Tufts nutrition scientists say it is premature to focus on nutrient supplements over diet

07/18/05

Authors urge caution in JAMA article: High dose nutrient supplementation may have more adverse consequences than anticipated

BOSTON, July 19, 2005, 4:00 P.M. ET--In a special communication piece that appears in the July 20th issue of the Journal of the American Medical Association (JAMA), Alice Lichtenstein, DSc, senior scientist and director of the Cardiovascular Nutrition Laboratory at the Jean Mayer U.S. Department of Agriculture (USDA) Human Nutrition Research Center on Aging at Tufts University and the Center's director and senior scientist, Robert Russell, MD, report that the most promising data on nutrition and optimal health outcomes relate to dietary patterns, not nutrient supplements. They further state that there are insufficient data to justify altering public health policy from an emphasis on foods and dietary patterns to one on supplements.

The authors emphasize that nutrient supplementation, particularly for certain at-risk populations, has an important place in health care. However, they point out that there is an important difference between observing associations between particular nutrients and health outcomes and detecting causal connections.

"Perhaps no better example exists than the disheartening results of the vitamin E intervention trials for the prevention of cardiovascular disease," says Russell. Lichtenstein explains that although observational studies suggest positive effects, "we lack supporting evidence from intervention trials, and that is critical for making recommendations to the public."

Data are insufficient in other areas as well, according to Lichtenstein. "Disease-nutrient relationships are by their nature very complex. Within the context of high dose nutrient supplementation, outcomes are frequently unexpected. Not only have some studies failed to yield positive results but, occasionally unanticipated negative effects have been observed."

The authors point out that some of the unanticipated findings from high dose single or nutrient cocktails may be because the levels used are much higher than those necessary to prevent deficiency disease. In one study, adding a nutrient antioxidant cocktail to a well established cholesterol-lowering drug treatment actually lessened the beneficial effect. "We still have a lot to learn about the use of high doses of nutrients. The important point is to prevent the cart from getting in front of the horse; we need to validate the science before there is wide scale adoption by the general public as we saw with vitamin E. We can no longer automatically assume there will be no adverse consequences," notes Lichtenstein.

In their overview of the existing literature, Lichtenstein and Russell, both professors at Tufts University's Friedman School of Nutrition Science and Policy and School of Medicine note that their caution is "based on the lack of a complete understanding of nutrient requirements and interactions, and disappointing results of intervention studies with single nutrients or nutrient cocktails."

"The identification, isolation, and purification of nutrients in the early 20th century raised the possibility that optimal health outcomes could be realized through nutrient supplementation," write the authors, but this advance has been "a double-edged sword."

While the current expert opinion is that there is not enough evidence to justify emphasizing nutrient supplements instead of food and diet for maintaining good health, this topic remains under rigorous research, and new data is published regularly. Based on the available information, the authors say, "eat a diet rich in fruits, vegetables, low-fat dairy products, whole grains and fish."

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