Vitamins – a waste of money or victims of bad science?

B vitamins benefit in high quality trial

In fact a well conducted, placebo controlled trial has shown that giving high dose B vitamins to people who already have mild cognitive problems,  not only caused no dangerous side effects but slowed progress of the disease dramatically. The reason this approach works is because the vitamins affect an amino acid called homocysteine long known to be associated with Alzheimer’s. For a more detailed account of how this works see here [5].

The trial, run by Professor David Smith of Oxford University, found that in patients given high dose B6 (20mg), folic acid (800mcg) and B12 (500mcg) there was a substantial reduction in risk of developing dementia, in the rate of memory decline and in brain shrinkage.[6] In this study the level of B12 was twenty times higher than that of the ‘multivitamin’ trial because, the older you get the more B12 you need due to decreasing absorption.

While neither study showed any harm from the vitamins, the unsupported advice given by the journal to doctors to stop patients taking vitamins is actually very harmful. Almost half the population over 65 have insufficient B12 to stop brain shrinkage [7] Elderly people absorb vitamin B12 poorly and need much higher doses to raise blood levels a little bit.

Vitamins may also be protective against heart disease if a person isn’t on a cocktail of drugs, although the definitive properly designed study has yet to be done. Certainly strong evidence exists for magnesium and vitamin C in lowering high blood pressure, folic acid and B12 for reducing stroke risk, vitamin D, omega 3 fish oils and co-enzyme Q10 for overall protection.[8]

 

Declaration of interest: While authors of trials have to declare their conflicts of interest shouldn’t journals too? This journal, like most, is dependent on drug company advertising and/or sponsorship. In this context, an editorial message to ‘keep taking the drugs’ and ‘stop taking the vitamins’ makes good commercial sense, even if based on bad science.

Patrick Holford is author Say No to Heart Disease and the Alzheimer’s Prevention Plan which provide detailed accounts of the role of nutrients in the treatment and prevention of the respective diseases. He also authors a range of vitamin and other supplements and receives royalties from their sales.


 

1. E. Guallar et al., ‘Enough Is Enough: Stop Wasting Money on Vitamin and

Mineral Supplements’ Ann Intern Med. 2013;159(12):850-851-851.

2. G.Lamas et al., ‘Oral High-Dose Multivitamins and Minerals After Myocardial Infarction A Randomized Trial’Ann Intern Med. 2013;159:797-804.

3. See https://www.patrickholford.com/blog/aspirin-stops-b-vitamins-benefit

4. B. Manuel-Y-Keenoy et al. Impact of Vitamin E supplementation on lipoprotein peroxidation and composition in Type 1 diabetic patients treated with Atorvastatin. Atherosclerosis. 2004 Aug;175(2):369-76. http://www.ncbi.nlm.nih.gov/pubmed/15262194

5. See http://www.foodforthebrain.org/hcyevidence

6. Smith, A.D. et al., ‘Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial’, Public Library of Science ONE, 5(9) (2010); see also  De Jager, C. et al., ‘Cognitive and clinical outcomes of homocysteine lowering B vitamin treatment in mild cognitive impairment: a randomized controlled trial’, Int J Geriatr Psychiatry (2011)

7. Vogiatzoglou A. ET AL., ‘ Vitamin B12 status and rate of brain volume loss in community-dwelling elderly’ Neurology. 2008 Sep 9;71(11):826-32 [http://www.ncbi.nlm.nih.gov/pubmed/18779510]

8. See evidence presented in Say No to Heart Disease, P.Holford 2012 (Piatkus).

Patrick Holford

Patrick Holford

Patrick Holford is a nutrition expert specialising in mental health. In 1984 he founded the Institute for Optimum Nutrition. He is director of the Food for the Brain Foundation, and it's outpatient clinic, the Brain Bio Centre. He is author of 36 books, including the best-selling Optimum Nutrition Bible and, together with Jerome Burne, Food is Better Medicine than Drugs and 10 Secrets of Healthy Ageing. patrickholford.com.
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9 Comments

  • Patrick Holford! That’s such a shame. I was starting to like it here.

    • Editorial

      I’d just ask you to read it. Patrick certainly has his detractors but he knows a lot about vitamins and what would be sensible ways to test them and what wouldn’t. Let’s not start off down the ad hominem route. Be really interested to hear your response to what he actually writes.

  • I too have had doubts about some of Mr Holford’s advice in recent years – although I bought a couple of his books before I had stumbled across Gary Taubes’ “The Diet Delusion”.

