Are Vitamins bad for you

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Hi kk
In the papers and on the news it says vitamins you take can effect your health. I know you should not believe everything but it was a very detailed report by a top scientist lab. I am just wondering what is your take on it all.

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kk - CNP are members of the Health Food Manufacturers Association and rather than give you my opinion of the flawed recent study, I will let your read their response.



Dear Member

As flagged in yesterday’s Mailout 236, the revamped antioxidants research has hit the headlines in various papers, notably the Mail & Telegraph. In both papers, Patrick Holford (a member of the HFMA Expert Panel) is quoted extensively

The HFMA statement (shown below) was issued to the media late yesterday and is being quoted widely on BBC radio. Following a call from Radio 4 to the HFMA late last night, Patrick took part in discussion on this morning’s ‘Today’ programme and very effectively demolished the research. He is now participating in a Radio 5 phone-in and is likely to be on other programmes during the day

Also attached are releases from Patrick Holford and the US CRN:

Embargoed until 00.01 on 16th April 2008
Statement prepared by the Health Food Manufacturers' Association (HFMA)

"Healthy consumers can still feel confident that they can safely take their antioxidant supplements," said Dr Michele Sadler on behalf of the Health Food Manufacturers’ Association.

“The antioxidant meta-analysis which has been updated for publication in the latest issue of ‘The Cochrane Database of Systematic Reviews 2008’ is, in essence, systematically flawed.

“The analysis focused on one broad category of study, then evaluated just 67 of the 748 studies that could be included in the review. Therefore, the paper’s conclusions are drawn on less than nine per cent of available evidence. In no way can this review be considered comprehensive.

“In fact, although the authors claim to be assessing antioxidant supplements for the prevention of mortality, they exclude all 405 studies that reported no deaths whatsoever. The conclusions also go much further than the scope of the evidence and limitations of the individual studies used. Indeed, the paper’s results focus on all-cause mortality, but the actual causes are not determined.

“Antioxidant supplements cannot be expected to undo a lifetime of unhealthy living, but combined with good lifestyle choices, can play an important role in promoting overall health and wellbeing.”

Best regards
David

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Anti-oxidants ARE important for good health

An extensive body of scientific research has shown that taking antioxidant supplements consistently over the long-term, can play a role in reducing the risk of chronic disease, therefore an updated meta-analysis published in the Cochrane Database of Systematic Reviews1 should not cause consumers to question the efficacy or safety of antioxidant supplements.

Patrick Holford one of the UK’s leading nutrition experts who provides the latest information on nutrition research on his website www.patrickholford.com, comments on the review, which claims potential harm from taking antioxidant supplements:

“It’s a stitch up. If you look objectively at all the studies reviewed, which were chosen strictly for reducing mortality, and not for the many other benefits reported in other studies, Bjekalovic et al conclude ‘Beta-carotene, vitamin A and vitamin C, used singly or in combination with other antioxidants had no significant effect (on mortality)’, although a number of vitamin C studies did report reduced mortality. . . and that ‘selenium used singly or in combination with other antioxidants significantly decreased mortality’”.

The only way this review could produce the negative results was by finding reasons to exclude most of the positive studies, including all the positive ones on selenium. Their basis for exclusion in a previous meta-analysis published in JAMA (Journal of the American Medical Association) has been heavily criticized in mainstream medical journals.

One of the world’s leading experts in this field, Dr Balz Frei, said “This is a flawed analysis of flawed data, and it does little to help us understand the real health effects of antioxidants, whether beneficial or otherwise2.”

Moreover, although the authors claimed to be assessing antioxidant supplements for the prevention of mortality, they excluded all studies – 405 of them – that reported no deaths.

Patrick Holford says, “Anti-oxidants are not meant to be magic bullets and should not be expected to undo a lifetime of unhealthy habits. But when used properly, in combination with eating a healthy diet full of fruit and vegetables, getting plenty of exercise and not smoking, antioxidant supplements can play an important role in maintaining and promoting overall health.”

In practical terms this means that beta-carotene supplements, as we already knew, are best not taken singly by smokers. Vitamin E in high doses, should not be taken by those on cholesterol lowering medication. (These drugs stop you making CoQ10 turning vitamin E from an antioxidant into a potentially harmful oxidant.) Selenium and vitamin C are the most likely to be beneficial.

Patrick says, “I take, and will continue to take an all-round antioxidant supplementing containing these nutrients as well as CoQ10, lipoic acid and resveratrol (the ‘red wine’ factor) and also eat a diet high in fruit and vegetables.”

