Are There Anti-Aging Vitamins?

Written by Dr. Steve Chaney on . Posted in Anti-Aging Vitamins, Vitamins and Health

Could You Live To Be 120 And Beyond?

Author: Dr. Stephen Chaney

anti-aging viataminsRecent headlines suggest that we can slow biological aging just by increasing our consumption of certain vitamins. That sounds wonderful.  After all, everyone is still hoping for that mythical “Fountain of Youth” and anti-aging vitamins could be just the ticket.

But, what did the paper behind the headlines actually show? The paper (J-Y Lee et al, Journal of Human Nutrition and Dietetics, DOI: 10.1111/jhn.12403, 2016) reported that people who consumed the most vitamin C and folic acid had the longest telomeres.

You might be wondering how journalists extrapolated from that study to headlines proclaiming that those vitamins could slow biological aging. To understand the answer to that question you need to know two things:

  • What is biological aging?
  • What are telomeres and why are they important?

What Is Biological Aging?

biological agingIn simplest terms, biological aging refers to the aging process on a cellular level. This concept is based on the “Hayflick Limit” first proposed by Leonard Hayflick in 1962. He showed that normal human cells have a maximum lifespan of 40-60 cell divisions. As they approach that upper limit, DNA damage accumulates and cell division slows and eventually stops.

The “Hayflick Limit” is important because our tissues depend on constant cell division to remain young and vital. Our organs are made up of various tissues and depend on those tissues performing at an optimal level. Thus, as more and more cells lose the ability to divide, our tissues and our organs begin to age. This is thought to be associated with disease and eventually death.

Thus, even though biological aging refers to aging at a cellular level, its significance is thought to extend far beyond the cellular level. It is thought to influence aging, disease, and death at a whole-body level. It reminds me of the famous quote “For want of a nail…the kingdom was lost.” If you’ve forgotten that quote, look it up. It is a perfect analogy for how something that seems so inconsequential can have such a profound effect on our health and mortality.

What Are Telomeres And Why Are They Important?

anti-aging vitamins telomeresTelomeres are sequences of repetitive DNA at the ends of our chromosomes that protect their integrity. Telomeres become progressively shorter as we age. As a very simple analogy we can think of telomeres as being similar to the tips of our shoelaces. If you have ever lost the tip of your shoelace, you know that the shoelace is worthless once the tip is gone.

That analogy holds perfectly with respect to our telomeres. As the telomers become progressively shorter, DNA division slows and eventually stops. DNA division is essential for cell division. Telomere shortening is postulated to be responsible for the Hayflick Limit. Thus, it is no surprise that telomere shortening is associated with aging, age-related diseases such as hypertension, diabetes, heart disease and dementia, and death.

Telomere shortening is a bad news, good news phenomenon. On the “bad” side, telomere shortening is inevitable. I hate to be the bearer of bad news, but we will all die at some point.

On the “good” side, there is tremendous heterogeneity in telomere length between individuals at any given age. Some of these differences in telomere length may be genetic, but many appear to be lifestyle related (MA Shammas, Current Opinion in Clinical Nutrition & Metabolic Care, 14: 28-34, 2011). For example, short telomers appear to be associated with things like smoking, environmental pollution, stress, meat consumption, and fat consumption. Long telomeres are associated with the lack of those things and with positive lifestyle characteristics such as exercise and consumption of fresh fruits and vegetables.

Are Some Vitamins Anti-Aging Vitamins?

slow agingMore recent studies have begun to look at the influence of individual nutrients on telomere length. The study featured this week (J-Y Lee et al, Journal of Human Nutrition and Dietetics, DOI: 10.1111/jhn.12403, 2016) is just the latest example.

This study used food frequency questionnaires to assess nutrient intake of 1958 middle-aged and older Koreans between June 2001 and January 2003. They measured intake of vitamins A, B1, B2, B3, B6, B9 (folate), C and E plus calcium, phosphorous, potassium iron and zinc.

Ten years later they measured telomere length in the same population and reported that:

  • Telomere length was positively associated with intake of vitamin C, folate, and potassium.
  • No association with telomere length was seen for the other nutrients.

So, are these anti-aging vitamins?  Let’s look at the strengths and weaknesses of this study.

This study has some notable strengths:

  • It is a fairly large study, so the results are statistically significant.
  • There is a good biochemical rationale for vitamin C and folate being protective for telomeres.
  • Antioxidants such as vitamin C, vitamin E, carotenoids, and polyphenols protect the DNA from oxidative damage.
  • Folic acid, vitamin B6, and vitamin B12 are involved in pathways that stabilize and repair DNA.
  • It is consistent with previous studies (See below)

However, this study also has some glaring weaknesses:

  • It only measures associations, not cause and effect.
  • The diet analysis was not repeated at the end of the study. The authors assumed that dietary habits did not change, but we don’t know that.
  • The use of dietary supplements was not assessed, so we don’t know how that might have influenced the outcome.

What Does This Study Mean For You?

If we look at the totality of published studies(MA Shammas, Current Opinion in Clinical Nutrition & Metabolic Care, 14: 28-34, 2011) :

  • There is good evidence that optimal intake of the antioxidants C and E is positively associated with telomere length.
  • There is good evidence that optimal intake of folic acid and vitamin B12 is positively associated with telomere length.
  • There is preliminary evidence that optimal intake of carotenoids, polyphenols, and omega-3 fatty acids is positively associated with telomere length.

However, there is a lot we don’t know about telomeres. We know that short telomeres are associated with aging, age-related diseases and death. What we do not know is whether telomere shortening is the cause of the aging process or merely a marker of aging. Let me rephrase those two possibilities in a more understandable manner.

  • If telomere shortening is the cause of the aging process, anything we can do to decrease the rate of telomere shortening would slow the aging process and delay the onset of age-related diseases.  If the vitamins mentioned above then caused this decrease, they could indeed be considered anti-aging vitamins.
  • If telomere length is simply a marker of aging, we can consider it like the “canary in the coal mine”. That analogy might be particularly apt. The value of the canary is that it can detect toxic gases when they are still undetectable to humans. It turns out that it is virtually impossible to detect the effect of nutrient intake on longevity (We simply live too long), and it has proven very difficult to determine the effect of nutrient intake on age-related diseases. Having a simple marker of the aging process may well give us valuable insight into how we can best delay the aging process.

Either way longer telomeres are probably a good thing. Based on a limit of 40-60 cell divisions for normal human cells, Leonard Hayflick estimated a maximum human lifespan of 120 years. If we could truly decrease the rate of telomere shortening, would that potentially increase maximum human lifespan or would it mean that more of us reach 120 in good health? Most of us would probably be happy with either outcome.

 

The Bottom Line

 

  • Telomeres are the tips at the end of our chromosomes that protect the chromosomes from unraveling.
  • Our telomeres get progressively shorter as we get older. Short telomeres are associated with aging, age-related diseases, and death.
  • Recent studies have shown that our lifestyle can influence the rate of telomere shortening. For example:
  • Short telomers are associated with things like smoking, environmental pollution, stress, meat consumption, and fat consumption.
  • Long telomeres are associated with the lack of those things and with positive lifestyle characteristics such as exercise and consumption of fresh fruits and vegetables.
  • Recent studies have also shown that optimal intake of certain nutrients can influence the rate of telomere shortening. For example:
  • There is good evidence that optimal intake of the vitamins C, E, folic acid, and B12 is positively associated with telomere length.
  • There is preliminary evidence that optimal intake of carotenoids, polyphenols, and omega-3 fatty acids is positively associated with telomere length.
  • There is a lot that we do not know about telomere length. In particular,
  • We do not know whether telomere shortening is the cause of the aging process or merely a marker of aging, like the canary in the coal mine.
  • In either case, anything we can do to reduce the rate of telomere shortening is probably a good thing.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Vitamin D Help Prevent Asthma Attacks?

Written by Dr. Steve Chaney on . Posted in Prevent Asthma Attacks, Vitamin D, Vitamins and Health

Author: Dr. Stephen Chaney

breaking newsWhat do the experts say about vitamin D helping to prevent asthma attacks?  You’ve seen the headlines. Vitamin D is no longer just for healthy bones. It has become the latest “miracle” nutrient. If you believe everything you read, vitamin D can prevent or cure everything from multiple sclerosis to diabetes, heart disease, and cancer. Unfortunately, the evidence for many of those claims is weak.

