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Health & Medicine for Senior Citizens

Multivitamins with Minerals May Save Lives of Older Women with Invasive Breast Cancer

WOW - Following years of bashing multivitamins, there is possibility they are lifesaver for senior women ages 50 to 79 - See information on below news report

October 10, 2013 - Findings from a study involving thousands of postmenopausal women suggest that women who develop invasive breast cancer may benefit from taking supplements containing both multivitamins and minerals. The new research, published yesterday in Breast Cancer Research and Treatment, found that the risk of dying from invasive breast cancer was 30 percent lower among multivitamin/mineral users compared with nonusers.

"Our study offers tentative but intriguing evidence that multivitamin/mineral supplements may help older women who develop invasive breast cancer survive their disease," said Sylvia Wassertheil-Smoller, Ph.D., lead author of the study and distinguished university professor emerita of epidemiology and population health at Albert Einstein College of Medicine of Yeshiva University.

Multivitamin/mineral supplements are the most commonly consumed dietary supplements among U.S. adults. They usually contain 20-30 vitamins and minerals, often at levels of 100 percent of U.S. Recommended Dietary Allowances or less, and the usual label recommendation is to take them daily.

The research was conducted as part of the Women's Health Initiative Clinical Trials and the Women's Health Initiative (WHI) Observational Study. Combined, the two studies include data from 161,608 postmenopausal women ages 50 to 79 when they first joined the study. These women were enrolled at 40 clinical centers throughout the United States during the years 1993-1998.

 

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The current study focused on 7,728 participants who were diagnosed with invasive breast cancer during the WHI and were followed for an average of seven years after their diagnosis. Invasive breast cancer is defined as cancer that has spread outside the membrane of the milk glands or ducts and into the breast tissue. Two common types of invasive breast cancer are invasive ductal carcinoma and infiltrating lobular carcinoma.

About Multivitamin/Mineral Supplements

Americans have been taking multivitamin/mineral (MVM) supplements since the early 1940s, when the first such products became available. MVMs are still popular dietary supplements and, according to estimates, more than one-third of all Americans take these supplements.

MVMs account for almost one-fifth of all purchases of dietary supplements and more than 40% of all sales of vitamin and mineral supplements.

(Sales of all dietary supplements in the United States totaled an estimated $30 billion in 2011. This amount included $12.4 billion for all vitamin- and mineral-containing supplements, of which $5.2 billion was for MVMs.)

More information about vitamins below news report.

After enrolling in the WHI and during repeated follow-up visits, all participants provided extensive information about their health including whether or not they had taken a multivitamin/mineral supplement at least once a week during the prior two weeks.

About 38 percent of the 7,728 women who developed invasive breast cancer during the WHI were using the supplements. The vast majority were taking the supplements before their breast-cancer diagnosis. A comparison of mortality rates revealed that women with invasive breast cancer who took multivitamin/mineral supplements were 30 percent less likely to die from their cancers than women with invasive breast cancer who hadn't taken the supplements.

Could differences between the multivitamin/mineral users and nonusers account for this finding?

The researchers looked at many possible confounding factors including additional supplements that the women took, their smoking status, education, race/ethnicity, weight, depression, alcohol use, physical activity, age at breast cancer diagnosis, and diabetes. The association between regular use of multivitamin/mineral supplements and reduced risk of death persisted even after these factors were taken into account.

"Controlling for these other factors strengthens our confidence that the association we observed – between taking multivitamin/mineral supplements and lowering breast-cancer mortality risk among postmenopausal women with invasive breast cancer – is a real one," said Dr. Wassertheil-Smoller, who also holds the Dorothy and William Manealoff Foundation and Molly Rosen Chair in Social Medicine Emerita. "But further studies are needed to confirm whether there truly is a cause-and-effect relationship here. And our findings certainly cannot be generalized to premenopausal women diagnosed with invasive cancer or to other populations of women."

Notes:

The paper is titled "Multivitamin and Mineral Use and Breast Cancer Mortality in Older Women with Invasive Breast Cancer in the Women's Health Initiative." Dr. Wassertheil-Smoller is the principal investigator of the WHI at Einstein. Other authors of the study at Einstein are Aileen McGinn, Ph.D., and Gloria Ho, Ph.D., and additional co-authors are affiliated with the following centers: University of Oklahoma Health Science Center, Los Angeles Biomedical Research Institute, University of Tennessee Health Science Center, Stony Brook University School of Medicine, University of Massachusetts Medical School, Fred Hutchinson Cancer Research Center, Stanford Prevention Research Center, University of Alabama School of Medicine at Birmingham, Brigham and Women's Hospital and the University of Arizona Cancer Center.

