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Should I Take a Multivitamin?

I’ll start with a confession. I used to do something irrational. I used to take a daily multivitamin, not because I thought there was good scientific evidence to support the practice, but for psychotherapy. I tried to eat a healthy diet and worried about it. By taking a pill, I could stop worrying.

Then I found out that higher intake of vitamin A was associated with an increased risk of hip fractures in postmenopausal women like me, and I stopped. (High doses of vitamin A also cause births defects and are contraindicated in pregnancy.) Now I only take supplemental calcium and vitamin D, not on general principles but because of personal risk factors.

We’re being bombarded by advice to take vitamins and various other supplements. Health gurus like Andrew Weil recommend that everyone take vitamins (which they just happen to sell). The orthomolecular followers of Linus Pauling want us to take megadoses of vitamins. Ray Kurzweil tells us we should take vitamins to make us live longer; he takes 250 vitamin and supplement pills a day and thinks he will live forever. (You can read about his ideas in his book Fantastic Voyage: Live Long Enough to Live Forever.) Who should we believe?

I don’t get my medical information from popular sources. I rely on primary sources and on secondary sources that I have come to trust to accurately represent the current state of the peer-reviewed medical literature, for instance, the American Academy of Family Physicians and The Medical Letter.

The official position of the American Academy of Family Physicians is not to recommend vitamins or other supplements for the general population. They say

The decision to provide special dietary intervention or nutrient supplementation must be on an individual basis using the family physician’s best judgment based on evidence of benefit as well as lack of harmful effects. Megadoses of certain vitamins and minerals have been proven to be harmful.

The Medical Letter is an independent unbiased source written by a group of experts who review all the literature and provide periodic updates. Their most recent review of vitamin supplements (Vol 47 No 1213, p.57-8, July 18, 2005) concluded,

Supplements are necessary to assure adequate intake of folic acid in young women and possibly of vitamins D and B12 in the elderly. There is no convincing evidence that taking supplements of vitamin C prevents any disease except scurvy. Women should not take vitamin A supplements during pregnancy or after menopause. No one should take high dose beta carotene supplements. A balanced diet rich in fruits and vegetables may be safer than taking vitamin supplements. No biologically active substance taken for a long term can be assumed to be free of risk.

That’s it. That’s all science has to say about vitamins for the general population. Of course there are specific indications for individual patients with various health conditions. Patients who have had gastric bypass need large doses of vitamins. Niacin can be used therapeutically for patients with hyperlipidemia. There are lots of specific indications that your doctor knows about and can prescribe for. And if you have one of those indications, you may need a higher dose than you would get from a multivitamin.

Enthusiasts misrepresent the science. For instance, they are selling products to “prevent” age-related macular degeneration. A combination of high-dose beta-carotene, vitamin C, vitamin E, and zinc delays progression in patients who already have the disease, but there’s no evidence that it can prevent it from developing in the first place.   

Beta-carotene is touted as an antioxidant, but it also has pro-oxidant effects in the body. There is good evidence that high-dose beta-carotene supplements can be harmful.

According to the NIH,

Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect. In people who smoke, beta-carotene may increase cardiovascular mortality. In men who smoke and have had a prior myocardial infarction (MI or heart attack), the risk of fatal coronary heart disease increases by as much as 43% with low doses of beta-carotene. There is some evidence that beta-carotene in combination with selenium, vitamin C, and vitamin E might lower high-density lipoprotein 2 (HDL2) cholesterol levels. HDL levels are protective so this is considered to be a negative effect. Dizziness, reversible yellowing of palms, hands, or soles of feet and to a lesser extent the face (called carotenoderma) can occur with high doses of beta-carotene. Loose stools, diarrhea, unusual bleeding or bruising, and joint pain have been reported.

In addition to vitamins, we hear recommendations for all kinds of other diet supplements. There’s no good evidence for most of them. For fish oil, one of the most popular supplements, the evidence boils down to this:

(1) In patients who have had a heart attack, fish oil improves survival.
(2) It reduces triglycerides.
(3) In patients with high cholesterol levels it reduces the risk of coronary events but does not decrease mortality.
(4) It reduces blood pressure slightly.

Studies show fish oil may increase the risk of death and arrhythmias in patients with certain heart conditions, and high doses can worsen control of diabetes and can increase bleeding tendency.

The Medical Letter says,

Eating fatty fish may be beneficial for healthy people, but there is no evidence from prospective trials that fish oil supplements prevent cardiovascular disease in the general population.

I vote for leaving the fish oil in the fish.

Lots of people believe that vitamin supplements make a difference in our health and give us energy. Lots of people think taking vitamins will make you live longer. Different people believe many things; the real question is whether there is any evidence to support their beliefs.

You can find all sorts of studies and speculations suggesting that various supplements are good for you, but when you stick to rigorous science, the evidence just isn’t there. There are two philosophies: to take everything that is suggested just in case, or to wait for scientific validation before taking anything. Based on long experience, I consider the latter course more reasonable. I can’t begin to tell you how many times I’ve heard strong recommendations for something that was later shown to be useless or harmful.

One example: Vitamin E was strongly recommended to prevent heart disease and for other indications. Then they discovered that the high doses they were recommending were toxic. They lowered the dose. Then better studies showed that supplementation with vitamin E either did no good or made things worse.

More and more studies are showing that while vitamins in food are good for you, extra vitamins in pill form may not be so good. For instance, antioxidants were thought to reduce the risk of cataracts, but a 2006 study showed no effects. Then a 2008 study tested whether taking a Centrum multivitamin daily could slow the development of cataracts. They did find a reduction in “lens events” but there was no significant difference in the rate of cataract surgery or moderate visual loss, and the number of posterior subcapsular cataracts (the worst kind) doubled.

Most multivitamins contain iron, but there is evidence that lowering iron levels might be advisable. Lower body iron stores may protect against malignancy by reducing iron-induced oxidative stress.

There are some promising studies on vitamin D, but they haven’t yet translated into consensus recommendations for the general population. I’m withholding judgment; meanwhile there doesn’t seem to be any downside to taking 800-1000 IU of vitamin D a day if you want to.

There are many other things we can do to “improve our health” that don’t involve taking pills, vitamins or any other supplements. Eating a healthy diet, exercising, getting enough sleep, reducing stress, and maintaining ideal weight top my list.

Critics of medicine often pick on Big Pharma for its profit motives. How much money do you think Big Vitamin makes? How much money is being spent on unnecessary vitamins that provide no real benefit? Any excess is promptly eliminated. Are we just producing expensive urine? Are our toilets getting the benefit? Are all those vitamins in our sewage good for the environment?

One could argue that multivitamins are good for healthy sewage bacteria and healthy profits for manufacturers. But I’d rather support my own health than theirs.

Posted in: Herbs & Supplements, Nutrition

Leave a Comment (231) ↓

231 thoughts on “Should I Take a Multivitamin?

  1. MedStudT says:

    Last week I underwent PRK (corrective eye surgery), and my surgeon told me to take 1000mg vitamin C daily for 3 months to aid in healing. Seems like overkill to me… I’m trying to get most of it by eating fruit instead of in pill form. Strikes me that between bioavailability and possible interactions with compounds we haven’t yet isolated, getting micronutrients the “natural” way trumps taking pills.

    Not a primary source, but check out this report on how the usefulness of antioxidant molecules may be contingent on the method of consumption: http://www.economist.com/science/displaystory.cfm?story_id=11662560

  2. Adrian says:

    I had read about multivitamins a few years ago and it really illustrated the value of scepticism. Even without the obvious quack cues there are plenty of inflated claims out there.

    What do you think about other supplements? I have a friend that is ga ga over Resveratrol (http://en.wikipedia.org/wiki/Resveratrol). I’ve tried looking around for info and it does seem to be positive but I’m reluctant to take this at face value since I’ve seen how positive or hype stories make the press and more sceptical ones don’t. Do you know anything about this in particular or maybe just have some advice in general for evaluating supplements?

    Resveratrol has some shades of Pascal’s Wager – if it works you stay healthy longer and live a good life and if it doesn’t work, you aren’t harmed. “If a longer/healthier life is worth the cost, why shouldn’t you do?” seems to be the common argument.

  3. Michelle B says:

    Big Vitamin. So true. Great post.

  4. Calli Arcale says:

    Amen. It’s good that people are suspicious of Big Pharma — but the very same people are all too often completely oblivious to the *existence* of Big Vitamin. Not that there’s always a difference between the two. The big multinational conglomerates aren’t stupid; they’ll horn in on anything that promises high profit margins for minimal risk, and vitamin manufacturing is exactly that. Just look at all of the big food companies getting in on the gig! It’s pure gold. For a trivial increase in cost, they can double or even triple the sale price of many of their products.

    And all this for no benefit at all to the consumer. It’s just marketing.

  5. DavidCT says:

    If there is money to be made, Big Vitamin and also Big Herb will soon be owned by Big Pharma. At least when this happens there is a good chance that what is on the label is in the bottle.

    Science can be hard on one’s beliefs. My thyroid pills are beginning to get lonely now that one by one the unnecessary vitamins are no longer going into my pill carrier.

    Thanks for the post!

  6. Harriet Hall says:

    Adrian,

    I’m skeptical about resveratrol. It hasn’t been tested in humans, just in animals – mainly mice. Its big claim to fame is that obese mice can avoid the adverse health effects of overeating by comsuming an amount of resveratrol comparable to 1500 bottles of wine a day for a human.

    And Pascal’s wager doesn’t apply. We don’t know whether taking high doses has any adverse health effects.

    The Natural Medicines Comprehensive Database doesn’t give it a “SAFE” rating but rates it as “LIKELY SAFE …when consumed in amounts found in foods. There is insufficient reliable information available about the safety of resveratrol when used in supplemental doses in amounts greater than those found in foods.”

    It has antiplatelet effects and preliminary evidence shows that it might inhibit the cytochrome P450 enzymes, CYP3A, CYP1A, and CYP2E1. So there are potential interactions with other drugs and herbs. There is concern that it might have estrogenic effects, with potential danger in hormone-senstive conditions.

    There’s also the problem that the commercially available products are sold under DSHEA rules and have not been adequately tested for purity and may not contain the amount stated on the label.