For further comment from Patrick Holford please contact Stephanie Fox on 02088719249 x202 or email tephanie@patrickholford.com" href="mailtotephanie@patrickholford.com">stephanie@patrickholford.com

1. Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007176. DOI: 10.1002/14651858.CD007176.
2. http://oregonstate.edu/dept/ncs/newsarch/2007/Feb07/vitaminstudy.html

Antioxidant Supplements for Prevention of Mortality in Healthy Participants and Patients with Various Diseases”
Bjelakovic G., et al., Cochrane Database of Systematic Reviews 2008, Issue 2

Background:
An updated meta-analysis examining the efficacy of antioxidant supplements in primary or secondary
prevention of mortality was published in The Cochrane Database of Systematic Reviews 2008, Issue 2, in April 2008. The authors of the meta-analysis conclude that “there is no evidence to support antioxidant supplements for primary or secondary prevention of mortality and that vitamin A, beta-carotene, and vitamin E may in fact increase mortality. Future randomized trials could evaluate the potential effects of vitamin C and selenium for primary and secondary prevention. Such trials should be closely monitored for potential harmful effects. Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing.”

These are the same authors that published similar meta-analyses in the Journal of the American Medical Association (JAMA) in February 2007 and in the Lancet in September 2004. Although they have updated their meta-analysis, by handpicking additional studies and correcting a litany of minor mistakes made in previous versions, it is for all intents and purposes not a new study, nor is it truly new information. In fact, it appears to be a systematic attempt by the authors to publish work that supports their own pre-determined conclusions about antioxidants and the way they should be regulated.

The Council for Responsible Nutrition (CRN) believes this latest attempt to discredit antioxidants does nothing to change the practical implications for consumers, specifically a generally healthy population, that uses antioxidant supplements as part of their proactive wellness regimen in an attempt to fill nutrient gaps or help reduce the risk of chronic disease. Healthy consumers can feel confident in continuing to take antioxidant supplements for the benefits they provide. Consumers with serious illnesses, such as cancer, heart disease, liver disease, etc., should consult with their physician on anything they put into their body. This updated meta-analysis does nothing to change those facts.

There are a number of serious flaws with the meta-analysis, several of which were previously pointed out in response to the JAMA publication. These flaws have not been addressed with this updated meta-analysis and include the following points:

• This meta-analysis only evaluated randomized, controlled trials (RCTs); there is an equally vast, if not more so, body of observational data involving antioxidants, which was not considered in this analysis. Thus, this covers only a portion of the evidence base, so it cannot be considered comprehensive.

• The researchers identified 748 studies that could be included in this analysis; however, then determined that there were only 409 “eligible” RCTs. Of those, they excluded all but 67 studies. Thus, their conclusions are based on less than nine percent of the totality of available RCT evidence on antioxidant supplementation, and do not look at any research other than RCTs, which are in essence treatment trials.

• In selecting which RCTs to use, the researchers excluded any RCT in which no deaths were reported (405 articles), which begs the question of how one can properly evaluate whether a substance can prevent mortality when studies that demonstrate no harm are automatically excluded.

• The selected studies included studies examining different antioxidants (and in some cases, not even antioxidants), different doses, different populations with different health statuses, for different durations—in short, the authors combined heterogeneous studies and tried to make one generalized conclusion. As the saying goes, it’s like comparing apples to oranges.

• The authors relied on their own self-selected, and far from agreed upon, criteria for assessing bias (identical to that used in the last JAMA meta-analysis and criticized at that time by some highly respected researchers in the form of letters to the editor) where they established specific inclusion criteria. If any of the inclusion criteria from a scientific trial was deemed "inadequate", in the researchers’ opinions, then the study was deemed “high risk bias.” Not surprisingly, the studies that are considered “high risk bias” in this meta-analysis tend to be those that show a benefit to antioxidant supplementation, while those labeled as “low risk bias” tended to show harm.

• Only all-cause mortality was assessed in the review. As a result, the authors didn’t seek to eliminate deaths that may have been caused by accident, homicide, suicide, medical conditions that have nothing to do with supplementation or other circumstances. The authors intimated that all deaths were attributable to antioxidant supplements, ignoring other potential factors and did not offer any biological plausibility for their conclusions.

• These authors included vitamin A studies in their meta-analysis, despite the fact that experts within the scientific community universally agree that vitamin A does not function as an antioxidant and should not be characterized as one. The vitamin A RCTs that were included used extremely high doses of vitamin A, in some cases well above the established Tolerable Upper Limit (UL) established by the Dietary Reference Intakes (DRI), which may have significantly skewed the overall results of this analysis.

