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Mechanism,

 

For me it's mostly (b). Isolated micronutrients haven't been shown to be beneficial, and on occasion have been shown to perhaps be detrimental (e.g. beta-carotene without other carotenes, alpha-tocopherol without the other tocopherols), except when consumed in order to compensate for frank deficits (e.g. B12 in vegans, vitamin C in old-time mariners). There are a couple rare exceptions where it looks like individual micronutrients may be beneficial in >RDI amounts (e.g. vitamin D). But those are quite few and far between. Taking a "shotgun" approach by taking a multivitamin as "insurance" against deficiency hasn't been shown to be beneficial even in the general population [1], to say nothing of health-conscious people who eat a good diet and get most or all of their micronutrients from food.

 

Even when a multivitamin has been shown to have some benefit, the benefit is pretty tiny, e.g. in [2], an 11-year randomized, placebo controlled trial of a daily multivitamin in men, which found rate of all cancers dropped by 1.3 cases per 1000 person years. In other words, about 13 men would have to take a multivitamin for their entire adult life before you'd be expected one of them to avoid a single case of cancer. Further, the cancer mortality rate wasn't significantly improved by the multivitamin. And these were in the general population, eating (presumably) a pretty bad diet.

 

Led by Michael, (thanks Michael!) it seems to have become consensus amount CR practitioners that the best way to go is to avoid supplements if possible by getting your micronutrients from whole (mostly plant) foods, and only supplementing selectively and in moderation based on good science and in an individualized fashion based on the results of running your diet through CRON-O-Meter to see where you may be coming up short.

 

--Dean

 

---------------

[1] Am J Clin Nutr. 2013 Feb;97(2):437-44. doi: 10.3945/ajcn.112.049304. Epub 2012

Dec 19.
 
Multivitamin-multimineral supplementation and mortality: a meta-analysis of
randomized controlled trials.
 
Macpherson H(1), Pipingas A, Pase MP.
 
Author information: 
(1)Center for Human Psychopharmacology, Swinburne University of Technology,
Hawthorn, Australia.
 
Comment in
    Am J Clin Nutr. 2013 Feb;97(2):237-8.
    Am J Clin Nutr. 2013 Aug;98(2):502-3.
    Am J Clin Nutr. 2013 Aug;98(2):502.
 
BACKGROUND: Multivitamins are the most commonly used supplement in the developed 
world. Recent epidemiologic findings suggest that multivitamin use increases the 
risk of mortality.
OBJECTIVE: We aimed to determine whether multivitamin-multimineral treatment,
used for primary or secondary prevention, increases the risk of mortality in
independently living adults.
DESIGN: We performed a meta-analysis of randomized controlled trials. Multiple
electronic databases were systematically searched from March to October 2012.
Randomized controlled primary or secondary prevention trials were considered for 
inclusion. Eligible trials investigated daily multivitamin-multimineral
supplementation for ≥1 y. Cohorts described as institutionalized or as having
terminal illness (tertiary prevention) were excluded. The number of deaths and
the sample size of each study arm were extracted independently by 2 researchers. 
Twenty-one articles were included in the analysis, which generated a total pooled
sample of 91,074 people and 8794 deaths. These trials were pooled in a
meta-analysis, and the outcomes were expressed as RRs and 95% CIs.
RESULTS: The average age of the pooled sample was 62 y, and the average duration 
of supplementation was 43 mo. Across all studies, no effect of
multivitamin-multimineral treatment on all-cause mortality (RR: 0.98; 95% CI:
0.94, 1.02) was observed. There was a trend for a reduced risk of all-cause
mortality across primary prevention trials (RR: 0.94; 95% CI: 0.89, 1.00).
Multivitamin-multimineral treatment had no effect on mortality due to vascular
causes (RR: 1.01; 95% CI: 0.93, 1.09) or cancer (RR: 0.96; 95% CI: 0.88, 1.04).
No statistical evidence of heterogeneity or publication bias was observed.
CONCLUSION: Multivitamin-multimineral treatment has no effect on mortality risk.
 