However, the effect of vitamin D on the severity of asthma symptoms appears to be an exception. That relationship appears to be on much more solid ground.

A review published last year(S.K. Bantz et al, Annals of Pediatrics and Child Health, 3: pii: 1032, 2015) concluded “We emphasize that all children, especially those who are asthmatic, should be assessed to ensure adequate intake or supplementation with at least the minimum recommended doses of vitamin D. The simple intervention of vitamin D supplementation may provide significant clinical improvement in atopic disease, especially asthma.” [Note: Atopic disease refers to diseases characterized by a hyperallergenic response, such as eczema, hay fever, and asthma.]

That was followed by the recent publication of a Cochrane Review  that concluded “Vitamin D is likely to offer protection against severe asthma attacks”. To understand the significance of that statement you need to understand that this is not just another clinical study or another review. Cochrane Reviews are conducted by an international group of experts and are considered the “Gold Standard” for evidence-based medicine.

You may remember that famous commercial: “When E.F. Hutton speaks, people listen.”  In this case: “When Cochrane Reviews speak, doctors listen.”

Let’s look briefly at how the review was conducted, and then examine exactly what the review said, and what it didn’t say.

Does Vitamin D Help Prevent Asthma Attacks?

certifiedOne of the characteristics of Cochrane Reviews that set them apart from many of the other reviews that you find in the literature is that they include only the highest quality clinical studies in their analysis. This is one of the things that gives them such credibility.

This particular Cochrane Review included seven trials involving a total of 435 children and two trials involving a total of 658 adults. Most trial participants had mild to moderate asthma. The duration of the trials ranged from four to 12 months.  All studies were placebo controlled and used close to RDA recommended doses of vitamin D.

The results were pretty clear cut:

  • Vitamin D supplementation reduced the average number of severe asthma attacks requiring treatment with oral steroids by 36%.  This conclusion was based on 3 high-quality studies involving 680 participants.  Here, these studies clearly show vitamin D does  help prevent asthma attacks.
  • Vitamin D supplementation reduced the number of acute asthma attacks requiring emergency room visits and/or hospitalizations by 50%. This conclusion was based on 7 high-quality studies with 963 participants.  These studies also show vitamin D helps prevent asthma attacks.
  • None of the studies reported any severe adverse effects from vitamin D supplementation. (Compare that with all warnings associated with those ads for asthma medications you see on TV.)

However, they did not see any effect of vitamin D supplementation on day-to-day asthma symptoms.

What Does This Study Mean For You?

prevent asthmaThis study strongly suggests that vitamin D supplementation in the RDA range (600 IU for ages 1-70 and 800 IU for adults over 70) significantly reduces the risk of severe asthma attacks requiring steroids or hospitalization. Thus, if you or your child have asthma, vitamin D supplementation in the RDA range just makes sense.

However, this study also suggest that vitamin D is not a panacea that will make all asthma symptoms disappear.

Also, even Cochrane Reviews have limitations.

  • None of the studies included in this review looked at vitamin D status prior to the study. We simply don’t know whether vitamin D supplementation might be effective at reducing day-to-day asthma symptoms in individuals who were vitamin D deficient.
  • The studies included in this review did not include asthma sufferers with severe symptoms. Again, we don’t know whether vitamin D supplementation might make day-to-day symptoms more tolerable and easily controlled for people with severe asthma symptoms

One final thought: Blood levels of 25-hydroxy-vitamin D are the best indicators of vitamin D status. For reasons that we don’t understand, not everyone consuming RDA levels of vitamin D ends up with optimal levels (50-75 nmoles/L).  For that reason, it is a good idea to get your blood levels of 25-hydroxy-vitamin D tested as part of your annual physical exam.

If you are already getting RDA levels of vitamin D and your 25-hydroxy-vitamin D levels are not in the optimal range, you may want to supplement with extra vitamin D.  Just be sure to monitor your 25-hydroxy-vitamin D levels on a regular basis to make sure they don’t exceed the optimal range.

So, according to the Cochrane Review, vitamin D does help prevent asthma attacks.

 

The Bottom Line

 

  • A recent Cochrane Review concluded that vitamin D supplementation in the RDA range (600 IU for ages 1-70 and 800 IU for adults over 70) significantly reduces the risk of severe asthma attacks requiring steroids or hospitalization in both children and adults. This is significant because Cochrane Reviews are considered the Gold Standard for evidence-based medicine.
  • Thus, if you or your child have asthma, vitamin D supplementation in the RDA range just makes sense.
  • However, blood levels of 25-hydroxy-vitamin D are the best measure of vitamin status, and not everyone consuming RDA levels of vitamin D ends up with optimal levels (50-75 nmoles/L). If you are already getting RDA levels of vitamin D in your diet and your 25-hydroxy-vitamin D levels are not in the optimal range, you may want to supplement with extra vitamin D. Just be sure to monitor your 25-hydroxy-vitamin D levels on a regular basis to make sure they don’t exceed the optimal range.
  • This Cochrane Review did not find any effect of vitamin D supplementation on day-to-day asthma symptoms.
  • However, even Cochrane Reviews have limitations.
  • None of the studies included in this review looked at vitamin D status prior to the study. We simply don’t know whether vitamin D supplementation might be effective at reducing day-to-day asthma symptoms in individuals who were vitamin D deficient.
  • The studies included in this review did not include asthma sufferers with severe symptoms. Again, we don’t know whether vitamin D supplementation might make day-to-day symptoms more tolerable and easily controlled for people with severe asthma symptoms

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Calcium and Breast Cancer Prevention

Written by Dr. Steve Chaney on . Posted in Calcium and Breast Cancer, Supplements and Health, Vitamins and Health

Author: Dr. Stephen Chaney

 

calcium and breast cancerIs there a connection between calcium and breast cancer prevention?  There has been lots of confusion about calcium supplements lately. Just a few years ago most health professionals were recommending calcium supplementation for women to prevent osteoporosis. Now that recommendation has become controversial. That’s because some studies have suggested that increasing calcium intake doesn’t actually prevent osteoporosis. Other studies have suggested that calcium supplementation may actually cause heart disease.

As if all this wasn’t confusing enough, the latest headlines are claiming that increased calcium intake will reduce breast cancer risk. What are we to believe about the value of calcium for our health? Should we take that calcium supplement we threw away out of the trash can and start using it again?

I have previously evaluated the studies behind the previous headlines and debunked the headlines. For example, I reported that previous studies suggesting that calcium supplementation might increase heart attack risk were followed by a much larger, better designed study showing that, if anything, calcium supplementation actually decreases heart attack risk in Do Calcium Supplements Increase Heart Attack Risk?. I also reported that the study claiming calcium supplements did not prevent osteoporosis was fatally flawed in Do Calcium Supplements Prevent Bone Fractures?.

Now it is time to evaluate the study behind the latest calcium headline. Is this headline myth or is it true?  What is the connection between calcium and breast cancer.

 

Calcium and Breast Cancer Risk Reduction

calcium reduces breast cancer riskThis study (Hidayat et al, British Journal of Nutrition, 116: 158-166, 2016) was a meta-analysis of 11 previous clinical studies published between 2002 and 2013 with a total of 872,895 women subjects which measured calcium intake and breast cancer. Follow up ranged from 7 to 25 years in these studies, during which time 26,606 of the women developed breast cancer.

Dietary plus supplemental calcium intake was determined at the beginning of each study using either a 24-hour diet recall or a food frequency questionnaire. Calcium intakes ranged from 203 mg/day to 1,750 mg/day.

In short this was a very large and well done study. Because of the large number of subjects and the large number of cancer cases, this study had the sensitivity to detect even small effects of calcium on breast cancer risk – something that was not possible in previous studies. In addition, the investigators were able to conduct a dose-response evaluation of the effect of calcium and breast cancer risk reduction. This was also had not been possible in previous studies.

