Why we shouldn’t believe New Scientist’s claim that supplements don’t work

By Jerome Burne

Vitamins are attacked as being ineffective and possibly dangerous a couple of times a year in the press, usually following a study in a medical journal. The implication is that it is better to stick to drugs that have been properly tested and found to be safe and effective.

And a dietician usually adds that you won’t be missing out if you avoid supplement because you can get all the minerals and vitamins you need from a “healthy balanced diet” (HBD).

Leaving aside the issue of just how safe and effective drugs are – especially the ones people are encouraged to take long term for prevention – what’s striking is just how poorly done or downright misleading the trials can be that claim vitamins lack an evidence base.

I’ll come to some specific examples shortly but first a quick summary of the latest version of the “vitamins make expensive urine” feature which appeared in the New Scientist last week -A to zinc: What supplements are worth taking? (Subscription only)  It dismissed nearly all of the 20 most popular supplements as either having no evidence to support the claims made for them or because the research was inconclusive.

Rules of evidence based medicine ignored

Vitamin C, for instance, might help a bit with a cold but there’s no good evidence it will do anything for cancer; in fact trial results suggests it’s not much good for anything. Chromium has recently become popular for weight loss and to make people with diabetes more sensitive to insulin but the trials don’t support its use. 

There’s a similar report for vitamin E, thought at one time to help protect the heart but more recent trials found no benefit; however it could increase your risk of cancer. Vitamin K may help with your bones but it’s too early to say. Magnesium, it turns out, doesn’t helps with diabetes, heart disease or with lowering blood pressure. Co-Q10 is no good for boosting energy or protecting the heart. And so on.

Now running rigorous tests on vitamins would be fine if they followed the rules of evidence based medicine and you’d expect a big round up like this one in a science base magazine to have checked on the quality of the trials.

Unfortunately that’s not what has happened. It’s impossible to go into the details of the dozen or more glaring errors, but their assessment of B vitamins and whether they can help to slow or prevent loss of memory and poorer thinking in elderly people, is so ill-informed and simply wrong that it calls into question the sweeping dismissal of all the others.

A nine-fold reduction in brain shrinkage

“Randomised trials fail to support the idea” that B vitamins can help prevent cognitive decline, it says. This is simply not true. It completely ignored the existence of a well-conducted, randomised controlled trial  - “Homocysteine Lowering by B vitamins Slows the rate of Accelerated Brain Atrophy  showing that high doses of folic acid, B6 and B12 dramatically cut brain shrinkage in older people ‘at risk”. It involved giving B vitamins to older people with the early stages of memory decline (Mild Cognitive Impairment) and found it preserved their thinking skills. A closer examination of the results found almost a nine-fold reduction in the amount of shrinkage of the Alzheimer’s related areas of the brain in those on B vitamins.

Published four years ago the trial, done by a research unit at Oxford, was assumed by those involved to be a hugely important breakthrough that would be enthusiastically received and followed up, especially since there is no effective treatment for Alzheimer’s. Instead the shameful, and all too successful, response by the Alzheimer’s establishment has been to ignore it and attempt to discredit it. The most plausible explanation is commercial interests.

The New Scientist’s conclusion simply reflects what has become received wisdom. Over the last year there have been two widely reported trials that have mounted heavyweight attacks, not on the actual trial itself, but just on the idea that B vitamins might be able to have on impact on dementia.

One published in the Annals of Internal Medicine came with an editorial that provided the scare headlines but which didn’t remotely reflect what the studies actually found, as will become clear. The key sentences read: “Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

Vitamin trial was gold standard

The other looked impressive at first sight. Entitled “Effects of homocysteine lowering with B vitamins on cognitive aging it was an analysis of 11 trials involving 22,000 people designed to see if B vitamins could cut their risk of developing Alzheimer’s. The conclusion was equally damming: ‘Homocysteine lowering by using B vitamins had no significant effect on individual cognitive domains or global cognitive function.’