PMID: 23255568
 
------------
[2] JAMA. 2012 Nov 14;308(18):1871-80.
 
Multivitamins in the prevention of cancer in men: the Physicians' Health Study II
randomized controlled trial.
 
Gaziano JM(1), Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M,
Manson JE, Glynn RJ, Buring JE.
 
Author information: 
(1)Department of Medicine, Brigham and Women’s Hospital and Harvard Medical
School, Boston, Massachusetts 02120, USA. jmgaziano@partners.org
 
Erratum in
    JAMA. 2014 Aug 6;312(5):560.
 
Comment in
    JAMA. 2013 Mar 13;309(10):980-1.
    JAMA. 2013 Mar 13;309(10):980-1.
    JAMA. 2013 Mar 13;309(10):980.
    JAMA. 2012 Nov 14;308(18):1916-7.
    Dtsch Med Wochenschr. 2013 Feb;138(6):243.
    Evid Based Med. 2013 Dec;18(6):214-5.
 
CONTEXT: Multivitamin preparations are the most common dietary supplement, taken 
by at least one-third of all US adults. Observational studies have not provided
evidence regarding associations of multivitamin use with total and site-specific 
cancer incidence or mortality.
OBJECTIVE: To determine whether long-term multivitamin supplementation decreases 
the risk of total and site-specific cancer events among men.
DESIGN, SETTING, AND PARTICIPANTS: A large-scale, randomized, double-blind,
placebo controlled trial (Physicians" Health Study II) of 14 641 male US
physicians initially aged 50 years or older (mean [sD] age, 64.3 [9.2] years),
including 1312 men with a history of cancer at randomization, enrolled in a
common multivitamin study that began in 1997 with treatment and follow-up through
June 1, 2011.
INTERVENTION: Daily multivitamin or placebo.
MAIN OUTCOME MEASURES: Total cancer (excluding nonmelanoma skin cancer), with
prostate, colorectal, and other site-specific cancers among the secondary end
points.
RESULTS: During a median (interquartile range) follow-up of 11.2 (10.7-13.3)
years, there were 2669 men with confirmed cancer, including 1373 cases of
prostate cancer and 210 cases of colorectal cancer. Compared with placebo, men
taking a daily multivitamin had a statistically significant reduction in the
incidence of total cancer (multivitamin and placebo groups, 17.0 and 18.3 events,
respectively, per 1000 person-years; hazard ratio
, 0.92; 95% CI, 0.86-0.998;
P=.04). There was no significant effect of a daily multivitamin on prostate
cancer (multivitamin and placebo groups, 9.1 and 9.2 events, respectively, per
1000 person-years; HR, 0.98; 95% CI, 0.88-1.09; P=.76), colorectal cancer
(multivitamin and placebo groups, 1.2 and 1.4 events, respectively, per 1000
person-years; HR, 0.89; 95% CI, 0.68-1.17; P=.39), or other site-specific
cancers. There was no significant difference in the risk of cancer mortality
(multivitamin and placebo groups, 4.9 and 5.6 events, respectively, per 1000
person-years; HR, 0.88; 95% CI, 0.77-1.01; P=.07). Daily multivitamin use was
associated with a reduction in total cancer among 1312 men with a baseline
history of cancer (HR, 0.73; 95% CI, 0.56-0.96; P=.02), but this did not differ
significantly from that among 13 329 men initially without cancer (HR, 0.94; 95% 
CI, 0.87-1.02; P=.15; P for interaction=.07). Conclusion In this large prevention
trial of male physicians, daily multivitamin supplementation modestly but
significantly reduced the risk of total cancer.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00270647.
 
