Monday, December 14, 2015

Tips for Novel Writing (Without Going Totally Insane)

As someone who's written multiple (read: double digits) novels, it is both easy and hard - it really depends on how you approach it!

Romanticon's Tips for Novel Writing (Without Going Totally Insane):


Part 1: Before you start

  1. Come up with an idea! If you don't have an idea, you don't have a novel. Simple as that.
  2. No idea? Pick a genre you like. Do you read a lot of mystery, romance, scifi? Set out to write what you know.
  3. Background research. If you want to write a Victorian period piece, you should read up on Victorian era daily life. If you want to write a space adventure, read up on rockets and space.
  4. Plot-in-a-sentence. Imagine that you're in an elevator with Christopher Nolan. How do you convince him to buy your book as a movie deal before he reaches his floor?
  5. Accountability. Set a reward for completion, but a punishment if you don't hit a daily goal. I've found that a good punishment for me is running a mile on each day I don't hit my word goal.
  6. Choose a time or place to write, and make it a habit. I personally have a favorite coffee shop where I can people watch as I write.
To outline, or not to outline?

I've talked to other writers, and they swear by always/sometimes/never outlining their stories. Personally, it really comes down to what you feel works best for you. I outline, because I like the organization, and it helps me push through the "middle slog" when I no longer love my plot any longer.

I also find that a good outline means my book is already about 20% written! I'll start with just listing out the plot-in-a-sentence, and then I'll break that down into a list of events that happen in the book. Break those down a little further, and I've got chapters! Add in a few sentences describing what happens in each event, and I've got chapter summaries!

From there, I find it easy to just take a chapter summary a day and flush it out into a full chapter.

Part 2: Time to write! Uhhhh....

  1. Have a word goal in mind before you start writing. I will usually aim to write 2,000 words a session - that gives me a 50k word novel in 25 days! Even a 500 word a day goal still gets you a novel in under 4 months.
  2. Remove distractions. Check out apps like Write or Die, or even turn off your internet connection for the writing time. You can also find apps that block access to certain sites for a length of time (like turning off Reddit...).
  3. Use a timer! I personally am a fan of the Pomodoro method - 25 minutes on, 5 minutes off. Great for writing intensely without getting burned out.
  4. Find a writing group! Writing is much easier with other people, even if it's only a digital connection.
  5. Keep a cheat sheet of important details. Write down your characters' names, descriptions, important backstory details, etc. I've had a character's eye and hair color change halfway through the story because I forgot how I originally described him. This also helps you with backstory.
  6. Don't go back and edit! Editing a story before it's finished is a death stroke to the novel. If you realize you need to go back and re-write a plot point, make a note of it, and then KEEP GOING to the end before backing up to make changes.
  7. If you think of a cool plot point or detail to add in at a future chapter, make a note of it so you don't forget. At the bottom of my document, I keep a slowly growing list of "things to remember".
Part 3: Halfway through and hating it
  1. Relax. Every writer hates their story at some point and wants to scrap the whole thing. Keep going.
  2. If you have an outline, don't forget to refer back to it - or update it if your story takes a new direction.
  3. If your characters get "stuck", think about their goals. What are they after to be happy? Why don't they have it, what's holding them back? How do they accomplish their goal? What does that mean for your other characters?
  4. Remember, your story doesn't need to hit a certain word limit, just wrap up. Some of my novels stopped at 45k words, some went all the way to 65k words. The story ends when it ends.
I'm done! Now what?

First, congratulations!
Second, put the novel aside for a few days. You need to distance yourself.
Once you're starting to forget some of the details of what you've written, go back and re-read it, preferably with a highlighter. I review in the following order:
  1. First, does the overall plot flow? If not, what do I need to change?
  2. Second, do the characters stay consistent in talking style, goals, motivation, attitude, and so on? If not, fix that after the plot's solid.
  3. How's the logical consistency? If a character doesn't have a car, how do they get around? Is a broke character flying around the world? Is an awkward geek flirting effortlessly with supermodels? Make sure things make sense.
When I read one of my stories, I often try and see it as a movie in my head. If scenes in the movie aren't clear or don't make sense, I know I need to rewrite that section.

Composition of a novel


When I write a novel, it ends up being about:
  • 20% descriptions and scenery
  • 40% dialogue
  • 20% emotion (how's the character feeling, thinking?)
  • 20% action
Your numbers may be different, but you do need a blend of all 4 of these. Leave out emotions, and your characters all feel robotic. Leave out dialogue, and the thing doesn't feel real. Leave out descriptions, and your readers will be utterly confused.

Okay, now I'm really done with the thing. Now what?


Now, put your baby out in the world! You can either:
  • Submit to traditional publishers (although you'll want an agent for this, and it's a long slog)
  • Publish it yourself for free! Check out programs like Scrivener for making an ebook, and printing platforms like Lulu to get a physical copy.
  • Put it up for sale! I sell my novels through Amazon's Kindle Direct Publishing (KDP) platform, as well as on other sites.
Remember, every author hates his finished product most of the time. You only get better through practice and self-assessment. You can do it!

Some other resources to check out:

www.nanowrimo.org
- National Novel Writing Month is a competition every November, where people challenge themselves to write a novel in a month, 1,667 words per day! It's a great way to get motivation, with local writing groups all across the US and around the world.

www.savethecat.com
- guide for anyone wanting to write a screenplay. In addition, google "Save the Cat beat sheet" for a great outline for writing a novel.

www.kboards.com/authors/
- forum for self-published authors through Amazon's Kindle Direct Publishing program, great for getting started in self-publishing.

www.literatureandlatte.com/scrivener.php
- Scrivener is a great tool for writers - it lets you organize by chapters, compile a book from separate documents, adjust formatting, and export in many different formats, including as an epub book.

www.duotrope.com
- exhaustive, amazing list of all markets for submitting stories, long or short. Well worth the membership fee.

1099 Contract v Employee status

Here's some financial points where you will likely be losing out compared to being an employee. Try to put some monetary values on these so you have a good idea of how hard you are being screwed.
  • no longer receiving medical benefits
  • no longer getting matching 401k
  • no longer receiving PTO
  • no longer getting paid holidays
  • no longer receiving 6.2 percent social security tax contribution
  • no longer receiving 1.45 percent medicare tax contribution
Beyond those things that have a direct financial impact, also keep these things in mind:
  • You are no longer eligible for unemployment benefits if you are terminated or the company goes under
  • You aren't covered by workers compensation insurance
  • You aren't protected by many labor laws
  • The max amount of untaxed income that you can contribute to your retirement plan decreases from something like $13,000 to $5,500 per year. (may not be exact numbers, but your tax liability will increase)
  • You may be financially responsible for investments in tools and resources required to do your job.
  • You'll have to file estimated taxes on a quarterly basis.
  • Taxes will be more complicated - you might have to hire someone to help you.
  • You'll have to take the time to find private health insurance.
If you decide that you are not OK with your employer attempting to reclassify you, you may choose to remind or inform them of the following:
  • Simply calling you an independent contractor does not make it so in the eyes of federal and state entities. Whether a worker is an employee is a legal question determined by the economic realities of the working relationship between the employer and the worker, not by job title or any agreement that the parties may make.
  • If the IRS or other government agency determines that a hiring firm has unintentionally mis-classified an employee as an independent contractor, it can impose fines of $50 for each form that was not filed, 1.5% of the wages plus interest accruing daily, 40% of the FICA that the employee should have paid, and 100% of the FICA that the employer should have paid.
  • A responsible person (including corporate officers and employees or members or employees of a partnership) with authority over the financial affairs of the business who willfully fails to collect and pay taxes may be held personally liable for the total amount of the uncollected tax up to 100% under the provisions of the Internal Revenue Code (I.R.C.), as well as subjected to criminal prosecution.
  • If the IRS suspects fraud or intentional misconduct in employee classifications (deliberately misclassifying to avoid taxes), the IRS may levy criminal penalties of $1,000 and/or 1 year in prison for failure to properly classify and withhold wages. If the IRS obtains a felony conviction against a person or company for “attempting to evade or defeat tax,” the fines are up to $100,000 ($500,000 in the case of a corporation), or imprisonment not more than 5 years, or both, together with the costs of prosecution (I.R.C. §7201).
  • A responsible person (including corporate officers and employees or members or employees of a partnership) with authority over the financial affairs of the business who willfully fails to collect and pay taxes may be held personally liable for the total amount of the uncollected tax up to 100% under the provisions of the Internal Revenue Code (I.R.C.), as well as subjected to criminal prosecution.
Useful links:
NOLO- what to do if you are misclassified
Department of labor fact sheet

SOURCE

Wednesday, December 2, 2015

How to Find Your Best Life

Know this right up front: it's okay to not have all the answers and it's okay to keep looking for answers.