    I’d say it’s a gamble, and in gambles like this the odds are against winning.

  7. daedalus2u says:

    Very nice article.

    Regarding a Pascal’s wager type of situation, the actually is the possibility of harm from even modest supplements. All of the large, double blind, placebo controlled, long term trials of supplements have found no benefits and perhaps slight negative effects of supplemental anti-oxidants. Short term trials have found positive effects sometimes, but usually those are much smaller trials and looking at surrogate endpoints.

    The motivation for these trials has been the very robust and very reproducible correlation between a diet rich in green leafy vegetables and good health. My interpretation of this data is that “oxidative stress” is not set at all by diet, but is instead controlled by physiology; that your body has an “oxidative stress setpoint”, and then controls physiology to achieve that setpoint. If you consume excess antioxidants, then physiology must destroy the excess by generating even more superoxide. That excess generation of superoxide is responsible for the slight adverse effects observed in the large supplement trials.

    With this interpretation, the explanation for the very robust correlations observed in diet and health is due to diet choice being due to the state of oxidative stress. If physiology calls for a high oxidative stress setpoint, a diet devoid of anti-oxidants is “healthier” than a diet rich in them because then physiology doesn’t need to destroy them. All the diet effects have been observed in self-selected diets. Diet choice is under physiological control, people choose diets which contain approximately the proper ratio of fat, carbohydrate and protein, approximately the appropriate number of calories and the proper amount of water and electrolytes. Presumably there are physiological mechanisms that adjust appetite until the diet that physiology calls for is consumed.

    Non-self-selected diets are extremely difficult for people to adhere to. I think that diet choice is mostly an effect of a state of health, not a cause of it.

    With this interpretation, supplements beyond levels needed to prevent deficiency diseases are unlikely to be beneficial, and may be harmful. If this interpretation is correct, excess antioxidants from any source, including green leafy vegetables may cause the same adverse effects of supplements.

    I agree with what Harriet said about resveratrol. Many phytochemicals are metabolized by the cytochrome P450 system (the Phase I system) where they generate superoxide and that activates the Phase II system to detoxify the superoxide and reactive species produced by the Phase I system. Short term positive effects may not translate into long term positive effects because physiology may compensate for the deviation from the “setpoint” caused by the intervention.

  8. llysenwi says:

    Does anyone know anything about the need or lack thereof for vitamin supplementation in high performance athletes. Although the overall nutritional requirements are more extreme than average (e.g., caloric intake), do they also have greater need for vitamin intake? Does the increased caloric intake usually accommodate any increased need for vitamins?

  9. Wicked Lad says:

    DavidCT writes:

    If there is money to be made, Big Vitamin and also Big Herb will soon be owned by Big Pharma. At least when this happens there is a good chance that what is on the label is in the bottle.

    Good point! That would be useful. Partly due to a discussion on a credible blog, I’ve started taking CoQ10 regularly, and I do wonder about the quality control. (And the dose. But that’s a different discussion.)

  10. overshoot says:

    All the diet effects have been observed in self-selected diets.

    Well, sort of. Population studies carry largish cultural and availability components.

    Otherwise, self-selection runs into the obvious confounders present when diet choices are part of an overall lifestyle that can include greater amounts of exercise etc. Of course if that exercise has a good bit of sunshine included the vitamin D that results …

  11. Big Vitamin is already owned by Big Pharma. In the largest drug related settlement in history Roche Pharmaceuticals payed a half billion in fines after being convicted of a price fixing scheme involving vitamins with other manufacturers. They met yearly at a fancy resort and fixed prices, like OPEC. One of the Swiss execs had to do jail time in Texas. Serves them right.

    Kudos no evidence of benefit of any vitamin or supplement, only possible harm. As for Vitamin D you can get your fix by taking a walk in the sun without being slathered in sunscreen. That is probably why the only study to show benefit of Vitamin D and calcium was in French nursing home residents who probably didn’t get out much.

    Another scam is how we have to eat processed ‘fortified’ foods to get the vitamins we need.

  12. daedalus2u says:

    If supplemental dietary antioxidants don’t change the state of oxidative health, then oxidative health is not regulated at all by dietary antioxidants. I think people just have a hard time believing that, so they make non-physiologic stuff about “natural” vitamins being good and synthetic ones being bad. They are the same molecules. Synthetic vitamins are the same as natural vitamins.

    I don’t think there have been any studies to look at actual needs for vitamins in high performance athletes to try and distinguish those needs from sedentary adults. Such studies would be difficult to do.

    A reasonable expectation would be that the vitamin need would be proportional to caloric intake, which is actually a fairly modest increase.

    One of the most extreme aerobic sports is the Tour de France. Those athletes only need to consume ~6000 calories per day to stay in balance.

    http://www.sportsscientists.com/2008/07/le-tour-de-france-2008-feed-them-well.html

    For someone with a basal metabolism of ~2000 calories, that is only a factor of ~3 higher. What ever increased food is required will also supply increased vitamins along with that food. I can’t think of any mechanism that would increase vitamin requirements more than proportional to energy consumption. It probably isn’t even be that high.

  13. Fifi says:

    james – Actually people at northern latitudes tend to be deficient in vitamin D during the winter because of location. It’s why cod liver oil are traditionally used (and was given to children to prevent rickets). You can also get vitamin D from various cold water fish and liver. Cod liver oil tends to be high in vitamin A as well though, and tastes very unpleasant, so there are many reasons why pill form is a better choice for some people. There’s been research into the impact of vitamin D on prostate cancer in Canadians, which indicates that taking vitamin D or a vacation in the sun during the dark winter months is preventative (from my understanding, which may be incorrect, it’s due to the increased bioavailability of calcium since calcium and vitamin D work in synergy).

    During the summer or if you live nearer the equator, getting some sun before putting on sunscreen makes more sense.

  14. qetzal says:

    Derek Lowe has some very nice posts about resveratrol and other compounds that may (or may not) extend lifespan. See here: http://pipeline.corante.com/archives/aging_and_lifespan/.

    Very interesting stuff, but I agree with Dr. Hall. There’s not nearly enough information to judge whether resveratrol (or any other supposed anti-aging compound) is likely to be either safe or effective in humans.

  15. Danio says:

    James,
    Here in Oregon it’s the standard of pediatric care to prescribe vitamin D supplements to all infants, particularly if they’re being breast-fed. Moreover, higher incidences of vitamin D deficiency/insufficiency among immigrant groups from equatorial countries are well-documented in northern latitudes. (one example: http://www.ncbi.nlm.nih.gov:80/pubmed/17388737?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). There’s nothing about this that says ‘scam’–it’s a valid health concern that is easily addressed by supplementing the diet. I think the same might be said of the other ‘fortified’ foods you mention–research has showed that the population benefits from having these important nutrients added (back, in some cases) to processed food. I’m not saying corruption doesn’t exist in ‘Big Pharma’ or the business of dietary supplements, just that the specific examples you cite are more about societal health benefits than about ‘sticking it to the little guys’.

  16. lee says:

    my ophthalmologist was insistent about taking AREDS formula multivitamins (which involve some pretty high dosages). I’m very curious to hear your views on this. Is the medical evidence convincing?

  17. delaneypa says:

    This posts points out the logic some people use to take vitamins and supplements: “if it helps sick people, then it should also benefit healthy people, like me.” That’s the reason people take ginkgo to improve memory, when studies really only show a small benefit for those with memory difficulties.

    One argument to disabuse people of this misuse of logic is to ask them why they don’t take insulin since it helps diabetics. This usually works pretty well. I don’t recall where I got this analogy (where’s the ginkgo?) but wouldn’t be surprised it if were from one of Harriett’s writing from long ago.

  18. Harriet Hall says:

    “wouldn’t be surprised it if were from one of Harriett’s writing from long ago.”

    Guilty as charged, and not so long ago. From my SkepDoc column on Ultrasound Screening, Fish Oil and Ear Candles: “People see that fish oil improves survival after a heart attack so they assume it should also help prevent heart disease in people who don’t yet have it. That doesn’t necessarily follow: insulin improves survival of diabetics, but that doesn’t mean healthy people should take insulin to prevent diabetes.”
    http://www.skeptic.com/eskeptic/08-02-20.html#feature

  19. nwtk2007 says:

    A lot of the biochemistry of vitamins is well known and well documented so I hope the ‘posters” here aren’t going to start asking for studies to back up what has been in biochem texts for decades.

    The question is whether or not our diets bring us enough of these vital supplements and how much is enough and how much is optimum.

    For those of us who see patients regularly, we can probably say with all honesty, the state of nutritional health and exercise health in the US is staggeringly poor. I have patients who have been raised on chips and soda and don’t even know what is happening when they feel soreness after exertion. Some have literally never experienced it. Literally.

    Most diets are inadequate and I think supplements would be very beneficial to those. In fact, the number of people who have a perfect diet is probably few to none, so why not supplement.

    I would challenge anyone who has a poor diet, or even a good one, who is also in their thirities or forties, who are relatively active and experience aches and pains associated with activity to increase their vit C supplementation and see if a good deal of those aches and pains don’t deminish.

    I could relate my experience but the skeptics would just call it anecdotal so I’ll spare you. But I can tell you that my debilitating low back pain was greatly deminished as a result of regular supplementation with vit C, basically throughout the day, 250mg at breakfast, same at lunch, mid-afternoon, dinner and bed time. The original reason I started taking it has remained but after a few weeks I noticed that my back was not a concern, I could stand on my feet the morning after a long run and lost every ache I ever had in my knees, ankles and hands which would occur after exertion.

    Sure we all know people who lived to a hundred without one single supplement. But supplements are not necessarily about living longer, they are about improving quality of life.

    The biochemistry of C is pretty basic and once I pulled my head out of my behind, I realized what had occurred. It is very simple in some examples of supplementation and not so obvious in others.

  20. Harriet Hall says:

    nwtk2007 said,

    “the number of people who have a perfect diet is probably few to none, so why not supplement.”

    We don’t know what a perfect diet is, but it’s probably true that a whole lot of people have a poor diet. Why not improve their diet instead of popping pills?

    It intrigues me that some of the same people who discourage prescribing pills for medical reasons encourage prescribing pills to make up for poor eating habits.

