Reader question: In your book, you seem to be against taking vitamins if you have a healthy diet. What do you think of Rhonda Patrick’s work and Dr. Bruce Ames’ Triage Theory. They both advocate taking vitamins.

 
In your book, you seem to be against taking vitamins if you have a healthy diet. What do you think of Rhonda Patrick’s work and Dr. Bruce Ames’ Triage Theory. They both advocate taking vitamins.
 

 – Wondering in Wandsworth

 
I’m not exactly sure what you mean by Rhonda Patrick’s work. Her old experimental work seems to be largely esoteric cell biology and now she seems to only write reviews.

In any event, I don’t want to get caught up in anything regarding the particulars of supplements. You can always find some theoretical arguments, or some animal studies, or some small human trials showing something if you want to.

But the bottom line is (to quote recent JAMA guidance for clinicians) that “most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance … may have harmful effects.”

You won’t find any articles in top medical or science journals recommending supplements for healthy people with healthy diets. Why not? Because there really isn’t any strong experimental evidence to support such a recommendation. And it’s not for lack of trying. The same journals are filled with studies that attempted — and failed — to generate such evidence.

Of course, it’s possible that there is a vast conspiracy on the part of leading doctors and scientists to suppress the creation and dissemination of strong evidence in support of supplements in order protect their privileged positions. But, well …

As for Bruce Ames’ Triage Theory, his website summarizes the theory as follows:

When micronutrient availability is limited, functions required for survival will be prioritized over functions whose loss can be better tolerated.

The upshot is that while nutrient deficiencies may not kill you quickly, they may be killing you slowly through their contribution to chronic diseases.

Sure. Why not? I don’t know whether there is any direct support for the prioritization part of the idea, but otherwise it’s basically saying that nutrient deficiencies have long-term negative consequences for health. That’s not too controversial.

But it also isn’t a reason for a healthy person with a healthy diet to take supplements. The theory seems to address what happens in the case of deficiency. But if you are just a typical person with a healthy diet then you won’t have any deficiencies. And if you don’t have a healthy diet, then you should try everything you can to fix that before thinking about taking supplements.