In fact the New Scientists had already picked up on the widespread official scepticism about B vitamins in a feature on dementia it ran last January. After accepting that lifestyle and nutrition might well affect your chances of developing the disease, the author mentioned that supplements of vitamins B, C and E and omega 3 fish oil could be beneficial. But then promptly dismissed them all saying: “randomised trials of adding extra to the diet in the form of supplements haven’t shown benefits.”

So what is going on here? Maybe there were mistakes in the original Oxford trial or maybe the negative studies have come up with important counter evidence.

So what did the Oxford trial involve and what did it find? It met all the requirements of evidence based medicine. It was a “gold standard” RCT: it ran for two years; it had over 200 people in it; used brain scans to measure changes in brain shrinkage and it made a clear prediction.

Strong predictors for developing Alzheimer’s

It proposed that people with high levels of an amino acid (homocysteine) in their blood stream would benefit from having their homocysteine lowered by the vitamins, while people with an already low level wouldn’t. And the prediction proved to be correct. You don’t get any more solidly evidence based than that.

About half the 65+ population have a raised homocysteine level which, according to scientists at the US National Institutes of Health (NIH), is one of several factors – along with lower educational attainment and decreased physical activity – that are particularly strong predictors of developing Alzheimer’s. 

So if you are going to ignore or dismiss an inexpensive treatment which several sources of evidence suggest could significantly cut the number of Alzheimer’s cases or at least dramatically slow down the rate of brain shrinkage and memory loss, you have to have strong counter evidence. Is that what New Scientist and the other establishment critics and have?

What about the trial that concluded: “B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified”? Well it was a gold standard RCT but one that seemed particularly pointless.

Trial failure no surprise

It involved giving a multivitamin tablet called Centrum Senior to 6000 doctors aged 65 and over for an average of 8 years. In other words people who were well-educated, reasonably well nourished and not especially ‘at risk’ of dementia got a low dose of B vitamins, for some probably no more than they were getting from their food.

What made it pointless was that the trialists didn’t for example, record whether subjects had high or low homocysteine levels. The result was that those on the multivitamins had about the same rate of dementia as those on the placebo. No one who knew anything about vitamins would have expected anything else.

It didn’t tell you anything about B vitamins specifically, let alone the effect of high doses given to people known to be at risk and there was no evidence that anyone was harmed. In fact like many other vitamin trials it didn’t seem to be intended to discover anything useful at all. If you want to see if vitamins can slow cognitive decline, the sensible thing to do is to take a group of patients who are showing signs of decline and then see if giving vitamins makes a difference.

No attempt to find anything useful

So what about the second study that confidently concluded that B vitamins had no significant effect? Again there was no sense that the researchers were interested in finding out anything useful. There was no attempt to use the data to build on what the Oxford study had found.

The analysis could have looked at whether patients with high homocysteine did better than those with low. Unlike the previous trial they did record the participants’ homocysteine levels. If it had been designed to be useful, it would have given figures showing the difference between the scores of those in the placebo group and those getting the vitamins, with high or low homocysteine levels.

However it did none of those things. Instead what it actually showed – again – was that if you treat healthy people on a variety of doses of B vitamins, using an insufficiently sensitive memory test that can’t detect the small changes you’d expect to find in healthy people over five years and ignore the fact that people with low levels of homocysteine are unlikely to benefit from B vitamins anyway, you are not going to find any large change in memory scores.

Again utterly predictable if you know anything about vitamins, and no basis for concluding that lowering homocysteine with high levels of B vitamins has no benefit. According to lead author of the original RCT that found benefit – Professor David Smith from Oxford University – this trial was substantially ‘underpowered’, in other words it could never have shown a significant effect even if there was one.

Magazine either ignorant or biased

So even though you might assume that that the New Scientist’s conclusion provided evidence based support for the official line of no benefit, it clearly doesn’t. A more accurate description would be that there is a very impressive randomised trial showing that B vitamins can help and several negative studies that do nothing to undermine that conclusion.

Revealingly the link that the magazine provided to support its negative claim referred to a review of trials that only used vitamin B6 and did no tests for homocysteine. Yet again, like the other supposedly negative trials, this set up did nothing to confirm or disprove the Oxford study.

