Enough is Enough

Are Multivitamins useful? Is Organic Produce better? Does Science trump common sense? What is common sense? Let’s start with the most recent sensational report:

“The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries”

This report from The Annals of Internal Medicine left many people confused or angry. The scientific community was content. The nutrient companies felt attacked. The public, jilted.

My thoughts?  “Finally. All this bias is getting aired out”.

Finally we are talking about our society’s strange addiction to pills and powders and potions, wishing for magic.
Finally, we get to watch how conclusions are the real reason why science is continuously misunderstood.
Finally, we are in a generation that allows for public dialogue, no matter how fiery.

We all have our biases. Some of us veer left, right or maybe just always against “the other”. Some of us bias numbers, some of us bias experience. I have a bias for my own brain – which tends to be leery of the “alternative” industry and simultaneously defensive against scientific bullying, whilst chuckling at dark comedy. This usually means that no one likes me. I’m okay with that.

lan Gaby, MD posted a long, arduous review of this recent report, in the Huffington Post, regarding his opposition of this new multivitamin information. His bias for supplementation shines bright and that bias leaves him grasping for straws. He uses research terms and irrelevant analysis for some pretty shoddy rebuttals. If you don’t understand statistics, he bowls you over with his rhetoric, and if you do understand statistics, he bowls you over with his dodging skills and refusal to admit the facts.

There is an increasing trend in the nutrition/natural medicine community that drives me up the wall:

1. A report comes out with results that support a current practice that NDs do. Without so much as a glance over the validity and quality of the study, NDs & alternative healthcare practitioners (HCPs), or private practice stateside MDs are tweeting, sharing, posting, pinning, shoving it in the face of some Doubting Thomas, stating it as if ‘we knew it all along’, and now we have science to prove it.

I am valid. My career is valid. I will accept that messiah crown, thank you very much. 

2. A report comes out with results that do not support a current practice that NDs do. As it threatens a career that was initially built on belief, intuition & being the whistleblower, NDs & alternative HCPs defend, react, ignore, eye-roll, celebrity-quote, pharma-trash.

“Yeah buts”, followed by – “The study wasn’t big enough, the study wasn’t including things that I would have, the significance was understated, they just don’t know how to study natural remedies. I took a course in statistics, and I know all about your stinkin’ p-levels and confidence intervals. So let’s take this outside, and finish it off."

You can’t bully me. I have learned how to fight, & I am clinging to the title of underdog. 

Does anyone else see the arrogant ignorance in this? I sometimes want to drop out of my profession because of these disgraces to the name “doctor”. Suck it up. Learn how to read critically (Critical does not mean defensive.) Critical means to analyze with an intelligent eye, without taking it personally. If you want to use science, you have to learn to drop your bias to “win”. And try not to be pompous bastards about concepts you have just accepted as truth.

Humble confidence looks a lot better on you than arrogant pride, no matter whether you are the underdog, or the top cheese.

Just because someone is being a jerk, doesn’t mean you should be too. Didn’t your mother ever tell you that?

Now – The baby, the bathwater, and the bin of pill bottles:

The report compiled three large-scale studies that assessed whether or not multivitamins improve chronic conditions, prevent cognitive decline or prevent heart disease/cancer in healthy, well-nourishedpopulations & discovered that they don’t.

Voila. That’s the news.

It’s a generic over-the-counter pill that has over 20 different substances in it. It’s not a magical-only-good-statements-8-ball.

If you are generally healthy and well nourished, stop trying to do more. There is nothing wrong with you. If there is a health condition you have, then a sloppy joe of vitamins and minerals is not the answer either.

You cannot prevent many things. Particularly not the types of conditions we are dealing with in medicine in this era. If these two sentences seem strange to you, read my post on prevention.

There is a huge nutraceutical industry that is “educating” the public and alternative healthcare providers, that external nutrients are the key to preventing demise. And I say: hogwash.  Nutrients can be helpful for certain conditions, but does that mean you won’t get Cancer or Alzheimer’s or Heart Disease? Hell no. But you might feel better right now, for a while. It’s a little legalized hit.

Sure, some people eat crappy food, or not enough food, and therefore don’t get adequate nutrients, which could lead to long term consequences. But these people are not the healthy individuals they studied. And in that situation, could we really then call a multivitamin preventative? Or is that barely making it out alive from a broken system? I’ll move on, before I get political or personal.

Supplement: a substance that is taken to remedy a deficiency. No one ever uses the word supplement in any context to mean that it can hold its own, or contribute as a major game changer. It is an extra, and add-on, an enhancement. It’s nice to have on occasion, but something you could do without. That’s the whole point.

Multivitamins are not medicine, they are a Hail Mary Pass. No one is deficient in all of the substances in a multivitamin pill. And if they are, you’ve got a bigger problem to deal with.

You know the free mini-bottle of Kahlua you get when you buy a nice bottle of Gin? No one expects or wants the Kahlua to be the major player in their fancy drinks. But when you run out of your spirit, at least you’ve got something to tide you over until you get some nice gin again. Don’t get into a fight about whether Kahlua makes high quality cocktails. It just doesn’t. It’s Kahlua. Multivitamins are the Kahlua of the nutrient industry. Not the worst thing you could do, but just not worth bragging about.

