"Overrefining and overprocessing foods is a real issue," Willett contends. "We've been told that there is no problem with vitamin and mineral intake in this country because gross deficiencies like scurvy and pellagra have been eliminated. But when I was in med school at Michigan, if someone suggested that something as simple and cheap as providing women of child-bearing age with folic acid supplements would reduce spinal bifida by 70%, I'd have said they were kooks. Today, it's almost malpractice not to recommend folic acid supplements to women of child-bearing age. It can be too late if they wait until they are pregnant to start taking it.
"To me, that demolishes the idea that there's no problem with vitamin adequacy in this and most other countries. Our study provides strong evidence that heart disease and colon cancer also are associated with folic acid deficit. Eating plenty of broccoli and oranges would help supply higher levels, but average intake gives you only about half the optimum level. People who aren't getting enough in their foods should take a supplement. That's true for other vitamins as well, especially vitamin B6
and vitamin E. Having sufficient amounts of folic acid and reducing red meat appear to be more important in protection against cancer.
"Our study showed a 40% lower risk of heart disease for those taking vitamin E supplements. That's a greater benefit than you get from fat-reducing drugs, which cost about $1,000 a year versus $10 to $20 for vitamin E. People with macular degeneration, a rare eye disease, could be harmed by high doses of vitamin E, however.
"It makes sense for most people to take a multivitamin that contains vitamins E, B-complex, A and C. A large body of evidence supports taking a vitamin E supplement beyond the multivitamin amount. Women should choose a multivitamin/multimineral supplement that adds iron if they are of
child-bearing age. They are a good nutritional safety net. Older people, especially those who live in the north, can benefit from the vitamin D in these supplements.
"People should tell their physicians what supplements they're taking, and if they don't, their physicians should ask them about their vitamin intake in detail and not treat vitamins as trivial chemicals. Unfortunately, most physicians don't even discuss vitamins with their patients."
. . . Fall 1996