PMCID: PMC3517179
PMID: 23162860

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Mechanism,

 

After B12, vitamin D/ca++, DHA what do you consider the next most important supplement you take?***

 

Actually, up there with B12 & D, and before calcium and DHA, I'd put iodine, lutein/zeaxanthin, and iron. Iodine for thyroid health because I don't eat any added (iodized) salt, or any processed food (the sodium in which is unlikely to be iodized anyway). Lutein/zeaxanthin because I'm genetically prone to macular degeneration. Iron is idiosyncratic for me too - I find if I don't supplement with iron I drift towards anemia. The rest of what I take (documented here) I consider worthwhile, but less critical. 

 

As you can see, my supplement choices are tuned for me, which is what I'm advocating.

 

--Dean

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Mechanism,

 

Shame on you. Once again you seem to have neglected to do you own homework - using either Google or the pretty good search page for these forums to answer you own questions. But I'll cut you some slack this time, especially since there are a couple subtleties about the supplements you inquire about that it are  worth touching on and which I haven't covered in detail elsewhere.

 

In addition to the 'core' supplements I listed above, you ask about my rational for three second-tier supplements - vitamin K2, strontium and zinc.

 

Vitamin K2 - Here is the post where I talk about my rationale for K2 - based on the scientific evidence for its ability to improve bone health (a concern for CR folks) and improved arterial function. While I eat a small amount natto, the richest dietary source of K2, I eat that mostly for the nattokinase. The amount of K2 in the 1/4 serving per day of natto I eat is pretty minimal.

 

Strontium -  Here is an entire thread about strontium where Michael answers my questions about strontium and bone health. He basically points to the evidence and says it good enough for him to be taking it. That's endorsement enough for me.

 

Zinc - Zinc, as well as DHA/EPA, are part of the ARENDS protocol, which has been shown in placebo controlled studies to be beneficial for slowing the progression of macular degeneration (MD), something that is important to me because of my genetic risk or MD. Here is the post where I talk about it. In addition, a diet very rich in vegetables tends to be higher in copper than zinc, especially for people (like me) who eat a lot of mushrooms, which (besides kale) is the highest dietary source of copper. Copper competes with zinc for absorption. Iron (which I supplement to avoid anemia) competes with zinc as well (but iron doesn't compete with copper). So while I get slightly more than 100% of the RDI of zinc from foods, I get several hundred percent of the RDI of iron and copper, so I supplement with zinc to prevent it from getting crowded out.

 

Hope that helps illustrate why I take these specific supplements, and further elucidates my overall supplement strategy.

 

--Dean

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...In addition, a diet very rich in vegetables tends to be higher in copper than zinc, especially for people (like me) who eat a lot of mushrooms, which (besides kale) is the highest dietary source of copper..."

Me, too: loads of kale, many steamed shiitake shrooms, and today in a massive feast for me (>2,900 kcal) I managed to consume 7.2 mg of copper (that's 797% RDA, which is scary...) and I don't like seeing these high copper numbers, but as you say, the dietary copper appears to come from chowing down on mushrooms and greens like kale (also 58,136 IU vitamin A, or 1,938% RDA -- clearly this is piggy and too much) so... What? Less green? Fewer shrooms?

 

...So while I get slightly more than 100% of the RDI of zinc from foods, I get several hundred percent of the RDI of iron and copper, so I supplement with zinc to prevent it from getting crowded out.

So I'm back on the cronometer gogo-food wagon since my prolonged fast, and it's been a nerdy adventure I really only feel safe sharing here with you fellow geeks. Today's stuff-my-face-chew-fest resulted in 36.4 mg of iron (plant based, but still 454% RDA, what, do I donate blood now?); way too much copper; versus 18.2 mg of zinc (or 165% RDA...) Off-balanced here.

 

Obviously none of these numbers are accurate and they're just fingers pointing at the six moons, but still.

 

Tomorrow will be different. But since my fast of a few weeks ago, I love green leafy and cruciferous vegetables so much it's insane: chard, kale, watercress, spinach, arugula, collard greens, red cabbage, broccoli, Brussels sprouts... Realize way too much of a good thing, and moderate, please, I'm seeing some boundaries thanks to weighing and entering into cronometer. I need, oddly, less green leafy goodness, and more balance from something else. Who knows what.

