A bias against supplements within the medical community

[Perpetual Student]

Low Vitamin B12 Levels Linked to a Shrinking Brain (http://www.alzinfo.org/newsarticle/templates/newstemplate.asp?articleid=314&zoneid=3)

Edited to include link from original thread.

A bias against supplements is quite apparent here.

On the one hand:

*“Many factors that affect brain health are thought to be out of our control, but this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory,” said study author Anna Vogiatzoglou of Oxford University.But on the other hand:

*“This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage.” No evidence or rational is given for these seemingly contradictory statements. I sometimes sense a dogmatic bias against supplements within the medical community. Am I wrong?

Split from: Latest Alzheimer's research? (http://forums.randi.org/showthread.php?t=134502)

[Klimax]

A bias against supplements is quite apparent here.

On the one hand:



But on the other hand:



No evidence or rational is given for these seemingly contradictory statements. I sometimes sense a dogmatic bias against supplements within the medical community. Am I wrong?

What contradictory?First they say it possibly has some effect on brain,but since no definitive evidence is so far available they include themselves sort of disclaimer.Nothing dogmatic AFAIS.And since test is alread being conducted...

And one must not forget "mega dose C".

Maybe your sense needs bit adjusting?

[Perpetual Student]

What contradictory?First they say it possibly has some effect on brain,but since no definitive evidence is so far available they include themselves sort of disclaimer.Nothing dogmatic AFAIS.And since test is alread being conducted...

And one must not forget "mega dose C".

Maybe your sense needs bit adjusting?

Did you read the quotes I provided?
First, "simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory."
Then, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage."

Huh? Try again!

[Professor Yaffle]

Did you read the quotes I provided?
First, "simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory."
Then, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage."

Huh? Try again!

I have bolded the relevant word. All they found was an association between B12 levels and brain shrinkage, not necessarily a causative relationship. It could be (for example) that some third factor causes both the brain shrinkage and the lower levels of B12, or that levels of B12 happen to correlate with another causative factor etc etc. Hence they need a clinical trial to find out if there is a causative relationship.

[Perpetual Student]

I have bolded the relevant word. All they found was an association between B12 levels and brain shrinkage, not necessarily a causative relationship. It could be (for example) that some third factor causes both the brain shrinkage and the lower levels of B12, or that levels of B12 happen to correlate with another causative factor etc etc. Hence they need a clinical trial to find out if there is a causative relationship.

OK, fair enough. But if we should consider "adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk" why would someone (say, a vegetarian*) not "go out and buy vitamin B12 tablets tomorrow"? I saw elsewhere that toxic levels of B-12 are not an issue. I see a doctrinaire anti-supplement bias here.

*I am not a vegetarian, but I have learned elsewhere that the best sources of B-12 come from meat -- hence the reference to "fortified" cereals. And while on that point, let me observe that there is little difference between "fortifying" a food and taking a supplement.

[fls]

A bias against supplements is quite apparent here.

On the one hand:

But on the other hand:

No evidence or rational is given for these seemingly contradictory statements. I sometimes sense a dogmatic bias against supplements within the medical community. Am I wrong?

One is a statement about a balanced diet, the other is a statement about an unproven therapy. I will agree that the medical community has a bias against unproven therapies.

Linda

[Baby Nemesis]

OK, fair enough. But if we should consider "adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk" why would someone (say, a vegetarian*) not "go out and buy vitamin B12 tablets tomorrow"? I saw elsewhere that toxic levels of B-12 are not an issue. I see a doctrinaire anti-supplement bias here.

*I am not a vegetarian, but I have learned elsewhere that the best sources of B-12 come from meat -- hence the reference to "fortified" cereals. And while on that point, let me observe that there is little difference between "fortifying" a food and taking a supplement.

Perhaps they were just hedging their bets, in case some people did start spending money on supplements, and then later it turned out that they didn't help, and people complained about the extra expense they thought they'd been led to believe would be worth it.

[Klimax]

Did you read the quotes I provided?
First, "simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory."
Then, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage."

Huh? Try again!
I have bolded the relevant word. All they found was an association between B12 levels and brain shrinkage, not necessarily a causative relationship. It could be (for example) that some third factor causes both the brain shrinkage and the lower levels of B12, or that levels of B12 happen to correlate with another causative factor etc etc. Hence they need a clinical trial to find out if there is a causative relationship.
What he said.

OK, fair enough. But if we should consider "adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk" why would someone (say, a vegetarian*) not "go out and buy vitamin B12 tablets tomorrow"? I saw elsewhere that toxic levels of B-12 are not an issue. I see a doctrinaire anti-supplement bias here.