  21. Harriet Hall says:

    nwtk2007 said,

    “I can tell you that my debilitating low back pain was greatly deminished as a result of regular supplementation with vit C.”

    No you can’t. You can only tell us that your symptoms diminished when you took it. You can’t know whether they diminished “as a result.” Correlation doesn’t prove causation.

    I thought from your posts on another thread that you were a chiropractor, or at least believed in chiropractic. I’m wondering why you chose vitamin C instead of fixing your subluxations.

  22. nwtk2007 says:

    Harriett, Harriet, Harriett,

    You are just looking for an argument aren’t you?

    Well I don’t have one.

    As to improving the diet, if I thought is might actually be possible to get optimum levels in todays foods with out the cost of an arm or a leg, then I would be there with you. And for some healthy individuals, it cold very easily be all that is needed.

    But lets face it, there is little health in the US today and there is too little education from anywhere that can overcome the ignorance that exists about diet and nutrition.

    Basically, to get optimum levels of any of the supplements, and not just the RDA levels, a person would have to eat a great deal to say the least. Foods are just too “messed” with, to put it bluntly. Most are old, too processed, too treated with all kinds of gook, too handled, etc to even carry the optimum levels of nutrients like vitamins. It just can’t be done.

    Besides vitamins are easier to get and cheaper to boot.

    Also, it wasn’t just my back pain. I was developing a great deal of generalized pain over the years which became pronounced after activities which I had been doing all of my life. Those aches are also gone. The gradual increase in pain associated with activity occurred over ten to fifteen years and within three weeks of C supplementation had dropped to levels which I experience today.

    And believe me, my activity levels are just as high as they ever were. Yes, at 51 I feel like I have been hit by a truck after two and a half hours of hard racquetball, but recovery is quick to say the least. Since I was 15 I have run 15 to 20 miles per week. The aches associated with the running disappeared as well, and those almost completely.

    “Correlation doesn’t prove causation.” It kind of does if backed by research. The effects and biochemistry of vit C are very well understood and documented, almost to the point of being common knowledge. Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?

    On this point, you must be high.

    Also, I AM a chiro, but I, like the vast majority of the ones I know, do not treat subluxations. Now, I am wondering why you chose to end your last post with such a “smart ass” comment.

  23. Harriet Hall says:

    nwtk2007 said,

    “Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?”

    Yep. Read my post on antibiotics for sinusitis. http://www.sciencebasedmedicine.org/?p=12

    I apologize for assuming you were a subluxation chiropractor: the majority are.

    I think we CAN get optimum nutrition from food, and so do most scientists and dietitians.

    Vitamins are cheaper and easier than food, but there is evidence that taking vitamins in pill form can be hazardous to your health. Didn’t you read what I wrote about that? That was sort of the whole point of my article.

  24. Calli Arcale says:

    jamesdouglasbremner:
    “Another scam is how we have to eat processed ‘fortified’ foods to get the vitamins we need.”

    Actually, the introduction of fortified flours a few decades ago was responsible for one of the great health advances of the 20th Century — a dramatic reduction in neural tube defects such as spina bifida in newborn babies. It’s not difficult for most people to get adequate nutrition through diet alone, with one major exception: pregnant women. Insufficient folate causes neural tube defects, the problem that the March of Dimes was originally founded to tackle. Serious defects are very rare nowdays.

    But the price of this is that we’re spending money to fortify even the foods of people who aren’t pregnant women. Given the dramatic improvement in birth defects without any negative side effects from the somewhat increased level of folic acid, I think it’s worth it.

    That said, there are a lot of fortifications that aren’t worth squat. Some of the worst offenders are beverage manufacturers, who are pushing ever closer and closer to making actual medical claims for their products (and in some cases, actually *are* making medical claims while thumbing their noses at the FDA — cf. Florida orange juice).

  25. nwtk2007 says:

    nwtk2007 ” “Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?”

    Harriett – “Yep. Read my post on antibiotics for sinusitis.”

    I read it. It seems that you are saying that is possible for a sinus infection to clear up without any antibiotic treatment. I would agree. I defeat these things in my head from time to time without an intervention other than antihistimines, which keep my sinuses dry, and stop the bugs from growing. I can honestly say that I have never defeated a sinus infection without at least the drying effect of an antihistamine.

    Back when I worked in a hospital as a med tech I was beset with these things that would go on for months at a time, break free through sheer agony of sinus headaches and finally sinuses which would eventually open up, once right onto a patient from whom I was taking blood, and then return.

    One of the doctors there gave me erythromycin and the sinus infection was 90% gone by the next day. I was amazed and have had to periodically take something when I unable to defeat the bug by other means.

    In your article, you emphasize the possibility of recovery without antibiotic intervention, you don’t actually say antibiotics don’t work. So I can say that they do (assuming it truly is a sinus infection) just as surely as I can say that Vit C has done for me what I have said it does.

    What medical science is saying, is that we shouldn’t be instantly going to the antibiotic. But there are risks. What was the death rate of sinus related encephalitis prior to antibiotics?

    Antibiotics are a tough subject. How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use? How many people would not be alive were it not for antibiotics? I think medicine is dug in too deep to turn that clock back, or perhaps not.

    I also understand what you are saying about the dangers of some supplements. Your mention of the link of beta carotene and smoking and ling cancer is one I am familiar with as are some of the others.

    It is definitely a big unknown so I will just stick to C for now.

    Are there any studies showing that consumption of up to 1250mg of C daily, spread out over the day (water soluble you know) has any harmful effects? How many fruits and vegies would one have to eat each day to achieve that level? And how could you know you are actually getting that level? If you could each that much, you would most definitely be getting a great deal of fiber, but what about calories?

  26. pmoran says:

    “Basically, to get optimum levels of any of the supplements, and not just the RDA levels, a person would have to eat a great deal to say the least. Foods are just too “messed” with, to put it bluntly. Most are old, too processed, too treated with all kinds of gook, too handled, etc to even carry the optimum levels of nutrients like vitamins. It just can’t be done.”

    You are definitely getting the wrong messages from somewhere. Look up the numerous studies, both interventional and observational, looking at health outcomes with vitamin intakes from various sources. Contrary to what you say there is a strong association of certain health benefits with a high consumption of (even today’s) fruit and vegetables, but there is no consistent association with supplement usage.

    Clearly there is more to a good diet than a certain mixture of vitamins and antioxidants. “Alternative” medicine has been guilty of medical negligence in its promotion of supplement usage at the expense of healthy living in other respects, even sometimes promoting supplements to mitigate the ill effects of a poor diet, alcohol and smoking .

  27. wertys says:

    nwtk2007, when you said
    “Antibiotics are a tough subject. How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use? How many people would not be alive were it not for antibiotics? I think medicine is dug in too deep to turn that clock back, or perhaps not.”

    I only agree with the first sentence. You had better clarify what you mean and back it up with some references, as it appears you are labouring under the whole ‘antibiotics weaken the immune system’ delusion, and combining this with some type of misrepresentation of epidemiology. I cannot make sense of it as it stands. Are you saying that the human species has lost its ability to handle bacterial infections since antibiotics were introduced 60-odd years ago ??

  28. Okearnyshire says:

    What about recommendations for HIV-positive folks? There’s plenty of recommendations swirling the web that we need much higher levels of micronutrients than the normal population. I fell for a lot of it initially, then I noticed that the few studies all involved people not taking HAART. I’m on a HAART regimen (Truvada, Reyataz, Norvir) that’s working very well for me — no side effects, I feel fantastic; my CD4+ is >500 and my VL is undetectable. So I cut out almost everything except the multivitamin, a Ca+D+K supplement (to counteract bone loss), and a fish oil (to keep triglycerides in check). I eat a well-balanced diet, with one or two servings of plants at each meal. Knowing that my body is still under much greater stress than a healthy person, should I stick with my supplementation, or toss it out? What does some of your research indicate for folks with HIV or other chronic diseases? Thanks for your article here, please continue writing.

  29. Harriet Hall says:

    lee said,

    “my ophthalmologist was insistent about taking AREDS formula multivitamins (which involve some pretty high dosages). I’m very curious to hear your views on this. Is the medical evidence convincing?”

    I mentioned the negative and contradictory evidence for cataracts in my article, with links to 2 studies. The evidence for age-related macular degeneration shows that it slows progression of established AMD, but there is no evidence that it prevents AMD, and the high dose of beta carotene is worrisome.

    The ophthalmologists I know do not recommend AREDS or similar formulas unless the patient has a moderate degree of AMD.

  30. Harriet Hall says:

    nwtk2007,

    You missed the subtleties of what I said. The research I cited was only for bacterial sinusitis diagnosed by the clinical criteria used by many primary care physicians. It doesn’t apply to more stringent diagnostic criteria used by ENT specialists. Some cases of sinusitis do require antibiotics.

    Your story about erythromycin doesn’t ring true. When antibiotics work, they usually take longer than that.

    “just as surely as I can say that Vit C has done for me what I have said it does”

    Didn’t you understand my point about correlation and causation? You can’t be sure you’re not committing the post hoc ergo propter hoc fallacy.

    “antihistimines, which keep my sinuses dry, and stop the bugs from growing”

    I was taught that antihistamines are contraindicated in sinusitis, because they dry and thicken the secretions and impede drainage. Antihistamiines are certainly not effective in treating sinusitis, and they certainly do notohing to stop the bugs from growing.

    “the immunological weakness passed on to the population as a whole ”

    What on earth are you talking about? Is this some myth you’ve fallen for, or a garbled account of bacterial resistance?

    As for vitamin C, there is no reason to think you can’t get plenty in a normal diet, and there is no evidence that taking higher doses has any beneficial effect. If you think taking that dose makes you feel better, taking up to 2000mg a day is probably safe.

    May I suggest an N=1 trial? If you can get identical-appearing pills and set up a double-blind so you don’t know which you’re getting and the person who gives them to you doesn’t know which you’re getting, you might find you can’t distinguish the effect of your vitamin C pills from the effect of a placebo.