 

I'm just sharing here... And for now I'm only supping B12, D, biotin, phosphatidyl-choline, strontium for some RDI holes. For experimentation (sucker-falls for longevity hucksterism) I'm supping pterostilbine, resveratrol, Niagen (I know, I know, I've read stuff, too...) astragalus, olive leaf extract (added to oil) and for a while I was: gulp: true confession: concocting my own c60 in olive oil mixtures and taking a few tablespoons once per month, but I stopped that in January after reading some stuff by Kmoody...

Edited by Sthira

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Mechanism,

 

I don't think anyone here is advocating for heavy DHA/EPA supplementation like is being discussed in those threads, and that Jeff Novick is advocating against.

 

I personally supplement with a small amount of algae-derived DHA/EPA (equiv. of one fatty fish meal per week) out of caution, in the off chance that I'm an especially poor converter of ALA to the longer-chain omega-3s.

 

If I weren't vegan I probably wouldn't take any preformed DHA/EPA given the mounting evidence that it's initial apparent promise for cardiovascular and brain health hasn't panned out.

 

--Dean

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So here's my selenium update: I did find Greg's cron-o-https://www.crsociety.org/topic/11385-what-drove-me-from-vegan-food-to-a-pill/?fromsearch=1meter analysis showing inadequate selenium informative. Thank you Dean for the encouragement. Based on the above I figure a case-by-case approach based on dietary habit cron-o-meter analysis +/- some insurance to cover for for soil/plant variation in selenium content would be very reasonable -- in my case I'm still thinking it over but in low doses the risk should be fairly small albeit the beta carotene and tocopherol studies & cost / convenience give me pause for thought. Thanks to the trhe CRONie community, I am well on my way to ON.

Not quite sure what you're saying here, Mechanism, regarding selenium? Maybe I'm not very literate haha... Too little in selenium ur diet r u saying?

 

So if you're unwilling to eat half a Brazil nut every now and then, find high selenium numbers in shiitake mushrooms (rather than a pill). If I eat like 12 then that's pretty close to 100%, at about 140kcal or so. Unfortunately 12 shiitake shrooms while delicious is also a lot of copper... So there's that sad face. I hope copper from mushrooms isn't gonna give me Alzheimers before we're all peacefully inoculated against it...

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All,

 

I found the studies discussed in this popular press article titled Vitamin pills can lead you to take health risks quite interesting in light of the original topic of this thread - multivitamins. The studies were all by the same group, and the most interesting of the lot was [1]. In it the researchers gave all subjects a placebo pill, but told half of them that they were getting a multivitamin and the other half that they were getting a placebo. Note this was just a one-time deal - one pill on the day of the experiment. Then in one arm of the experiment they offered subjects from both groups the opportunity for a free lunch, either a healthy organic meal or a buffet-style, much less healthy meal. In the second arm of the experiment they equipped subjects with a pedometer allegedly to help the experimenters assess its accuracy. They were told they needed to return the pedometer with one hour to either one of a two return spots at known landmarks. One landmark was 600m away from the starting location and the other 1200m. They were told they could walk anywhere they wanted and as far as they wanted in the meantime, as long as they returned the pedometer within the hour.

 

You can see what the researchers were doing - basically seeing whether folks chose to engage in more or less healthy diet and lifestyle choices when they thought they were getting a (beneficial) vitamin vs. an inert placebo. Here are the results, in tabular form:

 

KuN42xd.png

 

As you can see, subjects who thought they'd taken a healthy multivitamin consistently engaged in less healthy behaviors, including choosing the unhealthy buffet meal (71% vs. 44% for placebo) and choosing to drop off the pedometer sooner / closer (68% vs. 41% for placebo).