It's easy to feel inferior in comparison to people based on what they share on social media or even on what they say in person. Keep in mind they're only showing you the highlight reel, not the outtakes and bloopers.
Happiness begins when comparison stops.

This guide might be inspiring: A Brief Guide to World Domination: How to Live a Remarkable Life in a Conventional World (PDF).

You hate your job. Should you quit today?

No. If you have bills, etc., that would be financially irresponsible.

But if you're not happy, you can start making plans. Start saving money, looking for other jobs, thinking places you'd rather live in, etc. Your goal is to build a "freedom fund" that will give you enough to quit your job and move somewhere else to find a better job. Your goal is to build a life more in line with what you want.

The first step: check in with yourself. Do this in a quiet place alone. Traveling by yourself can also do wonders for removing the external voices telling you what to do with your life (parents, family, friends, co-workers, etc.). Just go somewhere by yourself. Like a park or the library.

Ask yourself who you are, what you want, and other big questions like that. These can feel intimidating and difficult, especially if you haven't been alone for a while and have competing voices in your head from the people around you.

Who do you admire? It could be someone you know. It could be a successful person you've read about. Who do you look at that makes you think, "Man, I'd love to do what that person is doing"? Make a list. Keep finding more people who inspire you. If you read interviews of successful people, you'll often find they had an inspiring role model. Sometimes they had a relationship with that "mentor" sometimes not. The important thing was that it gave them a starting point.

Don't make the mistake of being seduced by someone's passion though, and think, "If I do the same job/career/business, I'll be as happy too!" Do you actually like the work itself, without getting interviewed on TV or being on magazine covers? Most people toil in obscurity.

A fun exercise is to imagine a future scenario of your perfect day. Let's say it's five years from now. There's a great quote by Bill Gates that goes like, "We overestimate what we can accomplish in one day, but underestimate how much we can accomplish in one year." So in five years you could go far.

The key thing is to let your imagination go wild, and silence the doubting voice that says, "That will never happen." Think of it like a "Choose Your Own Adventure" book.

What's your perfect day?
  • You wake up. What kind of place do you live in? Log cabin in the forest? Modern loft in the middle of a bustling city? Villa by the beach? Where is your home? What city?
  • You go to work. Where's your office? Maybe it's downtown, or maybe it's down the hall from your bedroom?
  • There are photos on your office wall. Who are in the pictures with you? Friends? Family? Celebrities? Leaders in your industry? Attractive girlfriends? (or boyfriends, I'm not judging).
  • There are photos of places you've been. Where are they? Cities? Jungles? Art galleries? Bungee jumping? Wine tasting? What experiences have you had you that you wanted to remember? (as your future self, not now).
  • You check your e-mail. What kind of e-mails are in your inbox that make you smile? Happy customers who love your product? Fan letters saying how much they love your book/music/other creations?
  • You get phone calls. Who's on the other end of the line? A businessperson with a multimillion-dollar deal to offer you? A reporter to interview you about your new project? A hot sexy person asking you out on a date? The answers are for your eyes only, and you get to decide how it's rated :)
  • What do you do at work? Writing a book? Writing a business plan? Doing a Skype call with a big shot? Leading a meeting?
The next thing would be to start working backward. What steps did you take to get to that perfect day? For example, I did this exercise with a friend who's a writer. His novel is about a character running in a marathon.
  • Perfect day: seeing the title of his novel on The New York Times bestseller list in the newspaper.
Starting to work backward, what things would have led to that moment?
  • He was interviewed on national TV about his book. Gave him instant wide publicity and boosted sales.
  • He had earlier been mentioned in a national newspaper article about running. A TV producer read the article, thought it was an interesting angle for a story, and called him up to fly to Burbank for an interview.
  • My friend had set up Google Alerts to notify of him of any news stories about running. He built a list of reporters who'd written articles on the topic. He also signed up for Help A Reporter Out (HARO), where journalists seek sources for their articles.
Whenever he saw a chance to relate his novel to an upcoming story, he'd get in touch and offer himself as a source or someone who could provide some quotes. Most were not interested, but he kept trying. Eventually, he answered a posting on HARO by a reporter who was looking for people to interview for a story about running. He sent an e-mail as soon as he saw the posting, and then they e-mailed questions and answers back and forth, and used some of his quotes in the article. That started the ball rolling.

Another option is to make a set of lists of the things you want.

Use these categories to set your goals:

Have
Material things: Mansion, sports car, etc. Maybe the things you want are way cheaper. What matters is that you want it, not what you're told to want. Hint: go for tools that will help you with your hobbies, which will lead to . . .

Do
Occupation and hobbies: Write a novel, paint art, fly in a wingsuit (that shit is so badass!)

Be
A good friend, a donor to worthy causes, a supporter for things you believe in, a volunteer to improve other people's lives somehow, etc.

We'd all like to believe we're high-minded, evolved beings and jump straight to the "Be" goals, but you really need all three to be happy. Don't feel guilty about having desires. This is for you, so it's okay to be a bit selfish.

A similar way to think about these are
  • pleasure (have)
  • passion (do) 
  • purpose (be) 
Once you have your list, get on Google and do the most fun research you'll ever do. What resources are out there that can help you get those things?

If you'd like to do a similar exercise, but with a video of someone guiding you along the way, you can watch this:

The 3 Most Important Questions to Ask Yourself

More resources:

'follow your passion' is wrong: Cal Newport speaks at World Domination Summit 2012 (Video)

Also good: Dan Pink: The puzzle of motivation. What things make people happy while working? Pink breaks it down.

If you want to dive deep: The Overjustification Effect. Does getting paid to do what you love make you happy? Not necessarily, as this article explains.

The Happiness Advantage by Shawn Achor is a great book. He makes a convincing case that it's not "you become successful, then get happy." Instead, it's the reverse: you get happy, then become successful. He backs it with a lot of research and studies.

SOURCE

Monday, November 30, 2015

The Earth's 5 Major Extintion Events

PROTEROZOIC EON (NEO-PROTEROZOIC)


Tonian Period (1,000 Million Years - 720 Million Years)

Single-celled organisms are prolific in the Earth's oceans. Acritarchs, believed to be a kind of primitive plankton - were abundant. No complex life yet exists, and continents are barren. The continents are tectonically drifting southward and assembling into a supercontinent, which will be called Rodinia. The planet begins to cool as the far-southern continents begin to glaciate.

Cryogenian Period (720 - 635 Million Years)

The supercontinent Rodinia completely assembles in the southern hemisphere, with its interior straddling the south-pole. Runaway icehouse conditions cause the planet to plunge into the coldest ice-age ever. All of the supercontinent is covered in glaciers, and even the north-pole, which was nothing but open ocean, begins to form sea ice. By the peak of the Cryogenian, the entire planet is covered in nearly a kilometer of ice - which scientists lovingly dub "snowball earth". Any would-be alien passerby's would see only a giant iceball in space. Despite these extreme conditions, live continues to evolve relatively oblivious - as all life is essentially hardy microbes. Complex life does evolve at this time, however. Primitive sponges about a quarter the size of a pinky-nail, and jellyfish. Rodinia begins to break apart through intense volcanic rifting, resulting in temperatures rising.

