Vitamin Rebuttal

[cshadyp]

I'm sure some of you have heard about Rhonda Patrick from the Joe Rogan Experience podcast. She has "[...] a Ph.D. in biomedical science from the University of Tennessee Health Science Center, Memphis TN and St. Jude Children’s Research Hospital, Memphis TN. She also has a Bachelor’s of Science degree in biochemistry/chemistry from the University of California, San Diego. She has done extensive research on aging, cancer, and nutrition."

I've read in multiple places on your forum that you don't usually recommend supplementation (like multivitamins), and that most get enough from their food, though please correct me if I'm wrong. I want to know your take on Dr. Rhonda Patrick's vitamin rebuttal of the editorial, "Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements," which stated that vitamin and mineral supplementation is useless or even harmful. This was published in the annals of Internal Medicine. Dr. Rhonda disagrees, and explains why:

If you have time and interest, I'd appreciate your opinions. Thank you.

[Jordan Feigenbaum]

Yea, this isn't something I am interested in spending time on. She is unlikely to change her mind given her current position and we will continue to follow the evidence, which currently doesn't support her view on vitamin consumption in most populations.

[cshadyp]

I don't know what to believe. Can you at least tell me why her claims are wrong?

Methodological Problems with the studies:

1. Most studies lacked any quantitative biochemical analyses of vitamin and mineral concentrations in plasma or blood cells at baseline or at followup.
2. Many individuals in some of the studies were severely deficient in a particular vitamin and mineral, and after the treatment they were still deficient in this particular vitamin and mineral, which suggests that the dose of the vitamin and mineral supplement was inadequate.
3. In some of the studies, excessive amounts of vitamins and minerals were given.
4. In some of the studies, individuals were in a severely advanced disease state, which is strange because the editorial focuses on the effects of vitamin and mineral supplementation on disease prevention.
5. In the meta-analysis, some of the studies included positive effects of vitamin and mineral supplementation on cancer incidence and cardiovascular disease, and yet this positive data was left out and not mentioned in the editorial. This makes her believe that the authors of the editorial had an overt bias and an agenda.

She also said that there was no mention of how common vitamin and mineral deficiencies are in the U.S., and the data is available from the CDC.

She goes into more detail in the video. If you disagree, what is the evidence that you've seen specifically? I think Rhonda pretty much says in the end that we need to do more research because the studies we have now are inaccurate.

[Jordan Feigenbaum]

I don't know what to believe. Can you at least tell me why her claims are wrong?

That would mean engaging in an internet argument with someone else who is not present to state their actual position. Hard pass.

[/quote]
1. Most studies lacked any quantitative biochemical analyses of vitamin and mineral concentrations in plasma or blood cells at baseline or at followup.[/QUOTE]

Most of what studies? There are a number of well-performed studies on vitamin supplementation that do includes this. Interestingly, this is a similar problem in data used to "support" vitamin use.

'[/quote]
2. Many individuals in some of the studies were severely deficient in a particular vitamin and mineral, and after the treatment they were still deficient in this particular vitamin and mineral, which suggests that the dose of the vitamin and mineral supplement was inadequate..[/QUOTE]

That is a non clinical person trying to force the data to fit their hypothesis. Sometimes this does happen, of course, yet more often humans are more complex and vitamin deficiencies don't always respond to vitamin replacement or even cause disease.

'[/quote]
3. In some of the studies, excessive amounts of vitamins and minerals were given.[/QUOTE]

There would have to be a clinically studied dosing regimen that has been validated, which for many vitamins has not been shown- though you'd have to go vitamin by vitamin here.


[/quote]
4. In some of the studies, individuals were in a severely advanced disease state, which is strange because the editorial focuses on the effects of vitamin and mineral supplementation on disease prevention..[/QUOTE]

As far as I can tell none of these studies are held up to "prove" vitamins supplementation doesn't prevent disease, rather that disease processes are more complex and artifacts of those diseases- such as vitamin deficiencies- are hard to treat.

[/quote]
5. In the meta-analysis, some of the studies included positive effects of vitamin and mineral supplementation on cancer incidence and cardiovascular disease, and yet this positive data was left out and not mentioned in the editorial. This makes her believe that the authors of the editorial had an overt bias and an agenda.[/QUOTE]

There are no reliable benefits on vitamin and mineral supplementation on cancer or cardiovascular disease. At best, some small data sets suggest a marginal benefit -though this data is at risk for Type I error given the small sample sizes (on vitamin D for example) and at present, the bulk of the data doesn't seem to show a benefit > risk. This has been repeatedly studied in many different populations and again, we'll have to go through vitamin by vitamin.

[/quote]
She also said that there was no mention of how common vitamin and mineral deficiencies are in the U.S., and the data is available from the CDC.[/QUOTE]

Again, treating these "deficiencies" depends on the vitamin or mineral and the benefit of vitamin replacement. Blanket statements are generally a bad idea.

[/quote]
She goes into more detail in the video. If you disagree, what is the evidence that you've seen specifically? I think Rhonda pretty much says in the end that we need to do more research because the studies we have now are inaccurate.
[/QUOTE]

Claims made without evidence can be dismissed without evidence. I'm dismissing these claims on that basis and you'll need to ask a more specific question if you want resources. I would also encourage you to see what you can find.

Some vitamin D stuff:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007469.pub2/full?highlightAbstract=mortality%7Cwithdrawn%7Cvitamin%7Cmortal

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007470.pub3/full?highlightAbstract=mortality%7Cwithdrawn%7Cvitamin%7Cmortal

[cshadyp]

Interesting. I tend to side with you, but I will be looking into it. I'm out of my element here, haha. I remember Rhonda calling out quacks like Dr. Mercola, and it's true you see a lot of doctors who don't know anything about nutrition. Here, I thought Rhonda with her expertise in biochemistry, would bring something new to the table, but every time I begin to trust someone, I'm disappointed. Can you tell me what credentials/skillset a person needs to see the truth in nutrition research? Is it true that doctors only take one nutrition course in their schooling?

[Jordan Feigenbaum]

If you're wanting clinical advice, e.g. stuff that applies to patients, then you'd probably want it to come from a clinician (MD, DO, or similar) who has expertise in the particular topic that interests you and/or a medical professional in a public health role. That being said, these are very general guidelines.

Most medical schools these days don't have distinct "classes" anymore, rather integrated learning modules and problem based learning are becoming popular. In that sense, there's a lot of nutrition education baked into each module, where applicable, in addition to residency training for some specialties. That being said, I tend to think most professionals without a personal interest in nutrition science won't have sufficient knowledge to discuss the intricacies pertaining to nutrition, though they would likely be aware of the data surrounding vitamin supplementation in populations they treat- which tend to be of no benefit in most individuals.

If someone is recommending widespread vitamin supplementation....that is a big red flag.