The U.S. Preventive Services Task Force (UPSTF) is an independent panel of volunteer experts who are charged with the job of reviewing published evidence on health-related matters, making recommendations, and establishing guidelines. The only reason I have written about the USPSTF in the past is the issue of PSA screening for prostate cancer (PCa).
This time, the USPSTF is promulgating guidelines about something far more common and widespread: adult use of vitamins and supplements. The panel recently “commissioned a review of the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation.”[i]
If you personally take one or more of these over-the-counter (OTC) products, you are among the estimated 86% of Americans who do.[ii] Why do so many people spend over $10 billion annually on these pills and liquids? It’s because they believe that vitamins and supplements promote health, especially heart health and cancer prevention.
With regard to cardiovascular and cancer benefits, the USPSTF’s latest statement says all these users are mistaken. After combing through 84 studies for pros and cons of supplementation, the panel says there is not enough evidence to “determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.”[iii] Is this disappointing? Their findings are not new. They are in line with their 2014 conclusion that there’s not enough evidence to evaluate the balance of pluses and minuses regarding multivitamins and nutrient supplements.
Today’s panel also has the same “moderate certainty” it had in 2014 over two particular supplements that either provide no protection or can actually be harmful:
- Vitamin E supplements offer no net benefit in preventing cardiovascular disease or cancer
- Beta carotene, when taken by smokers or persons whose work exposes them to asbestos, increases the incidence of lung cancer.
Importantly, taking high doses of certain supplements can also be harmful. Increased dosing with vitamin A can lower bone density, while high doses may do liver damage. Vitamin D at high doses raises the chances of kidney stones. The panel recommends that users practice due diligence before taking high amounts of any supplement.
On the other hand, the USPSTF has in fact published numerous recommendations on evidence-based ways to lower the risk of heart disease and cancer, including cancer screenings, statin drug use, aspirin use, smoking cessations, behavioral and lifestyle interventions to prevent obesity/metabolic disorders, and counseling to reduce preventable skin cancers. They support specific research-based supplement use, like vitamin D and calcium to reduce bone mineral loss, vitamin D to help prevent older adults from falling, and folic acid during pregnancy to help prevent certain brain/spine birth defects.
Do we need to take vitamins?
In reality, most Americans who take nutritional supplements may be the victims of clever marketing rather than proven benefits. That’s the opinion of Dr. Peter Ubel of Duke University, who says it’s easy to market the unproven benefits of supplements due several biases in what people believe: a) vitamin supplements are good; b) if a little is good, then more must be better; c) vitamins occur in nature, so supplements are “natural” and therefore good for health; and d) action—that is, taking vitamins—is better than inaction—that is, leaving nutrition to diet alone.[iv]
Do you believe that the natural way is truly the best way to stay healthy? If so, skip the supplements and eat more nutritious foods, says the Academy of Nutrition and Dietetics. While there are some people who truly benefit from popping vitamin pills, this isn’t true for most people in our resource-blessed nation. “Taking a daily dose of any of the single minerals, vitamins or multivitamin/mineral supplements that line the shelves of supermarkets and drug stores may be tempting. However, according to the 2020 – 2025 Dietary Guidelines for Americans, ‘Nutritional needs should be met primarily from foods and beverages — specifically nutrient-dense foods and beverages.’”[v]
Nutritional supplementation and prostate health
When it comes to prostate health, our Center stands by the principle that if it’s good for the heart, it’s good for the prostate. While each person is born with a unique genetic program in terms of their immune system and health-related risk factors (e.g., a family history of heart disease, cancer, etc.), everyone can take advantage of good lifestyle choices to optimize their individual health. This includes diet, exercise, rewarding social relationships, stress management, etc. There is ample research showing that obesity and metabolic disorders that lead to chronic inflammation in the body increase the chances for cancer, including prostate cancer (PCa). These risk factors can be genetically modified through proactive lifestyle changes, as demonstrated by the famous 2008 PCa study conducted by Ornish, et al.
I value evidence-based medicine. I occasionally blog about new studies I find on the merits of specific supplements in regard to prostate cancer (PCa). Here are two examples:
- Are Men’s Health Supplements Worthless for Prostate Cancer?
- Can a Simple Dietary Supplement Cure Prostate Cancer?
I also believe in informed decision-making. If you choose to use nutrition supplements, don’t just look at the ingredients and the suggested daily dose. First and foremost, discuss using supplements with your doctor, whose access to your health records gives him/her information (e.g., test results) which can point to nutritional deficiencies and how supplements may help fill gaps. Just as important, before you plunk money down for a product, research the manufacturer. Keep in mind they are profit-driven. Supplements are not regulated, and product names may psychologically hook you into interpreting that you’ll become super healthy. For example, when I googled “best power vitamins,” here are some actual product names (and my skeptical comments):
- Pure Synergy Super Food (not only will your body achieve health, your energy may reach new heights)
- Brain & Body Power (take these pills and you’ll build mental as well as physical muscle)
- Balance of Nature Fruits & Veggies Whole Food Supplements (does this mean you’ll never have to eat broccoli again?)
To be clear, I’m not telling you to put your wallet away and never purchase another vitamin or supplement. Rather, I’m suggesting you give consideration to the USPSTF recommendations. True, their shifting PSA screening guidelines have created some confusion and alarming PCa trends over the last decade. However, the panel’s research and conclusions on supplements have been stable and consistent. I support the position that our best nutrition comes from a well-balanced diet. I have posted more blogs on the merits of anti-inflammatory diets like the Mediterranean and DASH diets, which are backed by ample evidence of cardiovascular and cancer prevention value. This means your prostate can prosper, as well. Just think about it.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] US Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326-2333. doi:10.1001/jama.2022.8970
[iii] USPSTF, ibid.
[iv] Ubel PA. Why Too Many Vitamins Feels Just About Right. JAMA Intern Med. Published online June 21, 2022.
[v] Klemm, Sarah. “Vitamins, Minerals and Supplements: Do You Need to Take Them?” Eat Right/Academy of Nutrition and Dietetics, July 6, 2020.