  31. Harriet Hall says:

    Calli Arcale said,

    “we’re spending money to fortify even the foods of people who aren’t pregnant women”

    Fortifying foods affects the whole population, not just those who stand to benefit. Extra iron may be good for women who are menstruating, but bad for people with iron storage diseases, and may do more harm than good for men. People who eat fortified food and also take vitamins may get an overdose. Adding anything to our food should be very carefully thought out and the risk/benefit ratio studied.

    We still recommend folate supplementation for pregnant women and women who may become pregnant, because we can’t depend on them getting enough from fortified foods.

    Ideally, I’d rather see nothing added to food, and patients monitored for adequate nutrition and given individualized supplements when needed.

  32. DLC says:

    Dr Hall: good article. I can remember being handed vitamins as a child and being told to take them because they were good for me.
    Now I wonder how much money my mother wasted on such things.

    Re Sinusitis: My own experience is that sometimes it just clears up, and sometimes it doesn’t without aid. (yes, I know.. Anecdotes…)
    But then, we haven’t really found a cure for the common cold either, just palliative treatment.

    PS:
    Where’s Antivax with his Whale.to cites proving you’re wrong?

    (grin)

  33. DavidCT says:

    Wicked Lad wrote:

    I’ve started taking CoQ10 regularly, and I do wonder about the quality control. (And the dose. But that’s a different discussion.)

    I would suggest looking at http://www.consumerlab.com. They do independent testing of vitamins and supplements. They might have tested the brand you use.

  34. Calli Arcale says:

    Fortifying foods affects the whole population, not just those who stand to benefit.

    Exactly my point, of course. I think that in the case of folic acid, it’s worth it to fight spina bifida. For the other things that are added, like iron, perhaps it was meaningful when the fortification programs began decades ago (when meat was more of a luxury), but not any more. Meat is cheap enough now that iron supplementation for everybody don’t make a whole lot of sense, at least in my opinion*. Vegans can take iron and B12 supplements; the rest of us should be fine.

    *I’m a software engineer, not a dietitian, so adjust the value of my opinion accordingly. ;-)

  35. vinny says:

    What has a long standing criticism of vitamin and supplement research is that the administration of numerous vitamins has been limited to one body route. A large study is necessary to test the efficacy of natural supplements as they are administered in the form of anal suppositories. A similar method has been proposed to test homeopathic remedies; the standard regiment of 6 – 10 times per day, using both sprays and the little white spheres.

  36. vinny says:

    ai, again I submit too fast: What has been a long standing criticism,…

  37. Fifi says:

    nwtk trots out one of the most retarded sales pitches of Big Vita (in which I include all supplement manufacturers, including pig farmers turned supplement manufacturers) – that food just isn’t good enough. Good food is more than adequate (I’m not talking the preprocessed food products and fast food that some Americans mistake for food, but fresh whole foods). What makes this pitch so obviously ludicrous is that the people who promote it simultaneously promote the idea that “natural is better” and “synthetic is evil” while promoting vitamins – pills instead of food!

    Vitamin C is the granddaddy of the mega supplement industry. Even though there’s more than enough evidence to show that megadoses of vitamin C don’t prevent cancer, the common cold or much of anything apart from scurvy (worth avoiding though if you’re planning to spend months at sea with no access to fruit since it leads to loosing teeth!). Not to mention that Linus Pauling, who first promoted this idea, died of cancer! Sure he was old at the time but cancer is cancer and clearly the vitamin C didn’t prevent it for him (despite all the excuses people make up who want to believe or sell supplements). Pauling is notorious for having gone on a witch hunt, and of destroying the research evidence, of scientists associated with him who did research that revealed his theories weren’t valid (even though this evidence emerged as a result of trying to prove validity).

  38. Fifi says:

    Besides, magnesium is actually more effective for muscle cramps (if one is deficient in magnesium, that is). It’s pretty telling that the person promoting supplements – nwtk – isn’t even aware of this and promotes vitamin C as a panacea instead. (I’d think it’s more of a placebo, people seem to respond better to placebos if their pee changes colour so vitamin C is tailor made for the job!)

  39. durvit says:

    if I thought is might actually be possible to get optimum levels in todays foods with out the cost of an arm or a leg, then I would be there with you. And for some healthy individuals, it cold very easily be all that is needed…

    Besides vitamins are easier to get and cheaper to boot.

    That might be true in some parts of the world but not in the UK and it seems to vary tremendously with the brand. One recent calculation estimated that the basic set of recommendations costed out at £5.80 per person per day or around $11.50. You could buy some very decent additions to the diet with that sort of money, never mind the cost of adding in the raft of other supplements that some enthusiasts advocate.

    However, I accept that there are cheaper brands. It just seems that people who spend serious sums on supplements might be better off buying a better diet, in the absence of clinical need for supplementation and the raft of tests that many ‘nutritional therapists’ seem to recommend.

  40. Fifi says:

    nwtk wrote “But lets face it, there is little health in the US today and there is too little education from anywhere that can overcome the ignorance that exists about diet and nutrition.”

    Actually, no, the problem is people like yourself trying to spread misinformation for profit! Doctors have been advising people get up off the couch and exercise, and eat a moderate and healthy diet (lots of leafy greens, whole grains, etc) since I was a kid (and I’m in my 40s now). As for being “more expensive”, real food has always cost more than “food products” (but real food is certainly MUCH cheaper than vitamins and supplements, especially the brands sold by chiropractors and naturopaths which are attributed magical properties). Where I live in Canada enrolling with a farm that is part of the local CSA (community supported agriculture) and getting a weekly box of organic fruit and veg from June through early November is actually cheaper in the long run than buying non-organic from the big supermarkets. But best of all, I get fresh picked, plant ripened fruit and veg that is much more tasty and interesting than anything that can be bought in a supermarket. And I get to know who grows my food and improve my local environment. But, really, the best thing about it is the vine-ripened, heirloom tomatoes that have as much flavor as the ones I ate as a kid!

  41. Fifi says:

    And let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels and any vitamin. Just because something’s water soluble doesn’t mean that it flows right through one like water (though even too much water can cause death, more is NOT better than enough or even not enough sometimes!)

  42. Yes Linus Pauling truly was a nutcase and the fact that he put medical faith ahead of empirical truth means that we should stop taking him seriously as a scientist, whatever his “real” scientific contribution was.

    Folate: less than 1% of the female population has a genetic defect that makes them susceptible to having babies with spina bifida. This can be prevented with folate supplementation, but only if they are taking at the time of conception, not after. Yes we had vitamin deficiencies 100 years ago (e.g. pelagra here in the South, when the diet for most consisted of fatback, corn bread and molasses). The invention of the refrigerated train car meant that we can now eat fruits and vegetables all year round. We don’t need to take pills, unlike what Ray what’s his name quoted by the author says, that modern agriculture depletes vitamins from natural foods so you need to take pills. As for RDA you may not know it but this is set by USDA and is based on requirements for a young active male, and then doubled for good measure (see ‘The Vitamin Book’). If anyone actually followed this garbage they would become obese. Which is what Big Food wants– for you to keep eating their breakfast cereals, and other packaged/frozen/processed crap.

    Vitamin C: most of it gets peed out so not toxic, unlike fat soluble vitamins (A,D,E,K) which can store up in the body and become toxic.

    Studies of vitamins and alternative treatments in general: Only positive study yet from NCAM is chinese herbal medicine for IBS (need replication for that one!). Otherwise negative for black cohash, palmetto, ginkgo, etc etc. Whenever a trial is negative we change the criteria (i.e. they used the wrong dose, etc etc). Don’t we have anything better to spend our money on?

    Physicians: don’t want to be seen as “against” alternative treatments. I read the reviews on alternative medicine by the American Family Practitioners journal and then went and read the primary sources and all of the “positive” evidence cited was highly flawed or not actually positive (e.g. statistically negative but authors made conclusions anyway).

  43. Fifi says:

    eh, correction for clarity – let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels OF any vitamin.

  44. nwtk2007 says:

    Man FiFi, you must know everything.

    I have one comment about vit C and all of the sudden I am thrown into the Big Vita group. What a conclusion jumper.

    And you say, “let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels OF any vitamin.”

    Do you even know what is going on in the kidney. Processing? “Unnaturally high” levels. If I were touting natural versus synthetic you would probably jump onto that band wagon critisizing those in favor of “natural” as opposed to synthetic.

    And then FiFi says “Actually, no, the problem is people like yourself trying to spread misinformation for profit! ”

    What do you mean people like me? I don’t sell vitamins and I don’t promote the use of all supplements. Vitamin C yes, but not necessarily any others. The fact is you don’t know yet.

    Don’t be so quick to attack and accuse and condemn FiFi. A great deal of what you say and the way you say it shows the level of your expertise and involvement.

    Also, if you think poor health is not a problem, then you are truly blind. You don’t think there is a lack of education about nutrition in the US? Then how is the general public so ignorant about the subject? They know practically nothing about it. Whose fault is that anyway?

    Most would not know a nutrient from a mineral just as they wouldn’t know a Motrin from an Advil from an ibuprofen, and it is because they are not being educated, but that is another story.

    And wertys, I am not saying that antibiotics weaken the immune system, although there is evidence to suggest it and a vast number of medical opinions agreeing with that assumption. But I am not saying that. People are born with varying degrees of immune “strength”, so to speak, with some having high levels of factors present and some with low levels. What I am saying is that with the advent of antibiotics and their extensive use, the population as a whole has a greater number of individuals with deficiant immune systems and they are passing these “weaknesses” to their offspring. It is just natural selection and genetics. More weak survive and pass on their weakness.

    And you shouldn’t be so critical of Linus Pauling, his original work in atomic structure still stands. He did go a little off the deep end with vit C, but when you see the diff with supplementation of C, then I can understand it, in a small way.

    Pretty pretentious to think anyone on this forum is the better of him.

  45. Joe says:

    nwtk wrote “Most would not know a nutrient from a mineral just as they wouldn’t know a Motrin from an Advil from an ibuprofen …”

    I have not finished your post; but I gotta be first to ask- what is the difference between Motrin, Advil and ibuprofen?

  46. Harriet Hall says:

    nwtk2007 said,

    “when you see the diff with supplementation of C, then I can understand it, in a small way.”