Ediacaran Period (635 - 541 Million Years)

The Earth thaws out & Rodinia has broken up into smaller continents. Primitive complex life evolves in force across the oceans. Most of these organisms are "nature's experiments", in that nearly none of them will survive past the Ediacaran, they resemble nothing that followed after them. If you could swim around in the Ediacaran seas, you would likely believe you were on an alien planet, that's how weird these animals looked.

PHANEROZOIC EON/PALEOZOIC ERA


Cambrian Period (541 - 485 Million Years)

The Cambrian Explosion takes place. It wasn't an actual explosion, calm down silly. It was an "explosion of life." Think of it this way, imagine a stadium and everyone in it represented a single species on the Earth. In the Ediacaran there were 250 people in the stadium...and then in the matter of about 5 minutes, there were suddenly 10,000 people! That's a huge jump in the different kinds of animals on the Earth in a short span of time, hence a figurative "explosion." Of course, this explosion took a couple million years, but geologically that's a blink. The first superpredator, Anomalocaris is on the hunt (it only got like 3 feet long, but at the time that was huge). Trilobites evolve and proliferate as the little iconic seabugs people see when they read about paleontology. Primitive chordates evolve, which will give rise to fish..and all vertebrates in an age to come. The continents are still barren.

Ordovician Period (485 - 444 Million Years)

Life continues to evolve in the oceans at a brisk pace. Echinoderms like sea-urchins and sea-lilys evolve, so life is beginning to look a little more recognizable. Fish evolve, but are jawless - they just swim around sucking up muck. Mollusks, which evolved in the Cambrian, get big in the Ordovician, like really big (think as a big as a school bus). Arthropods continued to diversify, with sea-scorpions becoming another major predator. Continents were still barren, all life still lived in the ocean.

THE FIRST MAJOR EXTINCTION, THE ORDOVICIAN-SILURIAN EXTINCTION

  • Was actually a 2-staged extinction pulse that killed off 27% of all families, 47% of all genera, and 65% of all species. It is considered the second worse mass extinction in Earth history, and is believed to be the result of sudden ice-ages. Though there are those who argue it could have been the result of a much more terrifying possibility - a gamma-ray burst.

Silurian Period (444 - 419 Million Years)

The ice-ages recede, and most of the Earth is quite inundated with water. A majority of the continents are covered in shallow seas, and organisms love shallow seas...particularly shallow tropical seas. Nautiloids mollusks are still major players in the food chain, as are sea-scorpions (what's crazy is that these ancient sea-scorpions were distantly related to modern day scorpions! How neat is that?) Fish continue to evolve, and though they are still jawless, have developed bony plate-armor on their bodies. Primitive tiny plants begin to colonize the shores of the continents.

Devonian Period (419 - 359 Million Years)

Fish evolve jaws, and shit just got real for every other creature on the planet. A primitive group of jawed fish, called Placoderms, become the major players in the Earth's oceans. Dunkleosteus is considered the first fish superpredator. They would have been pretty scary, no doubt about it. Nautiloid mollusks continue to evolve, though never again will they be the big-boys of the seas. The colonization of the continents is underway! At first simple fungus-biomes (minecraft lol) existed on the shores, but soon primitive fern-forests take over along the coastal regions. Some bony fish crawl out of the water to get on land, no doubt to get away from Dunkleosteus, and behold! The first amphibians! Bugs have long since moved on to land, with insects and arachnids crawling about for the first amphibians to munch on.

THE SECOND MAJOR EXTINCTION, THE LATE DEVONIAN EXTINCTION

  • This event affected marine life almost exclusively - land animals seemed to have gone through it relatively fine. Massive anoxic events are believed to be the culprit behind the Late Devonian Extinction, in which oxygen levels plummeted to dangerously low levels - causing mass die offs. Lots of debate as to what caused the anoxic conditions, but no doubt low oxygen levels were the problem. Particularly hard hit were coral reefs, which would survive - but only just. Corals reefs would not experience a resurgence until the Mesozoic, over a hundred million years later. Placoderms, those scary-ass armor plated killing machines, die out completely. All of them. Never will the tree of life suffer such a complete die off of a clade until the death of the dinosaurs. Goodbye placoderms, we hardly knew ye. 19% of all families, 50% of all genera, and 70% of all species go extinct.

Carboniferous Period (359 - 299 Million Years)

The placoderms are gone, but another fish is eager to fill their now vacant job position. Sharks have arrived, and the world will never be the same. Sharks had been around since the Devonian, but had relegated to minor roles in the ecosystem, with the placoderms out of the picture they now were able to quickly diversify and take over nearly all roles of fish. The Carboniferous was a golden-age for sharks, as sharks made up nearly 2/3 of all fish in the water. A type of freshwater shark, called xenacanths, even began to proliferate in the Carboniferous. They looked like a cross between a shark and an eel...yay. The continents are still inundated with tropical seas, so nearly all land above water is covered in tropical fern forests. Oxygen levels in the atmosphere begin to spike to dangerous levels (oxygen is a volatile gas!), with o2 levels reaching 33%. Intense forest-fires raged across the planet due to oxygen burn-offs from the high levels of o2. Fun fact, the higher the oxygen levels, the bigger bugs can get. So in the Carboniferous dragonflys got to be as big as eagles, spiders got as a big as house cats, cockroaches got as a big as dinner platers, and millipedes got as big as motorcycles. It was a golden age for bugs, too. Amphibians continued to diversift and evolve, with a type of crocodile-like amphibian called a labyrinthodont as a major land predator. But I saved the best for last! A new type of land vertebrate has evolved that has scales and sealed-eggs...reptiles! Reptiles are now on the evolutionary scene. The continents begin to merge into a supercontinent, this one will be called Pangea.

Permian Period (299 - 252 Million Years)

All the continents have merged to form Pangea. The interior of the continent becomes dry and barren. These arid & colder conditions spell the end for the fern forests and the swamp animals that lived in them. A new type of land plant appears that can produce its own natural form of antifreeze, and is better able to retain moisture...these plants are conifers - the same group of plants that include pine trees. Conifer forests take over across the continent where it isn't totally inhospitable. Amphibians don't do so well in the Permian, surprise surprise. Reptiles, which evolved in the Carboniferous, are separated into two clades: Synapsids and Diapsids. People are often told that mammals are an offshoot of reptiles, but this isn't entirely true. The lineage that gave rise to mammals split from other reptiles almost immediately after reptiles evolved. Diapsids are the group of reptiles that would give rise to dinosaurs, birds, lizards, turtles (I like turtles), and crocodiles. Synapsids, though once diverse, would eventually be just mammals. Fun fact, the Dimetrodon, was a synapsid, not a diapsid...one of our distant relatives, how neat is that? Marine life struggles to survive in less and less marine habitats as more of the continents close up to form Pangea. Land life struggles to survive in an ever-drying out environment as more of the supercontinent becomes a desert.

THE THIRD MAJOR EXTINCTION, THE PERMIAN-TRIASSIC EXTINCTION

  • Also called "The Great Dying." This one is the grandaddy of all extinctions. Life was already in bad shape by the end of the Permian, what with all the deserts and crummy marine life conditions, so what follows is just more than the world could bear. Pangea begins to rift apart, and in doing so massive volcanics begin to occur (particularly in what is now modern-day Siberia). This is called the Siberian Traps, and is essentially a mountain range the size of Texas of non-stop erupting volcanoes. Lots of ash, lots of greenhouse gases, lots of toxins. Oceans become anoxic, life begins to die. Oxygen levels even in the atmosphere are low, land life dies. It is the greatest of all extinctions - with 57% of all families, 83% of all genera, and 96% of all species die out. Some notably casualties include trilobites, therapsids, xenacanths, and labyrinthodonts.