When the women with the highest calcium intakes were compared to the women with the lowest calcium intakes:

  • Calcium reduced breast cancer risk by 8%.
  • The effect was much larger for premenopausal women than postmenopausal women:
  • Calcium reduced breast cancer risk by 25% in premenopausal women.
  • Calcium reduced breast cancer risk by 6% in postmenopausal women.
  • The dose response effect was fairly linear over the entire dose range with a 2% decreased risk of breast cancer for every 300 mg/day increase in calcium intake.

 

What Does This Study Mean For You?

As I said in the beginning, when you read the headlines proclaiming that increasing your calcium intake could decrease your breast cancer risk, you probably had two questions:

Is it true?  The answer appears to be yes. This was a very large, very well done study and it showed there is a connection between calcium and breast cancer risk reduction. It was capable of detecting even small effects of calcium on breast cancer risk – something that previous studies simply could not do.

Does it matter?  Here the answer is more complicated. If you’re a postmenopausal woman, increased calcium intake only decreases your risk of breast cancer by 6%.  If you are a premenopausal woman, increased calcium intake decreases your risk of breast cancer by a more robust 25%. However, in both cases you should think of calcium as only one component of a holistic approach to reducing breast cancer risk – something I’ll discuss in more detail below.

Now that you know the answer to those two questions you probably have a third question:

How much calcium do I need?   That’s pretty simple. The calcium DV for adults is 1,000 mg/day, increasing to 1,200 mg/day for women over 50.

How Can You Reduce Breast Cancer Risk?

In a previous article Preventing Osteoporosis,  I reported that while calcium supplementation alone had only a very modest effect on reducing osteoporosis risk, it played an important role as part of a holistic bone-healthy lifestyle. The role of calcium in reducing breast cancer risk is no different.

Most experts estimate that between 30 and 60% of breast cancer cases could be prevented by diet and lifestyle changes. In addition to calcium, both the Mayo Clinic  and the American Cancer Society make the following recommendations for reducing breast cancer risk:

  • calcium supplementsLimit or avoid hormone therapy. This is the single most important step you can take to reduce breast cancer risk.
  • Eat a plant-based diet with plenty of fresh fruits and vegetables, whole grains, legumes and nuts. Use fats in moderation and choose healthy fats such as olive oil and omega-3 fats. Limit the amounts of red meat and processed meats.
  • Control your weight.
  • Be physically active.
  • Don’t smoke
  • Limit alcohol intake.
  • Avoid exposure to radiation and environmental pollution.
  • Breast feed.

Where Should You Get Your Calcium?

Many experts recommend that you get your calcium only from food. Is that the best advice?  I always like to start with food as the source of essential nutrients, but in the case of calcium that usually isn’t sufficient. Here are some facts to ponder:

  • Plain, nonfat yoghurt is the calcium champion, with an 8 ounce serving supplying 42% of the DV (the calcium DV = 1,000 mg/day). However, most yoghurt cups in the market these days are 4 ounces or less.
  • Milk and a few cheeses supply around 30% of the DV. However, many people can’t or don’t consume the 3 or more servings needed to reach the DV.
  • Green leafy vegetables are often mentioned as another good food source. However, a serving of them only provides around 10% of the DV, and many leafy greens contain oxalates which decrease calcium absorption.
  • Beyond that,  most food sources of calcium supply only 1-8% of the DV for calcium. If you don’t drink lots of milk, you need to be a dietitian with an advanced degree to figure out how to get enough calcium from foods alone.
  • If that isn’t bad enough, many foods contain substances that interfere with calcium absorption. In addition to the oxalates in leafy greens, these substances include phytates from whole grains, phosphate from sodas, and saturated fat from red meats.

 

Experts often also recommend getting calcium from calcium fortified foods such as calcium fortified orange juice. That can help you reach the recommended calcium intake, but in my opinion calcium-fortified foods are likely to be more expensive and no better than regular foods plus a calcium supplement.

I recommend getting as much calcium as possible from food and adding a calcium supplement for the rest. Here are my tips on calcium supplementation:

  • If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. I personally recommend that it also contain zinc, copper, and manganese as well.
  • Your calcium supplement will be best utilized if taken between meals.
  • Your calcium supplement will be best utilized if you don’t take more than 500 mg at a time.
  • In most cases there is no need for more than the DV of calcium.

Let’s review the connection between calcium and breast cancer risk reduction.

 

The Bottom Line

  • A recent study has shown that increasing calcium intake reduces the risk of breast cancer. The effect of calcium intake on breast cancer risk was much greater for premenopausal women (25% risk reduction) than it was for postmenopausal women (6% risk reduction).
  • While the effect of calcium alone on breast cancer risk was relatively modest,  it is likely to be an important component of a holistic approach for reducing breast cancer risk.  Additional recommendations of the Mayo Clinic and American Cancer Society for reducing breast cancer risk are contained in the article above.
  • While many experts recommend getting your calcium from food alone, a careful analysis of food sources of calcium clearly shows how difficult that is for most people.
  • Calcium supplements are a safe and effective way to make sure you are getting the calcium you need. In the article above, I describe the optimal design of a calcium supplement and how to take a calcium supplement for optimal utilization.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Multivitamins Reduce the Risk of Miscarriage?

Written by Dr. Steve Chaney on . Posted in Multivitamins and Miscarriage, Vitamins and Health, Weight Loss

Will A Multivitamin A Day Keep YourBaby Healthy?

Author: Dr. Stephen Chaney

multivitamins reduce risk of miscarriageThe standard medical advice for years has been to take a prenatal supplement (basically a multivitamin with extra folic acid, iron and sometimes calcium) both before and during pregnancy. Does that really make a difference? Will it reduce the risk of miscarriage? Will it give you a healthier baby?  A recent study suggests that multivitamin use may significantly decrease your risk of miscarrying, but before going into the study you need a little background.

 

It’s a new world. It used to be that a woman didn’t know for sure that she was pregnant until she had missed one or two periods and finally got an appointment with her doctor – a month or two after conception actually occurred. In today’s world accuracy in home pregnancy tests allow women to learn they are pregnant much earlier – often before the first missed period.

With the early detection of pregnancy has come the realization that miscarriage rates are much higher than previously assumed. In spite of improved prenatal care, the rate of miscarriages in the US increased by 1% per year between 1985 and 2005. In part that is because women using the in-home pregnancy tests are detecting their pregnancies much early. However, it also reflects the fact that early miscarriages are often asymptomatic. They can only be detected by negative pregnancy tests.

With that in mind, let’s look at the study.

Do Multivitamins Reduce the Risk of Miscarriage?

pregnancy and miscarriageThis study (Louis et al, Fertility and Sterility, doi.org.10.1016/j.fertnstert.2016.03.009, 2016), had a very interesting design. It enrolled 501 couples ages 18-40 from Michigan and Texas who were actively trying to become pregnant into something called the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. The women in the study were instructed in the use of a commercial fertility urine test to help the couples plan their intercourse to maximize the chances of conceiving. They were also instructed in the use of a commercial pregnancy urine test to determine the onset and potential loss of pregnancy (miscarriage).

The couples were given no guidance on health practices to follow before and during pregnancy. They were interviewed individually upon enrolment to obtain sociodemographic, lifestyle, and medical history information. They were asked to keep a daily journal recording things like cigarettes use, consumption of alcoholic or caffeinated beverages, and multivitamin use (The journal did not distinguish between over-the-counter multivitamins and prescribed prenatal vitamins).

Of the couples who enrolled in the study, 347 (69%) of them became pregnant. Three of the women conceived twins and were eliminated from the study. Of the remaining 344 women, 98 (28%) of them experienced a miscarriage during the first 22 weeks. No miscarriages were observed after 22 weeks.

When they looked at risk factors that affected pregnancy loss (miscarriages):

  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.

Putting This Study Into Perspective

This was a fairly well designed study, but it is a single study.  Let’s put each of the main findings in the context of previous studies.

Multivitamin Use: Earlier studies have shown that supplements containing extra folic acid probably reduce miscarriages. However, now that foods are routinely fortified with folic acid in the US, the benefit of multivitamins and prenatal supplements has become more controversial. Some studies have shown, like this one, that multivitamins reduce miscarriage risk. Others did not. However, multivitamin use before and during pregnancy has relatively few risks, so it is still probably a good idea.

