Vitamins: Good or Bad?

We are not a post-vitamin society, yet.
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As the iconic Tim "The Tool Man" Taylor would say, "[guttural grunt], more power."

If I'm properly remembering Home Improvement, things rarely went awry for Taylor and his wife Jill. His North Star was the simple, relentless pursuit of the twentieth-century American "more is more" ethos. Taylor owned a multi-story house, had three stylish boys, a happy marriage, and a career that afforded him both celebrity and pursuit of his passion. Meanwhile the family's painfully levelheaded neighbor, Wilson, squandered most of his time clinging to eccentric cultural anachronisms alone in his backyard. It was strongly implied that he had lost the bottom half of his face in some sort of terrible accident.

The moderate Al Borland was also perpetually drab, surpassed by Taylor in every quantifiable metric of success.

Taylor is not America's Doctor today, though. (America's Doctor is of course Dr. Mehmet "A Revolutionary New Way to Live Years Longer: It's Red Palm Oil" Oz.) On the whole, twenty-first century medicine is ushering in a revival of moderation. This weekend, Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia, wrote a fact-heavy piece in the Opinion section of The New York Times, "Don't Take Your Vitamins." It was the most popular article on the Times' site.

SHARK300200.jpg@KatyPerry shows off bags of supplements and vitamins, labeled "Upon Rising," "Breakfast," and "Dinner."

I know what it's like to be reduced to a headline. People sometimes put articles on their Facebook walls without reading past the headlines, I hear. Offit's actual point is more nuanced, if no less reactionary: Multivitamins are not a panacea; more is not always better; more is sometimes quite bad. Some of the anti-supplement data he cites is compelling:

In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta-carotene, both or a placebo. The study found that those who had taken beta-carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study on vitamin supplements. In it, 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta-carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

Then, in 2004, a review of 14 randomized trials for the Cochrane Database found that the supplemental vitamins A, C, E and beta-carotene, and a mineral, selenium, taken to prevent intestinal cancers, actually increased mortality.

Another review, published in 2005 in the Annals of Internal Medicine, found that in 19 trials of nearly 136,000 people, supplemental vitamin E increased mortality. Also that year, a study of people with vascular disease or diabetes found that vitamin E increased the risk of heart failure. And in 2011, a study published in the Journal of the American Medical Association tied vitamin E supplements to an increased risk of prostate cancer.

Finally, last year, a Cochrane review found that "beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A."

When you put it that way, vitamins look bad. Beta-carotene, very bad. The fat soluble vitamins (A, D, E, K), as a rule of thumb, are the easiest to get too much of. Still reductive notions swaying perception too far against nebulous notions of vitamins is also bad. Everything we knew is not wrong.

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James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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