Any decision about whether to spend money on vitamins and supplements, generally would be based on how well the product works. That means that I wanted to see what the evidence is.
I thought it would be easy for me to decide if vitamins, probiotics, anti-oxidant food supplements like acai berry juices, resveratrol, and other supplements to aid general wellbeing are worth spending money on. After all I have been doing scientific literatures since I did an epidemiology degree and all throughout my 20 year career as a public health researcher.
I went straight to the Cochrane Library of evidence-based systematic reviews (see screen shot to the left; click on the image to be directed to the Cochrane website). That would give me the answer I thought, it is the trusted authority for evidence-based information after all. I clicked on the topic "Complementary and alternative medicine" (see screen shot) and was excited about all the reviews posted in the Cochrane Library about probiotics, Echinacea, the effect of prayer etc. in fact there are 626 reviews about 'complementary medicines' in the Cochrane library on today's date 25 Apr 2015!!! (when you are on the results page, you need to scroll down the menu at the left of the screen to the 'stage' menu; you need to select reviews, and unselect protocols and anything else listed in that menu). My excitement was short-lived. As I clicked on the reviews of interest, and read them, most of the reviews concluded that there is insufficient evidence to recommend use.
Sure there were a few exceptions. An anti-oxidant supplement was found to enable 60% of asthmatic children to stop using their anti-asthma inhaler, compared to only 10% in the control group. This anti-oxidant product tested was a type of pine-tree extract. In another study in ADHD children, it was found that use of the supplement lowered the level of oxidative damage by a small statistically-significant amount. Echinacea supplement was found to reduce the number of occurrences and the duration of colds slightly. But the study designs were not considered high quality. Well-designed, adequately powered trials are needed to establish the value of this treatment.
Similar conclusion for probiotics: Probiotics were better than placebo in reducing the number of children who experienced an upper chest infection, and also reduced the average length of and infection, reduced the need for antibiotics use, and reduced the number of cold-related school absences. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the quality of the evidence was low or very low.
Likewise, nasal saline irrigation possibly has benefits for relieving the symptoms of upper chest infections. However, the studies were generally too small and were not considered reliable enough.
Use of supplement to treat eczema was not supported: "There is no convincing evidence of the benefit of dietary supplements in eczema, and they cannot be recommended for the public or for clinical practice at present. Whilst some may argue that at least supplements do not do any harm, high doses of vitamin D may give rise to serious medical problems."
But I was specifically interested in the fish oil data in the review about natural medicines for treatment of eczema. Why? Because I had spent 1.5 years stressing over my then 18-month old daughter's eczema. I spent money on calendula cream, naturopathic pilules from my local health food shop, strawberry flavoured fish oil (which did not taste like strawberry and my daughter refused to take), Moo Goo cream, and the corticosteroid creams prescribed by my GP (two kinds, one with only steroids, and another with steroid plus an anti-fungal agent), all with teeny-tiny results (not one of those treatments led to any significant improvement in her eczema, which was all over the creases of both elbows, both armpits and behind one knee; the treatments kept it from getting worse and kept flares to a mild level, but certainly nothing cleared it up). I was then recommended an orange-flavoured yummy fish oil gel that kids only need to take every other day. It was cheap and I tasted a sample myself to make sure I would not waste my money again on something a child would not eat, and it was delicious. Behold, my daughter's eczema cleared up completely within 4 weeks, and even when we got lazy and stopped buying wheat-free food, it has not come back at all. That was over 9 months ago and I have long forgotten the stress of that year and a half. We have moved on with our lives! So, of course I expected the Cochrane Review about fish oil supplements for eczema to show that it works! I read the details in the Cochrane Collaboration excema review (by the way, there are contact details on the Cochrane collaboration site for you to get help reading and interpreting these reviews). This is what it said:
"The three studies looking at fish oil versus placebo found no significant differences for any of the primary outcomes. However, pooled analysis of two of the studies found that fish oil significantly improved the effect on daily living compared to placebo (our secondary outcome looking at quality of life). This analysis also found a significant difference in area affected at the end of treatment as assessed by the physician (one of our tertiary outcomes). One study evaluated itch at the end of the study and found that fish oil significantly improved itch compared to the placebo group. The largest of the fish oil supplementation studies did not show any benefit over placebo."