MESOZOIC ERA


Triassic Period (252 - 200 Million Years)

Ok, before I go any further I got to tell you about Lystrosaurus, because I find it so goddamn funny. The Permian Extinction was bad right, nearly everything on the planet got handed the pink slip. But not the Lystrosaurus, oh no. Not only did it survive, it took over nearly every plant-eater niche on land. Think of if this way, imagine nearly all plant-eaters on Earth died out, except for pigs. Now imagine pigs took over everywhere as a result. Replace all deer with pigs. Replace all horses with pigs. Elephants get replaced with pigs. Hippos too, for that matter. Elk are gone, just pigs. And you can forget about oxen & sheep. Make those pigs too. Pigs...PIGS. EVERYWHERE PIGS. Well that's what happened with the Lystrosaurus as the start of the Triassic, that thing was all over the place since pretty much all the plant eaters died out.

Ok, back on topic - the Triassic. Dinosaurs evolve! They start out tiny, but they'll get bigger in time, boy will they get bigger. Some synapsids continue to evolve, of which a group called mammaliaforms appear....sound kinda familiar? Eh? Eh? Sea reptiles evolve, with Ichthyosaurus being an iconic one from that time. Turtles are doing their thing. Pterdons evolve and are the first true-flying vertebrates. Mosquitos evolve.....hooray.

THE FOURTH MAJOR EXTINCTION, THE TRIASSIC-JURASSIC EXTINCTION

  • Believed to be caused by global cool and a spout of intense volcanics as North America began to rift away from Africa (fun fact, Florida is a remnant piece of Africa that North America got to keep after rifting away). The last of the large amphibians, synapsids, and non-dinosaur reptiles (like crocodiles) were all badly hit - leaving dinosaurs little competition. 23% of all families, 48% of all genera, and 75% of all species went extinct.

Jurassic Period (200 - 145 Million Years)

Another golden age of sharks kicks off. A new kind of modern-form sharks evolve, most of all the sharks we know today come from this lineage. Rays and sawfish also evolve. Nautiloids (remember them?) are still around, with ammonites also enjoying a burst of diversity. Dinosaurs get big, really big. Allosaurus is an alpha predator, and brachiosaur herds are stripping entire pine forests of their needles. A new kind of land plant, deciduous plants, begins to diversify as they grow faster and can recover from dinosaur grazing faster than conifers. Pterodons continue to dominate the skies, but a new winged vertebrate is muscling into their turf - birds. Ichthyosaurs are still around, as are plesiosars and pliosaurs. The biggest fish ever to evolve, Leedsichthys appeared in the Jurassic - it got as big as blue whale. Here's a bonus pic of a pliosaur called Liopleurodon swimming near one.

Cretaceous Period (145 - 66 Million Years)

The Earth is getting hot, like steamy hot. Median ocean temperatures are something like 90 degrees. Dinosaurs continue to evolve and diversify, though the giant long-neck dinosaurs disappear from all the continents except South America, where they not only survive - but get even bigger. Titanosaurs should be a dead ringer that these things get huge. Gigantosaurus, a T-Rex like predator - but bigger, had to hunt in packs to bring down their prey, Titanosuars got that big. Speaking of T-Rex, it's out and about, as are raptors. Iguanadons give rise to duck-billed dinosaurs, and triceratops is grazing in the meadows. Pteradons are all but gone, they just can't compete with birds. Asteroid impact or not, pteradactyls would not have survived much longer, they were a dead clade walking. Ichthyosaurs and Pliosaurs are gone, but Mosasaurs are here to take their place. Mosasaurs didn't get as big as Pliosaurs (despite what Jurassic World would have you believe), but hunted in packs like a dino-age orca. They were also related to snakes, so think about that. Cross a python with an orca and you got a mosasaur. Snakes evolve too, obviously. Ants evolve from wasps, yay. JUST YAY. Primitive mammals evolve!!

THE FIFTH MAJOR EXTINCTION, THE CRETACEOUS-PALEOGENE EXTINCTION

  • A lot went wrong for the K-Pg extinction to happen. Most people pin it on the asteroid impact, but it wasn't alone in this. Not saying a 10 mile-wide chunk of rock slamming into Mexico at 16,000 miles an hour did the Earth any good, but it wasn't the only problem that lead to the death of the dinosaurs. The Earth was in bad shape prior to the Chicxulub impact. First off, intense volcanics (notice this keeps popping up when an extinction happens?) was occurring in what is now western-India. This was the Deccan Traps event, and though not as bad as the Siberian Traps in the Permian - it was still bad news. The planet was in the throes of a runaway green house, oxygen levels in the oceans were somewhat lower, and then you throw a giant rock at our planet and you're bound to get some serious die-offs. And so went the dinosaurs. And ammonites. And all marine reptiles except turtles (I like turtles). 17% of all families, 50% of all genera, and 75% of all species became extinct.

THE CENOZOIC ERA


Because the geologic record is more complete for the the Cenozoic, we are able to look at and discuss the Age of the Mammals in more detail than the preceding spans of time. As a result, I will cover the Epochs of the Cenozoic, not just the Periods.


The Paleogene Period

The Paleocene Epoch (66 - 56 Million Years)

The dinosaurs are gone, but their tropic world is not. Not only is the planet still steamy hot, it's actually getting even hotter. People are told that mammals inherited the Earth after dinosaurs died out, but like most inheritances - it was hotly contested. Not only were mammals rapidly diversifying in a world without dinos, but so were birds. And while mammals succeeded in taking over a lot of ecological niches, the birds got the upperhandwing on reaching the top of the food chain. Terrorbirds evolved in the Paleogene, and might as well have been dinosaurs 2.0. Titanoboa, the largest snake ever to live, was in South America swallowing 20-foot crocodiles whole. The oceans remain relatively empty, sharks for some reason never diversified in a 3rd golden age.

The Eocene Epoch (56 - 34 Million Years)

The planet finally peaks in temperature at the start of the Eocene in what is called the Paleocene–Eocene Thermal Maximum. After that, the Earth finally begins to cool off. Why? Well, India is just beginning to plow into Asia - so the Himalayas are starting to rise. Mountains disrupt weather, and the Himalayas will certainly be doing that. Grass evolves! As the planet cools, the tropical forests begin to give way to savannas of this new grass. Mammals actually do better in colder environments, and the changing climate of the Eocene is what finally tips the scales in our favor over birds (suck it birds). Primitive whales take to the seas. The first horses begin grazing on all this awesome grass. The first predators were ungulates, as carnivora hadn't evolved yet. Andrewsarchus was one such alpha predator. Its claws were actually specialized hooves, how neat is that?
 The Oligocene Epoch (34 - 23 Million Years)

The Earth continues to cool. Australia begins to rift from Antarctica, it's a bitter divorce - and Australia pretty much gets everything. The problem was, Antarctica has pretty much sat around the south pole for the past 100 million years, it had stayed relatively warm by being connected to Australia. Australia was more northerly located, and diverted warmer currents south towards the far south. Once Australia rifted away, Antarctica began to slowly freeze solid, dooming nearly all life on the continent to an icy grave. The first carnivora (dogs, cats, wolves, bears, etc) evolve at this time, though they looked like weasels and nothing more. Terrorbirds are gone from nearly all continents except for Australia and South America. Marsupials, which I guess I should have mentioned in more detail, have long since been replaced with more modern mammals on all continents except for Australia and South America also.