Caffeinated Beverages: There have been relatively few studies to date on the effect of caffeinated beverages on miscarriage risk, but the few that have been performed tend to agree that caffeinated beverages may increase the risk of miscarriage. While the data are far from definitive at this point, it is probably a good idea to limit your caffeinated beverages before and during pregnancy.

Age: Age is a well-established risk factor for miscarriages. While many consider 40 as the threshold for increased risk, this study and several other recent studies suggest it may be closer to 35. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.

Other Factors:This study did not find an effect of obesity, smoking or alcohol on pregnancy risk. However, many other studies have shown that each of these increases the risk of miscarriage. It’s probably a good idea to drop a few extra pounds and avoid both smoking and alcohol if you wish to maximize your chances of a successful pregnancy outcome.

If You Are Pregnant, What Does This Study Mean For You? 

preventing miscarriageThis study supports multivitamin use before and during pregnancy and suggests that excessive consumption of caffeinated beverages may have a negative effect on pregnancy outcome. However, it doesn’t significantly alter the standard medical advice for what you should do before and during pregnancy.

  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

The Bottom Line

 A recent study showed:

 

  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.
  • This study reinforces the recommendation for multivitamin or prenatal vitamin use, but the standard medical advice for a successful pregnancy isn’t really changed:
  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Multivitamins Reduce Heart Disease Risk?

Written by Dr. Steve Chaney on . Posted in Healthy Lifestyle, Vitamins and Health, Vitamins and Heart Disease

Will A Multivitamin A Day Keep The Doctor Away?

Author: Dr. Stephen Chaney

 

Junk foods and convenience foods have become the American way. We are perhaps the most overfed and undernourished country on the planet. Even worse, we are exporting our unhealthy lifestyle to the rest of the world.

Because of the foods we eat experts estimate that only somewhere between 3% and 10% of us get the nutrients we need on a daily basis. For the vast majority of Americans who are undernourished, multivitamin use helps us fill the nutritional gaps in our diet.

But could multivitamin use do more than just fill nutritional gaps? Could it also help us protect our health?  Could multivitamins reduce heart disease risk?  Here things get a bit murky. We are confused by conflicting headlines. One day the headlines blare that multivitamins are placebos. They are useless. They are a waste of money. The next day the headlines claim that multivitamins are panaceas that can help protect us from heart disease, cancer, diabetes, and whatever else ails us.

In this week’s Health Tips From the Professor, I will review the latest study claiming that multivitamin use reduces heart disease risk and help you put that study into perspective.

Do Multivitamins Reduce Heart Disease Risk?

 

reduce heart disease riskThe current study (Rautianinen et al, Journal of Nutrition, doi: 10.3945/jn.115.227884, 2016)  was a re-analysis of data collected in the first Physician’s Health Study between 1982 and 1995. That study was originally designed to test the effect of aspirin and/or beta-carotene on heart disease and cancer. It enrolled a total of 22,071 male physicians over the age of 40 and followed them for an average of 12.2 years. The conclusions of the initial study were that aspirin use decreased cardiovascular risk while beta-carotene had little effect on either heart disease or cancer.

However, the study also collected data on a wide range of lifestyle factors (including diet and supplement use) and clinical outcomes, so it has provided a valuable database for many subsequent studies, including this one.

This study analyzed a subset of the population (18,530 male physicians) that did not have any sign of heart disease or cancer at the beginning of the study and looked at the effect of multivitamin usage on several cardiovascular disease outcomes including:

  • Non-fatal heart attacks
  • Non-fatal strokes
  • Death due to cardiovascular disease
  • Total cardiovascular events (the sum total of the previous three events)

Here were the results of the study:

  • When the authors simply asked whether the participants were using multivitamins or not at the beginning of the study, multivitamin use had no effect on any of the cardiovascular disease outcomes listed above. These results are similar to several similar studies.
  • However, when the authors compared those who had been using multivitamins for 20 years or more at the beginning of the study to non-users, long term multivitamin use was associated with a statistically significant 44% decrease in total cardiovascular events.
  • When the authors looked at each of the individual cardiovascular disease outcomes (heart attack, stroke, and death due to cardiovascular disease) there was a similar percentage decrease when comparing 20+ year multivitamin users with non-users, but there were not enough people in each of these individual categories for the differences to be statistically significant.

The authors concluded that their study suggests that “multivitamin use over a long duration may be associated with a lower risk of major cardiovascular events” but that further studies are needed because of the low number of long-term multivitamin users in the study.

Putting This Study Into Perspective

There are several clinical studies looking at the effect of multivitamin use on cardiovascular outcomes that have come up empty handed. However, there are an equal number of clinical studies that have shown a positive effect of multivitamin use on cardiovascular outcomes, at least under certain conditions and with certain population groups. For example:

  • For those physicians who had a prior history of heart disease, multivitamin use was associated with a 44% reduction in the risk of heart attack.  So, in this case multivitamins were shown to reduce heart disease risk.
  • There was a significant effect of age, with physicians who were 70 or older showing a stronger effect of multivitamin use on the reduction of overall cardiovascular disease.
  • This study did not ask how long the participants had been using multivitamins prior to the study so it could not assess the effects of long term multivitamin use.
  • Other studies suggest that long-term multivitamin use could also reduce heart disease risk in women. For example:

In short, the available data suggest that the benefits of multivitamin use are most likely to be apparent with those who are at highest risk of having a heart attack because of age or pre-existing disease as well as those who have been using multivitamins for decades, not just a few years.

Multivitamins And Heart Disease Risk:  Placebo Or Panacea?

placeboIf you just read the headlines you have every right to be confused. Some headlines claim that multivitamins are just placebos. They are a waste of money. Other headlines seem to suggest that multivitamins are panaceas that will prevent everything from heart disease to cancer and diabetes.  As usual, the truth lies somewhere in between.

Let’s start with the obvious. If you are in great health, have a heart healthy diet and lifestyle, and do not have a genetic predisposition to heart disease, your chances of having a heart attack, stroke or other forms cardiovascular disease are very low. A multivitamin might benefit you in other ways, but it is unlikely to significantly reduce your already low risk of heart disease. Many of the subjects in previous studies fall into this category, which is why many of those studies come up empty handed.

The people who are most likely to benefit from multivitamin use are those who have a poor diet, or are at increased risk of heart disease because of genetic predisposition, pre-existing disease or age. None of the studies to date have looked at groups with poor diets or genetic predisposition to see whether multivitamin use did reduce heart disease risk. The one study that did look at groups who were older or had pre-existing disease found a beneficial effect of multivitamin use in those groups.

The recent study, along with several other studies, also suggests that it may require decades of multivitamin use to significantly impact heart disease risk. That makes sense. Heart disease doesn’t just happen overnight. It takes decades to develop, so it is only logical that it might also require many years of multivitamin use to significantly impact heart disease risk.

If so, this highlights a very serious flaw in those studies reporting no effect of multivitamin use on heart disease risk. Most of the negative studies only inquired about multivitamin use at the beginning of the study. They did not ask how long those people had been using multivitamins. If you ignore the long term multivitamin users, you are very likely to get a negative result.

The study featured in this article (Rautianinen et al, Journal of Nutrition, doi: 10.3945/jn.115.227884, 2016)  is a perfect example. The group who had been using multivitamins for 20+ years had a 44% decrease in heart disease risk. However, this group represented only 5% of the multivitamins users. The size of this group was not large enough to influence the overall results. Consequently, when the authors of the study looked at multivitamin users as a whole, there was no significant effect of multivitamin use on heart disease risk.

 

The Bottom Line

The question of whether multivitamin use could reduce heart disease risk has been contentious in recent years, with some studies claiming that multivitamin use has no effect, and other studies suggesting that multivitamin use significantly reduces heart disease risk. A recent study helps provide a better understanding of why previous studies have reported such conflicting results.

