Multivitamins in postmenopausal women: One doctor’s view of the WHI study

by James Hubbard, M.D., M.P.H.

The conclusion from the Women’s Initiative Study that multivitamins don’t prevent cancer, heart disease or overall mortality troubles me for some reason.

Don’t get me wrong, I love the Women’s Initiative Study. It involves a large group of women (161, 808) followed over a long period (eight years in this instance.)  Statisticians analyze the tons of data known about this group and report the findings.  The data doesn’t care what I or anyone else thinks.  It is what it is.

In the comment section of this report the author cites two other good, long-term women’s studies that showed an association between multivitamins and decreased colon cancer. It took 10 years in one group and 15 years in the other to start seeing a decrease.

But that’s not what bothers me.  It’s not the study itself, but that people might get the idea no one needs vitamins. I mean, the New York Times has an article entitled “Vitamins; A False Hope?” This was a study on multivitamins, in set doses.  It concluded nothing about set groups of individuals needing specific vitamins at other dosages.

I’m not talking about groups with diseases here either.  I’m saying particular vitamins are very important to certain groups of otherwise healthy people. Enough so that they should consider supplementation.


WHO NEEDS VITAMINS?

For instance, take pregnant women or those who might become pregnant. They need to make sure they have enough folic acid (folate). Sure you get it from diet, but if you’re a deficient you’re risking serious neurological birth defects in your baby.  The neurological system starts developing early—maybe even before you know you’re pregnant—so why take chances?  The usual recommendation is 400 micrograms (0.4 mg) daily.

Then there’s iron.  Menstruating women lose blood, which contains iron.  Again, diet is essential, but it doesn’t hurt to get a blood count check at your regular doctor visit.  I’ve seen a lot of anemic women who need a little extra iron supplement.  Men and nonmenstruating women should not take it routinely unless they’re anemic, as it can cause an iron overload in the liver.

As I’ve mentioned before, 2008 was the year of vitamin D. With so many studies showing so many positive benefits, a supplement of around 400 IU seems a good idea.  Most of us don’t get enough sun and vitamin-D-rich food to ensure we get enough otherwise.

If you’re lactose intolerant, or just don’t like calcium-containing foods like milk, cheese or yogurt, consider taking 1000 mg per day.

And if you can find these in a multivitamin, well, why not take it?

I am in no way implying a supplement will take the place of a healthy diet in which we get vitamins and minerals in the form and combination we can best utilize.  Neither do I necessarily think more is better.  Not long ago we thought high doses of beta carotene decreased the risk of lung cancer in smokers until a study showed it actually did the opposite.

I’m just going with the information I have at hand.  With new vitamin studies coming out all the time these days, I’m sure some recommendations will change.

What do you think?  Some vitamins cause side effects such as nausea or constipation.  What do you do and do the new studies influence you?

As always, these are not personal recommendations and can’t take the place of a consultation with your doctor.

Doctors and business owners: Send customized issues of James Hubbard’s My Family Doctor to your customers or patients. E-mail publisher-at-familydoctormag.com for details.

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10 Responses to “Multivitamins in postmenopausal women: One doctor’s view of the WHI study”

  1. LizS Says:

    Great post! And I wrote about this very issue on Flashfree. Appreciate your comments here and there!

    LizSs last blog post..Wednesday “Bubble:” Bioidentical “hormones”

  2. James Hubbard, M.D., M.P.H. Says:

    Thanks Liz, Yes I read your post at http://flashfree.wordpress.com/2009/02/10/wednesday-bubble-vitameatavegamin/ and think it was terrific.

  3. FatFighterTV Says:

    Thanks for your input on this.

    Personally, I have taken a multivitamin every day for as long as I can remember. And I will continue to do so. I figure it can’t hurt and it might help with something!

  4. Sagan Says:

    I don’t take anything. There’s too many contradicting studies about vitamins for me to take a definitive stance on the issue… I need to do more research before even starting to take a multivitamin.

    Sagans last blog post..Taking the “work” out of the workout

  5. James Hubbard, M.D., M.P.H. Says:

    FatFighter,

    There is a big study coming out in 2012 which is supposed to give us more answers. However, it is men this time.

  6. James Hubbard, M.D., M.P.H. Says:

    Sagan, the research backs you up right now.

  7. Blake Says:

    Thanks for the info. I agree, a multivitamin can’t replace a healthy diet, but it may help get the necessary vitamins and minerals some people need.

    Blakes last blog post..A Ridiculous Ticket and My Favorite Fruits and Veggies

  8. Shelley Binkley MD Says:

    Great post, JH! I think the importance of vitamins is way underestimated by the medical “establishment”. People (patients and health care providers) tend to overlook the basics when distracted by the fancy high-tech options.

    Shelley Binkley MDs last blog post..Breast-feed and Protect Two Hearts at Once

  9. James Hubbard, M.D., M.P.H. Says:

    Thanks, Dr. B,

    You are so right

  10. design logotipos Says:

    fantastic blog you got here. Just find you using amazon! thanks all you empaty into this job online.

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