The first Chinese emperor and unifier of China, Qin Shi Huang, ruled from 246 B.C. to 210 B.C.  In his 35-year reign, massive construction projects included the first part of the Great Wall of China and the 8000 clay-soldier Terracotta Army with horses and chariots, which guarded his tomb.  He also purged China of all schools of thought that disagreed with his own notions, burning books, burying 460 scholars alive, and stoning another 700 scholars to death.  In his quest for immortality he became obsessed with finding the elixir of life.  In response, the court doctors and alchemists concocted a number of potions many of which contained quicksilver (Mercury), which hastened the emperor’s death.

         Even though we have become technically far more advanced, emperor Qin Shi Huang’s history remains as pertinent today as it was 2256 years ago because we are still ‘burning, burying, and stoning’ the evidence that disagrees with our own notions about the elixirs of life.  The vitamin and supplement industry has become a multi-billion-dollar establishment and remains, with very few exceptions, non-evidence based.  By non-evidence based I mean lacking the double-blind, placebo-controlled studies that would substantiate its elixir-of-life claims. 

        Laboratory evidence shows that, when studied, the ingredients in supplements may be many times more or many times less than the labeled amounts.  Moreover, impurities, adverse effects, and the details of the manufacturing processes remain largely concealed from the eye.  And, in spite of the fact that these pills and powders come in bottles and are sold on shelves, many of them are labeled ‘natural’ as if pills and powders actually grow on trees.

        At the present time, the medical sciences have enough data to say the following about certain over-the-counter vitamins and supplements, as recently reported in The Medical Letter of December 12/26, 2011.

Vitamin E in food is mainly gamma-E and acts as an antioxidant while vitamin E in supplements is mostly alpha-E, which may block gamma’s antioxidant activity, may have a pro-oxidant effect, and may interfere with clotting and platelet function.  In 26 pooled clinical trials, supplementation with vitamin E +/- vitamin A increased mortality risk.  In 9 pregnancy trials, vitamin E and C increased the risk of high blood pressure and premature rupture of membranes.  In 9 stroke trials, vitamin E increased the risk of hemorrhagic stroke by 22%.  In a large, 7-year controlled trial, men who took vitamin E had a 17% increase in prostate cancer.

Vitamin A is an antioxidant but it may also have pro-oxidant effects.  Multiple studies have shown that vitamin A supplements increase lung cancer and men with high vitamin A levels have a higher rate of prostate cancer.

Vitamin D3 800-1000 units/day plus calcium 1200 mgs/day reduce fractures and falls while vitamin D 500,000 units given once/year increased fractures and falls.

Vitamin C + vitamin E failed to reduce the risk of cancer in an 8-year study while in another study the combination also failed to prevent cardiovascular disease.  In 30 pooled trials, vitamin C failed to reduce the risk or the severity of common colds.  High doses of vitamin C cause diarrhea and might also increase the risk of kidney stones.

Vitamin B12 when given in high doses to persons who do not have a proven deficiency may increase the risk of cancers.

Folic acid prevents brain and spinal cord defects only in women of child-bearing age but high doses of folic acid may cause brain and spinal cord degeneration in those who are deficient in vitamin B12.

Vitamin B6 given with folic acid and B12 failed to reduce the risk of stroke and cardiovascular events in multiple trials.  In 12 pooled studies, vitamin B6 appeared to reduce colon cancer but in two controlled studies it did not reduce any type of cancer.

Multivitamins +/- Iron, magnesium, zinc, or copper—when studied in 40,000 women—showed an increased mortality rate.

        Before taking any supplement, and there are hundreds of unstudied supplements on the shelves, one needs to examine the controlled studies that substantiate the claims made on the labels.  Controlled studies mean that, unbeknownst to them, some persons received a placebo while others received the intended supplement.  If there are no published studies on whose basis supplements are promoted, it means that the claims made are not sanctioned by science.  It also means that the chances of harm resulting from the impurities or the active ingredients themselves have not been safely excluded to the satisfaction of scientific scrutiny.

        With very few exceptions, there is little reason to take multivitamins, or vitamin E or A or C or B.  A good clue to remember is this.  If a supplement is labeled to be good for so many things and not bad for anything because it is ‘natural’, ask for the published controlled studies, read them carefully, and discuss them with your medical scientist.  If there are no studies, then taking supplements based only on what the label says would be like the first Chinese emperor, Qin Shi Huang, who was poisoned by mercury because he believed that it was the elixir of life.