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How do vitamins work? - Ginnie Trinh Nguyen

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Vitamins are the building blocks that keep our bodies running; they help build muscle and bone, capture energy, heal wounds and more. But if our body doesn't create vitamins, how do they get into our system? Ginnie Trinh Nguyen describes what vitamins are, how they get into our bodies -- and why they are so crucial.

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One in two adults takes a daily vitamin pill, and Americans spend tens of billions of dollars each year on supplements. Now, a small coterie of physicians writing in a leading medical journal has offered this blunt advice: “Stop wasting money.”

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One in two adults takes a daily vitamin pill, and Americans spend tens of billions of dollars each year on supplements. Now, a small coterie of physicians writing in a leading medical journal has offered this blunt advice: "Stop wasting money."

In an unusually direct opinion piece, the five authors say that for healthy Americans worried about chronic disease, there's no clear benefit to taking vitamin and mineral pills. And in some instances, they may even cause harm.

The authors make an exception for supplemental vitamin D, which they say needs further research. Even so, widespread use of vitamin D pills "is not based on solid evidence that benefits outweigh harms," the authors wrote. For other vitamins and supplements, "the case is closed."

"The message is simple," the editorial continued. "Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided."

"We have so much information from so many studies," Dr. Cynthia Mulrow, senior deputy editor of Annals of Internal Medicine and an author of the editorial, said in an interview. "We don't need a lot more evidence to put this to bed."

Officials with the Natural Products Association, a trade organization that represents supplement suppliers and retailers, said they were shocked by what they termed "an attack" on their industry, pointing to a study published last year that found a modest reduction in overall cancers in a long, randomized, controlled trial of 15,000 male doctors.

"Our members market and sell their products in order to assist people to achieve a healthier lifestyle," said John Shaw, executive director of the association, adding that he could not understand why the industry was being criticized "for trying to promote health and wellness."

Demand for vitamin and mineral supplements has grown markedly in recent years, with domestic sales totaling some $30 billion in 2011. More than half of Americans used at least one dietary supplement from 2003-06, up from 42 percent from 1988-94, according to national health surveys conducted by the Centers for Disease Control and Prevention. The most popular products are multivitamin and mineral supplements, which are consumed by some 40 percent of men and women in the United States, according to data from the National Health and Nutrition Examination Survey.

Whether regular long-term use can prevent heart disease and cancer has never been clearly established, and the authors of the editorial are not the first to point that out.

The Cochrane Collaboration, which publishes reviews of medical evidence, has also concluded that taking vitamins does not extend life. An updated review of the evidence by the United States Preventive Services Task Force, published online on Nov. 12, likewise concluded that there was limited evidence that vitamin and mineral supplementation could prevent cancer or cardiovascular disease.

The task force pointed out, however, that two clinical trials had found slight cancer reductions among men who took multivitamins. Yet other studies have found that beta-carotene supplements may actually increase the risk of lung cancer in smokers, the task force review noted, and that high doses of vitamins A and E cause harm and may increase the risk of death.

The editorial in the Annals is accompanied by two new studies reporting dismal results for multivitamins in helping preserve cognitive function and preventing heart attacks. In one study of nearly 6,000 male physicians 65 and older, participants who took a multivitamin for over a decade were no more likely to retain cognitive function as they aged than similar doctors who took a dummy pill.

But Dr. Francine Grodstein, one of the lead authors of that study, said that since physicians tend to have healthy diets and be well-nourished, the added nutrients may not have made a difference in their cases. "I do think there's room for more research," said Dr. Grodstein, who did not write or sign the editorial.

Demonstrating the prevention of chronic diseases can take decades and conducting long-term, randomized, controlled trials is both tricky and very costly. "We don't and probably never will have randomized trial data over decades," she said.

The results of another clinical trial published in the journal found that high-dose vitamins and minerals did not protect heart attack patients 50 and older from experiencing additional cardiovascular events, though the research was marred by a high dropout rate.

There have been few randomized clinical studies of the effects of multivitamins and minerals on heart disease, cancer and risk of death, said Dr. Stephen P. Fortmann, of the Kaiser Center of Health Research, who led the task force review. A draft of new task force recommendations, based on the updated review, said there was insufficient evidence to recommend taking or not taking vitamins.

But Dr. Fortmann, who also did not write or sign the editorial, suggested that those who buy vitamins may be "throwing their money away," adding: "Don't think it makes up for a bad diet, that you can eat a lot of fast food and then take a bunch of supplements. That's not a good idea."