• Given the researchers’ own conclusion that antioxidant supplements should undergo pre-market approval, they betray their scientific duty and display their personal bias. The researchers do not explore the regulatory practices anywhere in this 191-page paper and it is not clear that the researchers possess any expertise in the field of policy and public health. The entire paper, therefore, seems designed to support this regulatory agenda.

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Too much of anything is bad for you. Trouble is, what constitues too much ?

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kk - Following on from my previous post I thought I would continue to add the Health Food Manufacturers information as they send it to us.

Health Food Manufacturers' Association

MAILOUT 237 – 21st April 2008
TOPIC NEWS / ISSUES

ANTIOXIDANTS RESEARCH – HFMA/PEGASUS ACTION
Below is a summary of the key actions & results up to last Friday (18th):
• Tuesday 15th April, Pegasus despatched a strong rebuttal to the antioxidant research to every news and health contact across the national and broadcast media, in addition to newswires such as PA News.
• Wednesday 16th April: Pegasus liaised with news, health and science correspondents from across the national print and broadcast media to provide additional information, statements from Patrick Holford and CRN as well as background information on the beneficial role that antioxidant supplements play in maintaining good health. Pegasus organised 12 expert interviews in total, in particular using Professor Patrick Holford, Dr Marilyn Glenville (both from the HFMA Expert Panel).
• Dr Alan Stewart - an independent, nutritionally-inclined doctor who had criticisms of the Cochrane paper – appeared in various interviews but is not on the HFMA Expert Panel nor is an HFMA spokesperson.
• Despite the BBC 10 o’clock and 6 o’clock news having heavily editing Dr Alan Stewart’s interview, the press office achieved some balance in coverage throughout the day on:
o BBC Radio 1 Newsbeat (Listeners: 10,693,000)
o BBC Radio 4 (Listeners: 9,342,000)
o BBC Radio 5 (Listeners: 6,174,000)
o BBC News 24 (Viewers: 2,721,000)
o Sky News (Viewers: N/A)
o The Wright Stuff (Viewers: N/A)
• For broadcast media for which readership figures are available, the HFMA’s messages have reached over 154 million people.
• On Wednesday 16th and Thursday 17th April, the HFMA was quoted in 23 instances, notably on BBC Breakfast News (Viewers: N/A), and in The Guardian (Circ: 358,142), Yahoo News (Unique users per month: 3,000,000) and Sky News (Unique users per month: 5,000,000).
• Since the initial event, and in response to the media’s desire for an alternative angle, we and CHC have developed a strong commentary on flaws in the research, incorporating comment from Dr Michele Sadler PhD, David Adams, Sue Croft and a selection of CHC’s celebrity supporters including Sir Cliff Richard. This has been distributed to 179 national print and broadcast correspondents, plus national in-house and freelance writers.
• HFMA letters have also been sent to the editors of the Daily Mail and Daily Telegraph in response to the negative articles both papers published in Wednesday 16th.
• Today’s (Monday) Times carries a more balance piece (attached) although still not entirely accurate. There is also a brief negative comment from the Times Science Editor – he was the subject of our (upheld) complaint to the Press Complaints Commission in 2005


RECENT HFMA
PR ACTIVITY


• Attached is a summary of recent coverage instigated by Pegasus together with a list of some anticipated future coverage - they have been working very hard!

NEW MEDIA ALERT

• Professor Edzard Ernst has co-authored a new book - Trick or Treatment?: Alternative Medicine on Trial - that is being published this week
• Already extracts have been published in the Daily Mail – expect further negative comment elsewhere




FOOD SAFETY GUIDANCE
• The FSA has written new guidance notes to compliance with the Food Safety Act 1990 and is consulting on this (deadline for responses: 11 July 2008)
• The guidance can be downloaded at: www.food.gov.uk/multimedia/pdfs/consultation/fsaguide08incip.pdf


NUTRITIONAL LABELLING & RDAs
• Attached is the HFMA response to the FSA consultation on the proposed amendments to the Nutritional Labelling Directive in which, in particular, we express concerns re certain RDA levels
• The HFMA response re the draft ‘Food Information Regulation’ is being prepared for submission before the 2 May deadline


Attachments
 HFMA media coverage – summary: 18.04.08
 ‘Times’: ‘Vitamin Pills: Friends or Foes?’ – 21.04.08
 HFMA response to the FSA’s Nutritional Labelling consultation – 18.04.08