    Interesting. We offer him scientific information about vitamin C, suggest an N=1 trial, and explain that he hasn’t ruled out the possibility that he has fallen for the post hoc ergo hoc fallacy.
    In return, he offers another unsupported claim (testimonial) that supplementation makes a difference.

    He said, “How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use?”

    Then he said, “I am not saying that antibiotics weaken the immune system, although there is evidence to suggest it and a vast number of medical opinions agreeing with that assumption.”

    Now I think I understand what he means. Antibiotics have saved lives and interfered with natural selection, allowing some individuals with “weaker” immune systems to survive. I hope he’s not advocating we abolish modern medicine to allow only survival of the fittest.

    I don’t know of any evidence that antibiotics weaken the immune system and I have never heard that opinion from a reputable source. Where’s your evidence?

    FYI, Motrin and Advil are brand names for ibuprofen.

  47. daedalus2u says:

    Consuming vitamin C does increase oxalate formation. Calcium oxalate is the major cause of kidney stones. Consuming large quantities of vitamin C could exacerbate kidney stones.

    http://jn.nutrition.org/cgi/content/full/135/7/1673

  48. Joe says:

    When I wrote “what is the difference between” I think it should have been “what are the differences among;” although that, too, is lacking (from a certain point of view).

    nwtk, do you have any reliable sources for the speculation you offer to wertys? … I didn’t think so.

    nwtk wrote “And you shouldn’t be so critical of Linus Pauling, … He did go a little off the deep end with vit C, but when you see the diff with supplementation of C, then I can understand it, in a small way.

    Pretty pretentious to think anyone on this forum is the better of him.”

    Pauling went way off the deep end with his “orthomolecular” therapy. Pretty pretentious to think a chiropractor can evaluate that nonsense as, further, demonstrated by your confusion about your own use of vitamin C.

    As for anyone on this forum thinking we are better than Pauling- where did you read that? Can you say “straw man?” I knew you could.

  49. vinny says:

    nwtk, and you know what the best part about homeopathic vitamin C in the 200C strength? You can use it as an anal spray 15-20 times per day and expect an excellent outcome. Just check whale:to for more information about homeopathic anal vitamin sprays.

  50. Fifi says:

    Firstly, I certainly don’t know everything and make no claims to but I have bothered to educate myself about the things I speak about – clearly I know a bit more about which vitamins do what than you do.

    Secondly, as a regular on these blogs any opinions about you and what you say are based on the entirely of your posts not just this one. I’ve taken my time coming to the conclusion you’re here to defend chiropractice and associated non-evidence based beliefs. I did note that you say you don’t believe in subluxations, however you have been consistently hostile to EBM (not questioning, just hostile and lacking in an understanding of science) in your posts here so it does make it appear as if you’re here to try to demean science and promote woo. Your beliefs about vitamin C seem to confirm that, as does your refusal to see that your subjective experience isn’t a form of evidence.

    As for Linus Pauling. I don’t question his earlier work at all, only his work after he became so obsessed by proving vitamin C cures cancer that he started destroying evidence and going after researchers (that he himself had hired because they shared his beliefs) whose research showed that his ideas were wrong. This was a prime case of in-fighting between people who promote odd ideas of this kind.

  51. vinny says:

    I was reading a book titled “Homeopathy, scientific proofs of efficacy” by guna edditors. There are some very interesting studies they quote there. For example a homeopathic remedy was equal to non-homeopathic remedy in the treatment of common cold symptoms. Specifically, 6 weeks after the initial appearance of symptoms, there were no significant differences in the two treatment groups. They achieved equally impressive results during their treatment of other self-limiting conditions.

  52. Linus Pauling: the looniness of his later “work” and lack of ethics calls into question the validity of what he did earlier. He did a tremendous amount of harm and wasted a great deal of resources on negative trials based on his “name” which people took to say “good scientist, whatever he says must be true” (i.e. take it on faith). What a great representative of the scientific profession. Waying the benefit versus the damage might be interesting. I for one don’t have time to do that analysis.

    Antibiotics and inflammation: posters may not be as looney as some might think. Antibiotics decrease natural gut flora which affects leptin (neuropeptide that affects appetite) which may cause obesity (sorry saw this presented but not sure if it is published yet), there is some evidence for a link between obesity and impaired immunity.
    http://www.ncbi.nlm.nih.gov/pubmed/12119664

  53. nwtk2007 says:

    I have never seen such defensive people. One little contradiction or even an offer of additional info and man, you too like Pauling, are off the deep end.

    Instant assumptions and out of context interpretation of what I have posted. Is this typical? Read carefully please and try to get by your biases related to anything anti-chiropractic and evidence based anything.

    I love your educating us about the diff between Advil, Motrin and ibuprofen. Duh! The point is that most people don’t know they are the same. Get it?

    FiFi, you are a hoot. You say – “Firstly, I certainly don’t know everything and make no claims to but I have bothered to educate myself about the things I speak about – clearly I know a bit more about which vitamins do what than you do. ”

    Clearly? Really? I hate to provide a resume just to counter this remark. So I won’t.

    Daedalus – “Consuming vitamin C does increase oxalate formation. Calcium oxalate is the major cause of kidney stones. Consuming large quantities of vitamin C could exacerbate kidney stones.”

    Yes, as does a high protein diet, and anything with elevated levels of phosphate. Are you familiar with the physiology of calcium and phosphate in the blood. The blood level concentrations of calcium and phosphate are altered, partially by kidney function such that the product of the concentrations remains a constant value, within physiological ranges. Totally another topic.

    Harriett, yes you finally see my point. No I wouldn’t abolish medicine to prevent evolutionary changes or adverse genetic shift towards defecient immune systems, but it is a factor in medicine to always be considered.

    Finally, many here apparently say, as did FiFi above, “subjective experience isn’t a form of evidence. ”

    It is when coupled with good background knowledge and years of experience. The early humans came up with pharmacopia and “treatments” based upon just that, some of which still dominate today. Not many but some.

    Research is good, but in most fields, there is as much for a “thing’ as there is against a “thing”. The ones against have their reasons for believing the “for” part and the ones against have their reasons for believeing the “against” part.

    FiFi says I am hostile, but from just one post, I have been lightly assaulted and a bit insulted. But that is the fun of it.

    I do not promote woo, what ever that is, or magic or what ever. I try to look without bias and objectivity, but, of course, personal experience makes me a bit like that also. But only a bit.

    You say I demean science. Horse crap. I have been “in” science most of my life and ALL of my multi-faceted career. To argue against YOUR point, is not a strike against science, it is an argument against your point, to provide you with an opportunity to clarify your position, just as I am trying to clarify mine.

  54. Fifi says:

    nwtk – You make claims to have credentials as a scientist yet you claim to also be a chiropractor. Chiropractors often sell overpriced supplements as part of their “practice”. Is your “science” this “alternative science” that I keep hearing about from people who consider personal experience to be reliable evidence, don’t seem to understand their own subjective biases which influence the explanations they give themselves about their experiences and who believe in things DESPITE the evidence?

  55. Joe says:

    jdbremner wrote “Linus Pauling: the looniness of his later “work” and lack of ethics calls into question the validity of what he did earlier.”

    No! Your ad hom argument is uneducated and misguided. I do not know whence you derive your derision for his early work in chemistry, my field, but your complaint is unsupportable. I know that his orthomolecular therapy is nonsense, and you should stick to things that you know.

  56. Joe says:

    nwtk wrote “I hate to provide a resume just to counter this remark. So I won’t.”

    We know (your resume) that you went to a cult “school” and studied fantasies (subluxation, Innate). That is sufficient for us to recognize that you are a fool.

    If you eschew the subluxation, today, what do you think of the Innate? Do you accept that spinal adjustment cannot have any effect on visceral disease?

    nwtk wrote “You say I demean science. Horse crap. I have been “in” science most of my life and ALL of my multi-faceted career.”

    No! You clearly have no understanding of science; otherwise, you would not have gone to chiropracty school, nor profer your anecdotes.

    I note that you haven’t answered my inquiry concerning your rhetorical question about Advil, Motrin and ibuprofen. Dr. hall gave the answer, do you think your ignorance about that has been forgotten? Your ignorance is noted.

  57. nwtk2007 says:

    Joe – “I note that you haven’t answered my inquiry concerning your rhetorical question about Advil, Motrin and ibuprofen. Dr. hall gave the answer, do you think your ignorance about that has been forgotten? Your ignorance is noted.”

    Can you not read Joe? Are you really that dense? How utterly dumb you are.

    Do you honestly think you could educate me on the “differences” between Advil, Motrin, and ibuprofen? You say they are the same. Well in the words of leutenant Dan when Forrest pointed out that he had no legs, “YES, I know that!”

    You call me a “fool”. Joe, you remind me of a guy I refer to as “Wisdumb”. I’d almost be willing to bet you are him as you troll around the forums looking to put in your two cents worth against anything chiropractic. I thinkyou are caught again.

    And Joe, what exactly is an ad horn argument.

    And FiFi, the answer to your question is “no”.

    And in this subject in particular, your reference to evidence should be tempered with the understanding that, in this field of nutrition and supplements, there is a staggering amount of evidence for every position possible. The proof in the pudding then, for supplements, becomes biochemistry and plausability.

    Additionally, in this discussion I have given you nothing to assert that I am promoting anything chiropractic or alternative. Your bias has made you myopic.

  58. Fifi says:

    nwtk – I didn’t realize “supplements” was a “field” of science – it must be that “alternative to science” I keep hearing so much about. Nutrition, however, I am familiar with and follow the research. Apparently you don’t.

    I am also familiar with the supplement industry and aware if what often passes as “evidence” (none of it up to scientific standards of evidence), much like in the food industry (the giant corporations that add soy or omega3s or whatever is trendy at the moment to try to sell their foods as “healthy” – this is distinct from required supplementation of flour and milk, which was a public health initiative).

    Your promotion of vitamin C gives a fine example of your bias. If you believe there is a “staggering amount of evidence” what alternative sources to science are you getting your “evidence” from? Is it based on anecdotes such as your “feeling better” being evidence for your claims about vitamin C?

  59. Fifi says:

    nwtk – So what DO you believe as a chiropractor if you don’t believe in subluxations? What do you tell the people who come to you for help and based on what evidence? What does your practice consist of? Do you give advise about supplements? And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice? Why DON’T you believe in subluxations?