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One in two adults takes a daily vitamin pill, and Americans spend tens of billions of dollars each year on supplements. Now, a small coterie of physicians writing in a leading medical journal has offered this blunt advice: "Stop wasting money."

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The Evolution of vitamin intake dependency...Please read the article and respond with a  comment or question you may have about this topic:

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The Evolution of vitamin intake dependency...Please read the article and respond with a  comment or question you may have about this topic:

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"Today, a huge amount of research goes into understanding vitamins, but most of it is focused on how much of them people need to stay healthy. This work does not address a basic question, though: How did we end up so dependent on these peculiar little molecules?"

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In 1602, a Spanish fleet was sailing up the Pacific coast of Mexico when the crew became deathly ill. "The first symptom is pain in the whole body that makes it sensitive to touch," wrote Antonio de la Ascensión, a priest on the expedition. "Purple spots begin to cover the body, especially from the waist down; then the gums become so swollen that the teeth cannot be brought together, and they can only drink, and finally they die all of a sudden, while talking."

The crew was suffering from scurvy, a disease that was then both bitterly familiar and deeply mysterious. No one knew why it struck sailors or how to cure it. But on that 1602 voyage, Ascensión witnessed what he considered a miracle. While the crew was ashore burying the dead, one sick sailor picked up a cactus fruit to eat. He started to feel better, and his crewmates followed his example.

"They all began to eat them and bring them back on board so that, after another two weeks, they were all healed," the priest wrote.

Over the next two centuries, it gradually became clear that scurvy was caused by a lack of fruits and vegetables on long-distance voyages. In the late 1700s, the British Navy started supplying its ships with millions of gallons of lemon juice, eradicating scurvy. But it wasn't until 1928 that the Hungarian biochemist Albert Szent-Gyorgyi discovered the ingredient that cured scurvy: vitamin C.

Szent-Gyorgyi's experiments were part of a wave of early-20th-century research that pulled back the curtain on vitamins. Scientists discovered that the human body required minuscule amounts of 13 organic molecules. A deficiency of any of the vitamins led to different diseases - a lack of vitamin A to blindness, vitamin B12 to severe anemia, vitamin D to rickets.

Today, a huge amount of research goes into understanding vitamins, but most of it is focused on how much of them people need to stay healthy. This work does not address a basic question, though: How did we end up so dependent on these peculiar little molecules?

Recent research is providing new answers. It appears that vitamins were essential to life from its earliest stages some four billion years ago. Early life-forms could make their own vitamins, but some species - including ours - later lost that ability. Species began to depend on each other for vitamins, creating a complex flow of molecules that scientists have named "vitamin traffic."
A Universal Chemistry
Every vitamin is made by living cells - either our own, or in other species. Vitamin D is produced in our skin, for example, when sunlight strikes a precursor of cholesterol. A lemon tree makes vitamin C out of glucose. Making a vitamin is often an enormously baroque process. In some species, it takes 22 different proteins to craft a vitamin B12 molecule.

While a protein may be made up of thousands of atoms, a vitamin may be made up of just a few dozen. And yet, despite their small size, vitamins expand our chemical versatility. A vitamin cooperates with proteins to help them carry out reactions they couldn't manage on their own. Vitamin B1, for example, helps proteins pull carbon dioxide from molecules.

Vitamins carry out these chemical reactions not just in our own bodies but in all living things. "If you talk about bacteria, fungi, plants, humans - everybody needs them," said Harold B. White III, a biochemist at the University of Delaware.

This universal chemistry is likely the result of evolution. Scientists generally agree that life on earth today evolved from a chemically simpler form perhaps four billion years ago. Those primordial organisms relied on a single-stranded variant of DNA, called RNA. Back then, RNA did double duty, carrying genes, the way DNA does today, and catalyzing chemical reactions, as proteins do now.

Dr. White was one of the first scientists to think seriously about this primordial "RNA world." In 1975, he proposed that vitamins helped RNA molecules carry out their chemical reactions. While proteins took over those reactions, they still rely on the same vitamins. "There's no way we're going to get rid of them now," he said.

When Dr. White offered up his theory, other scientists were skeptical. "People were saying, 'How are you going to test it?' " he recalled. "I said, 'I can't.' I didn't see any way to do that work at the time."

It took nearly four decades for technology to catch up. Dipankar Sen, a biochemist at Simon Fraser University in British Columbia, set out in 2007 to test Dr. White's idea.

After six years of tinkering and testing, Dr. Sen and a graduate student, Paul Cernak, found an RNA molecule that could use vitamin B1 to pull carbon dioxide from another molecule. That is what proteins use B1 for today, just as Dr. White had predicted. Dr. Cernak and Dr. Sen described their experiment in Nature Chemistry.