  • This study found that when you just asked whether people were using multivitamins or not at the beginning of the study, there was no significant effect of multivitamin use on heart disease risk – in agreement with all of the previous negative studies.  That is because those studies did not take into account the length of multivitamin use.
  • However, when the authors of the study looked at the subgroup who had used multivitamins for 20 years or more, they had a 44% decreased risk of heart disease compared to non-users. It turns out that most of the previous studies reporting a beneficial effect of multivitamin use on heart disease risk also focused on long term multivitamin users.
  • Previous studies have also suggested that multivitamin use may significantly decrease heart disease risk for people at increased risk of heart attack, either due to age or pre-existing heart disease.
  • Taken together these studies suggest that long term multivitamin use may reduce your risk of heart disease. Even short term multivitamin use may be beneficial if you are at increased risk of heart disease.
  • Of course, multivitamin use is just one piece of the heart health puzzle. For the NIH’s recommendation for a heart healthy lifestyle, click a heart healthy lifestyle.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Omega-3 And Blood Pressure: The Good News

Written by Dr. Steve Chaney on . Posted in current health articles, Diets, Food and Health, Health Current Events, Omega-3s and Blood Pressure, Supplements and Health, Vitamins and Health

Will Fish Oil Lower Your Blood Pressure?

Author: Dr. Stephen Chaney

 

omgega-3 and blood pressureIs there a relationship between omega-3 and blood pressure we should understand to for health benefits?

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 363,000 deaths in 2010. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

  • 31% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).
  • Another 30% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 61% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure.  Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss . The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 47% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute, but let me start with the good news about omega-3 fatty acids.

 

The Good News About Omega-3 and Blood Pressure

omega-3s lower blood pressureWhat’s the good news about omega-3 and blood pressure?  We’ve known for some time that omega-3 fatty acids helped lower blood pressure, but two recent studies have really highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study (Miller et al, American Journal of Hypertension, 27: 885-896, 2014) was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure.

Here are the results of this study:

  • In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.
  • Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.
  • The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8 week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

Here are the results of this study:

  • In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.
  • The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

A Holistic Approach To Blood Pressure Control

 

lower blood pressure dietThe latest information about omega-3 and blood pressure is good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

  • The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low sodium, low sodium/high-potassium, low-sodium/low-calorie, low-calorie and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].
  • Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.
  • Reducing excess weight by 5% reduces systolic blood pressure by 3 points.
  • Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.

benefits of nitratesIf you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus everything else in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.

That’s significant because,as the graphic on the right shows, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could substantially decrease your risk of disease.

 

A Word Of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

  • Monitor your blood pressure on a regular basis.
  • If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.
  • Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.
  • Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control, the less medication your doctor will need to use (That means fewer side effects).

 

The Bottom Line

 

  • Recent studies have shown that supplementation with as little as 0.7 grams of long chain omega-3s (EPA + DHA) per day is sufficient to decrease systolic blood pressure by ~ 5 mm Hg in people with untreated hypertension (high blood pressure). If your blood pressure is currently in the normal range, it is not yet clear how much EPA + DHA you need to keep it there. That may require a higher dose.
  • When you combine that with other natural approaches such as the DASH diet, reducing sodium, losing weight, and increasing exercise you can decrease blood pressure by 18-22 mm Hg.
  • The CDC estimates that is enough to substantially decrease your risk of stroke, coronary heart disease, memory loss, kidney disease, erectile dysfunction, death from cardiovascular disease, and death from any cause.
  • The authors of these recent studies concluded that holistic lifestyle changes including substantially increasing omega-3 intake have the potential to significantly delay the onset of age-related hypertension and may allow people with elevated blood pressure to eliminate or substantially reduce the use of blood pressure medications – with their many side effects.
  • High blood pressure is a silent killer. It is important to monitor your blood pressure regularly. If it becomes elevated, work with your doctor to find the balance of natural approaches and medication that is right for you.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do B Vitamins Reduce Heart Disease Risk?

Written by Dr. Steve Chaney on . Posted in current health articles, Drugs and Health, Health Current Events, Healthy Lifestyle, Supplements and Health, Vitamins and Health

What Role Do B Vitamins Play in a Heart Healthy Lifestyle?

Author: Dr. Stephen Chaney

b vitamins reduce heart attack riskTwo weeks ago I shared some studies that challenge the claim that vitamin E doesn’t reduce heart attack risk. To close out “Heart Health” month, I want to share some information that may change how you think about B vitamins and heart disease risk. Once again, you’ve seen the headlines: “B Vitamins Do Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Once again, I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg who disagrees with this commonly held belief.

Dr. Blumberg is a Professor in the Friedman School ofNutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation, and his specialty is conducting and analyzing clinical studies. He believes that the media has seriously misinterpreted the studies on B vitamins and heart disease risk. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Do B Vitamins Reduce Heart Disease Risk?

heart disease in menThe study in question is called the “Heart Outcomes Prevention Evaluation-2“. In that study a group of middle aged men and women received 2.5 mg of folate, 50 mg of vitamin B6 and 1 mg of vitamin B12 versus a placebo and were followed for an average of 5 years.

The headlines that you may have seen said “B vitamins do not reduce the risk of major cardiovascular events in patients with vascular disease”. But, the headlines did not tell the whole story.

In the first place, that was only true for heart attacks and cardiovascular death. Strokes were reduced by 25%. I don’t know about you, but I consider strokes to be fairly major.

However, even when we focus on heart attacks and cardiovascular deaths the headlines didn’t tell the whole story. You see, even the best intentioned studies sometimes contain fatal flaws that aren’t obvious until after the study has been completed.

The Flaws In The Study

flawsThere were two major flaws in this study.

Flaw #1 was that 70% of the study subjects were eating foods fortified with folate and had adequate levels of that nutrient in their bloodstream before the study started.

For those people who were already getting enough folate in their diet, B vitamin supplementation didn’t make much of a difference. However, for those people not getting adequate levels of folate in their diet, B vitamin supplementation decreased their risk of heart disease by ~15%.

Flaw #2 was that ~90% of the people in the study had a history of coronary artery disease and most of them were already on cholesterol lowering medications.

To understand why this is a problem you have to understand both the proposed mechanism by which B vitamin supplementation has been proposed to lower the risk of heart disease AND how the cholesterol lowering drugs work.

Deficiencies of folate, B6 and B12 are thought to increase the risk of heart disease because the B vitamin deficiency causes an increase in homocysteinelevels in the blood, and high homocysteine levels are thought to increase inflammation – which is a risk factor for heart disease.  So supplementation with folate, B6 and B12 has been proposed to decrease heart disease risk by decreasing inflammation.

The problem is that the most commonly used cholesterol lowering medications also decrease inflammation.So you might not be surprised to learn that those people who had a history of coronary artery disease(and were taking cholesterol lowering medication that reduces inflammation) did not receive much additional benefit from B vitamin supplementation.

For those people in the study who were not taking cholesterol lowering medication, B vitamin supplementation also reduced their risk of heart attacks by ~15% – but there were too few people in that group for the results to be statistically significant.

So the headlines from this study really should have said “B vitamins do not reduce the risk of heart attacks or cardiovascular deaths in people who are already getting adequate folate from their diet or in people who are taking drugs that reduce the bad effects of B vitamin deficiency”. But that kind of headline just wouldn’t sell any newspapers.

What Does This Study Mean For You?

There are two very important take-home lessons from this study.

Lesson #1:  Once again this study makes the point that supplementation makes the biggest difference when people have an increased need. The studies discussed in Vitamin E and Heart Disease  two weeks ago illustrated increased need because of age, pre-existing disease, and genetic predisposition. This study illustrated increased need because of inadequate diet.

Lesson #2:  This study also illustrates a problem that is becoming increasingly common in studies of supplementation. It is considered unethical to not provide participants in both groups with what is considered the standard of care for medical practice. In today’s world the standard of care includes multiple drugs with multiple side effects, and some of those drugs may have the same mechanism of action as the supplement.

I have discussed this problem in the context of omega-3 fatty acids and heart disease in a previous “Health Tips From the Professor,”  Is Fish Oil Really Snake Oil?   In many cases it is no longer possible to ask whether supplement X reduces the risk of a particular disease. It is now only possible to ask whether supplement X provides any additional benefit for patients who are taking multiple drugs, with multiple side effects. That’s not the question that many of my readers are interested in.