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This Morning 6,000,000 Dr Chris Steele / HFMA Journalist of the Year 18th April 2007
Five News – Channel 5 11,400,000 Buckwheat honey – interview with Yvonne Black of Comvita 4th December 2007
BBC Radio 4 6,000,000 Supplementation – UK vs German market including a pre-recorded interview with Martin Last 28th December 2007
Colourful Radio 108,000 HFMA Survey Results 6th February 2008
BBC Radio 1 Newsbeat
– 12:45 10,693,000 Antioxidant Research / Health Industry Quoted 16th April 2008
BBC Radio 1 Newsbeat
– 5:45pm 10,693,000 Antioxidant Research / Health Industry Quoted 16th April 2008
Channel 5 –
Lunchtime News N/A Antioxidant Research / Interview with Prof Patrick Holford 16th April 2008
Channel 5 –
Evening News N/A Antioxidant Research / Interview with Dr Marilyn Glenville 16th April 2008
Sky News 132,000 Antioxidant Research / Interview with Prof Patrick Holford 16th April 2008
BBC Radio 4
- Today programme at 8:45am 9,342,000 Antioxidant Research / Interview with Prof Patrick Holford (HFMA quoted in news) 16th April 2008
BBC Radio 5 Live
- 9am 6,174,000 Antioxidant Research / Interview with Prof Patrick Holford 16th April 2008
BBC News 24
- 3pm live and throughout afternoon 2,721,000 Antioxidant Research / Interview with Dr Alan Stewart 16th April 2008
BBC News
- Breakfast N/A Antioxidant Research / HFMA Quoted 16th April 2008
BBC News
- Lunchtime N/A Antioxidant Research / Interview with Prof Patrick Holford 16th April 2008
BBC
- 6 o’clock News 4,610,000 Antioxidant Research / Interview with Dr Alan Stewart 16th April 2008
BBC
- 10 o’clock News 5,550,000 Antioxidant Research / Interview with Dr Alan Stewart 16th April 2008
Jeremy Vine
- 10am 5,710,000 Antioxidant Research / Interview with Prof Patrick Holford 16th April 2008
LBC Radio 642,000 Antioxidant Research / Interview with Dr Marilyn Glenville 16th April 2008
City Talk Radio N/A Antioxidant Research / Interview with Dr Marilyn Glenville 16th April 2008
Channel 4 News 1,250,000 Antioxidant Research / Interview with Dr Alan Stewart 16th April 2008
The Wright Stuff 1,065,000 Antioxidant Research / Interview with Prof Patrick Holford 17th April 2008
National
Daily Express 765,967 Supplementation and illness 24th July 07
Daily Express 827,491 Health News / Expert Panel Comment 30th October 2007
Daily Mail
2.339.278 Health News / Vitamin D Downgrade 31st October 2007
The Daily Telegraph 873,523 HFMA Survey Results 31st January 2008
Daily Mail 2.339.278 Health News / Ginkgo Biloba 28th February 2008
The Guardian G2 358,142 Antioxidant Research / HFMA Quoted - Statement 17th April 2008
National Women’s Interest
Good Housekeeping 435,238 HFMA Expert Panel Interview March 2008
Candis 302,327 Dr Rob Hicks Comment
March 2008
Retirement Press
Mature Times 200,000 HFMA Comment / Natural Alternatives to the Menopause March 2008
Regional
The Belfast Telegraph 85,916 HFMA Survey Results 31 January 2008
South Wales Argus 30,282 HFMA Survey Results 7th February 2008
South Wales Echo 49,032 HFMA Survey Results 12th February 2008
Trade
Health Food Business 3,205 Dr Chris Steele / HFMA Journalist of the Year June 2007
Natural Products 5,594 HFMA / A Question of Studies July 2007
Natural Products 5,594 HFMA Comment / FSA Goji Berries Verdict July 2007
Health Food Business 3,205 HFMA Profile September 2007
Natural Products 5,594 Health News / Launch of
HFMA Panel September 2007
Natural Products 5,594 Health News / Expert Panel Comment October 2007
Health Food Business 3,205 HFMA / New Legal Opinion November 2007
Health Food Business 3,205 HFMA / Conference November 2007
Natural Products 5,594 HFMA / Bulletin News January 2008
Health Food Business 3,205 HFMA / Reasons to Join the HFMA feature January 2008
Training Matters 19,000 HFMA / Survey Results February 2008
Natural Products 5,594 HFMA / HFMA Bulletin Board, Meet the Expert February 2008
Health Food Business 3,205 HFMA conference / Margaret Anderson’s column February 2008
The Grocer 45,000 HFMA / Survey Results 9th February 2008
Fresh Produce 3,000 HFMA / Survey Results 22nd February 2008
Health Food Business 3,205 HFMA / Survey Results March 2008
Health Food Business 3,205 HFMA / Legislation
Article March 2008
Online
Family GP Online 30,000 Health Journalist of the Year / Dr Chris Steele April 2007
Natural Products Online 5,000 HFMA Comment / Ruling on Dietary Supplements July 2007
Natural Products Online 5,000 HFMA Expert Panel 3rd August 2007
Fresh Info Online 160,000 HFMA Comment / Goji Berries August 2007
Nutraingredients Online 324,981 HFMA / New Legal Challenge 19th September 2007
Functional Ingredients Online N/A HFMA / New Legal Challenge September 2007
Food Quality News Online 6,101 HFMA / Survey News 30th November 2007
Potato Reporter Online N/A HFMA / Survey News January 2008
Healthy Direct Online N/A HFMA / Survey Results 30th January

