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Do You Need Vitamin Pills?
North Americans almost never suffer from vitamin deficiencies, except for vitamin D, yet more than 50 percent of the population spends more than 30 billion dollars each year for vitamin pills and other nutritional supplements that they do not need.  Forty-five percent of those who take vitamin pills believe that they will improve their health, but we have no good evidence that they do (JAMA Internal Medicine, Feb. 4, 2013).  The general consensus of the scientific community is that most people who take vitamin pills receive no benefit from them but are not harmed except for the money they have wasted.  Many people say that they take vitamin pills because they may not be eating the right foods, but a lousy diet with vitamin pills is still a lousy diet.  
 
How Do Vitamins Affect Your Body?
All of the vitamins necessary for human life and health come from foods, with the exception of vitamin D which comes primarily from sunlight.  Most vitamins, particularly  the B vitamins, are parts of enzymes that start chemical reactions.   Chemical reactions break down food so that it can be absorbed into you bloodstream, start the process that turns food into the fuel that your body uses for its various functions, and build and repair all the tissues in your body.  All of these chemical reactions are started by enzymes made by your body and the bacteria that live in your body.  
 
For example, for chemical A to go to chemical B and release energy for your cells to use, you need a first enzyme to start that chemical reaction.  Then you need a second enzyme to break down chemical B to form chemical C and release more energy.  If you have the first enzyme, you make lots of chemical B. If you lack the second enzyme that breaks down chemical B, chemical B could accumulate in large amounts in your body and may be toxic, which could cause disease and harm you.
 
B vitamins convert methionine to cysteine
 
How the B Vitamins Work
Scientists do not know all of the chemical reactions started by vitamins, but they have worked out how some of the B vitamins help to make all of the proteins in your body.  All human protein is made up of 21 building blocks called amino acids.  Eight amino acids cannot be made by the human body, so they are called essential amino acids.  The other 13 can be made from the essential amino acids, so you don't need to get them from your food; these are called the non-essential amino acids. 
 
For example, you use enzymes from the B vitamins to make the not-essential amino acid cysteine from the essential amino acid, methionine.  However, methionine must go through several chemical reactions that make homocysteine before it makes cysteine.  Thus Methionine > Homocysteine > Cysteine.  However, homocysteine is associated with increased risk for heart attacks, so if it accumulates in the body it can be harmful.  Vitamin B6 (pyridoxine) converts homocysteine to methionine and vitamin B9 (folic acid) and/or B12 (cobalamin) that convert homocysteine to cysteine.  Vitamin B3 (niacin) converts cysteine back into homocysteine.  The B vitamins depend on all of the other B vitamins and more to avoid the buildup of toxic chemicals in your body.  
 
My Recommendations 
Since nobody really knows all the chemical reactions that go on in your body, I recommend that you eat what most scientists feel is a healthful diet and not depend on pills that have more questions than answers.  
• avoid overweight 
• exercise 
• eat lots of fruits, vegetables and seeds (nuts, beans whole grains)
• restrict sugar-added foods and drinks, red meat, processed meats and fried foods  * avoid all forms of tobacco 
• restrict or avoid alcohol
• avoid recreational drugs and unnecessary prescription drugs
 
References:    
 
Data Associating Harmful Outcomes with Vitamin Pills
• A study of more than 35,000 men reported that high doses of Vitamin E pills are associated with increased risk for prostate cancer (JAMA.  Oct 12, 2011;306(14):1549-56).
• A study of 38,772 older women shows that taking vitamin and mineral pills is associated with increased risk of death with iron pills have the strongest association (Arch Intern Med. 2011 Oct 10;171(18):1625-33). 
• Women who take multivitamin supplements (vitamin C, E, beta-carotene, selenium, and zinc) are at increased risk for skin cancer (The Journal of Nutrition, Sept, 2007;137(9):2098-105).
• Vitamin A (beta-carotene) pills increase risk for lung cancer among smokers (Journal of the National Cancer Institute, Nov 6, 1996 Nov 6;88(21):1550-9) and The New England Journal of Medicine. April 14, 1994;330(15):1029-35.
• High doses of vitamin E increase risk of heart failure (JAMA.  Mar 16, 2005;293(11):1338-47).
• High doses of vitamin E increase risk of heart failure (JAMA.  Mar 16, 2005;293(11):1338-47).
• People who take daily vitamin pills do not live as long as those who do not take them  (Lancet. Oct 2, 2004;364(9441):1219-28 and JAMA.  Feb 28, 2007;297(8):842-57).
 