How to decide if vitamins and supplements are worth the money
Hmm, super convincing evidence is not available. Even for fish oil to treat childhood eczema is uncertain. If I didn't know for sure that fish oil completely cleared my daughter's eczema, as a consumer I would be confused whether I should spend my money on fish oil. I am glad I did use it before I read that Cochrane Collaboration review actually. The evidence for natural therapies is still, after 30 years of research, uncertain. Why? Why are studies in this area of research so unhelpful? Why do you still take supplements, if you do, despite some evidence that multi-vitamins may not do much for your wellbeing? I have so many questions and thoughts whether supplements are worth the money and why, I would love to hear other people's comments. And I certainly will be writing a lot more blogs about specific studies and findings in this area over years to come.
Tips for Trial and Error Of Vitamins and Supplements
Given the uncertain evidence about supplements for most ailments, I believe that a process and clear approach for trying supplements is the best way for any consumer looking for supplements and vitamins to improve your health. These are my tips:
1. Generally try a product for about 4 weeks (unless experiencing adverse effects; always speak to a health practitioner and read labels so that you know what to look for). But choose a timeframe that makes sense in relation to the specific ailment. Six (6) weeks is probably better long-term problems like sinusitis and facial wrinkles, whereas 1 week is long enough to decide if a cough or flu is improving.
2. If you are not experiencing noticeable improvements in your ailment within 4 weeks, move on, until you find what you are looking for.
3. Write down notes about your health or beauty problem before you start a new product, and document how this changes on a daily basis, either in a note pad or in your smart phone, or any other way that is really convenient for you.
4. Always ask about the refund policy. It makes sense to buy a product that provides a money-back guarantee if the product doesn't meet the consumer's expectations. Full money back guarantees are not that common, but I was surprised to find a number of companies that do offer this, and I am more willing to try products from vitamin and supplements manufacturers who do offer this.
5. Get ideas about what product to try for a specific ailment from your doctors, facebook, discussion groups and from forums. But take everything with a grain of salt. Evaluate products you have heard of yourself, by considering whether the product concept makes sense for your health concern and the product and company information. I have learned that doctors are simply not aware of all the options available from pharmacies, health food stores and other online stores, and regular people's experiences on discussion boards and forums may or may not be reflective of how a product will work for you.
6. Learn to review the scientific literature yourself if you are at all interested in looking a the scientific studies about vitamins and supplements. Although often the studies don't provide concrete answers, they do provide some information that is useful, including what kind of benefits some of the study participants experienced, and also side effects information.
And you can be comforted that, even when scientific studies don't provide clear answers, science itself is more and more turning to what is called "N of 1" experiments. This means that two different treatments are tried in one patient, in a controlled experimental setting (this means that the researchers go to efforts to make sure that the effects of each products are cleared out of the system before trying the next product, and often the patient tries both treatments two or more times, alternating in sequence). This kind of experimental trial is even being used for cancer medicines and other scientifically-developed medicines and device. As a consumer, you can learn valuable information about what products do and don't work for you, and what products you do and don't consider good value, by trying certain vitamins and supplements in sequence, and making notes on what benefits and side effects you feel.
I love the idea of feeling unbelievably happy and well, living in a world where everyone smiles a lot, and feels really healthy. I even read that by 2040, there will be many people over the age of 100 years old, more than this world has ever seen. Surely supplements will be partly the reason for this? Who knows! Again, I would love to hear comments, and watch this blog for more info about this. Please feel free to contact me at firstname.lastname@example.org if you need any help navigating the scientific literature yourself.