The top 6 vitamins and supplements you shouldn’t take

The evidence against supplements continues to pile up.

Recently I created a list of The Top 5 Vitamins You Shouldn’t Take. Now I’m expanding that list to include vitamin D, which is taken by almost half of older adults. Now, two new studies in latest issue of The Lancet show that most of these people are wasting their money.

The first study is a large review by Philippe Autier and colleagues, who found that taking supplemental vitamin D has no effect on a wide range of diseases and conditions. After looking at over 450 studies, the authors conclude:

“The absence of an effect of vitamin D supplementation on disease occurrence, severity, and clinical course leads to the hypothesis that variations [in vitamin D levels] would essentially be a result, and not a cause, of ill health.”

So it appears that we’ve been getting cause and effect backwards, at least as far as vitamin D is concerned. Autier looked at non-skeletal disorders, including heart disease, weight gain, mood disorders, multiple sclerosis, and metabolic disorders, all of which have been linked to lower vitamin D. In trial after trial, supplemental vitamin D had no beneficial effect on any of these conditions. Autier et al concluded that:

“associations between 25(OH)D and health disorders … are not causal. Low 25(OH)D [vitamin D] could be the result of inflammatory processes involved in disease.”

Instead, the researchers found, in study after study, that low vitamin D was the result of poor health, not the cause.

The Autier study didn’t look at the biggest supposed benefit of vitamin D: protection against osteoporosis. We’ve long known that vitamin D is associated with bone health. Fortunately, in the same issue of The Lancet, Ian Reid and colleagues looked closely at this question. They reviewed 23 studies with 4082 participants, all designed to determine at whether supplemental vitamin D improves bone density. Their findings? It doesn’t help. They concluded:

“Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.”

Vitamin D supplements, to put it plainly, are a waste of money.

(For those concerned about osteoporosis, the widely used drug alendronate (Fosamax®), has been shown to increase bone density by about 5%, as explained in a 2011 article by Dr. Sundeep Khosia. But Fosamax has side effects.)

It’s pretty easy to get enough vitamin D in a normal diet. Or, as Dr. Mark Gillinov explained in the Huffington Post last week, just 10 minutes of sunlight gives you about 4 times your daily recommended vitamin D requirement.

So here's my expanded list of the Top Six Vitamins You Shouldn’t Take, with the newest entrant at the end:

1. Vitamin C
2. Vitamin A and beta carotene
3. Vitamin E
4. Vitamin B6
5. Multi-vitamins
6. Vitamin D

You can read more about the first five in the original list.

What’s left? Well, if you don’t have a deficiency, there’s no reason to take any supplemental vitamins at all.  As my Hopkins colleagues Eliseo Guallar, Lawrence Appel, and Edgar Miller wrote last month in the Annals of Internal Medicine : “Enough is enough: stop wasting money on vitamin and mineral supplements.”  As they wrote, after looking at three more large studies just published last month,

"most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided."

Save your money. Or better yet, if you must spend it, buy a bit more fresh fruit. You'll be healthier for it.

Anti-vaccination propagandists help create the worst whooping cough epidemic in 70 years

The great northwest of the U.S. is known for its natural beauty.  It's also a high-tech region with a highly educated public - not exactly the kind of place one would expect to fall for the anti-science rhetoric of the anti-vaccine movement.

But it has.  The anti-vaxxers have convinced a frighteningly high number of parents in Washington State to withhold vaccines from their children.  A story in The Seattle Times last year reported that 

"Washington [state] parents are choosing not to vaccinate their kindergartners at a rate higher than anywhere else in the country."  

This despite the fact that the Bill & Melinda Gates Foundation (formed by the founder of Microsoft, which is headquartered in Seattle) is one of the world's leading sponsors of vaccine research.  

When the vaccination rates drop, everyone becomes more vulnerable to infectious diseases.  When more than 90% of the population is vaccinated, we have "herd immunity" - this means the disease can't spread because there aren't enough susceptible people in the community.  So the high rate of vaccine refusal in Washington makes it easier for whooping cough (and other diseases) to spread.

The media has been complicit in spreading some of the anti-vaccine misinformation.  Sometimes it comes straight from the media itself, such as the credulous, anti-science, anti-vax CBS reporter Sharyl Attkisson. Other times it comes from talk shows, magazines, or even airline advertisements that provide a platform for anti-vax celebrity doctors such as Jay Gordon (who gained fame as Jenny McCarthy's son's doctor) and "Dr. Bob" Sears, who has published his own "alternative" vaccine schedule in a book filled with anti-vaccine nonsense.  These characters continue to claim, at every chance they get, that vaccines cause autism (as Gordon has said, repeatedly), or that they cause other harms, despite overwhelming evidence to the contrary.  They use their medical degrees and their faux concern "for the children" to frighten parents into keeping their kids unvaccinated.

And now we learn that the U.S. is in the midst of the worst whooping cough epidemic in 70 years.  One of the most hard-hit states is Washington, which the CDC just announced (on 20 July) has suffered 2,520 cases so far this year, a 1300% increase over last year.  This is the highest number of cases reported in Washington since 1942.  This plot of the number of cases this year compared to last year shows the dramatic rise in infections:

The figure above shows the number of confirmed and probable pertussis cases reported, by week of onset in Washington, during January 1, 2011-June 16, 2012.  Source: Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention.

Making things worse, it seems, is an increase in cases among children aged 13-14.  Children get a booster shot at age 11-12, but the new outbreak indicates that the effectiveness of the booster may not last very long.  The dramatic increase in whooping cough this year also suggests that the bacterium that causes it, Bordetella pertussis, is mutating to make the vaccine less effective.  Nevertheless, the CDC emphasizes: 

"Vaccination continues to be the single most effective strategy to reduce morbidity and mortality caused by pertussis. Vaccination of pregnant women and contacts of infants is recommended to protect infants too young to be vaccinated."

This good advice is seriously undermined when misinformed doctors such as "Dr. Bob" Sears directly advise pregnant women not to get the whooping cough vaccine, as he did in the Huffington Post. (Hint: it's a good rule to be very skeptical of celebrity doctors who go by their first name.)

I should also point out that whooping cough is a national problem, not just Washington State's.  The U.S. has had over 17,000 cases this year, putting it on track for the worst year since 1959.  The highest rate of infection in the nation is in Wisconsin (which has also been hit hard by anti-vaccine effects), followed by Washington and Montana. 10 deaths have been reported, mostly in infants who were too young to be vaccinated.  For all this, we can thank the anti-vaccination movement.