Dec 23, 2013

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Several years ago when I lived on another street in Dauphin, we came home from visiting my parents in Pinawa for Christmas. We pulled up to the house to find our driveway completely impassable. So we parked on the street and trudged through the snow into the house. Then I got dressed to dig out the driveway so we could park the truck. After finishing our driveway, I noticed our neighbor, a few houses down, had a blown in driveway as well. She was an older lady, so being full of Christmas spirit I went down and started shoveling out her driveway. I was just about all the way up to her house when an RCMP patrol car pulled into the driveway and an officer stepped out.


The RCMP are an essential service to keep law and order. Just like eating a balanced diet is essential for maintaining good health. What happens if you dont eat well. Should you take a multivitamin? That is a very common question in the pharmacy. My standard answer to that question is What do you hope the multivitamin will do for you? or Why do you think you need a multivitamin? If the answer is that their doctor ran a test and the patient is low in Vitamin B12 or low in iron then we march straight out into the vitamin aisle. Depending on the situation we can pick a multivitamin with the deficient nutrient in it or a single entity product that contains just Vitamin B12 or just iron. If the answer to why do you think you need a multivitamin is, I dunno. I just thought that Id be healthier with it, my answer is usually different. I usually say sometime like, A well balanced diet with lots of fruit and vegetables in it should supply all the vitamins and minerals an otherwise healthy adult needs.


There now is more evidence to support my assertion that multivitamins dont necessarily help peoples health. The December 17, 2013 Annals of Internal Medicine had a trifecta of vitamin articles.


The first was study of people whod had a previous heart attack and were given high doses of vitamins and minerals. The study by Lamas et al. looked at 1708 patients aged 50 years or older who had a heart attack at least 6 weeks earlier. It turned out that most people in the study had their heart attack about 4 years before the study. These people were either given an oral 28 component, high-dose multivitamin and multimineral mixture or a sugar pill and were followed for about 5 years. The researchers were looking to see if the study participants had any more heart or stroke problems. What the researchers found was that there was no difference between the group taking the high dose vitamins and the group taking the sugar pill. Taking multivitamins did not reduce the number of heart problems or strokes.


I found this study interesting for a couple of reasons. The high dose multivitamin was designed by alternative medicine practitioners. We often get complaints that vitamin studies dont show the results that alternative medicine practitioners would like because the dose is wrong. The second interesting result was the drop out rate. The patients were required to take 6 large capsules per day to get the high doses of vitamins and minerals the alternative medicine practitioners were looking for. Perhaps not surprisingly that meant that 49% of patients stopped taking their vitamins during the study. The study participants kept on their vitamin regime an average of about 2.5 years on the 6 large capsules per day. So it could be argued that the study results didnt show an improvement because not enough participants took their pills. However at 6 large capsules per day, I think it is unrealistic to expect real people in the real world to takes these high vitamin doses for very long.


The next study by Grodstein et al. was interesting because they used doctors as guinea pigs. They looked at 5947 male physicians aged 65 years or older. They gave half a sugar pill and half a regular multivitamin. They did memory and thinking tests on the doctors and followed them for about 12 years. The researchers found no difference between the sugar pill group and the vitamin group when it came to cognitive decline. Some of the criticism of this trial involved the doctors themselves. As a highly educated group, some people wonder if you would notice a cognitive decline as well as you would in a not so educated group. Also, since the group was well fed with a good diet in general, some people wonder if you would have noticed more of a difference if the group was not so well fed.


The last article wasnt a study, but a meta-analysis. A meta-analysis is when researchers dont do a new study of their own, but look at a bunch of other peoples studies and look for patterns. The results from a meta-analysis arent as strong as those from a large double blind placebo controlled trial, but they can give us interesting ideas that should be studied further. This meta-analysis by Fortmann et. al., looked at 26 vitamin studies and 5 of them were multivitamin trials. When they pooled all their data, they found no effect of vitamins in reducing the chances of a person getting heart disease or cancer. They found some interesting blips in their data though. They found beta-carotene may increase the chance of lung cancer especially in smokers. They found 2 trials where multivitamins reduced the cancer rate in men, but the one trial on women showed no effect on cancer. But again, overall there was no effect of multivitamins on cancer or heart disease rates.


I dont want people to think there are no legitimate uses of vitamins and minerals. If your doctor says you are deficient in iron, Vitamin B12 or Vitamin D the take those vitamins. But on the other hand, there seem to be many people who take many multivitamins just because. For those people looking at your diet and adding more vegetables and fruit would probably do you more good.


It turns out I knew the RCMP officer who stepped out of the patrol car. He recognized me and was trying hard not to laugh. He had a report of a big scary looking hooligan shoveling his way up to a ladys house to rob it. The officer explained to the lady I wasnt trying to rob the house. She apologized for calling the police and we all had a laugh. Although it all ended well, I was wondering what was wrong with me that I go do a good deed and get the cops called on me. I dont want to say no good deed goes unpunished because that would be a little fatalistic. Instead, how about in the Spirit of the Season, go do a good deed because doing good for others is its own reward. Dont look for a reward for your good deed because it might not be what you were expecting.



The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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JAMA article on Vitamin B12 and PPIs -


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