doc E misses other important and intersting research with regards to vitamins such as this

Dr. Emer said...

Renzguerra: The study was done on the elderly population only.

May: Thanks. It's done! =)

Robert: I'm sorry if you felt offended by this post. I got nothing against vitamin supplements. I was merely commenting on the study done as published by the BMJ and reported by the BBC. The BMJ study design mentioned was a randomized, placebo controlled trial, with blinding of participants, outcome assessors, as well as the investigators. As you well know, all studies have limitations, and this one is no exception. The conclusion is merely a suggestion of likelihood of outcome. The authors never said anything absolute.

You should remember that the elderly have a different physiology than most of us. I agree that there are indeed "specific medical reasons why people might need to take supplements," but extra caution should be taken by the elderly population as they are more susceptible to risks accompanying higher doses of vitamin/mineral supplementation.

I meant no offense to you or to anyone, Robert.

Robert said...

I am not personally offended. I have come to realize that the main stream medical establishment has their mind set against vitamin supplements. I only hope and pray that some day you and many others in your profession will come to realize the value of vitamin supplements as well as the harm you have caused people by creating doubt in their minds which would prevent them from taking a simple and inexpensive preventive action like taking a multi vitamin with other specific supplements.

By the way, did you know that there are no confirmed deaths from vitamin supplements reported to the CDC in the US? All side effects from vitamin supplements are extremely mild. Compare this to the hundreds of thousands of deaths reported each year from legal drugs sold either over the counter or by perscription.

There is very little risk if any from high levels of vitamins, especially the water souluable ones.

I strongley suggest you read this book by Linus Pauling.

And lets be clear here. The author of the study which you blogged about suggested that elderly people could benefit from vitamins under certain circumstances. You however suggested that any benefit was simply a mental or placibo effect. I would call that prejudice and not science.

Dr. Emer said...

Point well taken, Robert. Believe it or not, but I'm a Linus Pauling fan since high school. The comments you read from my post come from my observations and personal experience as a physician. There is no intention on my part to cast any doubt on the use of vitamin supplements. If that happens, then it is probably an interpretation on the part of the readers. I am merely expressing an opinion based on observation and professional experience. I'm also not trying to dissuade people from taking vitamin/mineral supplementation. As a matter of fact, I even recommend them to select patients as the need arises.

I admire your passion in promoting vitamin/mineral supplementation. However, I hope you'll also respect my own opinion about it, no matter how disagreable it is to you.

My personal belief is that nothing can replace the natural vitamins. These are not the ones you get from the pharmacy. These are the vitamins and minerals you get from eating the right food items (fruits, vegetables, fish, nuts, etc.). The ones you pop from the bottle are there only for supplementation purposes in order to complete your RDA. Coupled with regular exercise, this can boost one's health and help him against many preventable illnesses including infections.

In the case of the elderly however, which is the topic of the study mentioned, their physiology is not as optimal as a young person or an adult like you and me. The supplements given in the study are here for your reference. The study involved 910 men and women aged 65 and over. The conclusion given is: Routine multivitamin and multimineral supplementation of older people living at home does not affect self reported infection related morbidity.

For your peace of mind, my friend, the authors did mention that they exclude the possibility that the intakes provided in the supplement were inadequate to affect the immune system. But they did not explore this because that wasn't their study's objective. I agree with the authors that it was a pragmatic study at best.

Robert said...

I wish I had a dollar for every person who has told me they are a fan of Linus Pauling yet they disagree or completely ignore his thoughts on nutrition!

I have sent you a report which goes into finer detail on this study. It is clear that it is just another attempt to cast a negative light on vitamin supplements. I hope you will follow up and share the information or comment on it.

I have to point out another area of concern here. The vitamin RDA's represent the bare minimum requirements to avoid serious disease. In most cases they are an educated guess and do not represent optimum values. Take vitamin C again as an example. In the US, the FDA RDA is 60 mg. However, the American Cancer Society recomends that you eat 9 servings of fruits and vegetables every day. If followed, 9 servings would equal approximately 400 to 600 mg of vitamin C. So who is correct here? My own opinion is that even 600 mg of Vitamin C is very little.

I have no problem with differences of opinion and I respect yours. However, I hope that you will study these matters more closely as I sincerely believe that you are misguided in your approach and understanding of Vitamins. Just ask Linus Pualing (by reading the book I mentioned) if you don't agree!

As a service to you and your readers, I offer
this link to the last interview with Linus Pauling. I hope this will spur you on to renewed interest in the role of vitamins and nutrition in our health!

Dr. Emer said...

People can always believe what they want to believe, Robert. I'm a fan of Linus Pauling because of his persistence and dedication to his work and research. But I also think and apply what I learned and learn everyday as I encounter and heal my patients.

I disagree with you that the said study was done to "cast a negative light on vitamin supplements." Scientific studies are done with specific objective(s). The conclusion always rests on how the study achieved or missed the said objective. There is no negative nor positive when researchers conduct a study. Interpretation, on the other hand, by people like you and me, make it positive or negative. But as I said, people can always believe what they want to believe.

You say I am misquided. Well, no offense meant to you, but I also think you are misquided, especially concerning the elderly. The good Linus Pauling (God bless his soul) might have lived to a ripe old age of 98, but don't pin all your medals to Vitamin C. Genetics and his family history might have had a major part in it, my friend. Then, there's his lifestyle --- exercise, diet, emotional stability, etc.

In my country, there is a place called Ilocos where old people live to more than 100. You might be surprised to know that they smoke tobacco --- not the sissy cigarettes --- but the real ones. Dried tobacco leaves made into cigars, much like Cuban cigars. They smoke that everyday. And they still live to a hundred. No, they don't pop megadoses of vitamin/mineral supplements. And so you may wonder why they live long. It is their genes and family history, Robert.

You simply cannot criticize a study by pointing out things that were not in its objective. You can be correct, but it may be out of place. You cannot apply Linus Pauling's work (no disrespect here, ok?), no matter how remarkable it is, on a study with an objective different from his.

I fully agree with your Vitamin C argument, but it is irrelevant (again, no disrespect here) to the study's objective. The study's objective is clear: To examine whether supplementation with multivitamins and multiminerals influences self-reported days of infection, use of health services, and quality of life in people aged 65 or over. It was an observational study. It was not interventional. It was just trying to describe what it found.

Thanks for the links and reports you have sent me. I will comment on them sometime.

bravomedic said...

The placebo can do amazing things...


Dr. Emer said...

That's because the human mind and body has an inherent healing process of its own, Bravomedic.

Thanks for visiting. :)

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