Q&A: Dr. Paul Offit on effects of supplements for kids
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Paul Offit is the author of Do You Believe in Magic? — a critical look at the vitamin and supplement industry in the United States. According to Dr. Offit, the vitamin and supplement industry sells billions and billions of dollars worth of supplements every year but is subject to very little regulation or oversight. As a result, vitamin manufacturers regularly make claims about their products that aren’t supported by science and, perhaps more disturbing, sell products that are adulterated or manufactured at different strengths than the label claims. In addition to his new book, Dr. Offit has written about vitamins and supplements for major publications including the New York Times and Wall Street Journal. He joins Bundoo to talk about the use of vitamins and supplements in children.
Dr. Sara Connolly: When we’re talking about vitamins and supplements in kids, what are the downsides exactly? Are there benefits also?
Dr. Paul Offit: Certainly there are situations in which supplemental vitamins are of value. Children need a vitamin K shot at birth, for example. If they don’t get one, they are at increased risk of bleeding. Children who are breastfeeding also need supplemental vitamin D. But do they need supplemental multivitamins like Gummy Flintstones? I think the answer is there is no need for it. There’s no evidence that multivitamins are of any value, and there’s no evidence they are harmful. However, in terms of mega-vitamins, I think there is evidence they are harmful. The Annals of Internal Medicine published a series of articles showing that large doses of vitamins A, E, and K and selenium are harmful.
One of the questions I’m seeing in the office is parents asking about vitamin-fortified smoothies, where they’re adding powdered vitamins to their Vitamix and making smoothies for their kids. I feel like I have no frame of reference for this, because I don’t know what they’re actually giving to their kids.
It’s a problem. People regularly ingest 1,000 mg of vitamin C in a pill. To get that same amount from food, you’d have to eat 8 cantaloupe melons or 14 oranges. Our stomachs wouldn’t let us do that. I think we’re fooling with Mother Nature with high-dose supplements, but the vitamin and supplement industry has been very good at convincing us we need them. If you look at that study I mentioned earlier, I think the message is, “Enough is enough.”
What about the idea that our foods don’t have the same levels of vitamins and nutrients as they used to because of modern farming practices, so we need to give our kids vitamins and take them ourselves to make up the difference?
Again, the industry has been very good at convincing us of this. But it’s not true. The extreme example of this is raw milk and the idea that critical proteins are destroyed by pasteurization, which is simply not true.
What about special needs kids? A lot of parents and parent groups recommend using supplements in various dosages to help special needs kids gain or recover skills. Is there any truth to these claims?
No. Again, this is not a new idea. Linus Pauling wrote a book 40 years ago about vitamin C and biomedical solutions to developmental problems. People still read it and believe it today. But there was no evidence for any of his claims then and there still isn’t now.
So let’s say you’re right, and there are no benefits to vitamins and supplements especially for children, how do pediatricians communicate that to parents, many of whom believe strongly in vitamins and supplements?
First, we need to be passionate about it, and we need to make it clear that parents and doctors are both in the same business of loving their child. Many people have this idea that doctors and professional groups who speak out against supplements are under the control of Big Pharma or some government agency. We need to make it clear we’re not just toeing a government line or some Big Pharma line. In fact, supplements are Big Pharma. It’s a $30 billion industry. People think these things are made by elves or old hippies, when in fact pharmaceutical giants Pfizer and Roche are two of the biggest players.
So what do you think about doctors who sell supplements from their offices?
I think it’s criminal. Doctors should have a professional standard and live by that standard. But too many people are in the thrall of these guru figures like Mehmet Oz or Deepak Chopra, who are very charismatic. Doctors need to counter those messages.
What’s your response to people who say, “Yes, but there are side effects in pharmaceuticals and they’re too strong for my kids or my family?”
Where I work at Children’s Hospital of Philadelphia, we have taken vitamins and supplements off the formulary. We don’t allow supplements in our hospital unless they meet a certain label standard, which excludes about 99 percent of the products. The thing people don’t understand is that this industry is not regulated. You might think you’re getting 50 mg of selenium when you’re actually getting 40,000 mg of selenium. Vitamins and supplements can have side effects, too. So yes, pharmaceuticals have side effects, but at least you know what you’re getting because there’s always a drug insert listing possible side effects. There’s nothing like that with vitamins and supplements.
Reviewed by Dr. Sara Connolly, May 2020
What is the AAP’s take on vitamins? My son takes a daily multi-vitamin with iron because his pediatrician said it was recommended for all infants, whether breastfeeding or formula-fed. I guess he’s more of toddler now, but I’ve continued to give him the vitamins. It makes me feel better that he’s getting some kind of nourishment daily, since he doesn’t always eat well (it’s hit or miss; sometimes he eats everything in sight, and sometimes he just pushes it around his plate and then onto the floor for the 4-legged child to clean up!).
I see that you found Jill Castle’s A-Z article but for others who share the same question, here is some information on whether children really need supplements: http://www.bundoo.com/articles/do-children-need-supplements/
Very interesting. Thank you for this. I do have a question; my son is 5 and takes liquid fish oil and liquid cod liver oil. I buy it from whole food and he takes about 5-10 mls of this daily. He has been for almost 3 years. Gross, I know, but he takes it with no problem. Is this a good thing? Bad thing? Is this helping him at all?
It’s hard to know how much omega 3 fatty acids are contained in your child’s supplement or if his diet is lacking in them to begin with. What we do know is that right now there is no standard recommended daily amount for children, so no way to know for sure if the dose is too little or too much. There is also not a clear cut role for supplementation with these nutrients above and beyond what we ingest in our foods.
Michele, thought you might find this article on fish oil helpful: http://www.bundoo.com/articles/is-fish-oil-safe-for-children/
I can’t wait to read this interview and this book – just bought it! I am a huge fan of supporting patients who want to use complementary medicine, but I really think we need to make sure we are being safe and evidence-based. Can’t wait to read.