Report Adds Fuel to Vitamin Controversy : Coalition Claims That Supplement Industry Peddles Products Most People Don’t Need

A coalition of health and consumer groups led by the American Dietetic Assn. charged Wednesday that the nation’s $2.6-billion-a-year vitamin supplement industry peddles products most adults and children don’t need to maintain good health and warned that toxic reactions can result from vitamin overuse.

The coalition, which called a New York press conference to bring attention to a set of new recommendations cautioning against vitamin overuse, emphasized that “there are no demonstrated benefits” in the use of vitamin supplements by otherwise healthy men, women and children.

The coalition’s claims were quickly disputed by a spokesman for the vitamin industry, who said that most people don’t fall into the “otherwise healthy” category. Instead, he said, they are part of subgroups that would benefit from daily vitamin intake.

The American Medical Assn. also entered the controversy by releasing an unrelated report that makes conclusions similar to the coalition’s point of view.

The AMA’s Council on Scientific Affairs concluded that, despite widely disseminated advertising claims by the makers of vitamin products, “healthy adults, 18 years of age and older, receiving adequate diets should have no need for supplementary vitamins.” Provided adequate nutrition standards are met, the AMA council concluded, the same is true of “essentially all healthy children.”

The report by the AMA council was disclosed two days earlier than planned after news organizations sought comment from the AMA on the coalition announcement.

The coalition includes the American Dietetic Assn., American Institute of Nutrition, American Society for Clinical Nutrition and National Council Against Health Fraud. The health fraud council is based in Loma Linda.

The new campaign emerges against a backdrop of increasing popularity of vitamin and mineral products--many of which are consumed by people who believe specific products, such as Vitamin C, can prevent or cure various illnesses from the common cold to cancer even though a variety of scientific studies have found no basis for such beliefs.

Dr. C. Wayne Callaway, director of the George Washington University Center for Clinical Nutrition, and a spokesman for the coalition, said in a telephone interview the new focus on vitamins comes because there have been no broadly based, objective new vitamin and mineral standards since 1959 and that there is growing concern both about people who take multivitamins “sort of as an insurance policy” against getting sick and those who take large doses in the belief they may prevent or cure specific diseases.

Major Concern

“There’s no particular evidence that (taking daily multiple vitamins) is beneficial but what evidence there is suggests it’s probably not harmful, either,” Callaway said. “Our major concern is people taking large amounts of (specific) vitamins that may be toxic. I can’t say how prevalent it is but until we get a better awareness of this, we’re sort of shooting in the dark.

“I guess the old rule in medicine--’First, do no harm’--really still applies.”

The vitamin industry has grown from sales of $1.2 billion in 1975. An estimated 40% of Americans use vitamin supplements on a regular basis.

The coalition and the AMA council said regular over-the-counter vitamin use should be confined to a small number of population subgroups including:

- Pregnant women and those who are breast feeding, because they may need iron, folic acid and calcium not available through ordinary dietary means.

- People who consume very low calorie diets that do not provide recommended daily allowances of a sufficient variety of nutrients.

- Some strict vegetarians who avoid all use of animal-origin foods. Such people may not receive adequate levels of calcium, iron, zinc and Vitamin B-12.

- Women with unusually heavy menstrual bleeding, who may require iron supplements.

But in Washington, a spokesman for the Council for Responsible Nutrition, the principal vitamin industry trade group, defended advertising campaigns aimed at the public, in general. The spokesman, Bruce Brown, said research studies have identified such a wide variety of subgroups for whom vitamin supplements are appropriate that the total of such people equals or exceeds the U.S. population at large.

“There is enough variety in those subgroups to justify broad advertising of the one-a-day (type supplement) products,” Brown said. Brown said vitamin consumers are sophisticated--especially in California, where health consciousness is thought to exceed the rest of the nation.

Interested in Optimum Health

“Vitamin supplement users do not substitute supplements for dietary improvements,” Brown said. “The profile of the user tends to be an individual interested enough in optimum health that he or she takes multiple steps to benefit their own health.”

