November 7, 2012
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
Now that the election is over, we can get back to something that really matters -- namely vitamins, and specifically whether they really help people.
Last month there was a large, well-done study from Tanzania showing that mega-doses of vitamins not only didn't help those HIV starting ART, but they actually were harmful -- LFTs went up, and there was a non-significant trend towards more deaths among the sickest patients who got the vitamins.
Granted, I've never been a fan of high-dose supplements, but given these results, and the fact that they cost a boatload of money, I came out pretty strongly against them. Spend the money on real food -- you know, the stuff we evolved as a species to eat -- not the shiny capsules in the GNC that come in plastic bottles with pseudoscientific labels.
And the papers are in the same journal. Jeeze.
First, in my defense, it's high doses of vitamin that I really object to -- the list of studies showing that mega-supplements do no good (and may do harm) is not short. Second, while this particular multivitamin study (part of the giant Physicians' Health Study II) showed a cancer prevention benefit, even the authors acknowledge that the effect size was small, and that cancer-related and overall mortality were similar. Third, this separate analysis of that same study showed no benefit in prevention of cardiovascular disease.
So for our patients wedded to taking something, let's leave it as "take a daily multivitamin -- if you must."
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.