Dr Thomas Stuttaford, Medical Briefing
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Every first-year medical student knows that the basis of a good diet is the correct balance of carbohydrate, fat and adequate protein, coupled with the correct amount of vitamins and trace elements, but without added salt.
Most would add that people should have five different types of fruit and vegetables (not including potatoes), and oily fish twice a week, with adolescent women needing a higher calcium diet than usual.
Most also believe that eating regularly, with meals in which the daily calorie intake has been divided equally between three meals, has advantages.
If all the food was good quality and fresh, from land that had been well cultivated, and the meat free range and not artificially fattened, it would be an added advantage. But few have the time, or live in the right environment, to achieve this.
Our food hasn’t been freshly picked, fished or slaughtered, and the vitamin content is low. We frenetic commuters have to make do with precooked, reheated calorie-dense foods stripped of their vitamin content. Those who decry vitamin and mineral supplements are harking back to an earlier era. If we are to have a satisfactory diet we now need to opt for second best and take a good quality multivitamin and mineral supplement. The value of vitamins has been proved with the vitamin folic acid, without which the number of deformed or disabled babies would have burgeoned, and the Omega 3 fats that improve intellectual ability in children and protect the cardiovascular systems in adults. Without additional calcium and vitamin D, the incidence of osteoporosis in a society where people are living longer will burden the health service with even more fractures.
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As a confirmed quack watcher I'd normally lap up the kind of study to which David Colquhoun refers. But it's flawed and confused. Look closely at how the data was actually compiled. Try using this to rubbish the nutriquacks and they'll come back and point out its limitations. We need a proper study, not one cobbled together with shifting criteria.
David, London, UK
One certainly has to sympathise with DPF. Yet again the papers presenthim with contradictory views on the same page. This time it is fairly easy though. The study described so well by Nigel Hawkes was careful and scholarly. One wonders if Dr Stuttaford actually bother to read it before expressing his opinions.
Often one is forced into making deceisions based on inadequate evidence, but not in this case. It has been obvious for many years that the claims made by the "supplement" industry are vastly exaggerated. No it seems that they may actually harm more than your wallet.
David Colquhoun, London, UK
If the claims made in this country for dietary supplements and health foods were made in the USA, they would have to go through the same stringent tests as other drugs making the same claims. In this country this level of proof is not required, so just about anything can claimed. It is not difficult to have a reasonably balanced diet, despite our 'frenetic' lifetsyles, so there is no need for all of these supplements (except perhaps for folic acid).
David Leslie, Perth, Scotland
Dr. Tom : If I read the JAMA article correcty, it is a compilation of over 300 other studies, which may or may not have similar criteria. There are many papers in the medical literature which support virtually any position one might choose to take. The two predictors of elederly fractures would appear to be: 1.) how far north your ancestors originated in Europe or Asia; and 2.) The amount of fluoride in the ground water before puberty. Vitamin D most likely has little real effect in decreasing elderly fractures. Selenium and lycopene have been associated with decreased prostate cancer. Genetics are probably a much greater determinant in coronary artery disease, than any other thing. But the bigger question is: are large scale epidemiologic studies of any real value to the individual? Or, is a study like this simply "stacked hearsay", as the US court system would call it?
Tony Francis MD , Wichita, KS/USA
DPF, one article reports evidence that several vitamin supplements do no good at all, whereas Dr. Stuttaford's presents an opinion that ignores this evidence. Worse, he seems to suggest that good evidence for the benefit of some vitamins (especially that for folic acid in early pregnancy) automatically implies that all vitamins and supplements are beneficial. What nonsense. For any drug, vitamins included, careful testing is vital to ensure that an assumed benefit - however obvious that assumption may seem - translates into an actual benefit in real life. Human beings are complicated things!
James, Cambridge,
So this article says take your vitamin pills, the one a few lines up says dont. I have no idea what I am supposed to do.
DPF, London,