 

The Bottom Line

  • Headlines have proclaimed for years the “B Vitamins Do Not Reduce Heart Disease Risk”. Dr. Jeffrey Bloomberg of Tufts University has reviewed one of the major studies behind this claim and found the headlines to be misleading.
  • For example, the study showed that B vitamin supplementation reduced strokes by 25%, which is a pretty significant finding in itself.
  • When he analyzed the portion of the study looking at heart attacks, he found two major flaws:

#1:  70% of the people in the study were already getting adequate amounts of B vitamins from their diet and would not be expected to benefit from supplementation. For the 30% who weren’t getting adequate amounts of B vitamins from their diet, supplementation reduced their risk of heart attack by 15%.

#2:  90% of the people in the study were taking a drug that masks the beneficial effects of B vitamin supplementation. For the 10% who weren’t taking the drug, supplementation with B vitamins also reduced their risk of heart attack by 15%, but there were too few people in that group for the results to be statistically significant.

Obviously, there were only a handful of people in the study who weren’t getting enough B vitamins from their diet AND weren’t on medication, so we have no idea what the effect of B vitamin supplementation was in that group.

  • Once again this study makes the point that supplementation makes the biggest difference when people have an increased need. The studies discussed in “Health Tips From the Professor” two weeks ago illustrated increased need because of age, pre-existing disease, and genetic predisposition. This study illustrated increased need because of inadequate diet.
  • This study also illustrates a problem that is becoming increasingly common in studies of supplementation. It is considered unethical to not provide participants in both groups with what is considered the standard of care for medical practice. In today’s world the standard of care includes multiple drugs, some of which may have the same mechanism of action as the supplement.

In many cases it is no longer possible to ask whether supplement X reduces the risk of a particular disease. It is now only possible to ask whether supplement X provides any additional benefit for patients who are taking multiple drugs, with multiple side effects. That’s not the question that many of my readers are interested in.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Vitamin E And Heart Disease

Written by Dr. Steve Chaney on . Posted in current health articles, Supplements and Health, Vitamins and Health

Does Vitamin E Reduce Heart Attack Risk?

Author: Dr. Stephen Chaney

vitamin e and heart diseaseSince February is “Heart Health Month”, I thought I would share some information with you that might change how you think about vitamin E and heart disease risk. You’ve seen the headlines: “Vitamin E Does Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Let me share the opinion of one expert who disagrees. This week I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg from Tufts University.

But first let me tell you who Dr. Blumberg is. Dr. Blumberg is a Professor in the Friedman School of Nutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation.

Now back to what I learned at his seminar. Dr. Blumberg’s specialty is conducting and analyzing clinical studies, and his perspective on some very influential clinical studies is a bit different from what you may have heard from media reports. He believes that the media has seriously misinterpreted several recent studies. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Does Vitamin E Reduce Heart Disease Risk In Women?

cardiovascular disease in womenLet’s start with vitamin E and the risk of cardiovascular disease in women. The most influential study on this subject was the Women’s Health Study (Lee et al., JAMA, 294:56-65, 2005). This was a major study in which 39,876 women were given either 600 IU of vitamin E every other day or a placebo and followed for 10 years.

The headlines said “Vitamin E Supplements Do Not Reduce Risk Of Cardiovascular Death, Heart Attack And Stroke In Women”. That was true if you looked at the total population of women in the study.

But Dr. Blumberg pointed out that when you looked at women who were 65 or older in that study vitamin E supplementation caused a…

  • 24% decrease in cardiovascular deaths,
  • 26% decrease in major cardiovascular events,
  • 21% decrease in venous thromboembolism (blood clots forming in the veins),

…and all of these decreases were statistically highly significant. That’s important because the risk of heart disease in pre-menopausal women is extremely low. It’s the over 65 group who have a high risk of heart disease.

Perhaps the headlines should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks”. But, of course, they didn’t. Perhaps that wasn’t considered newsworthy.

Other Studies On Vitamin E and Heart Disease Risk In Women

heart disease riskIf this were the only study suggesting the vitamin E might benefit women at high risk of having a heart attack or stroke, it might be easy to dismiss it, but it’s not the only study showing this effect.

For example, a subsequent study called the “Women’s Antioxidant Cardiovascular Study” looked at the effect of 600 IU of vitamin E every other day on cardiovascular events in 8171 women health professionals (Cook et al, Archives of Internal Medicine, 167:1610-1618, 2007).

Once again the headlines said that vitamin E supplementation had no effect on cardiovascular events in women. But, when the authors looked at those women who already had cardiovascular disease at the beginning of the study (and were, therefore, at high risk of suffering a cardiovascular event during the study) vitamin E supplementation caused a 23% decreased risk of heart attack, stroke and cardiovascular death.

Another important study was the HOPE (Heart Outcomes Prevention Evaluation) study (Levy et al, Diabetes Care, 27: 2767, 2004). The overall study results were similar to several other recent trials – no significant effect of vitamin E supplementation on cardiovascular health in the population group as a whole.

However, by the time that study was performed it was clear that a particular genetic variation in the haptoglobin gene called the haptoglobin 2-2 genotype lead to a significant increase in oxidative damage to the vascular wall (the professor will collect your quizes at the end of this email).

When the data were reanalyzed by genotype, it became clear that people with the haptoglobin 2-2 genotype experienced a significant decrease in both heart attack and cardiovascular death with vitamin E supplementation. This finding has been confirmed by a subsequent double-blind, placebo-control study specifically designed to look at the cardioprotective effects of vitamin E in people with different haptoglobin genotypes (Milman et al, Arterioscler. Thromb. Vasc. Biol., 24: 136, 2008).

In short, the headlines from all three studies should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks” – and, it doesn’t appear to matter whether the increased risk is due to age, pre-existing disease, or genetic predisposition.

Does Vitamin E Reduce Heart Disease Risk In Men?

heart disease in menFor men the most influential study was called the “Physician’s Health Study II” (H. D. Sesso et al, JAMA, 300: 2123-2133, 2008). In this study male physicians aged 40-84 were invited to participate in a double-blind clinical trial in which they were randomly assigned into groups who were given 400 IU of vitamin E every other day or placebo. They were followed for an average of 8 years during which data on both total mortality and cardiovascular mortality were obtained.

Once again, the headlines read “Vitamin E Does NotPrevent Cardiovascular Disease in Men”. But let me tell you what Dr. Blumberg said so that you understand “The Rest of the Story”. It starts by looking at the selection process for the Physician Health Studies.

Dr. Sesso and his colleagues sent out a letter asking 261,248 male physicians in the US if they would be willing to participate in the study. Only 112,528 responded and, of those responding, only 59,272 indicated that they were willing to participate. Of those who said that they were willing to participate only 32,223 met the selection criteria.

The exclusion criteria eliminated anyone who already had suffered a heart attack, stroke, angina or was on a blood thinner – in other words those people who were at greatest risk of suffering a heart attack or stroke during the study.

Finally, the study had an 18 week “run in” period to eliminate those people who were unwilling or unable to comply with the study protocol. This eliminated another 10,000 participants, leaving only 22,071 participants – less than 10% of the original.

This is where it gets really interesting. Dr. Sesso and his colleagues used publicly available databases to evaluate total and cardiovascular mortality in each group (H. D. Sesso et al, Controlled Clinical Trials, 23: 686-702, 2002). It turns out that at each stage of the selection process the incidence of both total and cardiovascular mortality during the 8-year period decreased.

In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole.

The bottom line is that the selection process eliminated almost all of the physicians at significant risk of having a heart attack or stroke during the study. The only ones who were actually enrolled in the study were those physicians who were at very low risk for having a fatal heart attack or stroke – or dying from any cause – during the study.

So the headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.The irony is that there was nothing wrong with the design of the study. It’s probably just a male ego thing. Guys who were unhealthy just didn’t want to participate in a study that might show how unhealthy they really were.

What Does This Mean For You?

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

 

The Bottom Line

  • The experts have been saying for years that vitamin E does not reduce the risk of heart disease. That claim is true, if you look at the general population, most of which is at low risk of developing heart disease – at least during the time frame of the clinical studies. However, when you look at people who are at high risk of developing heart disease, the answer is different.
  • For example, when you look at clinical studies with women, vitamin E significantly decreased the risk of heart attacks in women who…
  • Were over 65,
  • Had pre-existing heart disease at the beginning of the study,
  • Or, had a genetic predisposition to heart disease.

The headlines from these studies should have read “Vitamin E reduces the risk of cardiovascular disease in those women at high risk of heart attacks”, but they didn’t.