 

The authors attribute their results to the licensing effect in which engaging in one behavior considered "good" (either moral or healthy) licenses a person in their own mind to engage in less moral or health-oriented behaviors. It's as if people have an implicit sense of "good enough" that they are satisfied with achieving, and if they go beyond that threshold they reward themselves by engaging in non-so-good behaviors. I saw it when I worked in the field of automotive safety - we called it "risk compensation". When a new safety feature was introduced, like airbags, anti-lock breaks, or a collision warning system, we would paradoxically not see a reduction in the number of crashes or injuries. It turns out what was happening was a version of licensing. With a safer car or truck, people would simply drive faster in inclement weather, or take more risks generally, to maintain a setpoint for safety. In other words, they'd trade off the extra safety they could have enjoyed for a shorter commute time (faster driving) or something else they considered valuable - even the thrill of more risky driving. Tesla owners beware...

 

Back to the multivitamin studies - the authors confirmed this sort of licensing in another substudy, where they used a validated "invulnerability scale" to gauge how invulnerable people considered themselves to be using questions like "how likely is it that you'll be killed in a car accident?" or "how likely is it that you'll get cancer?" As expected, the vitamin folks rated themselves a more invulnerable than those who thought they'd received a placebo.

 

So this could explain the disappointing and sometimes even harmful effects observed in multivitamin studies which aren't placebo controlled. People who take them consider themselves to be healthier, more invulnerable and and have their nutrition "bases covered". So they may engage in unhealthy eating, and more risky detrimental behaviors in general, as a form of licensing or risk compensation. In fact, in yet another substudy, among subjects who were smokers, the researchers found a much higher proportion of those who thought they'd been given the multivitamin chose to smoke a cigarette immediately after the experiment was over.

 

Ah the craziness of human psychology. Presumably the rational folks around here won't be fooled into eating less healthily as a result of taking a few supplements. Pills can't replace healthy foods.

 

--Dean

 

---------------

[1] Psychol Sci. 2011 Aug;22(8):1081-6. doi: 10.1177/0956797611416253. Epub 2011 Jul 

15.
 
Ironic effects of dietary supplementation: illusory invulnerability created by
taking dietary supplements licenses health-risk behaviors.
 
Chiou WB(1), Yang CC, Wan CS.
 
 
The use of dietary supplements and the health status of individuals have an
asymmetrical relationship: the growing market for dietary supplements appears not
to be associated with an improvement in public health. Building on the notion of 
licensing, or the tendency for positive choices to license subsequent
self-indulgent choices, we argue that because dietary supplements are perceived
as conferring health advantages, use of such supplements may create an illusory
sense of invulnerability that disinhibits unhealthy behaviors. In two
experiments, participants who took placebo pills that they believed were dietary 
supplements exhibited the licensing effect across multiple forms of
health-related behavior: They expressed less desire to engage in exercise and
more desire to engage in hedonic activities (Experiment 1), expressed greater
preference for a buffet over an organic meal (Experiment 1), and walked less to
benefit their health (Experiment 2) compared with participants who were told the 
pills were a placebo. A mediational analysis indicated that perceived
invulnerability was an underlying mechanism for these effects. Thus, a license
associated with the use of dietary supplements may operate within cycles of
behaviors that alternately protect and endanger health.
 
PMID: 21764996

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Here's one with a longer followup of 26 years. One defence of taking a multivitamin is "in case of frank deficiencies" - indeed invoked by Dean in the very first post of this thread. What is notable in this study, is that even with a very long followup of 26 years, they found no effect of multivitamin mortality, that it was a randomized intervention, and most critically: regardless of nutritional status. Many people take a multi with the idea of it being a kind of "insurance" if they otherwise eat a crappy diet. This study says that multis are NOT helpful under those circumstances - they are no kind of insurance at all. To quote:

 

"In summary, during six years of multivitamin supplementation and 20 years of post-intervention follow-up, we observed no effect of multivitamins on total or cause-specific mortality in a nutrient-deficient population. Together with data from previous trials, these results demonstrate little benefit of multivitamin supplementation on mortality in either well- or poorly-nourished populations."