BBC News Online 4,000,000 HFMA / Survey News 31st January 2008
Daily Telegraph Online 3,523,681 HFMA / Survey News 31st January 2008
Tesco Diets Online 1,200,000 HFMA / Survey News 31st January 2008
Congoo Online 441,863 HFMA / Survey News 31st January 2008
Belfast Telegraph Online 85,916 HFMA / Survey News 31st January 2008
Web India Online 75,000 HFMA /Survey News 31st January 2008
Top News Online N/A HFMA / Survey News 31st January 2008
That’s Food & Drink Blog 12,516 HFMA / Survey News 31st January 2008
TNS Online 10,000 HFMA / Survey News 31st January 2008
FoodsforLife Online 5,000 HFMA / Survey News 31st January 2008
HAS Online 2,000 HFMA / Survey News 31st January 2008
Best Love Art Online N/A HFMA / Survey News 31st January 2008
Khabar Express Online N/A HFMA / Survey News 31st January 2008
Press Watch Online N/A HFMA / Survey News 31st January 2008
Bored Health Blog N/A HFMA / Survey News 31st January 2008
Your Friendly Earth Site Online N/A HFMA / Survey News 31st January 2008
Yahoo News India Online 3,000,000 HFMA / Survey News February 2008
Kerla Next Online 375,000 HFMA / Survey News February 2008
Fresh Plaza Online 45,000 HFMA / Survey News February 2008
B4U India Online 4,574 HFMA / Survey News February 2008
About My Area (Taunton) Online 2,000 HFMA / Survey News February 2008
About My Area (CV5) Online 2,000 HFMA / Survey News February 2008
Food Production Daily Online N/A HFMA / Survey News February 2008
Hydroxy Cut Online N/A HFMA / Survey News February 2008
Thaindian News Online 265,436 HFMA / Survey News 1st February 2008
Fresh Info Online 160,000 HFMA / Survey News 1st February 2008
Cost Sector Catering 15,000 HFMA / Survey News 1st February 2008
Angry Potato Online N/A HFMA / Survey News 1st February 2008
Nutraingredients Online 324,981 HFMA / Survey News 4th February 2008
Performance Biochemistry Online 250,944 HFMA / Survey News 4th February 2008
Cancer Research Online 50,000 HFMA / Survey News 4th February 2008
Specialty Food Magazine Online 16,000 HFMA / Survey News 4th February 2008
Food Navigator Online 11,521 HFMA / Survey News 4th February 2008
Confectionary News Online N/A HFMA / Survey News 4th February 2008
Med India Online 800,000 HFMA / Survey News 5th February 2008
Google-SINA Online 7,728 HFMA / Survey News 5th February 2008
World News Network Online 153,264 HFMA / Survey News 6th February 2008
Health Insurance & Protection Online 5,000 HFMA / Survey News 6th February 2008
Preferred Medical Online 4,500 HFMA / Survey News 6th February 2008
999 Network Online N/A HFMA / Survey News 6th February 2008
Horticom News Online N/A HFMA / Survey News 6th February 2008
Natural Products Online 5,000 HFMA / Survey News 8th February 2008
Feminine Zone Online 12,500 HFMA / Survey News 10th February 2008
Scotsman Online 2,822,521 HFMA / Survey News 11th February 2008
Interesting Facts Online N/A HFMA / Survey News 12th February 2008
Healthy Pages Online 3,500 HFMA / Survey News 22nd February 2008
Natural Products Online 5,000 HFMA / Executive Briefing News 28th March 2008
CNN Online 25,700,688 Antioxidant Research /
HFMA Quoted 16th April 2008
FOX News Online 5,807,139 Antioxidant Research / HFMA Quoted 16th April 2008
NutraIngredients 324,981 Antioxidant Research / HFMA Quoted 16th April 2008
Nutra Ingredients USA 28,085 Antioxidant Research / HFMA Quoted 16th April 2008
Sky News Online 5,000,000 Antioxidant Research / Interview with Dr Marilyn Glenville & HFMA Quoted 16th April 2008
LowCarbFriends Online 54,775 Antioxidant Research/
HFMA Quoted 16th April 2008
FoodNavigator 16,454 Antioxidant Research / HFMA Quoted 16th April 2008
Yahoo News N/A Antioxidant Research / HFMA Quoted 16th April 2008
Men’s Health Online 86,151 Antioxidant Research / HFMA Quoted 16th April 2008
Sky News Online 5,000,000 Antioxidant Research / Interview with Dr Marilyn Glenville & HFMA Quoted 17th April 2008
Scenta Online 6,648 Antioxidant Research / HFMA Quoted 17th April 2008
Blackmores Online 2,000 Antioxidant Research / HFMA Quoted 17th April 2008
GoddessesRising Online 2,000 Antioxidant Research/
HFMA Quoted 17th April 2008
The Guardian Online 19,519,923 Antioxidant Research / HFMA Quoted 17th April 2008
icWales Online 272,553 Antioxidant Research /
HFMA Quoted 17th April 2008
AOL News Online 3,500,000 Antioxidant Research / HFMA Quoted 17th April 2008
Sky News AUS N/A Antioxidant Research / HFMA Quoted 17th April 2008
Fox28 Online 80,374 Antioxidant Research / HFMA Quoted 17th April 2008
InTheNews.co.uk N/A Antioxidant Research / HFMA Quoted 17th April 2008