I’m going to say it again: Well-nourished, healthy, non-deficient people do not need to take anything. They never have. There never has been evidence for it. If someone tells you otherwise, you are being sold the promise of health. Think carefully whenever someone asks you to buy a promise.

What’s deficient when it comes to things we don’t measure? That is a big question. And the variability of this answer is what the supplement industry wants to capitalize on. I can’t answer that for general society. This will be the unending dialogue of science and industry. I try not to get involved in that crossfire.

What I know is that if I am going to prescribe beyond food and lifestyle, I consider packaged nutrients as medicine, not supplements. I better know what I’m putting in people and why and for how long. Otherwise, on so many levels, it is wasteful and potentially damaging.

Doctors are in the (un)fortunate position of eternally waiting to be proved incorrect. It is a humbling profession.

If your doctor doesn’t have a clear rationale for their choices, other than “overall disease prevention”, then I might call them charlatans. Stop running around trying to prevent things that we have no idea how to prevent.

Be selective, appreciate a substance for what it can assist you with, but don’t assume it is the holy grail to health. We may find out in 10 years that one of those things you selected was totally off base, but that’s ok. We choose. We learn. We choose again. Don’t get all up in a huff about progression. 

In fact, if you think taking a multi-vitamin or some high-dose vitamin somehow creates a protective shield for your health, and therefore gives you a get-out-of-jail-free card to not take care of your diet and lifestyle, then not only are you wasting your money, but you are also part of the data set that showed these multivitamins or high doses vitamins could cause harm.

We can’t ever predict the future and we certainly shouldn’t regret the past, but we can make the best decision with the information that’s in front of us, today.

Sometimes science & science writers get cocky. They write as if you, the reader, are ‘less than’ for not knowing. This is intellectual bullying. If someone really cares about educating you, they do not shame you for being outside of their world of research, or not-up-to-date with the onslaught of words published everyday. “I know something you don’t. I am part of a elite group of observers”, they say in their haute dialect.

Those people. 

If this is their tactic:

1. Remember to take note of what they are saying, but not how they are saying it.
2. Say thank you for sharing.
3. More than likely they are in a self-serving state of needing to be loved and admired for their hard work, savvy and lack of attention & belonging in some other part of life.
4. I say this, because I am that person, a lot. “I just learned this, see how smart I am? My intelligence defines me.”

Simultaneously, alternative health care is soaked in belief systems. Most of the clinical education is based on logic and historical precedent. It churns out individuals who speak of evidence-based medicine and academic rigour, but fail to account for new evidence as it is uncovered – information that would render certain therapies obsolete, if one were to look at them scientifically.  If there is evidence that shows that your chosen therapy is not effective, disregarding it while saying your practice is evidence-based, is irresponsible and dishonest. If you think that the scientific inquiry is irrelevant and continue to teach or practice that therapy, this is a belief based practice. And that’s ok. BUT OWN UP TO IT.

Faith is famous for its ability to ignore or dispose of relevant facts and promote self-serving facts, and use emotional (always effective) stories. Often those involved have a vested interest in this belief surviving, and thus the fear of their belief dying is palpable.

If this is their tactic:

1. Remember to take note of what value they are promoting, not what subject they are promoting.
2. Say thank you for sharing.
3. More than likely they are in a state of needing security and stability as the fear of change, loss of certainty or potential meaninglessness is far too much for the psyche to process. Noone wants to believe it’s all for nothing.
4. I say this, because I am that person, a lot. “Don’t challenge my belief that everything will be okay. How else am I supposed to survive through the crappy days?”

Overall: Hold your values tightly, your beliefs loosely, and let your theories be forever debatable.

There is so much information out there. You cannot be responsible for reading everything & analyzing everything.

If you honestly changed your decisions about life after one-time exposures to evidence, you would be forever chasing a dragon of discontent. There is no way that one person can be expected to keep flip flopping along with scientific discovery. It gets tiring and disempowering.

There will be a different threshold for the amount of evidence that will initiate a change in action for any individual. Some people change with one study. Some people wait until death. Neither are more intelligent. No one else can determine that threshold for you.

If you choose to do something because it seems like good sense based on some information you learned, that’s awesome. Sometimes (always) information shows up that’s the opposite of what you thought.

When this happens, if you feel defensive or ashamed, you are taking it too personally.
If you continue to do said action, just chalk it up to doing something that you can’t explain. That’s awesome too. But that’s not science & we can’t all be scientists about everything.

The world would be bland and boring if we were all the same. When we die, noone cares if we made art or music or wrote research papers or slept on the streets. Science is not better. Science is science.

If a report or study comes out, try not to lose your cool. It’s not about you. Read it. If it’s relevant to your choices, remember it as interesting. Keep it in your pocket as information that helps you understand more of this overwhelming world.

Notice, are you picking sides, feeling sheepish, or are you genuinely interested in developing wisely?

With all this perspective gathering in mind, here are two more things that you can watch your reaction to:

A Slate Magazine summary that states that organic fruits & vegetables are not chemically safer than conventional produce, several reliable references within. Boom.

An academic review article that found that organic produce is not more nutritionally sound. Woop.

Maybe ‘organic’ wasn’t the real reason we all went ballistic to buy organic. Maybe there is some deep-seated, inexplicable belief that growing food in a certain way feels better, regardless of sustainability, health or industry. Maybe we should look at our values around that.