    However, from what little I know his advice in the present article is spot on. It certainly seems to jibe with Dr Malcolm Kendrick’s views, for which I have the greatest respect.

    • We certainly should try to avoid “ad hominem” arguments. Not only for all the well-known reasons, but also because it seems to me that in the present state of nutrition science it seems unlikely that anyone at all has the whole truth and nothing but the truth. What is important is for us all to work together, as far as possible, and try to fit together the various pieces of the giant nutrition jigsaw.

      • Editorial

        Absolutely and without wanting to go down the conspiracy route it is the case that powerful commercial interests are involved in studies on diet- see Hannah Sutter’s recent article here on SACN. As for supplements pharmaceutical companies readiness to do whatever it takes to protect the bottom line – set out in Melayna Lamb’s post on clinical trials last week – would suggest they probably aren’t reluctant to muddy the water. And that’s quite apart from the fact that evaluating diet and lifestyle interventions is a lot trickier than testing a single drug.

  • Jerome, I can see where Eve and Tom are coming from, Jerome. Patrick can invoke mixed receptions amongst people. But his discussion of homocysteine, B vitamins, heart disease and Alzheimers is highly pertinent because homocysteine is an important link in the chain that joins ’cause and effect’ in these matters. Yes, and I think he is right to intimate we do not get objective and unbiased studies involving vitamin trials and why.

    Homocysteine is an important in the puzzle of chromic disease. In the test kit of diagnostics homocysteine testing can be a reliable indicator of background and lingering oxidative stress. But levels is homocysteine is influenced by several factors. High homocysteine levels can point to nutritional deficiencies and stresses, but there can be alternate nutritional factors at work, and high homocysteine can be induced by factors not directly related to nutrition. As ‘markers’ go homocysteine reliably informs something is wrong, but since several factors can bear upon homocysteine, cortisol being one, and so despite it’s reliability as a risk factor homocysteine lacks specificity in ability to point to underlying cause(s).

    So Patrick is correct to imply supplementation with B vitamins could be prudent, and that the evidential support may be imperfect, but although Patrick’s primary focus is nutrition, compromised nutrition is likely not the only lifestyle or environmental risk factor that has capacity to raise homocysteine levels. Actually the association homocysteine levels may have with cortisol levels links several generally well accepted risk factors with process, but it also points to the involvement of at least two additional potential risk factors that have hitherto been overlooked.

    Part of the difficulty is that informed people, Patrick included, can suggest protocols for treatment ahead of a real understanding of what factors (causes) actually give rise to the need for treatment in the first place. The virtue (or lack of it) in any prospective treatment(s) becomes a lot clearer if the action of the proposed treatment can be cross-referenced against an identified process linking cause with effect.

    In heart disease addressing elevated levels of homocysteine in the most natural ways possible is a way of diminishing atherogenic pressures that lead to atherosclerosis (and arteriosclerosis) and the general package we term’ CVD’ or ‘heart disease’.

    The capacity of cholesterol to potentate the process of atherogenesis still has not been established. In contrast the atherogenic properties, or capacity to potentate atherogenic process, of homocysteine and oxidised cholesterol is supported by evidence. And both homocysteine and insulin are implicated as risk factors for Alzheimers.

    Homocysteine, and oxidised cholesterols, of which ‘cholestane triol’ is one, deserve to get more air time and column inches. Credit to Patrick for his contribution to the process.

  • What irony from a man who has spent years selling the dam things!

  • Aidan Goggins

    I’ve read two rebuttals to these studies.

    The first from Dr Alan Gaby, a US doctor who received his undergraduate degree from Yale University, his M.S. in biochemistry from Emory University, and his M.D. from the University of Maryland. He is past-president of the American Holistic Medical Association and gave expert testimony to the White House Commission on Complementary and Alternative Medicine and has written numerous scientific papers in the field of nutritional medicine. So, quite the authority!

    http://www.huffingtonpost.com/alan-r-gaby-md/vitamins-study_b_4481739.html

    The second, this article here from Patrick Holford.

    Whilst Patrick’s and my own philosophies are probably best illustrated as a Venn diagram, reading both articles, I can indubitably state that Patrick has presented a far more relevant, thought provoking, and scientifically qualified and rigorous discussion on why we should not discount vitamin use.

    It is a shame if anyone dismisses this piece right off the bat instead of considering the merits of the content presented. I, for one, found many valid and well presented points.

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