The Neogene Period

The Miocene Epoch (23 - 5.3 Million Years)

Antarctica freezes solid, the Himalayas continue to rise, and North & South America form a land-bridge connecting between the two. The formation of the Central American land-bridge allowed for what is called the Great American Interchange, as tons of animals migrated between the two continents. Terror birds moved into North America and set up shop in the Florida region. Mammals like the big cats (sabretooth tigers!) migrated into South America. Modern whales evolve (their blow holes used to be much closer to their faces). Of which the predatory sperm whale called Livyatan melvillei hunted other whales. Hominidae, great apes, evolve...we are on our way to making humans!

The Pliocene Epoch (5.3 - 2.58 Million Years)

The largest shark ever to evolve, Megalodon is terrorizing the oceans. The Earth is getting seriously cold, in fact this is the coldest the Earth has been all the way back to the Cryogenian. We have ice at both poles. Now that may seem like business as usual, but in the context of the past billion years that's a big deal. Mammoths evolved to take advantage of the spreading tundras. Continents pretty much resemble what we know today. Australopithecines evolve, these are the forebearers of humanity.

The Quaternary Period


The Pleistocene Epoch (2.58 Million Years - 11,700 Years)

Megalodon goes extinct just as ancestral humans appear, and you thought God didn't do you any favors. Ice-ages continue to wrack the planet in pulses. Mankind was divided into some notable lineages, with Humans, Neanderthals, and Denisovans. Of which, only we humans remain. Neanderthals all went extinct in the second-to-last ice age 40,000 years ago; and the Denisovans went extinct not too long after that, but we're still hashing out exactly when. Mammoths were on the verge of extinction. The woolly rhino had gone extinct, as did the cave lion and cave bear. Some believe that over hunting by humans played a major role in these extinctions, though some argue the changing climate (which at the time we humans could not have influenced) played a more significant role in their dying off.

The Holocene Epoch (11,700 Years - Present Day)

The rise of humankind. Grab a history book and dive in. I could write about it, because I think early civilizations were cool as shit, but I'm tired as hell now.
 SOURCE

Monday, November 16, 2015

Do Multivitamins Improve Health?

I'm sure many of you take multivitamins, and you probably do it to avoid deficiencies and to fill the gaps in your diet. Before I begin, I want to stress that this review deals specifically with multivitamins, not supplements in general. Please scroll down for a summary of the findings.


So what are typical deficiencies in the American population? Women are at greater risk for iron and vitamin A deficiency, especially if they are pregnant. Vegans & vegetarians may become b12 deficient. Black skinned people are at greater risk for vitamin D deficiency because the "melanin in the skin diminishes the ability to synthesize Vitamin D from the sun". The elderly usually experience a decline in the gut absorption of micro-nutrients: "The age-related decline in the capacity to absorb calcium [56] appears due to a gut-resistance to the action of 1,25- dihydroxyvitamin D3 resulting from a loss of vitamin D receptors in the duodenal mucosa [57]". The elderly may be at risk for vitamin b6, b12, d and calcium deficiency.

The American Centers for Disease Control and Prevention's nutrition reports (CDC.gov) is "a series of publications that provide ongoing assessment of the U.S. population's nutrition status by measuring blood and urine concentrations of biochemical indicators".

They found that between 2003 and 2006:
"Of all the nutrients listed, the most people had vitamin B6, iron, and vitamin D deficiencies, and the fewest people had vitamin A, vitamin E, and folate deficiencies." [...] "However, for most nutrition indicators, deficiencies varied by age, gender, or race/ethnicity and could be as high as nearly one third of certain population groups.".

This should give you a general idea of what you might be deficient in. The best way to be 100% sure of your micronutrient levels, is getting a blood test.

This brings us to RDA. Every country gives recommendations for micronutrient intakes. These RDAs are divided into age groups, and are designed for the general population. The problem here is that athletes usually have higher requirements for minerals (as well as fluids and macronutrients - but that is beyond the scope of this RR). Furthermore, the RDAs are usually enough to avoid deficiency, but being non-deficient is not the same as having optimal micronutrient levels, and this is especially true for athletes.
"For active individuals a marginal deficiency in the nutrients may impact the body's ability to repair itself, operate efficiently and fight disease, said Melinda Manore, researcher in the Colleges of Agricultural and Health and Human Sciences." [...] "The stress on the body's energy producing pathways during exercise, the changes in the body's tissues resulting from training, an increase in the loss of nutrients in sweat, urine and feces during and after strenuous activity and the additional nutrients needed to repair and maintain higher levels of lean tissue mass present in some athletes and individuals may all affect an individual’s B-vitamin requirements, said Manore"
Larry Kenney from Pennsylvania State University states:
"The 2004 recommendations on water and sodium intake from the Institute of Medicine (IOM) of the National Academy of Sciences are targeted primarily at sedentary Americans. These guidelines for water and salt intake should not be applied to athletes. Athletes who follow the IOM recommendations to the letter may actually put themselves at risk for unintended decreases in performance or even untoward health consequences."
Weightlifting athletes may be particularly prone to the negative effects of vitamin D deficiency, because calcium requires vitamin D for optimal absorption. If absorption of calcium is hindered:
"Low vitamin D increases bone turnover, which increases the risk for a bone injury, like a stress fracture." [...] "vitamin D [...] also aids in regulation of electrolyte metabolism, protein synthesis, gene expression, and immune function [10,28]. These vital functions are essential for all individuals, especially the elite and recreational athlete."
An athlete may decide to supplement vitamin D. Unknowingly, he purchases D2: "Vitamin D3 increases the total 25(OH)D concentration [...] Vitamin D2 supplementation was associated with a decrease in 25(OH)D3,"

This goes to show that there are different forms of micronutrients. These forms have different bioavailabilities and effects on the body. For example, magnesium oxide is maybe the most commonly supplemented form of magnesium. The problem is that "magnesium oxide may have an absorbable magnesium potency as low as 4%. 7 8". I could write for days about micronutrient forms and bioavailability, but to keep it succinct: multivitamins are usually filled with the cheapest and worst forms of vitamins and minerals. If you want to learn more about magnesium check out this post. To get more information about bioavailability check this out.

This brings us to the concept of antinutrients:
"Antinutrients in foods are responsible for deleterious effects related to the absorption of nutrients and micronutrients. However, some antinutrients may exert beneficial health effects at low concentrations.".

A very potent antinutrient is phytic acid. It is usually found in large concentrations in seeds, nuts, grains, legumes. "phytic acid [has the] ability to bind to essential minerals such as iron, zinc, calcium, and magnesium in the digestive tract and inhibit their absorption by the body.1,2". A consequence of this is that if a person is consuming a meal rich in phytic acid along with his daily multi, the minerals in the multi may be rendered less useful. The good news is that vitamin C partly counteracts the negative effects of phytic acid

More info on phytic acid

There are other factors that limit micronutrient absorption. These factors are the interactions between the nutrients, called vitamin and mineral antagonism and synergy 1 2. Micros that have synergy, enhance each other’s uptake (i.e. Vit D enhances calcium uptake, Vitamin C enhances iron uptake). There is also antagonism, whereby micros inhibit absorption of other micros. For example calcium interferes with iron absorption, zinc uptake is hindered by minerals such as cal, mag, iron, because they share a transporter.

The takeaway here is that if you fill a multivitamin with micro antagonists, they will compete for absorption and hinder uptake levels.

The last part of the introduction deals with what I call the size paradox of multivitamins. Simply put, it is impossible to squeeze (common values) 400mg of magnesium, 600mg of calcium, 14mg iron, 10mg zinc, 500iu vitamin d, 500mg vitamin c, all the b vitamins, trace minerals, etc. into a small tablet). I have a bottle of Magnesium citrate 100mg tablets, and each tablet is twice the size of my multi.
"12 multivitamins provided less vitamin A, vitamin C, or folate, or than claimed, some with less than 30% of the listed amounts. These include a prenatal vitamin and products for men, adults (general), seniors, and even pets."