But the coalition that made the New York announcement charged that the time has come “to warn Americans about the unsafe use of (such products). One voice of reason, not driven by profit, is needed to give consumers guidance on the safe use of vitamin and mineral supplements.”

“The increasing belief that high-dose, single-nutrient supplements will promote good health or prevent disease suggests some Americans may be setting themselves up for potential vitamin or mineral overdose,” contended Mary Abbott Hess, head of the dietetic association’s vitamin task force.

The press conference was originally also to have been attended by a U.S. Food and Drug Administration consumer science specialist but the federal agency ordered the scientist, Alan Levy of the FDA’s Center for Food Safety and Applied Nutrition, not to appear on grounds that the New York event amounted to an advocacy forum. Press conference organizers said Levy’s participation had been announced through a misunderstanding.

Research done by Levy found that some heavy users of vitamin and mineral supplements may consume nearly eight times the recommended daily allowances of certain nutrients, with as many as 42% of those users taking doses from of from three to eight times recommended levels.

A coalition pamphlet released Wednesday and the new AMA report focused on what were described as a variety of misconceptions about vitamin and mineral supplements, including beliefs--all of them scientifically unproven or completely invalid--that:

- Supplements are necessary to maintain good nutrition. The coalition agreed with the AMA council that a well-balanced diet requires no additional vitamins and minerals.

- Large doses of Vitamins A and C can help prevent cancer. The coalition countered that “there is no evidence, in humans” that these beliefs are correct. The AMA council reached an identical conclusion.

- Osteoporosis can be prevented by use of calcium supplements. The groups contended that development of osteoporosis depends on factors more complex than simple calcium deficiency.

- People in stress situations require vitamins. The coalition dismissed a link between stress and nutrient requirements.

- Older people need vitamin supplements to maintain health as they age. The AMA noted that no recognized national or international health organization has ever validated this belief and that, in fact, slightly decreased vitamin allowances may be appropriate for men over 50.

- Vitamin E may be taken to promote rejuvenation, reverse aging and increase sex drives and large doses of Vitamin B have been able to treat premenstrual symptoms and even mental illness. The AMA found the claims totally unproven.

- Vitamin C can prevent or treat colds. The AMA also dismissed this vitamin belief--even though it is one of the most widespread and deeply entrenched of all, saying “there is no reliable evidence that large doses of ascorbic acid (Vitamin C) prevent colds or shorten their duration.”

The AMA council report, which was originally completed in 1985 but underwent revisions before final publication this week, emphasized that only pregnant or lactating women require routine vitamin and mineral doses significantly greater than what a healthy diet provides.

Adults in general who consume a healthy diet, for instance, require slightly more than half the Vitamin A that pregnant and lactating women do.

But in general, the council concluded, normal vitamin and mineral doses make up just fractions of what is contained in most supplement products. Adults require 60 milligrams a day of Vitamin C to maintain optimal health, for instance, while most vitamin products contain at least four times that much in each tablet. Children need just 40 milligrams, the council report concluded.

Opportunity for Misuse

“With such widespread use of vitamins by the American public, there is ample opportunity for misuse,” the AMA council concluded. “The rationales are often based on myths or distortions of experimental studies in laboratory animals.

“Some vitamins, such as A, E, C and B, are abused more commonly than others.

“Some persons have taken large doses of multivitamins in the belief that vitamins combat the chronic degenerative diseases or extend life. No objective benefits, however, have been demonstrated.”

The AMA council also warned that some vitamins--particularly A and D--have been linked to possibly dangerous toxic reactions when taken in extremely high doses. “Severe illness has resulted from the excessive use of Vitamin A and death has occurred after massive doses of Vitamin D,” the council said.

Vitamin D, the council said, is the most likely of all vitamins to produce toxic reactions, which can include kidney problems and vomiting in children and those and other problems--including high blood pressure--in adults.

Spokesman Brown of the Council for Responsible Nutrition dismissed the AMA report, however, contending “there’s no new scientific research here.

“It’s basically our position that what (the AMA report) consists of, setting aside the rhetoric of the council, is a list of all the subgroups in our population that can benefit from nutritional supplementation. If you (totaled up) every subgroup you would end up with a total that’s many times the U.S. population.”