Data Associating Health Benefits with Vitamin Pills
• Taking vitamin pills for more than 20 years was associated with reduced risk for heart attacks (J Nutr. April, 2016).
• A 10-year follow-up study of 31,671 post-menopausal women with no history of heart disease showed that those taking vitamin pills had a slightly reduced risk for heart attacks (Am J Clin Nutr. Mar, 2011;93(3):674).
• Daily use of multivitamins was associated with decreased risk for cancer  (JAMA. 2014 Aug 6;312(5):560 and Postgrad Med. Jan, 2015;127(1):107-16). 
 
Data that Taking Vitamin Pills Offers No Health Benefits
• Researchers followed 86,142 women, aged 34–59, who had heart disease over many years.  Those who took daily multivitamin pills did not have a reduced incidence of strokes or death from strokes (Eur J Neurol. Jul 30, 2017).
• A study followed for 5.4 years, 7540 men over age 60, given daily vitamin E, selenium, vitamin E and selenium, or placebo.  The supplements offered no advantage whatever in preventing dementia (JAMA Neurol. May 1, 2017;74(5):567-573).
• Researchers gave 6000 men either one of four different supplements advertised to make you smarter or a placebo, and found that none of the supplements offered any advantage whatever over placebos in brain function ((Journal of the American Medical Association. May, 2017;317(20):2054). 
• A review of 27 studies of 400,000 people showed that those who take vitamin pills daily do not live longer and did not suffer fewer attacks or cancers than those who do not take vitamin pills.
(Annals of Internal Medicine, April 17, 2017). 
• Researchers followed 37,193 healthy women, older than 45 years, for an average of 16 years and found no advantage from taking daily vitamin pills in preventing heart attacks, strokes, heart surgical procedures, or death from heart attacks (Am J Clin Nutr.  Jan, 2015;101(1):144-52).
•  The Physicians' Health Study II showed that taking a daily multivitamin does not prevent death from heart attacks, strokes or heart disease after more than 10 years of follow up (JAMA. Nov 7, 2012;308(17):1751-60). 
• Multivitamin pills did not prevent heart attacks, strokes, or death in women (Am J Clin Nutr. Jan, 2015;101(1):144-52).
*Neither vitamin E nor C pills reduced risk for heart attacks in 8 year follow up (JAMA.  Nov 12, 2008;300(18):2123-33).
• A follow up study for more than 11 years of 28.517 middle-aged women showed that taking vitamin pills neither raised nor lowered high blood pressure (J Hypertens. Aug, 2016;34(8):1513-9).
• A 16-year prospective study of 37,193 women older than 45 and free of heart disease and cancer shows that taking multivitamin pills was not associated with, or caused, heart attacks, strokes, heart revascularization surgery or heart attack deaths (Am J Clin Nutr.  Jan, 2015;101(1):144-52). 
• An 8 year follow up study of 161 808 post-menopausal women shows that taking vitamin pills did not affect risk for common cancers, heart attacks or death rate (Arch Intern Med.  Feb, 2009;169(3):294-304).  Cancers specifically studied were of the breast, colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung.
• Researchers followed 161,808 women for 8 years and found that 41 percent took daily multivitamin pills.  Those who took vitamin pills daily had the same incidence as those who took no vitamin pills of cancers of the breast, colon, rectum, endometrium, kidney, bladder, stomach, lung and ovary; heart attacks and strokes.  Overall death rates were the same for both groups (Arch Intern Med. Feb 9, 2009;169(3):294-304).
 
Checked  8/31/17
July 17th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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