So either the magazine is culpably ignorant of the evidence supporting the potential benefit of B vitamins and of the poor quality of the evidence claiming to disprove it, or it is aligning itself with an approach that seems keener to discredit vitamins in any way possible rather than honestly investigating what they can do and what they can’t.

Most of the negative studies treat each supplement as if it was a drug – to be tested in isolation for a particular disease. The New Scientist review essentially reported these failures. But unlike drugs we all need a certain amount of minerals, vitamins and other supplement for general health.

Elderly poor at absorbing vitamin B12

People may well be able to get all the minerals and vitamins from an HBD in some nutritional utopia but the reality is that average fruit and vegetable consumption in the UK is 3.84 pieces a day and nearly half the population have fairly unbalanced packaged or take away foods once a week.

The situation is even worse for older people who gradually become less efficient at absorbing B12 making it virtually impossible for many to obtain enough from their diet. A UK study found that two in five over 61 have insufficient blood levels of B12 to stop accelerated brain shrinkage.

As a result, as many as one in two adults and nine in ten of the elderly have inadequate intakes of key nutrients. Testing the effects of preventing deficiencies, rather than running trials on well-fed healthy people, would be a start in providing a more accurate picture of the benefits of supplementing.

The New Scientist gives two supplements a modest thumbs up – vitamin D and omega 3 fish oils. If you are deficient in Vitamin D, taking a supplement cuts your risk of death from all causes by 57%, while omega 3 lowers heart disease risk by 25%. They ignore the fact that a low fish or omega 3 intake is linked with almost a quarter of Alzheimer’s cases, according to this year’s NIH review of 247 studies. {already linked above]

Ironically you can’t get a sufficiently protective amount of either vitamin D or B12 from a HBD. Who in the real world is going to eat two or more oily fish a week? During the 6 months of the year in the UK when you can’t make enough vitamin D from the sun, you would have to eat a stupendous amount of organ meat to get the 1000 to 2000 IUs a day now recommended by many experts. Both are also promising as ways to lower Alzheimer’s risk.

An informed scientific approach to vitamins would set about running a well-constructed trial to confirm or disprove the Oxford study, not ignore the fact it had ever happened.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “10 Secrets of Healthy Ageing” was written with nutritionist Patrick Holford. He blogs at “Body of Evidence” – jeromeburne.com. 2015: Finalist for 'Blogger of the Year' award from Medical Journalists' Association.

6 Comments

  • I have never read a more inaccurate review of vitamins/minerals. The opening para says that Funk isolated vitamin B1. He didn’t. it was Eijkman.

    I picked, at random, chromium and noted the closing advice is ‘if you wish, taking 10milligrams a day more or less will do no harm.’I think they meant 10micrograms! Then it claims ‘no clear evidence that it can enhance insulin action and mediates blood glucose’. Strange, because ‘pubmed’ has 674 studies on chromium and insulin, and a nice systematic review by Balk [http://www.ncbi.nlm.nih.gov/pubmed/17519436]concluding “Chromium supplementation significantly improved glycemia among patients with diabetes.”

    Knowing something about 5-HTP, the NS reviewer said that a 2009 analysis found it worked compared to placebo but ‘may be linked to a very rare but potentially fatal syndrome known as eosinophilia-myalgia’. So I checked the review and it doesn’t say this. it says that ‘tryptophan has been associated with the development of a fatal condition’. This was a messed up tryptophan molecule, the first produced by genetic engineering, not 5-HTP, which is extracted from a bean.The review also ignored the recent head to head trial showing 5-HTP worked just as well as fluoxetine (Prozac) but has the advantage of less side-effects. [http://www.ncbi.nlm.nih.gov/pubmed/23380314]

    And on and on it goes. There is nothing here that I couldn’t have got from a ‘quack vitamin’ website ten years ago. I assume the editor’s brief was ‘pick any supplement that has traction and kill it, regardless of the evidence.’ My faith in the New Scientist as a voice of ‘ new science’ has evaporated.

