An interesting exchange of letters in the June 3, 2014 issue of The Annals of Internal Medicine offered some sharply differing views on the utility of vitamin supplements. This debate started with a review article in the December 17, 2013 issue of the Annals written for the US Preventive Services Task Force, which found limited evidence for any benefit of vitamins in preventing cancer or cardiovascular disease. An accompanying editorial was titled “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.” With a title like that, you hardly need any text, but the authors went on to say: “Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed — supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear value and might even be harmful….”

That set the stage for this month’s exchange. A quartet of experts objected vigorously to Enough is Enough, asserting that not all Americans are well-nourished, that the evidence for benefits from vitamin supplements is impressive and the risk of harm is small. They concluded by accusing the authors of the editorial of misinforming the public and the medical community.

The editorialists replied that the positive results reported in clinical trials of vitamins were “… only weak signals compatible with small or no benefit.” They went on to concede that they had not addressed the use of antioxidant vitamins in the treatment of age-related macular degeneration, which “may delay progression [of this condition] once it is started.” That is a subject we have written about, and I don’t think the anti-vitamin group needed to make a concession on that use either. But you can decide for yourself. Click here.

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