*I am not a vegetarian, but I have learned elsewhere that the best sources of B-12 come from meat -- hence the reference to "fortified" cereals. And while on that point, let me observe that there is little difference between "fortifying" a food and taking a supplement.

Well,from some articles said that "artificially" produced vitamins may not be effective as they were/may be wrong conformation.
Never dug under,so cannot say for sure.
B12 from tablets might have bigger problems getting in blood and to brain and/or there might be additional chemicals in meat affecting effectivnes of B12.
And lastly,supplements are usually not tested,except for safety,that's why they are usually not recommended.(There are some exceptions like B-komplex,product of Zentiva,which are sometimes prescribed by physicians and at the same time they are OTC supplements.)

[Perpetual Student]

One is a statement about a balanced diet, the other is a statement about an unproven therapy. I will agree that the medical community has a bias against unproven therapies.

Linda


Come on! The contradiction is obvious. I'm sensing a lot of defensiveness here from people with ties to the medical community. The suggestion to consider "adjusting our diets to consume more vitamin B12 through eating meat, fish..." is not a statement about a balanced diet.
As tenuous as the evidence may be here for the case of taking B-12 supplements, why would anyone advise against a prudent elderly person spending a few cents a day on this harmless supplement? If a correlation to B-12 intake is demonstrated ten years from now with good science (it would probably take that long), what benefit will it have for someone who has allowed his dementia to progress, by following this baseless and biased advice?
If no correlation is found, so he is out a few dollars (if he has dementia he won't care anyway). Is it worth it?

[sol invictus]

Come on! The contradiction is obvious.

Not to me.

And she didn't "advise against" it - she just said one shouldn't take the research as advice for it, while adding that it indicates that it may help.

[Perpetual Student]

Not to me.

And she didn't "advise against" it - she just said one shouldn't take the research as advice for it, while adding that it indicates that it may help.

"This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow"
sounds like advising against taking the supplement to me! I would not expect the statement "DO NOT TAKE B-12 SUPPLIMENTS!" unless there were toxic levels to be concerned about.
I'll tell you what: I am 69 years old and will take this harmless and inexpensive supplement based on my life experiences of playing the odds (I made my living as a actuary). If I proves to be worthless in a few years, I will have wasted a few dollars. If it proves to be beneficial, it will have improved my odds of knowing about it. It looks like a good bet to me!

[fls]

Come on! The contradiction is obvious.

Because you don't understand the difference between diet and supplements. You are probably used to seeing supplement manufacturers making claims based on research findings from diet in order to obscure the lack of research supporting the use of supplements. Since they treat them the same, you have become used to considering them the same thing.

I'm sensing a lot of defensiveness here from people with ties to the medical community.

Defensiveness? What the hell would we have to be defensive about? It's no skin off our back whether we recommend supplements or dietary changes. We merely prefer to make evidence-based recommendation - I don't know why this bugs you.

The suggestion to consider "adjusting our diets to consume more vitamin B12 through eating meat, fish..." is not a statement about a balanced diet.
As tenuous as the evidence may be here for the case of taking B-12 supplements, why would anyone advise against a prudent elderly person spending a few cents a day on this harmless supplement? If a correlation to B-12 intake is demonstrated ten years from now with good science (it would probably take that long), what benefit will it have for someone who has allowed his dementia to progress, by following this baseless and biased advice?

Why are you assuming the benefit outweighs the harm when you don't know either?

If no correlation is found, so he is out a few dollars (if he has dementia he won't care anyway). Is it worth it?

As has already been pointed out to you, nobody advised against an elderly person taking a supplement. They simply pointed out that there isn't evidence to suggest that it would be helpful.

Linda

[Perpetual Student]

Because you don't understand the difference between diet and supplements. You are probably used to seeing supplement manufacturers making claims based on research findings from diet in order to obscure the lack of research supporting the use of supplements. Since they treat them the same, you have become used to considering them the same thing.

You have no information about the understanding I have about the difference between diet and supplements and no basis to make such a comment.


Defensiveness? What the hell would we have to be defensive about? It's no skin off our back whether we recommend supplements or dietary changes. We merely prefer to make evidence-based recommendation - I don't know why this bugs you.

What could be more defensive than the above comment?

Why are you assuming the benefit outweighs the harm when you don't know either?


I know that the benefit is possible and the harm is negligible. Do you know that too or do you know the contrary?