Forthcoming Coverage

PUBLICATION CIRC. PRODUCT / FEATURE DATE
National
The Times 622,186 Antioxidant Research / Comment from Dr Michele Sadler 21st April
Daily Mail 2,365,499 Children and supplementation 22nd April
Daily Mail 2,365,499 Fertility and supplementation, including interview with Dr Marilyn Glenville PhD TBC
National Magazines
Bella 221,661 Slimming and supplementation, including interview with Dr Marilyn Glenville PhD April 2008
Mature Times 200,000 Complementary therapies Date TBC

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From The Times
April 21, 2008
Vitamin pills: friends or foes?
A new report has stated that taking supplements can shorten life expectancy. But that depends on a range of factors, including the size of daily dose
Peta Bee
For those who rattle to work on a slug of black coffee and a cocktail of vitamins and minerals, the latest slur on supplements is bad news indeed. In research published by the Cochrane Library last week, Danish scientists revealed how people taking antioxidant supplements, including vitamins A and E, may be inadvertently shortening their lifespan and increasing their risk of an early death.
In their review of 67 studies on 230,000 healthy people, the team from Copenhagen University found “no convincing evidence” that antioxidants help to keep diseases such as cancer at bay and that some may “increase mortality” by up to 16 per cent. “The review underlines the fact that many peopledo not need to take these supplements,” says Bridget Aisbitt, a scientist at the British Nutrition Foundation. “They can get what they need to stay healthy from food.”
In the UK, around one third of the population pops at least one vitamin pill a day, and the supplements industry is worth in excess of £330 million a year. But many of the pills are surrounded by controversy and it is not the first time that supplements have come under attack this year.
In February, the Copenhagen researchers published their first findings in the Journal of the American Medical Association. Then, scientists at the University of Washington reported how taking daily supplements of vitamin E for ten years was linked to an increased risk of lung cancer. In January, New Zealand researchers suggested calcium supplements, often prescribed after the menopause to counter the loss of bone density, raised the risk of a heart attack in older women.
Part of the problem highlighted in the latest report, says Aisbitt, is that the single large doses supplied in many supplements seem to throw the body's oxidative systems off kilter. Antioxidants such as vitamins A, C and E, beta carotene and selenium, are considered essential for health. They are known to mop up the free radical compounds in the body that cause disease and to boost the immune system. But there is no scientific confirmation that more is better or that the levels in supplements are beneficial. “Oxidation happens all the time and antioxidant vitamins do their best to keep this in check,” she explains. “But it is a very delicate system and ingesting too many antioxidant vitamins in one go could possibly disrupt the balance of things, although nobody has yet discovered precisely how or if this happens.”
Others are less convinced that we should discard our vitamin tablets. Dr Michele Sadler, an independent nutritionist who is scientific adviser to the Health Food Manufacturers' Association, says that although this study “throws up important questions, it does not prove unequivocally that vitamins are harmful”. While the authors claim to be assessing antioxidants for the prevention of mortality, she says, “they used two statistical methods that produced different results, so the evidence is far from clear-cut”. While antioxidant supplements “cannot be expected to undo a lifetime of unhealthy living”, Sadler believes that they “can play a role in promoting overall wellbeing, particularly if dietary intake is low, and are safe provided people stick to the intake on a product's label”.