Summary of introduction
  • Common micronutrient deficiencies are: Vitamin D, iron, B6. Deficiency prevalence is population based (age, sex, skin color, lifestyle)
  • Multivitamins are usually filled with the cheapest and worst forms of vitamins and minerals
  • Reaching RDAs may prevent deficiency, but may not necessarily give you optimal levels
  • Athletes need more micros than sedentary individuals
  • Antinutrients and micronutrient antagonism severely hinder the absorption rates and bioavailability of MVs
  • The minerals and vitamins found in MVs won't physically fit into a neat little pill
  • Companies may lie on the contents label (goes for all supplements)

Summary of the meta-analysis (scroll down to see the studies)

  • Antioxidants such as vitamin C and E may help fight cancer (but they could also hinder athletic performance improvements)
  • Most research is done on the elderly
  • There is no clear consensus because of contradictory evidence. However, the majority of the evidence points towards no effect
  • Smokers may want to avoid MVs (especially ß-carotene)
  • High doses of fat-soluble vitamins, such as vitamin A can be dangerous. Always check the bottle contents!

Final thoughts

Research does not support the hypothesis that MVs give health benefits. This does not mean that targeted or isolated supplementation is useless! For example, vitamin D3 supplementation has been shown to increase hormonal levels of vitamin D. You should probably figure out what you're deficient in and do targeted supplementation instead of buying a MV that probably won't do much for your health.

Part II - Studies

Before looking at the studies, we must identify the possible sampling biases of multivitamin research. It is possible that people who take multivitamins do so as a way to self-medicate, because they feel unhealthy or know they have unhealthy lifestyles. It could also be the effect of marketing. In most of the studies I reviewed, the participants were aged 50+. This is an issue because they do not represent the entire population. Lastly, studies usually rely on self-reported questionnaires. The risk here is that people lie or modify the truth.

I've tried to represent both sides of the debate as fairly as possible. I excluded studies with few participants, unclear methods, obvious spelling errors in the abstract (...), paid research (supplement marketing), very short trials, or generally poor design.

Example of excluded study with spelling errors, short trial, and likely paid

Example of excluded study because of purely self-reported statistics

Example of excluded study because low N and (relatively) short trial


Studies with evidence supporting multivitamin health benefits

Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
  • Published: 2009
  • Time period: 1993-2005
  • Participants: 161 808
  • Age: 50 to 79
  • Inclusion criteria: postmenopausal women
  • Exclusion criteria: alcoholism, drug dependency, dementia.

A total of 41.5% of the participants used multivitamins.

How they documented:
Dietary supplement data were collected during in-person clinic visits. Women brought supplement bottles to the baseline clinic visit and to annual visits thereafter in the CTs and to the baseline and 3-year visits in the OS.
What they documented:
We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.
What they found:
In this large cohort of postmenopausal women, we observed no overall associations between multivitamin use and risk of several common cancers or CVD. There were also no associations between multivitamin use and total mortality. Risk estimates did not materially change when stratified by class of multivitamins, with the exception of a possible lower risk of MI among users of stress-type supplements [STRESS SUPPLEMENTS = STACKED SUPPLEMENTS]. Many stress supplements include high doses of folic acid and other B vitamins; previous studies have supported a protective role for folic acid in relation to CVD and its antecedent risk factors.26,34- 36
Limitations: Only postmenopausal women were tested, only some cancers and risk conditions were tested.

Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women

  • Published: 2010
  • Time period: 1997-2007
  • Participants: 31 671 (no CVD) + 2262 (with CVD)
  • Age: 49–83
  • Inclusion criteria: Female
  • Exclusion criteria: Cancer, diabetes

How they documented:
Women completed a self-administered questionnaire in 1997 regarding dietary supplement use, diet, and lifestyle factors.

In the primary analyses we excluded 2262 women with a diagnosis of cardiovascular disorders

We also performed separate analysis to examine the association between multivitamin use and MI among those 2262 women with history of CVD
What they documented:
In the current study, we evaluated the effect of multivitamins with and without minerals on the risk of MI
What they found:
In this large, prospective cohort of women we observed a lower risk of MI among women with no history of CVD at baseline who were using either multivitamins alone or multivitamins in combination with other supplements. The association was stronger among women who used multivitamins for =5 y. The risk did not differ substantially when we stratified by factors such as age, smoking status, BMI, alcohol consumption, and hypertension.
Limitations: Only older women

Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States

  • Published: 2015
  • Time period: 1988–2011 (18 year follow-up)
  • Participants: 8678
  • Age: >40
  • Inclusion criteria: Females only, "NHANES III is a nationally representative, cross-sectional survey that uses a stratified, MVstage probability design to obtain a nationally representative sample of the civilian, noninstitutionalized US population".
  • Exclusion criteria: pregnant and lactating women, chronic kidney disease, missing supplement information, CVD, stroke, or congestive heart failure
How they documented:
NHANES III obtained data on medication use and health history by questionnaire

NHANES measured participants? demographic characteristics and health status and history, including dietary supplement use, during the personal interview.
What they documented:
Demographic data collected included sex, age, race, and education level. The race/ethnic groups identified in NHANES included non-Hispanic white, non-Hispanic black, Mexican American, and other. Education level was categorized as completion of less than high school, high school completion, or education after high school. NHANES participants showed containers of the dietary supple- ments, antacids, and prescription medications that contained nutrients to interviewers; the dietary supplement files contain these data. The interviewers asked about participant?s use of vitamins, minerals, herbs, and other supplements over the past 30 d and collected detailed infor- mation on type, consumption frequency, duration, and amount taken for each reported supplement.
What they found:
In this nationally representative, prospective sample of adults who were without prevalent CVD, use of MVMs [MULTIVITAMIN-MINERALS] for >3 years was associated with reduced risk of CVD mortality at a median of 18 y of follow-up.
Limitations: Only >40 years of age, only women

The Physicians' Health Study II - Multivitamins in the Prevention of Cancer in Men
  • Published: 2012
  • Time period: 1997-2011
  • Participants:14 641 (non-cancer) + 1312 (cancer)
  • Age: >50
  • Inclusion criteria: male physicians
  • Exclusion criteria: A 12-week placebo, run-in period excluded men who were nonadherent.
The PHS II was a randomized, double-blind, placebo-controlled, 2×2×2×2 factorial trial evaluating the balance of risks and benefits of a multivitamin

Participants were sent monthly calendar packs containing a multivitamin or placebo (taken daily) every 6 months for the first year, then annually thereafter.
How they documented:
We also sent participants annual questionnaires asking about adherence, adverse events, new end points, and risk factors
What they documented:

"Total cancer (excluding nonmelanoma skin cancer), with prostate, colorectal, and other site-specific cancers among the secondary end points."

What they found:
long-term daily multivitamin use had a modest but statistically significant reduction in the primary end point of total cancer after more than a decade of treatment and follow-up.
Limitations: Only men, only >50y,

Studies with evidence against multivitamin health benefits

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
  • Published: 2013 (META-ANALYSIS)
How they documented:
Two investigators independently reviewed each study's abstract against prespecified inclusion criteria. We included fair- and good-quality randomized, controlled trials that assessed the effectiveness or safety of supplements in the primary prevention of CVD, cancer, or all-cause mortality in the general adult population without a history of CVD or cancer. We included fair- and good-quality secondary prevention trials if they hypothesized effects on outcomes included in this review and not present at baseline in the study (for example, a trial of secondary skin cancer prevention that also reported on other cancers). We included only studies that were conducted among community-dwelling, nutrient-sufficient adults who had no chronic disease and were performed in countries with a Human Development Index of “very high” (11). We also required supplement doses to be lower than the upper tolerable limit set by the U.S. Food and Nutrition Board (12)
What they documented:
We specifically sought studies of the following vitamins and minerals: vitamins A, B1, B2, B6, B12, C, D, and E; calcium; iron; zinc; magnesium; niacin; folic acid; ß-carotene; and selenium. We included studies that evaluated single, paired, and combinations of 3 or more vitamins and minerals; we use the term “multivitamin” to refer to those combinations.

