On June 19, 2002, The Journal of The American Medical Association (JAMA) contained a scientific review article by RH Fletcher, MD, MSc and KM Fairfeld, MD, DrPH, which addressed the current debate regarding the use of vitamin supplements and the prevention of chronic disease in adults. After reviewing the body of evidence on this controversial subject, these researchers advised their medical colleagues that the use of vitamin supplements is a prudent intervention in the fight against many chronic degenerative diseases. They state that vitamin deficiency syndromes such as scurvy and beriberi are uncommon in Western societies. However, sub optimal intake of some vitamins above levels causing classic vitamin deficiency, is a risk factor for chronic diseases and common in the general population, especially the elderly. Fletcher and Fairfeld conclude, “sub optimal folic acid levels, along with sub optimal 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; and, low levels of the antioxidant vitamins (vitamin 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 they suggest that physicians should make specific efforts to learn about their patients’ use of vitamins to ensure that they are taking vitamins they should, such as folic acid supplementation for women in childbearing years, and avoiding high doses of vitamin A during pregnancy or massive doses of fat-soluble vitamins at any age.
Many experts in the health field view this 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. It now appears that the medical profession is 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 versus 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 and/or effectively treat a broad number of health conditions. Surveys indicate that 60% of the adult American population and approximately 70% of Canadian adults regularly take vitamin and other 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 the patient’s age, gender, past history of health, current health afflictions, family health history, co-morbidity issues and possible drug-nutrient interactions. It will undoubtedly 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 towards acceptance and promotion of this widely utilized health intervention. In my view, the ultimate challenge will be to help consumers choose supplements that are best suited to their individual circumstances and to prevent them from wasting money on supplements that are either inappropriate for their case or are of no, or little, value compared to supplements that deliver significant preventive benefits and/or are effective bioactive agents to treat, mitigate or help better manage a broad spectrum of health conditions. To accomplish this task it is necessary for both medical and CAM practitioners to have quick and easy access to evidence-based literature and continuing education programs that keep practitioners up to date on the latest research in this field. In turn, this will enable practitioners to make safe and effective recommendations to patients regarding the use of nutritional supplements and help to standardize the practice of supplementation across the spectrum of various health care practitioners.
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