As has already been pointed out to you, nobody advised against an elderly person taking a supplement. They simply pointed out that there isn't evidence to suggest that it would be helpful.
Linda

"This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow" is quite clearly advice against "go(ing) out and buy(ing) vitamin B12 tablets tomorrow." What else do you need?
As I said, the medical community is clearly biased against supplements. Thank you for providing more evidence in support of that fact.

[fls]

You have no information about the understanding I have about the difference between diet and supplements and no basis to make such a comment.

Then I am interested in your explanation for why you do not distinguish between the two.

What could be more defensive than the above comment?

Many things could be more defensive than the above comment. A statement of defense, for example, would be more defensive than a statement of explanation.

Seriously, why would I be defensive? Like I said, it makes no difference whatsoever to doctors whether or not the thing demonstrated to be useful is 'diet' or whether it is 'supplement'. There are many examples of recommendations of both based on evidence (e.g. folate supplementation before pregnancy, two servings of fish per week for omega-3's). So why are you assuming that doctors a priori avoid recommendations for supplements when the evidence says otherwise?

I know that the benefit is possible and the harm is negligible. Do you know that too?

What I meant is that it has not been established that there is benefit or that there is harm, so why assume one or the other in the absence of evidence for one or the other?

"This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow" is quite clearly advice against "go(ing) out and buy(ing) vitamin B12 tablets tomorrow." What else do you need?

I understand that you have chosen to interpret her words that way. However, the contradiction of a 'no' statement is a 'some' statement (basic deduction from categorical propositions). So the contradiction for "no people should buy B-12 tablets" is "some people should buy B-12 tablets".

As I said, the medical community is clearly biased against supplements. You have provided more evidence in support of that fact.

The evidence that has been presented so far shows that the medical community is biased towards evidence-based statements. You have not provided an example of an anti-supplement recommendation that contradicts the evidence.

Linda

[Perpetual Student]

From the NIH:

"What is the health risk of too much vitamin B12?
The Institute of Medicine of the National Academies did not establish a UL for this vitamin because vitamin B12 has a very low potential for toxicity. The IOM states that "no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals" [7]. In fact, the IOM recommends that adults older than 50 years get most of their vitamin B12 from vitamin supplements or fortified food because of the high incidence of impaired absorption in this age group of vitamin B12from foods that come from animals [7]."

LINK (http://ods.od.nih.gov/factsheets/vitaminb12.asp#h11)

How about that, Linda?

Bill

[fls]

From the NIH:

LINK (http://ods.od.nih.gov/factsheets/vitaminb12.asp#h11)

How about that, Linda?

Bill

Is that meant to be evidence against your assertion that there is an anti-supplement bias among doctors?

Linda

[Perpetual Student]

Is that meant to be evidence against your assertion that there is an anti-supplement bias among doctors?

Linda

No, it is evidence that the NIH doesn't "understand the difference between diet and supplements"(your words) and the NIH is "used to seeing supplement manufacturers making claims based on research findings from diet in order to obscure the lack of research supporting the use of supplements"(again). I love irony!;)

And, it is evidence that the Oxford researcher was so biased against supplements that she did not know that "the IOM recommends that adults older than 50 years get most of their vitamin B12 from vitamin supplements or fortified food because of the high incidence of impaired absorption in this age group of vitamin B12from foods..."

And, your knee jerk response to my comments are evidence of your own anti-supplement bias, especially in light of the NIH recommendations.

And, no physician has ever mentioned to me that I should take B12 supplements, in spite of the NIH recommendations. As I mentioned earlier, I am 69 and I consult with several physicians.

Proof enough? To use a sports analogy, I would call this a KNOCK OUT punch!

[Professor Yaffle]

"This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,”


How on earth does this statement mean to you that the researcher is telling people they shouldn't take supplements. It is solely a statement that the research they have done is not a strong enough reason to begin taking the supplements (because they have not yet established a cause-effect relationship). I really don't understand how anyone could read it any other way than this.

[Perpetual Student]

How on earth does this statement mean to you that the researcher is telling people they shouldn't take supplements. It is solely a statement that the research they have done is not a strong enough reason to begin taking the supplements (because they have not yet established a cause-effect relationship). I really don't understand how anyone could read it any other way than this.

More defensiveness! How could someone doing that research not know the NIH recommends B12 supplements for people over 50? Based on that small Oxford study, she should have said something like, "this is further evidence that people over 50 should take B12 supplements." Instead she made the negative comment shown above about using a B12 supplement. We are seeing a lot of defense here!

[fls]

No, it is evidence that the NIH doesn't "understand the difference between diet and supplements"(your words) and the NIH is "used to seeing supplement manufacturers making claims based on research findings from diet in order to obscure the lack of research supporting the use of supplements"(again).