We screened 12 766 abstracts, reviewed 277 full-text articles, and included 103 articles (26 studies) (Appendix Figure 2 of the Supplement). Four trials (19–22) and 1 cohort study (23) examined the benefits and harms of multivitamin supplementation (Supplement). Twenty-two trials and 2 cohort studies examined the benefits and harms of individual or paired supplements (Supplement): 6 studies of ß-carotene (24–29), 6 studies of vitamin E (22, 24, 30–33), 3 studies of selenium (33–35), 5 studies of vitamin A (23, 29, 36–38), 2 studies of vitamin C (30–31), 1 study of folic acid (39), 3 studies of vitamin D (40–42), 2 studies of vitamin D in combination with calcium (43–44), and 4 studies of calcium (40, 43, 45–46). The study sizes ranged from 128 to 72 337 individuals with average ages ranging from 22 to 77 years, although in most studies the mean age was older than 50 years (Supplement). Six studies were conducted among women only, 5 were conducted among men only, and the remaining studies were in mixed populations (24.2% to 84.7% women). The effects of the supplements were examined between 6 months and 16 years; most studies provided less than a decade of follow-up.
What they found:
This review included 26 studies (24 randomized, controlled trials and 2 cohort studies) that examined the benefits and harms of using vitamin and mineral supplements for primary prevention of CVD, cancer, or all-cause mortality in healthy individuals without known nutritional deficiencies. We found no consistent evidence that the included supplements affected CVD, cancer, or all-cause mortality in healthy individuals without known nutritional deficiencies. Other systematic reviews have arrived at this same conclusion (56–66). The certainty of this result is tempered, however, because few fair- or good-quality studies are available for all supplements except vitamin E and ß-carotene. For vitamin E, we identified 6 fair- to good-quality trials that produced clearly null effects on these end points. This result is consistent with the conclusions of other systematic reviews and meta-analyses of vitamin E (67–71). Our review also confirmed the established harm of ß-carotene supplementation on lung cancer incidence and death for individuals at high risk for lung cancer (24, 29, 72). Further, we identified 6 trials that failed to detect any benefit from ß-carotene supplementation for any individuals.

Dietary Supplements and Mortality Rate in Older Women
  • Published: 2011
  • Time period: 1986-2008
  • Participants: 38 772
  • Age: Mean age: 61,6
  • Inclusion criteria: Female
  • Exclusion criteria: "[...] excluding from all analyses those who did not adequately complete a questionnaire including food frequency and supplement use at baseline in 1986"
Of these women, 99.2% were white and 98.6% were postmenopausal

How they documented:
Food intake was assessed at baseline and in the 2004 follow-up, using 2 nearly identical versions of the validated 127-food item Harvard Service Food Frequency Questionnaire.

Supplement use was queried in 1986, 1997, and 2004 and included the 15 supplements assessed at all 3 surveys: multivitamins; vitamins A, beta-carotene, B6, folic acid, B complex, C, D, and E; and minerals iron, calcium, copper, magnesium, selenium, and zinc. Different forms of vitamin D, cholecalciferol (D3) or ergocalciferol (D2), were not distinguished. At the baseline and 2004 follow-up surveys, the supplement-related questions were part of the Food Frequency Questionnaire.
What they documented:
Mortality rates.

They excluded deaths that were "related to injury, accident, and suicide, because it is unlikely that supplement use would be causally related to these outcomes."

What they found:
[...] most of the supplements studied were not associated with a reduced total mortality rate in older women. In contrast, we found that several commonly used dietary vitamin and mineral supplements, including multivitamins, vitamins B6, and folic acid, as well as minerals iron, magnesium, zinc, and copper, were associated with a higher risk of total mortality. Of particular concern, supplemental iron was strongly and dose dependently associated with increased total mortality risk. Also, the association was consistent across shorter intervals, strengthened with multiple use reports and with increasing age at reported use. Supplemental calcium was consistently inversely related to total mortality rate; however, no clear dose-response relationship was observed.

Also, supplement users were more likely to have lower intake of energy, total fat, and monounsaturated fatty acids, saturated fatty acids and to have higher intake of protein, carbohydrates, polyunsaturated fatty acids, alcohol, whole grain products, fruits, and vegetables.
Limitations: Does not strictly deal with multivitamins, but still interesting

Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements
  • Published: 2013 (META-ANALYSIS)
How they documented: The authors did a meta-analysis of other studies

What they found:
The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries (9).

In conclusion, ß-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.
Limitations: Authors seem emotionally invested in the outcome of the debate. They may be picking studies that support their views.

Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers

Published: 2008 (META-ANALYSIS)

How they documented:
The authors systemically reviewed the published literature using a search of the MEDLINE database and performed a meta-analysis of large randomized trials that reported on the effect of beta-carotene supplementation on the incidence of lung cancer among smokers or former smokers. A sample of multivitamins was evaluated for their beta-carotene content and the suggested daily dosage.
What they documented: Beta-carotene's possible interaction with lung cancer in smokers

What they found:
Four studies contributing 109,394 subjects were available for analysis. The average daily beta-carotene dosage in these trials ranged from 20 to 30 mg daily. Among current smokers, beta-carotene supplementation was found to be significantly associated with an increased risk of lung cancer (odds ratio [OR], 1.24; 95% confidence interval [95% CI], 1.10–1.39). Among former smokers, there was no significant increase noted (OR, 1.10; 95% CI, 0.84–1.45). In a sample of 47 common multivitamins, beta-carotene was present in 70% of the identified formulas. The median dosage of beta-carotene was 0.3 mg (range, 0–17.2 mg) daily. The beta-carotene content was found to be significantly higher among multivitamins sold to improve visual health than among other multivitamins, with a median daily dosage of 3 mg (range, 0–24 mg).

Studies with mixed findings or no effect

Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort
  • Published: 2012
  • Time period: 1994-2006 (11 year average followup)
  • Participants: 23 943
  • Age: 35-64
  • Inclusion criteria: male and female
  • Exclusion criteria: cancer, myocardial infarction/stroke
How they documented:
In the EPIC-Heidelberg cohort, vitamin/mineral supplementation was assessed at different time points. In a baseline face-to-face interview, regular use of vitamin/mineral supplements was assessed by asking participants the following question: ‘‘Did you regularly take any medications or vitamin/mineral supplements in the last 4 weeks?’’

In a baseline self-administered food frequency questionnaire (FFQ), participants were also asked whether they had taken vitamin/mineral supplements for C 4 weeks in the last 12 months.

Intakes of 148 food and beverage items in the last 12 months before recruitment were measured using the baseline FFQ, which had been validated by twelve 24-h dietary recalls [ 8 , 9 ]. Baseline demographic, lifestyle, and other health-related characteristics were measured in a baseline lifestyle questionnaire survey and a baseline physical examination.
What they documented:

Cancer, cardiovascular, and all-cause mortality.

What they found:

After an 11-year follow-up of the EPIC-Heidelberg cohort, regularly taking any vitamin/mineral supplements was not statistically significantly associated with cancer, CVD, or all-cause mortality. However, antioxidant vitamin supplementation was significantly inversely associated with cancer mortality and all-cause mortality. In comparison with never users, baseline non-users who started taking vitamin/mineral supplements during follow- up had significantly increased risks of cancer mortality and all-cause mortality.