    And if you are confused and overwhelmed by the “evidence” about supplements, doesn’t it make sense to at least listen to someone who ISN’T confused and overwhelmed like the doctors who write here and pay the most attention to the best research?

  60. Harriet Hall says:

    nwtk2007 said,

    subjective experience isn’t a form of evidence. ”
    It is when coupled with good background knowledge and years of experience”

    That is an antiscientific attitude. By that definition, subjective experiences of bloodletting were evidence. They were supported by centuries of experience and they fit with the best background knowledge of their day and the existing medical textbooks.

    When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.

  61. Harriet Hall says:

    Okearnyshire asked about patients with HIV. That’s an area I know very little about. I pointed out in my article that there are specific indications for supplementation in patients with various health conditions. AIDS specialists would know the research in that area, and the doctor who prescribes your meds would be the one to ask.

  62. nwtk2007 says:

    FiFi, either you really don’t know or are playing ignorant. I will assume you know, there are probably 15 or 20 journals of nutrition or related peer reviewed journals. It is literally a plethra of information about ongoing research and studies by med schools, universities, etc.

    Now then:
    1. So what DO you believe as a chiropractor if you don’t believe in subluxations?

    Too broad a question. There is so much more to physical medicine I would not know where to begin. I will tell you that I don’t do much different than a PT except that I have the responsibility for diagnosis and I manage patient treatment as a provider and accept the responsibilities as defined for providers in the state of Texas. I can also see patients without a referral.

    2. What do you tell the people who come to you for help and based on what evidence?

    I have never ever been asked by a patient about evidence for anything. When they ask for help, I listen to their problem and if I can help them, then I do.

    3. What does your practice consist of?

    I treat musculoskeletal injuries.

    4. Do you give advise about supplements?

    Nope, unless specifically asked.

    5. And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice?

    The basic tenets are changing and thus do not require belief in what you claim chiropractic is. Sorry. Those who seem to know all about chiropractic simply do not know all there is to know about it. I don’t believe the bible is literally true and believable, but that didn’t stop me from being raised in the (a) church or going to a christian university. Not so myopic as you.

    FiFi also said, “doesn’t it make sense to at least listen to someone who ISN’T confused and overwhelmed like the doctors who write here and pay the most attention to the best research?”

    I am listening dear. But how do you know they are not confused? Do you take it on “faith”?

    Being a doctor doesn’t mean they are all knowing or the guiding light of science. Does it?

    I have given reasonable points of discussion. Why are you so touchy about it? Are you all knowing?

  63. Joe says:

    nwtk wrote “Do you honestly think you could educate me on the “differences” between Advil, Motrin, and ibuprofen? You say they are the same. Well in the words of leutenant [sic] Dan when Forrest pointed out that he had no legs, “YES, I know that!”

    Are you saying they (advil, Motrin and ibuprofen) are not the same, or are you admitting your rhetorical question was based in ignorance? … No, I don’t think you are educable.

    nwtk wrote “And in this subject in particular, your reference to evidence should be tempered with the understanding that, in this field of nutrition and supplements, there is a staggering amount of evidence for every position possible. The proof in the pudding then, for supplements, becomes biochemistry and plausability [sic].”

    Every position possible?? I should eat fruit, or avoid it, it’s all good?

    nwtk wrote “Additionally, in this discussion I have given you nothing to assert that I am promoting anything chiropractic …”

    Except, that you are a chiropractor … Don’t you promote what you do? I don’t recall anything specifically chiro; but, you do (mistakenly) offer yourself as a health professional.

    On that, ladies and gentlemen of the jury, I rest my case.

  64. nwtk2007 says:

    Harriett – “When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.”

    You couldn’t be more wrong.

    Antiscientific? Only by the EBM standards.

    I will take an experienced doctor over a rooky with evidence any day of the week.

  65. nwtk2007 says:

    Joe, you are tooooo funny. If you are going to put words in my mouth, please, at least know what you are talking about.

    And Joe, I take it back, you are Jim the Pizza boy. I should have known.

    Got any achovies buddy?

  66. Harriet Hall says:

    I think nwtk was trying to make the point that patients don’t know that Motrin, Advil and ibuprofen are the same. But he worded it very clumsily and gave us all the impression that he believed they were different.

    It took me a while to figure out what he was trying to say about antibiotics and immunity, because he worded that very clumsily too. He didn’t say what he thought he was saying.

    Clarity of thought is a prerequisite for clarity of language. It seems to me nwtk is confused about some things, especially about the true meaning of “correlation doesn’t mean causation.”

  67. Joe says:

    nwtk wrote “5. And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice?

    “The basic tenets are changing and thus do not require belief in what you claim chiropractic is. Sorry. Those who seem to know all about chiropractic simply do not know all there is to know about it. I don’t believe the bible is literally true and believable, but that didn’t stop me from being raised in the (a) church or going to a christian university. Not so myopic as you.”

    http://www.chirocolleges.org/paradigm_scopet.html
    “Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.”

    That official position sounds like it hasn’t changed in 118 years. What do you imagine has changed? Oh, oh, I know- nothing. I can also cite articles in recent issues of your Dynamic Chiropractic magazine that show there is nothing new since DD Palmer.

    If you realize that this chiropracty is nonsense, why aren’t you angry about the time and expense your school scammed you for nonsense? i know, you are too busy scamming the gullible.

    nwtk wrote “Being a doctor doesn’t mean they are all knowing or the guiding light of science. Does it?”

    Straw man.

    nwtk wrote “I have given reasonable points of discussion. Why are you so touchy about it?”

    No, you have only offered irrational bluster- no data.

    nwtk “Are you all knowing?” Another straw man. We know that you are little-knowing. There are a few chiros who burst out of that ; but you are not one.

  68. nwtk2007 says:

    You miss the point by your bias. Thus your defensiveness and inability to see the point.

    Since I disagree yo feel the need to “get the last word in”, so to speak.

    I’ll get back to correlation and causation. But I will tell you that it wasn’t philosophy or a lack of understanding about correlation and causation that caused the changes I saw and still see by taking the vit C just as it is not what allowed the antibiotics to get rid of my sinus infections.

    Getting back to that, are you saying that antibiotics should not be used because the sinus infections will go away on their own and thus they were never needed and represent an un-necessary risk to patients being exposed to the side effects of anti-biotics which they should not have been exposed to because the treatment has no benefit?

    Probably not.

  69. Harriet Hall says:

    nwtk2007,

    Your last comment shows you can’t read. Or at least can’t understand what you read. Sad.

    Please go back and read what I wrote about your vitamin C experience and what I wrote about antibiotics for sinusitis.

  70. nwtk2007 says:

    Sarcasm Harriett.

    I see what you are saying, I just don’t agree with you.

    I did say “Probably not”.

    And Joe, being retarded does not excuse your dim-witted comments. And you started it…. Go back to your anti-chiro web site.

    And like I said Harriet, I’ll get back to you on correlation and causation.

  71. nwtk2007 says:

    Lets see if I have this right.

    Harriett says that just because my sinus infections go away when I take an antibiotic (and have done so every single time I have finally resorted to one) I cannot assume that this correlation between the antibiotic and the disappearance of the sinus infection shows that the antibiotic caused the sinus infection to go away.

    Now, over the course of about thirty three years of getting these things, which, I guess, coincidentally started when I worked as a medical technologist in a very busy county hospital, I have been able to defeat these things on occasion by using nothing more than antihistamines which keep my sinuses dry and slow the drainage. (Harriett said she thought the use of antihistamines was not appropriate but when I did not use them the drainage would set up further infection in my upper chest, mainly bronchi and larynx.)

    It seems to me, that if the antibiotics worked every single time, whether I began them early in the infection or late, that I could reasonably assume that the antibiotic worked to kill the infection and could not be attributed to a placebo effect or some other confounding factor.

    The infections were pretty random as to the time of the year they would occur, they did not seem to be related to anything dietary as my diet has been very consistent (not a bad diet but not rich in fruits and green vegetables) and really don’t seem to be linked or related to anything. They occur about once to sometime twice a year and occasionally skip a year.

    But you say that I cannot link that this correlation between antibiotic use and elimination of sinus infection implies causation.

    I went to a resp specialist who made me take the antibiotics for six weeks continuously. According to him, the ten day rule was a good recipe for resistance. He felt very confident that the antibiotic was killing the infection. Through him we determine it was staph and his final conclusion about the whole thing was that I was colonized, a carrier, of staph. He said I would probably never be completely rid of the things and that the sinus infections would recur.

    But you say there is not enough scientific evidence here to link correlation with causation.

    With all due respect, I would have to disagree.

    I’ll have to get back to yo on the vit C thing.

  72. Fifi says:

    nwtk – If your diet isn’t “rich in fruits and vegetables” then it’s not a good diet (even if you think it’s not “bad”). Why would someone who claims to be knowledgeable in nutrition not take the minimal steps required to eat a healthy diet? It seems rather hypocritical considering you’ve been talking about how unhealthy and ignorant other Americans are. It also suggests that you may have a vitamin C deficiency. Personally I’d be concerned for any of the people who come to see you who trust your diagnostic skills and “expertize” if you can’t nourish yourself properly!

  73. Calli Arcale says:

    When you first described it, it sounded like a one-time-only event — sinusitus, got antibiotics, sinusitus went away. Indeed, without any outside information other than that, it is not possible to tell whether the antibiotics caused the infection to clear up. A lot of people don’t realize that, and it has led to an overuse of antibiotics. They had the sniffles, they took antibiotics, their sniffles went away. But if they weren’t tested, or if their symptoms were not very conclusive, it’s just as likely that they had a viral infection which their immune system dealt with, totally apart from the antibiotics.

    I know a woman who swears by antibiotics. She buys them bulk in Mexico and takes them at the slightest sign of a sniffle. That’s a fairly egregious example, but that’s the sort of thing I think most of us were thinking of when you brought up antibiotics.

    Now, in your most recent post, you’ve elaborated considerably and given plenty of good reason to conclude in your case that the antibiotics were responsible for clearing up the infection. You didn’t just go by the fact that a single infection went away when antibiotics were used; no, you have plenty more to go on. It’s perfectly reasonable to conclude that the antibiotics were a good choice.