Ah, I see. No, that is not an example. That information comes from research performed on supplements. So it is appropriate that it mentions supplements.

And, it is evidence that the Oxford researcher was so biased against supplements that she did not know that "the IOM recommends that adults older than 50 years get most of their vitamin B12 from vitamin supplements or fortified food because of the high incidence of impaired absorption in this age group of vitamin B12from foods..."

Since her statements were made with respect to evidence for B-12 supplementation in the prevention of Alzheimer's disease, you don't know what she would have to say in regard to supplementation for other reasons.

And, no physician has ever mentioned to me that I should take B12 supplements, in spite of the NIH recommendations. As I mentioned earlier, I am 69 and I consult with several physicians.

This is probably because most people of your age do not need supplements. Most do not have a condition which would impair absorption, and of those who do, a balanced diet would include sufficient fortified foods to make up for that. This information is included in the IOM report.

Linda

[Baby Nemesis]

Perpetual Student, don't forget they only recommended against rushing off to buy supplements until after clinical trials were done to establish whether they would be beneficial:

*However, the study did not look at whether taking vitamin B12 supplements would have similar benefits for the brain. David Smith, another author of the study, said the work established an association between low B12 levels and a shrinking brain, but it’s not clear if the nutrient deficiency actually caused the shrinkage.

*“This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage.”

[Professor Yaffle]

More defensiveness! How could someone doing that research not know the NIH recommends B12 supplements for people over 50? Based on that small Oxford study, she should have said something like, "this is further evidence that people over 50 should take B12 supplements." Instead she made the negative comment shown above about using a B12 supplement. We are seeing a lot of defense here!

Have a look through some other research that doesn't concern supplements. I am sure you will find equivalent statements. You are reading far too much into this. If the research was about the overall pros and cons of taking B12 supplements, you would be right, but it wasn't. The statement you are referring to was simply a caution that people reading it should not automaticlly assume that B12 would prevent alzheimer's and that they should not add B12 supplements on the basis of this research.

And I don't know what you think I am being defensive about. I don't even work in the health sector. I've just read enough research to understand the point they are making (and to be honest, anyone without some sort of axe to grind could see the point they are making).

[Perpetual Student]

Have a look through some other research that doesn't concern supplements. I am sure you will find equivalent statements. You are reading far too much into this. If the research was about the overall pros and cons of taking B12 supplements, you would be right, but it wasn't. The statement you are referring to was simply a caution that people reading it should not automaticlly assume that B12 would prevent alzheimer's and that they should not add B12 supplements on the basis of this research.

And I don't know what you think I am being defensive about. I don't even work in the health sector. I've just read enough research to understand the point they are making (and to be honest, anyone without some sort of axe to grind could see the point they are making).

Look, this is very simple. "The IOM recommends that adults older than 50 years get most of their vitamin B12 from vitamin supplements or fortified food because of the high incidence of impaired absorption in this age group of vitamin B12from foods that come from animals."
Now, these people at Oxford did research indicating that B12 levels were negatively correlated with brain shrinkage and dementia. Instead of saying something like, "we have further evidence here in support of taking B12 supplements for those over the age of 50," they said, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,”
That is a strong indication of a reluctance to support the use of supplements, which I believe I have seen before within the medical community.
Do I have an "ax to grind"? YOU BET! I am 69 years old and will do whatever makes good commom sense to prevent dementia, including taking a harmless and inexpensive B12 tablet that may or may not help.

[fls]

The recommendation from the IOM reads as follows (so as not to introduce any misunderstanding because of paraphrasing):

"Because 10 to 30 percent of older people may be unable to absorb naturally occurring vitamin B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a vitamin B12-containing supplement."

Linda

[fls]

Now, these people at Oxford did research indicating that B12 levels were negatively correlated with brain shrinkage and dementia. Instead of saying something like, "we have further evidence here in support of taking B12 supplements for those over the age of 50," they said, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,”
That is a strong indication of a reluctance to support the use of supplements, which I believe I have seen before within the medical community.

They didn't say that because the evidence provided by that study simply doesn't support that conclusion. The medical community is biased towards making evidence-based conclusions and statements based on those conclusions. If you ask for them to make statements that are not evidence-based, you will see resistance. It has nothing to do with supplements. The study could have been about aspirin and the result would be the same.

Do I have an "ax to grind"? YOU BET! I am 69 years old and will do whatever makes good commom sense to prevent dementia, including taking a harmless and inexpensive B12 tablet that may or may not help.