  • As a regular New Scientist reader I find the publication generally of real value and interest, usually well written and authoritative. However, reading this article relating to an area in which I have some knowledge I was truly taken aback by either the level of apparent ignorance or blatant prejudice of the contributors.

    Not since the ill informed Killing Us Softly by Paul Offit have I read a piece so selectively biased in terms of the material used to support what purports to be an objective review.

    I’m glad someone has penned a response. I thought about it, but as Jerome identified, the article is so full of biased inaccuracies, it is difficult to know where to start. However, I’m delighted to see such a well balanced response.

    Like Patrick Holford, this really does make me question how actively the contributors wield Occam’s broom on the rest of the content as they sweep away any material that doesn’t fit into their particular position on a scientific argument.

  • Several recent articles within New Scientist have left me so disappointed. Reports of this one will have me trip to the library to seek it out (I now resent the cover price). The one on fat was meaningless for its wilful resolution to sit on the fence, and an article by Jessica Griggs on Alzheimers reporting the work of Ewan McNay of Albany Medical school was riddled with inaccuracies and bias. So much so I thought it bordering on being fraudulent. It made claims and reported stuff that had neither been written-up for, nor published in, a peer reviewed journal. In an email exchange McNay was polite if tending to being evasive where the request to provide backing for certain claims was concerned.

    Editors do like a steady supply of copy. Hence science journalism suffers from having to fill column column inches when the journalist may not have accrued all necessary facts or made much sense of them. While at the other end of the spectrum editors like the word-count of any copy to fall in the Goldilocks zone. Thence when the author of an article has accrued necessary facts and could convey much much-needed sense based upon them restrictions are placed upon what they say and how they say it. If an author makes a significant cognitive advance an article explaining that is likely to be edited by a person whose understanding cannot perceive its significance.

    Editors do so like cake, often in several flavours, but never appreciate a really decent slice of any one flavour at any one time.

    I’m with you on this Jerome, I think vitamins and minerals deserve attention they do not generally receive because patents and markets reward a kind of novelty and innovation, whilst physiology, which is shaped from selection driven adaptation, is more comfortable with the familiar, and is far more likely to be disrupted by the novel and the unfamiliar. Magic bullets as patented medicines are quite likely to compare with friendly fire that sometimes arises in the combat zone.

  • The negative press around vitamins, minerals and herbs coinsides with the EU ban on the use of the same. Herbs have been hugely restricted and I understand vitamins and minerals are due to be restricted by their dose.
    I have been ill for around 40 years with an undiagnosed condition; Hypothyroidism; which causes a failure of the body to absorb and utilize nutrients from food. A common condition in young women and more common with menopause but the condition also affects men and particularly in old age.
    After 33 years of conventional medicine telling me nothing was wrong or diagnosing various symptoms or worse diagnosing M.E. a condition which IS Hypothyroidism but with another name and no known treatment; I finally got to see a Dr with a brain which thinks outside the Royal Colleges box – she pays a high price for it with GMC hounding her constantly,
    I got treatment 7 years ago including NDT and T3 – I cannot tello how my life has been given back to me. I could not have typed this comment before as my brain would not function to enable me to do so. My cholesterol levels fell without the use of Statins too. Oh so much has changed and my 300+ symptoms have virtually disappeared.
    Besides the thyroid hormones I have been taking I have taken a number of vitamins and minerals and herbs too. Without these, even now, I can feel less well than when taking them.
    I realise this is all to do with Drug companies bullying and decieving the public and further bribing the officials who will help them get their lobbying into law. It makes me sad that so many people are harmed by inaccurate information and I say thank you so sites like this one and others who publish the truth and out the lies.

  • I share the general misgivings about the New Scientist. Their recent article claiming that testosterone replacement was ill advised ( http://bit.ly/1qHt4LL )mentioned a study that claimed that it increased the risk of cancer – a study which was exploded long ago by Abraham Morgentaler with such a satisfying bang that one would hardly have thought anyone would ever have the face to mention it again http://bit.ly/1lGMoRD Yet here the New Scientist was, trotting it out again! I don’t trust anything I read there.

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