The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

About Albert Einstein College of Medicine of Yeshiva University

Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2013-2014 academic year, Einstein is home to 734 M.D. students, 236 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 353 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2013, Einstein received more than $155 million in awards from the NIH. For more information, please visit http://www.einstein.yu.edu and Twitter @EinsteinMed.

About Multivitamin/mineral Supplements

Dietary Supplement Fact Sheet:

Multivitamin/mineral Supplements

What are multivitamin/mineral (MVM) dietary supplements?

From Office of Dietary Supplements, National Institutes of Health (October 2013)

Click to updates and additional information

Multivitamin/mineral (MVM) supplements contain a combination of vitamins and minerals, and sometimes other ingredients as well. They go by many names, including multis and multiples or simply vitamins. The vitamins and minerals in MVMs have unique roles in the body. For more information about each one, see our dietary supplement fact sheets.

What kinds of MVM supplements are available?

There are many types of MVMs in the marketplace. Manufacturers choose which vitamins, minerals, and other ingredients, as well as their amounts, to include in their products.

Among the most common MVMs are basic, once-daily products containing all or most vitamins and minerals, with the majority in amounts that are close to recommended amounts. Higher-potency MVMs often come in packs of two or more pills to take each day. Manufacturers promote other MVMs for special purposes, such as better performance or energy, weight control, or improved immunity. These products usually contain herbal and other ingredients (such as echinacea and glucosamine) in addition to vitamins and minerals.

The recommended amounts of nutrients people should get vary by age and gender and are known as Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs). One value for each nutrient, known as the Daily Value (DV), is selected for the labels of dietary supplements and foods. A DV is often, but not always, similar to one's RDA or AI for that nutrient. The label provides the %DV so that you can see how much (what percentage) a serving of the product contributes to reaching the DV.

Who takes MVM supplements?

Research has shown that more than one-third of Americans take MVMs. About one in four young children takes an MVM, but adolescents are least likely to take them. Use increases with age during adulthood so that by age 71 years, more than 40% take an MVM.

Women; the elderly; people with more education, more income, healthier diets and lifestyles, and lower body weights; and people in the western United States use MVMs most often. Smokers and members of certain ethnic and racial groups (such as African Americans, Hispanics, and Native Americans) are less likely to take a daily MVM.

What are some effects of MVMs on health?

People take MVMs for many reasons. Here are some examples of what research has shown about using them to increase nutrient intakes, promote health, and reduce the risk of disease.

Increase nutrient intakes
Taking an MVM increases nutrient intakes and helps people get the recommended amounts of vitamins and minerals when they cannot or do not meet these needs from food alone. But taking an MVM can also raise the chances of getting too much of some nutrients, like iron, vitamin A, zinc, niacin, and folic acid, especially when a person uses more than a basic, once-daily product.

Some people take an MVM as a form of dietary or nutritional "insurance." Ironically, people who take MVMs tend to consume more vitamins and minerals from food than those who don't. Also, the people least likely to get enough nutrients from diet alone who might benefit from MVMs are the least likely to take them.

Health promotion and chronic disease prevention
For people with certain health problems, specific MVMs might be helpful. For example, a study showed that a particular high-dose formula of several vitamins and minerals slowed vision loss in some people with age-related macular degeneration. Although a few studies show that MVMs might reduce the overall risk of cancer in certain men, most research shows that healthy people who take an MVM do not have a lower chance of getting cancer, heart disease, or diabetes. Based on current research, it's not possible to recommend for or against the use of MVMs to stay healthier longer.

One reason we know so little about whether MVMs have health benefits is that studies often use different products, making it hard to compare their results to find patterns. Many MVMs are available, and manufacturers can change their composition at will. It is therefore difficult for researchers to study whether a specific combination of vitamins and minerals affects health. Also, people with healthier diets and lifestyles are more likely to take dietary supplements, making it hard to identify any benefits from the MVMs.

Should I take an MVM?

MVMs cannot take the place of eating a variety of foods that are important to a healthy diet. Foods provide more than vitamins and minerals. They also have fiber and other ingredients that may have positive health effects. But people who don't get enough vitamins and minerals from food alone, are on low-calorie diets, have a poor appetite, or avoid certain foods (such as strict vegetarians and vegans) might consider taking an MVM. Health care providers might also recommend MVMs to patients with certain medical problems.