  • For men the story is a bit different. The Physician’s Health Study is considered the definitive study on the subject. However, most of the unhealthy male physicians either didn’t enroll in the study or dropped out before its completion. In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole. The headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.
  • These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.
  • The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Calcium Supplements Prevent Bone Fractures? – Part1

Written by Dr. Steve Chaney on . Posted in current health articles, Health Current Events, Supplements and Health, Vitamins and Health

Why The Recent Headlines May Be Misleading

Author: Dr. Stephen Chaney

 

osteoporosisDoes calcium help prevent bone fractures?  Osteoporosis is a debilitating and potentially deadly disease associated with aging. It affects 54 million Americans. It can cause debilitating back pain and bone fractures. 50% of women and 25% of men over 50 will break a bone due to osteoporosis. Hip fractures in the elderly due to osteoporosis are often a death sentence.

For that reason, the RDA for calcium has been set at 1,000 to 1,200 mg/day to reduce the risk of osteoporosis, and calcium supplements are often recommended to reach that target.However, recent headlines are proclaiming that calcium supplements do not actually prevent bone fractures and might increase your risk of a heart attack. Are the RDA recommendations wrong? Should you throw out your calcium supplements?

In this article I will review the article behind the study and help you put it into perspective. After all, you don’t really want to know whether calcium supplementation is beneficial for the average adult. You want to know whether it will be beneficial for you.

Let me start by putting the heart attack myth to rest. I have covered this in detail in a previous “Health Tips From The Professor” article, Calcium Supplements Increase Heart Attack Risk . If you don’t want to go to the trouble of reading my previous article, the short version is that:

  • Most of the studies suggesting an increased risk of heart attacks are flawed.
  • A very large study (74,000 women followed for 24 years) has shown fairly convincingly that calcium supplements do not increase heart attack risk. If anything, they decrease heart attack risk.

Unfortunately, like most other nutrition myths, this one is still being repeated – even after it has been refuted by subsequent studies.

Bone Metabolism and Osteoporosis

bone metabolism osteoporosisBefore you can truly understand osteoporosis and how to prevent it, you need to know a bit about bone metabolism. We tend to think of our bones as solid and unchanging, much like the steel girders in an office building. Nothing could be further from the truth. Our bones are dynamic organs that are in a constant change throughout our lives.

Cells called osteoclasts and osteoblasts constantly break down old bone (a process called resorption) and replace it with new bone (a process called accretion). Without this constant renewal process our bones would quickly become old and brittle (I’ll discuss more about this next week when I talk about the side effects of drugs commonly used to increase bone density).

When we are young the bone building process exceeds bone resorption and our bones grow in size and in density. During most of our adult years, bone resorption and accretion are in balance so our bone density stays constant. However, as we age bone the bone building process (accretion) slows down and we start to lose bone density. Eventually our bones look like Swiss cheese and break very easily. This is called osteoporosis.

We should also think of our bones as calcium reservoirs.  We need calcium in our bloodstream 24 hours a day for our muscles, brain, and nerves to function properly, but we only get calcium in our diet at discrete intervals. Consequently, when we eat our body tries to store as much calcium as possible in our bones. Between meals, we break down bone material so that we can release the calcium into our bloodstream that our muscle, brain & nerves need to function.

If we lead a “bone healthy” lifestyle, all of this works perfectly. We build strong bones during our growing years, maintain healthy bones during our adult years, and only lose bone density slowly as we age – maybe never experiencing osteoporosis. We always accumulate enough calcium in our bones during meals to provide for the rest of our body between meals.

What is a “bone healthy” lifestyle, you might ask. Because calcium is a major component of bone, the medical and nutrition communities have long focused on calcium as a “magic bullet” that can assure bone health. Once the importance of vitamin D was understood, it was added to the equation. For years we have been told that if we just get enough calcium and vitamin D in our diets, we would build strong bones when we were young, maintain bone density most of our adult years, and lose bone density as slowly as possible as we age.It is this paradigm that the current study challenges.

Do Calcium Supplements Prevent Bone Fractures?

prevent bone fracturesLet’s start by looking at the study behind the headlines (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183). This was a meta-analysis that included 15 studies (1533 participants) looking at dietary sources of calcium and 51 studies (12,257 participants) looking at calcium supplementation in women.

The results of the meta-analysis were thought provoking, but do not exactly support the headlines you have been reading. For example:

The headlines say “Calcium Supplements Do Not Prevent Broken Bones”.

  • This study did not actually look at calcium supplementation and the risk of bone fractures. That was a previous study (Boland et al, BMJ 2015, 351:h4580) by the same authors.
  • This study showed that calcium supplementation increased bone density by 0.7-1.8%, which the authors concluded was sufficient to reduce fracture risk by about 5-10%. That’s a disappointingly small effect, but it is not zero – as the headlines suggested.

The headlines say “It’s better to get your calcium from food than from supplements”.

  • This study showed that it did not matter whether the calcium came from food or from supplements. The increase in bone density was identical.

Garbage-In, Garbage-Out

garbageMeta-analyses such as this one can be very strong, but they can also suffer from the “garbage-in, garbage-out” phenomenon. In short, if most of the studies that went into the meta-analysis were poorly designed, the conclusions of the meta-analysis will be unreliable.

The problem is that many of the individual studies were conducted 10, 20, 30 or 40 years ago when our knowledge of bone metabolism was incomplete.

  • Thirty or 40 years ago it was “state of the art” to just use a calcium supplement. Then we learned that adequate vitamin D was essential for efficient calcium utilization.
  • Most of the studies included in this meta-analysis looked at calcium supplementation without vitamin D. Only 13 of the studies (25%) included vitamin D.
  • Ten or 20 years ago it was “state of the art” to just use a calcium supplement with vitamin D. Then we learned that the blood level of 25-hydroxyvitamin D (the active form of vitamin D in the bloodstream) did not necessarily reflect vitamin D intake from the diet. In today’s world a study in which the 25-hydroxy vitamin D level is not measured should be considered sub-standard.
  • Only 18 (35%) of the studies measured baseline 25-hydroxy vitamin D levels.
  • If dietary calcium intake at baseline is already adequate, it is illogical to expect additional calcium to significantly increase bone density.
  • The baseline calcium intake was <800 mg/day (clearly inadequate) in only 26 (51%) of the studies. Baseline calcium intake was either not determined in the other studies or was already in the adequate range prior to supplementation.
  • In the future, we will probably want to include exercise as a component in the study (more about that next week). None of the studies included exercise as a component

In short, by today’s standards many, if not most, of the studies included in the meta-analysis had an inadequate design.

If I had designed the meta-analysis, I would have been a lot more restrictive in the studies I included.

  • I would have started by including only studies in which the baseline intake of calcium was <800 mg/day. If you want to critically evaluate whether calcium supplementation has a beneficial effect, you need to start with people who have an inadequate dietary intake of calcium. If their diets are already calcium sufficient, supplementation is unlikely to have any benefit.
  • At the very least I would only include studies that used calcium supplements containing 400-800 IU of vitamin D as well. In fact, based on the latest data, I would make sure that the calcium supplement I used also contained adequate levels of magnesium, vitamin K, zinc, copper and manganese. All of those have been shown to be important for bone formation and we cannot assume they are present at sufficient levels in their diet (more about that next week).
  • I would only include studies that measured blood levels of 25-hydroxy vitamin D at baseline and following supplementation with vitamin D so that we knew that the 25-hydroxy vitamin D level was sufficient to support optimal calcium utilization.
  • Finally, I would only include studies that specifically measured the effect of exercise on calcium utilization or included exercise as an integral part of their study.

The number of studies included in the meta-analysis would be much less, but they would all be high quality studies.

Finally, the authors also noted that a number of studies in the supplement group showed significantly greater (2.5 – 5.0%) increase in bone density. They dismissed them as outliers. I would have preferred a closer look at those studies to see if there was anything about the population group or study design that might explain the greater bone density increase in those studies.

Apples and Oranges

apples orangesBecause the authors included a wide variety of clinical studies, they were able to state that “Increases in bone mineral density were similar in trials of calcium monotherapy [calcium by itself] versus co-administered calcium and vitamin D…and in trials where baseline dietary calcium intake was <800 [clearly insufficient] versus >800 [probably sufficient] mg/day.” This could be considered a strength of their meta-analysis, but they are only valid comparisons if other important features of the studies being compared were uniform – i.e. they were comparing apples to apples.