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The Ability We Lost
Once the ability to make vitamins evolved, some species became especially good at making them. Plants, for example, evolved into vitamin C factories, packing their leaves and fruits with the molecule. At first, vitamin C probably defended plants against stress - a function it carries out in other species, including us. But over time, the vitamin took on new jobs in plants, like helping control the development of fruit.

It took hundreds of millions of years for plants to become such proficient vitamin C manufacturers, but vitamin production can change in far less time. Our own ancestors needed just thousands of years to alter their production of vitamin D. When humans left equatorial Africa and spread to higher latitudes, the sun was lower in the sky and supplied less ultraviolet light. By evolving lighter skin, Europeans and Asians were able to continue making a healthy supply of vitamin D.

Aside from vitamins D and K, we humans can't make any of the vitamins we need to stay healthy. In some cases, our ancestors could make them, but lost that ability. Our mammalian ancestors 100 million years ago never got scurvy, for example, because they could make their own vitamin C.

Many vertebrates can make vitamin C, and use an identical set of genes to do so. "We should be able to make it, too, since we have all the genes," said Rebecca Stevens of the French National Institute for Agricultural Research.

Unlike a frog or a kangaroo, however, we have crippling mutations in one of those genes, known as GULO. Unable to make the GULO protein, we cannot produce vitamin C.

"It's not just us - it goes back a long time," said Guy Drouin, a molecular evolutionary biologist at the University of Ottawa. He and other researchers have found that apes and monkeys, our closest primate relatives, have disabled GULO genes, with many of the same mutations. Dr. Drouin has concluded that the common ancestor we share with those other primates lost the ability to make vitamin C around 60 million years ago.
It Wasn't Just Us
Primates are not the only animals with a damaged GULO gene, however, and that's why scientists were able to discover vitamin C in the first place. Dr. Szent-Gyorgyi made his breakthrough thanks to a discovery that guinea pigs, unlike other rodents, get scurvy. It turns out that their GULO gene is disabled by a different set of mutations from the ones we carry.

As it did in primates and guinea pigs, the GULO gene became disabled in a few other lineages, like bats and songbirds. Scientists have found that animals tend to lose vitamin C after a switch to a diet rich in it. Our primate ancestors, for example, started eating fruit and leaves that supplied them with far more vitamin C than they needed.

"It may seem counterintuitive that you would lose a gene that enables you to be independent," said Katherine E. Helliwell of the University of Cambridge, co-author of an August review about vitamin decay in Trends in Genetics. "But if you're always surrounded by a vitamin for a long period of time, then you don't need to use the gene."

Now that scientists can scan genomes of thousands of species, they're discovering many more cases in which vitamin genes have either decayed or disappeared altogether. Sergio Sanudo-Wilhelmy of the University of Southern California and his colleagues recently surveyed the genomes of 400 of the most abundant species of bacteria in the oceans. As they report in a paper to be published in the Annual Review of Marine Science, 24 percent of the bacteria lack genes to make B1, and 63 percent can't make B12.

These recent studies are especially surprising because bacteria have long been considered self-sufficient when it comes to vitamins. Now scientists need to figure out why many species of bacteria in the ocean aren't dead from a microbial version of scurvy.

"Somebody's making it for the good of the community, but we don't know who," Dr. Sanudo-Wilhelmy said.

Only recently have scientists made measurements of vitamins in the sea. They are finding some places that are abundant with them and others that are vitamin deserts. It is possible that the difference influences not just bacteria and algae, but the animals that feed on them.

Vitamins flow in complex routes, not just in the ocean, but on land. We humans can't make our own supply of vitamin B12, for example, so we need to get it from food. One way is to eat meat like beef, which contains B12. It turns out that the cows and other animals that we consume don't make B12 in their own cells. Instead, the bacteria in their guts manufacture it for them.

We are also home to thousands of species of bacteria, which synthesize vitamins as they eat our food. Does that mean we depend on our internal vitamin traffic? "It's still theoretical," said Douwe van Sinderen, a microbiologist at University College Cork in Ireland. "But evidence is building that bacteria can provide some vitamins that we need."

If that's so, we may need to think of our bodies as self-contained oceans of vitamin traffic - a continuation of the traffic that has occurred on earth for four billion years.

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In 1602, a Spanish fleet was sailing up the Pacific coast of Mexico when the crew became deathly ill. "The first symptom is pain in the whole body that makes it sensitive to touch," wrote Antonio de la Ascensión, a priest on the expedition.