Working out how much of a vitamin or mineral you should be taking is fraught with complexity. Most food and supplement labels list a nutrient's recommended daily allowance (RDA), a figure set at EU level that, far from being a formula for tip-top health, is simply the minimum intake needed to prevent a nutritional deficiency. In the UK, dietary reference values (DRVs), set by the Government's Food Standards Agency, provide more specific recommendations for both men and women that take into account age and potential health issues at various times of life. But even these suggested levels are far below what is generally supplied in a supplement. Instead, manufacturers often supply doses much closer to the “safe upper levels” for nutrients, figures that were reached after the Government's Expert Group on Vitamins and Minerals analysed studies on intakes that actively promote health, rather than just prevent disease. So, while the RDA for vitamin C, for example, is just 60mg, consumers in the UK can buy it in 1000mg tablets.
It is these huge doses that are cause for concern. Many nutritionists have witnessed a growing trend for people to abandon meals in favour of a handful of tablets that they believe will provide the nutrients they need but without the calories or, indeed, the hassle of cooking. “Tablets can never replace a healthy diet,” Aisbitt says. “Foods contain a complex matrix of different components that can't be replicated by supplements. They provide fibre, phytonutrients and other nutrients that are essential to health. You just don't get that in a pill.”
Catherine Collins, the chief dietician at London's St George Hospital in London, concedes that some people do need supplements at times in their lives, such as during pregnancy or old age. “But for the vast majority there's absolutely no benefit in taking high-dose vitamin supplements and the latest research is extremely troubling,” she says. “People take them like they eat sweets. At best they are a waste of money and at worst a serious risk to your health.”

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18th April 2008

Julie Lucas
Nutrition Division
Food Standards Agency
Room 115
Aviation House
125 Kingsway
London WC2B 6NH


Dear Julie

Re: Commission Proposal Amending Directive 90/496/EEC Nutrition Labelling of Foodstuffs

The HFMA (Health Food Manufacturers’ Association) is a non-profit organisation that was founded in 1965 to represent the interests of manufacturers and suppliers of specialist health products in the UK. Our c.130 member companies include many suppliers of specialist food supplements and health foods.

The HFMA operates three long-standing codes of practice – for GMP, Labelling & Advertising and Upper Safe Levels for Supplements – to ensure that member companies adhere to high standards and offer good quality, safe products to UK consumers.

We would make the following comments/observations about the proposal:

As we see it, the key proposals are:

• A definition of dietary fibre
• New energy conversion factors for fibre and erythritol
• Updating Recommended Daily Allowances for vitamins and minerals


General comments

Definition of fibre:

We welcome and agree with the introduction of a definition of fibre – this will enable food and food supplement labels to carry information about important fibre components such as FOS (fructo-oligosaccharides, a prebiotic).

However we would comment:
- whereas (6) indicates that various non-carbohydrate components when closely associated with carbohydrate polymers of plant origin can be considered as fibre, but this is not reflected in the first part of the fibre definition in Article 1.1





We note that the fibre definition given in the Codex documents adds a footnote to the definition to clarify this point. It may be applicable to consider such an addition to the EC document (Ref: CL2007/3 – NFSDU).

- There is potentially a need to include details or information on the accepted methods of analysis of fibre and its fraction?

We understand there are a variety of different AOAC analytical methods that can apply which measure different ‘fractions’ of fibre (as outlined in Codex documents). Provision of such information may reduce difficulties in interpretation of the definition.

- In whereas clause (6) page 3, the final sentence needs to be amended to read (to avoid any ambiguity):

“However, when the non-carbohydrate components are extracted and added to a food they should not be defined as dietary fibre”.

Updating Recommended Daily Allowances for vitamins and minerals

We feel strongly that a more thorough review of the proposed RDA’s is needed.