    Incidentally, I suspect that your use of antihistamines and such doesn’t defeat active infections but rather reduces the risk of them taking hold in the first place, by reducing inflammation in your airways. I’m no expert of course; I’m a software engineer. But from what I’ve read, and from what I’ve learned from my own asthma management, it might be a factor.

    Vitamin C, though, is bunk in my opinion. It’s a very important vitamin, but the human body fiercely regulates the amount in the blood at any time, and stores up to a 30 day supply. Any surplus beyond that amount is excreted by the kidneys, so as long as you’re eating a healthy diet, supplementation isn’t going to really achieve anything. Linus Pauling was a brilliant man, but he had some nutty ideas too, and this was one of them. Sort of like Tesla in that regard.

  74. nwtk2007 says:

    Well it looks like I have this blog all to myself about this time of night. Cool.

    I did read the suggestion about the vitamin C N=1 experiment you suggested. This would be difficult in that I would probably suspect any difference in pills and to be honest, I would have to be on the placebo for a few months to notice any change, and I would not like to put my bod thru that. One degree of freedom just would not be suitable anyway. I would be hurting and you would then discount it for just that.

    This thing with vitamin C is a gradual change. It has to be. The effects on connective tissue would not occur within days but weeks.

    The biochemistry is this, as you probably know: Vitamin C is a reducing agent and with respect to collagen, aids in hydroxylation of, I think, five specific amino acids, which participate in hydrogen bonding between sheets of collagen proteins. The higher the number of hydrogen bonds, the greater the strength of the connection between the sheets of collagen. Thus in deficiency, too few hydrogen bonds results in weak connective tissue and thus scurvy and all of it’s S/S.

    Just enough vit C will prevent scurvy but how many hydrogen bonds are needed for optimum collagen strength is the key. There has to be a spectrum of hydrogen bond numbers beyond which there is no scurvy, but which represents a spectrum of collagen strengths.

    In activities which require repetitive movements and, lets face it, pounding, of connective tissues in joint capsules and ligaments, these repetitive actions represent repetitive traumas, aka, micro-trauma. And like a wire bent over and over repetitivly, it weakens form the abuse. Increased vit C with it’s resultant increased number of hydrogen bonds between sheets of collagen would fortify the proteins and thus reduce the damage. Elevated Vit C would continue to “do it’s thing” and repair this damage that much quicker. I have seen this senerio in a bio-chem book, but I do not remember which one.

    This is just the biochemistry, not really an arguable point. Now just common knowledge.

    Thus it stands to reason, that elevated levels of vit C strengthen connective tissues to a point where they experience less damage and repair more quickly. There may already be clinical studies as this is old science.

    This is obscured by the notion that vit C strengthens the immune system, which as far as I know, is based on only two studies which were appropriated by big vita, as FiFi would say, and is now the driving force of vit C marketing.

    It seems obvious to me. The research would be simple enough, but would have that subjective essence about it.

    My experience with it at least forms the basis for hypothesis which is testable and possibly verifyable. But what harm could come from trying it. I am convinced.

    I get 250 or 500mg tablets, I take one with breakfast, lunch, mid afternoon snack, dinner and before bed. It’s not mega-doses and I would challenge anyone to try it for them selves.

    And it ain’t Big Vita either. It is limited supplementation. The only thing about it is that the vit C needs to be spread out over the day due to the water sol nature of it and it’s subsequent loss in the urine. (Not processed FiFi)

  75. nwtk2007 says:

    FiFi – “It also suggests that you may have a vitamin C deficiency.”

    Not any more FiFi. Thats the whole point.

    And as to the diet, it boils down to life style and laziness.

    But simple to over come.

    Another thing I think is that I could not achieve the levels I am at through diet. I will do the math. But in between patients, I don’t have time to eat an orange or two you know.

    Hypocrite? Absolutely. Wee ALL are! Most definitely.

  76. nwtk2007 says:

    Dear Calli Arcale,

    Thanks for reading.

    And you might be right about the vit C.

    With respect to Pauling, in my Masters work some of my instructors knew him well and had many stories. They are mostly old now and probably dead.

    I only knew him thru them as a break through atomic structure giant – thus two Nobels.

    A nutrition nut friend of mine used his Nobels to defend Paulings vit C beliefs. He was a bit put off by the fact that the Nobels had nothing to do with vit C.

  77. Harriet Hall says:

    nwtk2007,

    Your experience with antibiotics and with vitamin C may seem very convincing to you, but others have been equally convinced about other things and have been wrong.

    There are many things that can make it seem like a treatment worked when it really didn’t. The natural course of illness, regression to the mean, conditioning, reinforcement, distorted perceptions, confirmation bias, expectation, and many other factors can mislead us.

    Please think about bloodletting. Doctors and patients used it over and over and it “worked” repeatedly and they were just as convinced as you are. And they had plenty of theory to back them up. But they were wrong, and there is a possibility that you could be wrong too.

    A friend of mine tells me she takes Echinacea at the first sign of a cold, and she hasn’t had a cold in several years. She believes taking Echinacea prevents colds. I “don’t” take Echinacea at the first sign of a cold, and I haven’t had a cold in several years either, so I could just as well believe that “not” taking Echinacea prevents colds.

    Most sinus infections as diagnosed by GPs on the usual clinical grounds will resolve without treatment: the symptoms gradually get worse, then they subside. When symptoms increase, that’s when people tend to try a treatment, and often that is the point at which the symptoms were about to decrease anyway, so the treatment unfairly gets the credit. That fooled both doctors and patients for decades, and we have now learned we were overtreating.

    I’m not saying you’re wrong; I’m just saying you can’t know you’re right. It is considered safe to take up to 2000 mg of vitamin C a day, so I don’t see any problem with you continuing to use it. There may be a problem with continuing to take antibiotics for sinus symptoms: antibiotics have side effects and lead to antibiotic-resistant strains of bacteria.

  78. Harriet Hall says:

    I said “When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.”

    nwtk2007 said “You couldn’t be more wrong. Antiscientific? Only by the EBM standards.”

    What other standards are there? Is there any kind of science that doesn’t go by evidence?

    “I will take an experienced doctor over a rooky with evidence any day of the week.”

    Sure, me too, but that’s not what I meant. I was referring to doctors who say “In my experience, X works well for condition Y” when all they have is personal experience. That’s testimonials, not evidence. The bloodletters all said, “In my experience, bloodletting works well and saves lives.” In reality, it was doing more harm than good.

    Personal experience used to be all we had to go on. Now we have something better: the scientific method. If you don’t accept the scientific method, you’re reading the wrong blog.

  79. Joe says:

    nwtk,

    Your reasoning power, inre vitamin C, is on a par with DD Palmer’s reasoning about subluxations. We have experimental/clinical data concerning both; which invalidates both claims.

    We try to teach college students to work from data, instead of speculation. Speculation is only a basis for research, not a conclusion. As you noted, there has been a lot of clinical research on vitamin C, and the conclusion is that your speculation is silly.

    Your assertion, above, that you act like a PT except that you “include diagnosis” is laughable. Where is the evidence that you learn as much as a PT in chiropracty school, or that you learn diagnosis. You certainly don’t learn diagnosis when your “education” is centered on subluxations and your “clinical” experience consists of a few healthy friends that you cajole, or bribe, to attend your clinic.

    You are a masseur/euse with delusions of grandeur.

  80. Fifi says:

    nwtk – The point was that you ate such a poor diet that you were suffering from vitamin C deficiency and couldn’t identify that vitamin deficiency in yourself. To me this says you don’t know anything about basic nutrition or about the benefits of diet, and you’re basically not even knowledgeable enough to feed yourself properly. Anyone who chooses a supplement over leafy greens and cruciferous veggies isn’t getting the cancer prevention benefits of leafy greens – on all fronts supplements just aren’t nearly as good as food.

    Though, of course, you pretend that food isn’t nearly as good as the pills you’re pushing – it seems to me that for all the talk of being “natural” and so on that chiros do on this blog, very few of them seem to actually promote natural sources! Bit Vita is just as much a pill pushing industry as Big Pharma – but without nearly as many safeguards or ethical restraints. Of course, despite all the accusations of medicine playing politics, supplement manufacturers are well known lobbyists – and have resorted to distorting the truth to try to fight legislation. It seems that Big Vita/Supplement is VERY political. While Big Vita and CAM constantly frame themselves as being some groovy “alternative”, there are actually a shocking amount of right wing and fringe Christian types involved in Big Vita/Supplement. Where the new agers and the right wing/Fundamentalists meet is their common war on “reality based thinking” and their constant attempts to use fear to manipulate people.

    So, ultimately, you’re not really promoting or advocating living a healthy lifestyle, which includes the basic building blocks of prevention and health – diet and exercise. You’ve said that you don’t live a healthy lifestyle yourself and pop pills rather than modify your diet so you’re eating healthy food (not something that’s very hard to do!). You claim to be knowledgeable but your own stories constantly belie your ignorance (I know, when caught in the web of your own ignorance you claim to be sarcastic but you’re only fooling yourself).

  81. Fifi says:

    If you think you need to eat two oranges every hour to get adequate vitamin C, clearly you’re misinformed about nutrition. The other thing about taking pills instead of getting vitamin C from food sources is you’re not getting any of the other things in an orange that are good for you and part of a healthy diet.

    Taking megadoses of vitamin C is also potentially dangerous for anyone who has metabolic problems with iron. So while one can’t overdose on vitamin C per se, megadosing can potentially have other undesirable side effects (including the increased risk of kidney stones). Vitamins and minerals, like anything that’s bioactive, have side effects. It’s yet another reason why anyone with an ounce of sense wouldn’t take nutritional advice from someone who doesn’t maintain a healthy lifestyle, who didn’t recognize something as obvious as a vitamin C deficiency in them self (and who is silly enough to be one of those people who demands antibiotics when they aren’t necessary) and who can’t discern credible evidence from propaganda from supplement manufacturers.