Seriously, it's perfectly okay for you to take a B12 supplement.

Linda

[Professor Yaffle]

Seriously, it's perfectly okay for you to take a B12 supplement.
Linda

And nobody said (s)he should stop...

[Skwinty]

Instead of saying something like, "we have further evidence here in support of taking B12 supplements for those over the age of 50," they said, "This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow


Perhaps they don't wish to compared to the Mattias Rath foundation.
He came to South Africa and caused untold damage with his
supplement quackery. Mind you he did have a partner in crime
Manto Tshabalala Msimang the South Afrian minister of health. She was known as Dr Beetroot.

Take 2 veg and call me in the morning. All this to cure AIDS.

[Skwinty]

Do I have an "ax to grind"? YOU BET! I am 69 years old and will do whatever makes good commom sense to prevent dementia, including taking a harmless and inexpensive B12 tablet that may or may not help.

Perhaps you should smoke some weed. There is lots of evidence that this helps prevent the onset of Alzheimers.

[Perpetual Student]

Seriously, it's perfectly okay for you to take a B12 supplement.

Linda

Oh, happy day! I'll triple my daily dosage!:rolleyes:

[Skeptic Ginger]

...


No evidence or rational is given for these seemingly contradictory statements. I sometimes sense a dogmatic bias against supplements within the medical community. Am I wrong?Yes, you are wrong. The medical community would love it if a pill replaced dietary vitamins. But the fact is in many studies, vitamins have not turned out to match the effects of their real food source counterparts.

But as Linda says, that doesn't mean vitamins are harmful or have no benefit.

OTOH, vitamin E and C have had mixed results in cardiac studies with the vitamins sometimes being worse than no vitamins. I take the 2 together because in a study combining them the outcome was better than no vitamin.

[the_smasher]

I don't know if there is a bias against supplements or not, but I don't think the linked article is a good starting place for discussion. The article and original post have quotes from two different authors of the study, possibly responding to different questions or conversations from the interviewer. Maybe a better example could be found?

Also, I believe the AAP recommends supplements of folic acid for expectant mothers and vitamin D for breastfeeding babies. If there is a bias, is it only against certain supplements or groups of people?

[athon]

I don't understand the fuss.

*“This doesn’t mean you should go out and buy vitamin B12 tablets tomorrow,” he said. “We need to know the results of a clinical trial in which we’re testing whether B12 does actually prevent brain shrinkage.”

And...it doesn't. The statement is not suggesting one should not take B12. It says the conclusion 'B12 might have an effect on brain development' does not merit the action 'supplement your diet with more B12'.

Sounds like good advice to me. It's suggesting that since you have to eat, you might as well eat foods with B12. But the evidence isn't strong enough to tell people they need to go that extra step and buy supplements.

Athon

[sol invictus]

"Vitamin supplements 'do us no good and may be harmful'"

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/vitamin-supplements-do-us-no-good-and-may-be-harmful-809607.html

[Perpetual Student]

"Vitamin supplements 'do us no good and may be harmful'"

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/vitamin-supplements-do-us-no-good-and-may-be-harmful-809607.html

From that article:
"The findings show that, if anything, people in trial groups given beta-carotene, vitamin A and vitamin E showed increased rates of mortality. There was no indication that vitamin C and selenium may have positive or negative effects; we need more data [on these]."

The researchers separated out the 47 trials with a low risk of bias and in these they found a significantly increased death rate. When taken separately, vitamin A was associated with a 16 per cent increased mortality, beta-carotene with a 7 per cent increase and vitamin E with a 4 per cent increase. For vitamin C and selenium there was no significant increase or decrease in the death rate.
The negative effects of vitamin A (&beta-carotene) and vitamin E supplements have been known for some time.

And vitamin C supplements have pretty much proven to be useless.

However, selenium supplements may have some value:

http://www.mayoclinic.org/news2007-mchi/4369.html (http://www.mayoclinic.org/news2007-mchi/4369.html)
and:
http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Selenium.asp?sitearea=ETO
"One long-term controlled study of people who had had skin cancer was started in 1983. The selenium supplement had no effect on the patients’ skin cancer; however, it was found that patients given a supplement of 200 micrograms of selenium per day had significantly fewer cancers of the lung, colon and rectum, and prostate, and fewer deaths from lung cancer than those who did not receive it."The point here is that one cannot make a blanket statement about all supplements. Each has to be studied independently.

However, are the same rules applied to other procedures used by the medical community? Have you had your annual chest X ray this year?
http://www.cancer.gov/newscenter/mayo20