Fletcher and Fairfeld conclude, "Suboptimal folic acid levels, along with suboptimal levels of vitamin B6 and vitamin B12, are a risk factor for cardiovascular disease, neural tube defects, and colon cancer and breast cancer; low levels of vitamin D contribute to osteopenia and fractures; low levels of the antioxidant vitamins (A, E, and C) may increase risk of several chronic diseases. Most people do not consume optimal amounts of all vitamins by diet alone. Pending strong evidence of effectiveness from randomized trials, 'It appears prudent for all adults to take vitamin supplements.'"
Later in their discussion, the researchers suggest that physicians should make specific efforts to learn about their patients' use of vitamins, to ensure that they take what they should (such as folic acid supplementation for women in childbearing years, avoiding high doses of vitamin A during pregnancy or massive doses of fat-soluble vitamins at any age).
Many health experts regard this research article as a significant turning point for the medical profession. The recommendation of vitamin supplementation has long been a common practice among chiropractors and other complementary and alternative medicine (CAM) practitioners, who have often been criticized by members of the medical community for using such unproven, potentially dangerous interventions to help prevent and treat various ailments.
The medical profession appears to be gearing up to acknowledge that the safe and responsible practice of nutritional supplementation represents an important self-care strategy, through which patients can reduce their risk of many common chronic degenerative diseases that plague modern society. This turnaround in posturing is likely to benefit consumers, who are often given conflicting information about the use of nutritional supplements from their medical (vs. CAM) practitioners. However, it appears that American and Canadian consumers are sold on the science that suggests that certain nutritional supplements can improve well-being; enhance energy; reduce risk of degenerative diseases; and help manage or treat a number of health conditions.
Surveys indicate that 60 percent of adult Americans, and approximately 70 percent of adult Canadians, regularly take supplements, and many adults take three or more different supplements on a daily basis. Helping patients decide which nutritional supplements best suit their individual needs should take into consideration a patient's age; gender; health history; current health afflictions; family health history; co-morbidity issues; and possible drug-nutrient interactions. Undoubtedly, it will take much more time before nutritional supplements are recommended by the vast majority of medical practitioners; however, many indicators suggest that the medical profession is slowly moving toward acceptance and promotion of this widely utilized health intervention.
The ultimate challenges will be to help consumers choose supplements best suited to their individual circumstances, and to avoid wasting money on supplements that are not effective bioactive agents to treat, mitigate or help manage a broad spectrum of health conditions. Medical and CAM practitioners must have easy access to relevant evidence-based literature and continuing education programs. In turn, this will enable practitioners to make safe and effective nutritional supplement recommendations, and help standardize the practice of supplementation across the spectrum of various health care practitioners.
- Fletcher RF, Fairfeld KM. Vitamins for chronic disease prevention in adults. JAMA 2002;287(23):3127-3129.
- Dietary Supplement Information Bureau (www.supplementinfo.org).
- Natural Health Product Directorate (www.hc-sc.gc.ca/hpb/onhp/welcome _e.html).
Please take time to listen to Dr. Meschino's informative interviews at www.chiroweb.com/audio/meschino. The titles of the latest interviews are: "Selenium and Its Influence on Cancer," "Benefits and Clinical Application of Alternative Medicine and Acupuncture"; and "Research and Strategies Related to Eye Health."
James Meschino, DC, MS
Toronto, Ontario Canada
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