The SCF values on which the revisions to the annex are mainly based were developed in 2003. They were not based on a full review of the science, but on a review of recommended intakes across member states. A more up-to-date, full review of the science is therefore warranted in setting the RDAs.

New energy conversion factors for fibre and erythritol:

The document proposes a blanket energy value for fibre of 2kcal per gram. However, different fibre sources provide different energy values per gram. E.g. the FSA nutrition labelling guidance refers to an agreement with LACORS that polydextrose is declared as 1kcal per gram. We would prefer to see a more flexible approach here.

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Specific comments

Folate:

The annex refers to folate rather than folic acid. In the SCF 2003 report it is commented that:

“For folates an upward trend in RDA values (NB across member States) is observed over the last 15 years (NB to 2003). For folates the RDA values have been increased considerably (25 to 100%) in recently established RDA lists such as for Germany/Austria/Switzerland, France, the Netherlands and the USA. New scientific data on the bioavailability of food folates compared to synthetic folic acid as well as its role in the reduction of the risk of neural tube defects of women capable of becoming pregnant were sufficiently conclusive to increase the recommended value in all recently published RDA lists.”

In view of the reference to bioavailability of food folates, we would argue that the RDA should be raised to 400µg as in the SCF report.

Selenium:

We would support the position, and the science behind it, of Professor Margaret Rayman of the University of Surrey, that 55µg is sub-optimal as an RDA. She is recognised as one of the world’s leading experts on selenium, and is advocating a higher level.

The UK RNI for adult males is 75µg per day and 60µg for women. The more recent review of dietary recommendations in Belgium gave a figure of 70µg.

Vitamin D:

We would question and welcome feedback on why the Commission/SCF have not taken this opportunity to increase the 5µg RDA for Vitamin D, in light of a wealth of published scientific evidence and calls from scientific experts and Committees to increase the level (Am J of Clin Nutr 2007;85:3; 649-650 – The urgent need to recommend an intake of vitamin D that is effective). Another important review sets out important arguments for increasing vitamin D RDA levels (Vieth R, Am J of Clin Nutr 1999;69:842-856), and whilst the current RDA was initially based to help to prevent certain bone deficiency diseases, higher levels are now implicated in the many other new areas of health (Vieth R, J Nutr Env Med 2001; 11:271-91). It is proposed that the current UK RNI for vitamin D across adult populations (10 mcg/day) should be considered as the minimum level for the revised average intake (EU RDA) for adults. While current research suggests a higher level still should be adopted, 10mcg is a cautious minimum, in line with the US RDI.

Important factors to consider include:

- Government health advice to reduce sun exposure (skin cancer) means less vitamin D produced;

- Reduced sun exposure in general for certain groups of the population whether for religious reasons/clothing, certain occupations, medical conditions (e.g. Lupus), persons with darker skin (greater skin melanin content reduces the skin’s ability to produce vitamin D);

- Increased requirement at certain lifestages e.g. - 10mcg supplement recommended by NICE during pregnancy and breast-feeding for bone health; elderly population – skin not able to synthesize vitamin D effectively therefore at increased risk of developing deficiency;

- Increased dietary intolerances, allergens (dairy - lactose);

- Dieting;

References:
Am J of Clin Nutr 2007;85:3; 649-650: www.ajcn.org/cgi/content/full/85/3/649
Vieth R, Am J of Clin Nutr 1999;69:842-856 www.ajcn.org/cgi/content/full/69/5/842
Vieth R, J Nutr Env Med 2001; 11:271-91 http://www.direct-ms.org/pdf/VitDVieth/ViethJ%20VitD%20Review2.pdf

Zinc:

The new proposed RDA level for zinc has been reduced significantly, by one third from 15 mg to 10 mg per day. A vast amount of scientific data exists supporting the role of zinc, which is a vital trace mineral involved in 300 different enzyme processes. Low zinc intake is often seen in the elderly, people with anorexia, and individuals on weight-loss diets, and deficiency can also be seen in those patients with mal-absorption diseases such as irritable bowel syndrome and coeliac disease.

The current 15 mg zinc RDA was set taking into account the severity of symptoms of zinc deficiency states occurring in susceptible population groups. An up-to-date review of the latest available evidence, including any new clinical evidence in relation to copper balance, should be undertaken and is requested before such a significant reduction is made.


We would welcome the opportunity to discuss this submission more fully with the FSA, and I trust that the above comments will be helpful.

Yours sincerely


Graham Keen
Director (Designate)