Multivitamin Use and Mortality in a Large Prospective Study

!!Important study!!
  • Published: 1999
  • Time period: 1982-1989
  • Participants: 1,063,023 (!!!!!!)
  • Age: >30 (!!!!!!!)
  • Inclusion criteria: 30 or older
  • Exclusion criteria:
Cancer Prevention Study II (CPS-II) is a nationwide, prospective mortality study of nearly 1.2 million US men and women aged 30 years and older that began in 1982. At the request of an American Cancer Society volunteer, each enrollee completed a four-page mailed questionnaire in 1982 that requested information on history of cancer and other diseases, use of medicines and vitamins, use of alcohol and tobacco, diet, as well as other factors potentially affecting mortality. This analysis includes 1,063,023 people (453,962 men; 609,061 women) who, at enrollment, reported usable data on vitamin use.
How they documented:
[...] each enrollee completed a four-page mailed questionnaire in 1982 that requested information on history of cancer and other diseases, use of medicines and vitamins, use of alcohol and tobacco, diet, as well as other factors potentially affecting mortality.

What they documented:
[...] we classified deaths due to ischemic heart disease (ICD-9 codes 410–414), cerebrovascular disease (stroke) (ICD-9 codes 430–438), and all cancers combined, except nonmelanoma skin cancer (ICD-9 codes 140–195 and 199–209). We examined separately the three most common causes of cancer mortality: lung (ICD-9 code 162), colo-rectal (ICD-9 codes 153–154), and (for men) prostate (ICD-9 code 185) and (for women) breast (ICD-9 code 174), and all other cancers combined. All-cause mortality included persons who died of any cause.
What they found:
This large prospective study provides limited support for the hypothesis that multivitamin supplements may reduce death rates from ischemic heart disease in the general population. Men and women who took a multivitamin without other supplements had lower death rates from ischemic heart disease than did those who took no multivitamins. However, the association was attenuated when analyses were adjusted for additional cardiovascular risk factors besides age, and no consistent gradient of decreasing risk was seen with either the frequency or the duration of multivitamin use.

Men and women who used both multivitamins and vitamin A, C, or E had lower risks of dying from heart disease and stroke than did nonusers than one might expect from the relative risks for users of either only a multivitamin or only a vitamin A, C, or E supplement.

Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study

  • Published: 2011
  • Time period: 1993-2005 (11 year average follow-up)
  • Participants: 182 099
  • Age: 45-75
  • Inclusion criteria: Living in Hawaii and California, ethnic group
  • Exclusion criteria: "we excluded participants who were not in one of the targeted 5 ethnic groups (n = 13,991) or who reported invalid dietary intakes based on total energy intake or its components (n = 8,264) (12). We also excluded those with missing information on multivitamin use (n = 4,451) or smoking (n = 7,013)"
How they documented:
The baseline questionnaire included questions about the use of multivitamins (with/without minerals) and 7 single vitamin/mineral supplements. Subjects were asked to indicate whether they had used any of these supplements at least weekly during the previous year.

In a follow-up questionnaire approximately 5 years after baseline (1999–2003), participants were asked the same question on multivitamin use but without duration of use.
What they documented:
During an average 11 years of follow-up, we identified 28,851 deaths (15,962 men and 12,889 women). Death from all causes was the primary endpoint in the analyses. In addition, according to the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10), we categorized the primary cause of death into cardiovascular diseases (ICD-9 codes 390–434, 436–448; ICD-10 codes I00–I78), cancer (ICD-9 codes 140–208; ICD-10 codes C00–C97), and all other causes.
What they found:
In this large multiethnic cohort, we found no associations between multivitamin use and mortality from all causes, cardiovascular diseases, or cancer. The findings did not vary across subgroups by ethnicity, age, body mass index, preexisting illness, single vitamin/mineral supplement use, hormone replacement therapy use, and smoking status. In addition, there was no evidence indicating that multivitamin use increased or decreased risk for cancer, overall or at major sites, such as lung, colorectum, prostate, and breast.
Limitations:
Multivitamin users are generally more health conscious than are nonusers (1, 36), which could confound the relation of multivitamin use with morbidity or mortality. Although we adjusted for well-known potential confounders including health-related behaviors such as smoking status, alcohol consumption, and physical activity (37), there may still be uncontrolled bias. In particular, we were unable to adjust for changes in potential confounders over time. The longest duration category for multivitamin use in our baseline questionnaire was 5 years and longer, although the effects of multivitamins on longevity and disease might take a longer period.
The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference.
  • Published: 2006 (META-ANALYSIS)

How they documented:
MEDLINE, EMBASE and the Cochrane Library were searched from 1966 to February 2006. References of articles were checked, experts were contacted, and tables of contents for 15 relevant journals were searched from January 2005 to February 2006. Search terms were reported in the full report (see Other Publications of Related Interest). Only studies reported in English were eligible for inclusion.

Randomised controlled trials (RCTs) which assessed the efficacy of a multivitamin/mineral supplement for the prevention of one or more of the following chronic diseases were eligible for inclusion: cancer; myocardial infarction or stroke; type 2 diabetes; Parkinson's disease or dementia; cataracts; macular degeneration or hearing loss; osteoporosis; osteopenia; rheumatoid arthritis; osteoarthritis; non-alcoholic steatorrheic hepatitis; non-alcoholic fatty liver disease; chronic renal insufficiency; chronic nephrolithiasis; HIV (human immunodeficiency virus) infection; hepatitis C; tuberculosis; and chronic obstructive pulmonary disease. Studies which included only the following types of participants were excluded from the review: pregnant women; people aged up to 18 years; people with a chronic disease or those receiving treatment for such a disease; patients in long-term care facilities; or people with a clinical nutritional deficiency. Studies which assessed only safety or which did not assess supplement use separately from dietary intake were also excluded. For the assessment of safety observational studies in adults and children were also eligible for inclusion.
What they documented:
To assess the efficacy and safety of multivitamin and mineral supplements for the primary prevention of cancer and chronic disease in the general population.
What they found:
There was insufficient evidence to determine the presence or absence of benefits from the use of multivitamin and mineral supplements for the prevention of cancer and chronic disease.

Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration
  • Published: 2012 (META-ANALYSIS)
The objective of this review was to assess the effects of antioxidant vitamin or mineral supplementation, alone or in combination, on the progression of AMD.

What they found:

People with AMD may experience delay in progression of the disease with antioxidant vitamin and mineral supplementation. This finding is drawn from one large trial conducted in a relatively well-nourished American population. The generalisability of these findings to other populations is not known. Although generally regarded as safe, vitamin supplements may have harmful effects. A systematic review of the evidence on harms of vitamin supplements is needed.


Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: U.S. Preventive Services Task Force Recommendation Statement

  • Published: 2014 (META-ANALYSIS)

How they documented:

In order to update its 2003 recommendation, the USPSTF reviewed evidence of the efficacy of multivitamin or mineral supplements in the general adult population for the prevention of cardiovascular disease and cancer (3, 12). The value of vitamins that naturally occur in food and the use of vitamin supplements for the prevention of other conditions (for example, neural tube defects) and for the secondary prevention of complications in patients with existing disease are outside the scope of this review.
What they documented:
This recommendation applies to healthy adults without special nutritional needs (typically aged 50 years or older). It does not apply to children, women who are pregnant or may become pregnant, or persons who are chronically ill or hospitalized or have a known nutritional deficiency.
What they found:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of multivitamins for the prevention of cardiovascular disease or cancer. (I statement)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of single- or paired-nutrient supplements (except ß-carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement)The USPSTF recommends against ß-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation)
Limitations:
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Long-Term Multivitamin Supplementation and Cognitive Function in Men
  • Published: 2013
  • Time period: 1997-2011
  • Participants: 5947
  • Age: >65
  • Inclusion criteria: male physician
  • Exclusion criteria:
How they documented:
Up to 4 repeated cognitive assessments by telephone interview were completed over 12 years
What they documented:
To evaluate whether long-term multivitamin supplementation affects cognitive health in later life.
What they found:
In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits.
Limitations:
Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.

Other studies
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