  82. Fifi says:

    I’d also like to bring up an environmental issue here. All those vitamins that are water soluble get flushed down the drain into the water system and back into the environment. Anyone who’s taking unnecessary vitamins and supplements is also contributing to unnecessary pollution of water supplies and the planet. (Not to mention the pollution created making the “natural” vitamins – often done in unclean and polluting factories in China – the plastic packaging created and then discarded, the energy and pollution created by transporting them to a store near you, etc).

    Anyone who claims to have a genuine holistic interest in health wouldn’t ignore the environment and contribute to gratuitous polluting of our waterways and environment.

  83. nwtk2007 says:

    FiFi – “Taking megadoses of vitamin C is also potentially dangerous for anyone who has metabolic problems with iron. So while one can’t overdose on vitamin C per se, megadosing can potentially have other undesirable side effects (including the increased risk of kidney stones).”

    You gotta reference on that FiFi?

    I will say that you are brilliant in your conclusion that I was vit C deficient. That was, essentially, the first point I was trying to get across. The other point is that most people are, but at lower activity levels, it doesn’t show up.

    As to the levels I recommend, they are only in the 1250 to 1500mg/day range, could be potentially less for smaller individuals, and is spread out over the day. The equivalent in fruits and oranges would amount to at least 4 – 5$ per day in cost, not to mention the time involved in consumption, excesses in sugar intake and even refrigeration costs, gas (car), shopping time, etc.

    You are also right that my diet was pretty poor, even though I eat better than probably 90% of the population in this country at least. But diet is a very difficult thing to change and to get people to change. I think it is easier to get people to change their religion than it is to get them to change their diet.

    Supplementation might be the only way to even come close to getting vit C levels up in the population as a whole. In reality, it will never be done.

    You also said – “To me this says you don’t know anything about basic nutrition or about the benefits of diet,”

    Thanks for that bit of an insult. But, again, in reality, and to a small degree, you are right. I should have known, but in the hustle and bustle of life and all the complexities there-in, we sometimes don’t see the forest for the trees. Your knee jerk responses to comments perceived out of context (poorly read) indicate that you also might be missing a bit of the forest.

  84. Fifi says:

    nwtk – You’re welcome for any insult I offered and you took, it was well earned on your part.

    Here’s some info on the dangers of excess iron (which, no doubt you’re aware, vitamin C enhances the absorption of…though since you didn’t recognize a vitamin C deficiency in yourself you may not be aware of the synergy between iron and vitamin C – or other vitamins and minerals for that matter). Vitamin C supplementation is also not advised for people with diabetes, so it’s a poor choice as a supplement for people who have “bad” diets.

    http://www.cancer.dartmouth.edu/iron/managing.shtml

    http://www-ksl.stanford.edu/people/kpfleger/multivitamins/cached/my.webmd.com_content_dmk_dmk_article_58947.html

    Wacky that you’re handing out nutritional information to your patients when you don’t know about the relationship between C and iron, the dangers of excess iron and can’t recognize a deficiency in your own diet and body!!!

    If you were eating a healthy diet to begin with, you wouldn’t need supplementation. That you’re too lazy and unmotivated to even look after your own health in the most basic way – yet claim to be a health professional and complain about how lazy, ignorant and unmotivated others are – is pretty dazzling. People who don’t know any better eat poorly out of an ignorance born of innocence. You’re actively choosing unhealthy choices in favor of popping a pill. I really don’t see how you can castigate “Big Pharma” when you show exactly the same kind of pill-popping, magic bullet kind of beliefs about supplements!

    If your diet isn’t rich in fruits and vegetables, what is it rich in? Meat? Carbs? Sugar? Fats? You’re really setting yourself up for quite a raft of health problems via your diet, and getting none of the cancer preventative benefits of eating leafy greens (since supplements don’t provide the same benefits).

  85. nwtk2007 says:

    I’m sorry Fi Fi, but I just couldn’t help it.

    There are much better sources related to vit C and iron. But I will tell you, in all cases thus far documented that shows any harm from vit C supplements and harmful iron overload , the persons involved were taking iron supplementation, which is rarely indicated.

    And there are no “EBM like” studies supporting even that.

    By that I mean any studies which would hold up to this forums definition of EBM.

    And really, you have been the most insulting person I have ever run into on a forum. Even when people agree with you, you insult them. Amazing.

    You do know the anti-cancer and anti-heart disease benefits of anti-oxidants (we called’em free radical traps) are now coming into question. A very complex picture indeed.

  86. Harriet Hall says:

    nwtk2007,

    In patients who do not take iron supplements there is some evidence suggesting that lower iron levels may be better for health. And some people are very susceptible to iron overload just from normal dietary sources, especially people with hemochromatosis that may not have even been diagnosed yet.

    Just as vitamin C increases iron absorption, it decreases copper absorption. It has a whole lot of other effects you may not be fully aware of. The Natural Medicines Comprehensive Database has 2 whole pages on vitamin C’s interactions with drugs, foods, lab tests, diseases and conditions.

    If these interactions happened with a prescription drug, we might worry more about them, but since vitamin C is “natural” we tend not to even ask about them.

  87. Fifi says:

    nwtk – Why would my opinion of you change just because you “agree” with the obvious rather than deny it? Does your opinion of people change merely because they agree with you or confirm your beliefs? Do “like” and act respectfully to those who do? And do you dislike and act insultingly to those that don’t? You have been neither polite, compassionate or pleasant for the most part – and your main objective here is to troll, try to diminish EBM and promote chiro and supplements – I see no particular reason to change my opinion of you merely because you’re sucking up since you got caught out saying a number of things that reveal your ignorance.

  88. Fifi says:

    Yep, I do know that antioxidant supplements are now appearing to not be the miracle supplement they’re touted as by the very same people who tout megadosing on vitamin C. That doesn’t mean that the studies showing that a diet rich in leafy green vegetables is preventative for cancer, though it does indicate once again that eating food (which provides a broad range of nutritious compounds not just one) is preferable to seeking a magic bullet in pill form.

  89. nwtk2007 says:

    FiFi – “and your main objective here is to troll, try to diminish EBM and promote chiro and supplements”

    You are so full of it FiFi. Show me where I ever promoted chiro on this forum. I speak about one single vitamin, C, and you say I am promoting supplements.

    These posts are numbered and date. Show me.

    I also never even implied that the vitamin C had to be natural or that natrual was better than anything,. I don’t think I ever even used the term.

    Check your nwtk2007 posts. Don’t be so defensive and act so all knowing and pretend to be so perfect.

    And this for example, – “I see no particular reason to change my opinion of you merely because you’re sucking up since you got caught out saying a number of things that reveal your ignorance.”

    What did I get “caught out” saying that revealed my ignorance. I fully admitted that I should have suspected the vit C deficiency from the beginning. Read my first post. And what ever gives you the idea that I am “sucking up” now?

    Pretty funny.

    And 1250 to 2000mg of C a day is not mega-dosing.

  90. weing says:

    I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.

  91. Joe says:

    nitwit2007 wrote “What did I get “caught out” saying that revealed my ignorance.”

    Well, there was the part about “simple biochemistry” supporting your excess dose of vitamin C. That was pretty ignorant. Of course, it makes perfect sense to a chiropractor.

    So, you claim to deny subluxations. What about Innate? You spent a lot of time and money studying that foolishness, too.

    Do you mangle children, or schedule customers for “maintenance” treatments? What makes you think you are as competent as a PT; let alone imagining you have the ability to diagnose?

    Your notions about vitamin C tell us you are not very bright. Your attendance at chiro college reinforces that.

  92. Joe says:

    weing on 17 Jul 2008 at 6:38 pm wrote “I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.”

    You seem to forget that disciples of DD Palmer have highly-refined diagnostic procedures and they can avoid such problems.

  93. nwtk2007 says:

    Hey there Weing, how about some EBM qualified links to your claim of reports of kidney stones and Vit C?

    Joe, what part of the biochemistry of vit C did you not understand? Care to elaborate or just picking a fight? What specifically was wrong with the biochemistry as I described it in relation to strengthening collagen by increasing hydrogen bonding between sheets of proteins? Are these notions about vit C?

    And Joe, for what it’s worth, I treat injured people so what I do is go around causing accidents and leaving my card at the scene. Or just throw a little water on the floor at Walmart, drop some grapes or something like that. Then when they come to me, I basically ring their necks until they pay me all they have, sell them supplements out the wazzoo on their credit card and shuffle them off to Fannie Mae for a loan to cover their life long maintenance care.

    Gosh, What’da ya think I do silly?

  94. weing says:

    http://jn.nutrition.org/cgi/content/abstract/135/7/1673
    That’s the most recent one I could find. I originally looked into this back in 1983-4 and it appeared a subset of patients had increased risk of renal stones from it and I made it a point not to prescribe over 1000 mg a day for wound healing. It also would give false negative tests for occult blood in stools. I would have to clean out my basement to find the original references.

  95. nwtk2007 says:

    Previously Weing said – “I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.”

    I have been roaming around the internet looking for sources indicating that Vit C is related to kidney stones and low and behold, I could only find studies and articles by MD’s, refuting any connection except that the elevated Vit C levels actually decreased the incidence of kidney stone or had no effect on it at all.

    More articles than not report that elevated Vit C levels decrease the stones and a few of the MD’s stated that they use Vit C to treat kidney stones.

    One pointed out how in the past it had been seen that Vit C increased oxalate levels and thus was born the recommendation to avoid high levels of C for fear of developing stones. This guy, an MD, was quick to point out that there has been no studies showing any increase in stones with inc Vit C levels or even increased oxalate levels.

    hmmm. Probably just a bunch of anectodal non-sense and not EBM.

  96. nwtk2007 says:

    I saw that one. It is sited by others as incorrect in the assumption that elevated levels of oxalate means increased stones.

    As Harriett says, correlation does not mean causation.

  97. Harriet Hall says:

    The current consensus is that it’s safe for most people to ingest up to 2000 mg of vitamin C a day. There are concerns (see the Natural Medicines Comprehensive Database) and it may not be safe for every individual. And dietary sources must be added to the dosage from the supplement pills.

    I think we can assume that nwtk2007′s use of vitamin C is not very likely to harm him. We can’t assume that it is absolutely safe, and we can’t assume that it is more effective than adequate diet and placebo.

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