 

26 Year Follow-up of the Randomized Linxian Dysplasia Nutrition Intervention Trial: No Effect of Multivitamin Supplementation on Mortality

 

JAMA Intern Med. Author manuscript; available in PMC 2014 Jul 15.
 
Published in final edited form as:
JAMA Intern Med. 2013 Jul 8; 173(13): 1259–1261.
doi:  10.1001/jamainternmed.2013.6066
PMCID: PMC4098709
NIHMSID: NIHMS535614
 
Jian-Bing Wang, PhD, Christian C Abnet, PhD, Jin-Hu Fan, BS, You-Lin Qiao, PhD, and Philip R Taylor, MD
 

Although substantial numbers of people worldwide take multivitamin supplements, including an estimated 40% or more of US adults, their effectiveness remains unclear. Recent reports from the Physicians’ Health Study (PHS) II, a randomized trial of daily multivitamins, found fewer total cancers in multivitamin recipients, but no effect on overall or cause-specific mortality 12 in a Western population that was well nourished. However, few multivitamin trials have been conducted in under-nourished populations where the potential for benefit is most likely.

In 1985, we initiated the Linxian Dysplasia Nutrition Intervention Trial (NIT) to evaluate the effect of multivitamin supplements on cancer incidence and mortality in Linxian, China, a region with extremely high rates of esophageal and gastric cardia cancer and multiple vitamin and mineral deficiencies. Individuals with a previous cytological diagnosis of esophageal squamous dysplasia were randomized to receive multivitamin supplementation or placebo for six years.3 Results after the six-year intervention period showed no statistically significant benefit on mortality.4 However, an additional 20 years of active follow-up after cessation of the intervention gave us the opportunity to examine the long-term effects of supplementation.

The purpose of this report is to update results of the Linxian Dysplasia NIT after 26 years of follow-up to provide data informative on the effect of multivitamin supplementation on mortality in an under-nourished population. Our findings should be helpful for clinical practice and public health recommendations.

 

So if there is such an uninspiring result of supplementing with multis, what reason is there to suppose that someone here would benefit from such supplementation?

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I'm now asking myself if I'm indeed engaged in the licensing effect or not. Sometimes it's hard to see ourselves, and by definition see our own blind spots. The most dangerous thing I do is leap from building to building at night under the sweet darkness with my airborne and silent cat:

 

 

This has absolutely nothing to do whatsoever with multivitamins, which I don't take. I prefer targeting.

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All,
 

In today's NutritionFacts.org video (embedded below), Dr. Greger rails against the "nutrition reductionism" and the "deficiency mindset" which together have lead people to think they've got their 'healthy diet' bases covered by eating vitamin fortified foods and taking a multivitamin. Sthira, he sounds exactly like you when he asks why we need more research like [1], a study investigating "the effectiveness of loquat leaf extract on cardiovascular disease in zebrafish fed a high cholesterol diet". 

 

Dr G. points to [2], which found that good health doesn't have to be rocket science. He says:

 

We already know that three-quarters of chronic disease risk—diabetes, heart attacks, stroke, or cancer—can be eliminated if everyone follows four simple practices: not smoking, not being obese, half an hour of exercise a day, and eating a healthier diet—defined as more fruits, veggies, and whole grains, and less meat. 

 

This seems like advice Michael can't argue with, despite his lack of belief in the credibility of its source.

 

--Dean

 

 

------------

[1] J Y Kim, J H Hong, H K Jung, Y S Jeong, K H Cho. Grape skin and loquat leaf extracts and acai puree have potent anti-atherosclerotic and anti-diabetic activity in vitro and in vivo in hypercholesterolemic zebrafish. Int J Mol Med. 2012 Sep;30(3):606-14.

 

[2] E S Ford, M M Bergmann, J Kröger, A Schienkiewitz, C Weikert, H Boeing. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med. 2009 Aug 10;169(15):1355-62.

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