Some people might benefit from taking certain nutrients found in MVMs. For example:

         Women who might become pregnant should get 400 mcg/day of folic acid from fortified foods and/or dietary supplements to reduce the risk of birth defects of the brain and spine in their newborn babies.

         Pregnant women should take an iron supplement as recommended by their health care provider. A prenatal MVM is likely to provide iron.

         Breastfed and partially breastfed infants should receive vitamin D supplements of 400 IU/day, as should non-breastfed infants who drink less than about 1 quart per day of vitamin D-fortified formula or milk.

         In postmenopausal women, calcium and vitamin D supplements may increase bone strength and reduce the risk of fractures.

         People over age 50 should get recommended amounts of vitamin B12 from fortified foods and/or dietary supplements because they might not absorb enough of the B12 that is naturally found in food.

Can MVMs be harmful?

Taking a basic MVM is unlikely to pose any risks to health. But if you consume fortified foods and drinks (such as cereals or beverages with added vitamins and minerals) or take other dietary supplements, make sure that the MVM you take doesn't cause your intake of any vitamin or mineral to go above the upper safe levels. (Use the Online DRI tool to learn the upper safe level of each nutrient.)

Pay particular attention to the amounts of vitamin A, beta-carotene (which the body can convert to vitamin A), and iron in the MVM.

         Women who get too much vitamin A during pregnancy can increase the risk of birth defects in their babies. This risk does not apply to beta-carotene, however. Smokers, and perhaps former smokers, should avoid MVMs with large amounts of beta-carotene and vitamin A because these ingredients might increase the risk of developing lung cancer.

         Adult men and postmenopausal women should avoid taking MVMs that contain 18 mg or more of iron unless their doctor has told them that they have iron deficiency or inadequacy. When the body takes in much more iron than it can eliminate, the iron can collect in body tissues and organs, such as the liver and heart, and damage them. Iron supplements are a leading cause of poisoning in children under age 6, so keep any products containing iron (such as children's chewable MVMs or adults' iron supplements) out of children's reach.

Are there any interactions with MVMs that I should know about?

MVMs with recommended intake levels of nutrients don't usually interact with medications, with one important exception. If you take medicine to reduce blood clotting, such as warfarin (Coumadinฎ and other brand names), talk to your health care provider before taking any MVM or dietary supplement with vitamin K. Vitamin K lowers the drug's effectiveness and doctors base the medicine dose partly on the amount of vitamin K you usually consume in foods and supplements.

Which kind of MVM should I choose?

Talk to a health care provider to help you figure out whether you should take an MVM and, if so, which one is best for you. Consider basic MVMs whose amounts of most or all vitamins and minerals do not go above the DVs. These MVMs usually have low amounts of calcium and magnesium, so some people might need to take one or both minerals separately. Make sure that the product does not have too much vitamin A and iron.

Also consider choosing an MVM designed for your age, sex, and other factors (like pregnancy). MVMs for men often contain little or no iron, for example. MVMs for seniors usually provide more calcium and vitamins D and B12 and less iron than MVMs for younger adults. Prenatal MVMs for pregnant women often provide vitamin A as beta-carotene.

Where can I find out more about MVMs?

         For general information on MVMs:

o    Office of Dietary Supplements Health Professional Fact Sheet on Multivitamin/mineral Supplements

         For information on recommended intakes of vitamins and minerals:

o    Office of Dietary Supplements Vitamin and Mineral Supplement Fact Sheets

o    Nutrient recommendations: Dietary Reference Intakes (DRI)

o    Online DRI tool

o    Daily Value (DV) tables

         For more advice on buying dietary supplements:

o    Office of Dietary Supplements Frequently Asked Questions: Which brand(s) of dietary supplements should I purchase?

         For more information on healthy eating:

o    MyPlate

o    Dietary Guidelines for Americans

Disclaimer

This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.

 

NIH Launches Dietary Supplement Label Database
June 17, 2013 (News Release)
Researchers, as well as health care providers and consumers, can now see the ingredients listed on the labels of about 17,000 dietary supplements by looking them up on a website. The Dietary Supplement Label Database, free of charge and hosted by the National Institutes of Health, is available at www.dsld.nlm.nih.gov.

 

Food and Drug Administration on Vitamins

Fortify Your Knowledge About Vitamins

FDA 101: Dietary Supplements

Dietary Supplements

National Institutes of Health Office of Dietary Supplements

Protect Your Health Joint FDA/WebMD resource

Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients

 


 

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