But what if they were comparing apples and oranges?

For example, we know that vitamin D is required for efficient calcium utilization. When the authors compared studies having a baseline calcium intake of <800 mg/day with studies having a baseline calcium intake of >800 mg/day, they did not even check to see whether use of vitamin D was evenly distributed between the two groups. If most of the studies with a baseline calcium intake of <800 mg/day did not include vitamin D with their calcium supplements, the authors would be comparing apples and oranges. The comparison would be invalid.

Similarly, we also know that if calcium intake at baseline is adequate, adding more calcium is unlikely to increase bone density significantly. When the authors compared studies with and without vitamin D, they did not even check to see whether baseline calcium intake was evenly distributed between the two groups. If the participants in most of the studies utilizing supplements providing both calcium and vitamin D were already consuming sufficient calcium at baseline, they would be comparing apples to oranges. Again, the comparison would be invalid.

The authors of the meta-analysis simply did not provide the detail needed to determine whether their comparisons were apples to apples or apples to oranges. Thus, what seemed to be a strength of their study is actually a major weakness.

 

The Bottom Line

 

  • A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from food or supplements, was not a very efficient way to increase bone density and prevent fractures.
  • This study suffers from some serious flaws. It is a meta-analysis of previous clinical trials looking at the effects of calcium on bone density. Meta-analyses can be very strong studies because they average the effects of many individual studies. However, meta-analyses can also suffer from the “garbage-in, garbage-out” phenomenon. Simply put, the quality of the meta-analysis is only as good as the studies that go into it. In this case the meta-analysis included many clinical studies that were done 10, 20, 30 and even 40 years ago. Based on what we now know about bone metabolism, the design of many of those early studies was clearly inadequate (details are given in the article).

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Heart Disease Risk and Multivitamins

Written by Dr. Steve Chaney on . Posted in Health Current Events, Healthy Lifestyle, Healthy Living, Supplements and Health, Vitamins and Health

Author: Dr. Stephen Chaney

heart disease riskIt’s so confusing. One week vitamins are going to reduce your heart disease risk and cancer risk. The next week they are worthless. They might even kill you. So when you saw the recent headlines suggesting that multivitamin-mineral supplement use might decrease heart disease risk in women, you probably weren’t sure what to think.

More to the point, you may be thinking “Why is it so hard to get this right? Why can’t scientists decide once and for all whether vitamins are beneficial or not?”

Perhaps, the best way to understand the significance of the present study is to look at the strengths and limitations of previous studies. Then we can start to gain perspective on why it is so difficult to come to a definitive conclusion about this very important question.

How Good Is The Evidence That Multivitamin Use Doesn’t Reduce Heart Disease Risk?

heart disease and multivitaminsMedical authorities are fond of telling you, with a great deal of confidence, that studies have conclusively proven multivitamin use does not decrease heart disease risk. However, in fact, that conclusion is based on only a few studies, and those studies have their limitations.

For example, the Physician’s Health Study II (Sesso et al, JAMA, 308: 1751-1760, 2012) reported that use of a multivitamin-mineral supplement for 11 years did not decrease cardiovascular incidence or mortality. It was a double-blind, placebo controlled clinical study. That’s the best kind of study, so it would be tempting to consider the case closed.

However, this study looked at a very small segment of the population. The participants were all male, primarily non-Hispanic whites, well to do, highly educated and health conscious. It also turns out that the participants that were in the poorest health and had the poorest health habits tended to drop out of the study and were not included in the final data analysis.

That means that the vast majority of participants in the study were at low risk of heart disease and were eating relatively healthy diets. Those are the people who would be least likely to benefit from supplementation. In short, this study proved beyond a reasonable doubt that the people least likely to benefit from supplementation did, in fact, not benefit from supplementation.

The studies that medical authorities quote as proving their case for women have all looked at antioxidant supplements and cardiovascular disease. There are three double-blind, placebo controlled studies that have all come to the conclusion that antioxidant supplements do not decrease cardiovascular risk in women. Once again, it might be tempting to consider the case closed.

However, in two of those studies (Lee et al, JAMA, 294: 56-65, 2005; Cook et al, Archives of Internal Medicine, 167: 1610-1618, 2007) when they looked at the subset of women who were at high risk of cardiovascular disease (either because of age or pre-existing disease), antioxidant supplements significantly decreased the risk of cardiovascular events and cardiovascular deaths. In short, these studies showed that those people most likely to benefit from supplementation, did, in fact, benefit from supplementation.

Finally, medical authorities have chosen to completely ignore a recent study reporting that multivitamin use significantly decreased heart attack risk in women, especially if they had been using the multivitamins for 5 years or more (Rautiainen et al, American Journal of Clinical Nutrition, 92: 1251-1256, 2010). In short, previous studies have not conclusively proven much of anything except that it is really hard to get definitive answers to this kind of question.

Does Multivitamin Use Decrease Cardiovascular Disease Risk In Women?

cardiovascular disease in womenThe current study (Bailey et al, Journal of Nutrition, 145: 572-580, 2015) compared multivitamin use in 8678 adults(65% women) 40 years or older, from the USDA’s NHANES III database and compared it with cardiovascular death reports in the National Death Index 18 years later.

At the time of the NHANES III study, 45% of the adults surveyed had used some kind of supplement within the past 30 days. When the researchers broke the data down further:

  • 21% were using multivitamin-mineral supplements (3 or more vitamins and 1 or more minerals)
  • 14% were using multivitamin supplements (3 or more vitamins, no minerals).
  • Among multivitamin-mineral and multivitamin supplement users, only 46% had been using them for 3 years or more.

When they compared supplement usage with cardiovascular deaths 18 years later, the results were as follows:

  • When they asked if multivitamin-mineral or multivitamin use at the beginning of the study affected cardiovascular mortality 18 years later, the answer was a clear no.
  • When they looked at women, use of a multivitamin-mineral supplement for 3 years or more was associated with a 35% decreased risk of cardiovascular mortality.
  • However, they did not find any cardiovascular benefit from long term use of a multivitamin supplement alone for women. From this, they concluded that the beneficial effects of the multivitamin-mineral supplement came from one of the minerals, most likely magnesium or calcium.
  • There was a slight hint that multivitamin use might be beneficial for men, but the number of cardiovascular deaths in that group was too small for the results to be statistically significant.

What Does This Study Mean?

This study suggests that long term use of a multivitamin-mineral supplement may decrease the risk of cardiovascular disease deaths in women. Whether long term multivitamin use also reduces risk of cardiovascular disease in men is an open question. This study is consistent with another recent study looking at multivitamin use in women (Rautiainen et al, American Journal of Clinical Nutrition, 92: 1251-1256, 2010). However, these studies are just a piece of the puzzle. It will take time and more studies before we will really be able to definitively say whether or not multivitamin use can decrease the risk of heart disease, or any other disease.

How Can You Reduce Your Heart Disease Risk?

The surest way to reduce your risk of heart disease is to develop a heart healthy lifestyle.

  • reduce heart disease riskLose weight and/or maintain ideal body weight. Overweight and obesity dramatically increase all of the major risk factors for heart disease – LDL cholesterol, triglycerides, diabetes, hypertension and inflammation.
  • Exercise for more than 30 minutes – 3 times or more/week. Regular exercise reduces the risk of heart disease by 30-40%.
  • Follow a diet low in saturated fat and trans-fat (substitute monounsaturated fats like olive oil and omega-3 fats); low in sugars and artificial sweeteners; and high in fiber, whole grains, legumes, fruits, vegetables, and fish.
  • Work with your physician to control predisposing diseases such as diabetes and hypertension.

What about supplementation? What role does it play in a heart healthy lifestyle? At present it’s pretty clear that the scientific community cannot definitively prove whether supplementation reduces the risk of heart disease or not. All the available evidence suggests that supplementation is most likely to prove beneficial for those who are at highest risk for heart disease and/or are most likely to be deficient in key nutrients – either because of poor diet or genetic variations that increase nutrient requirements.

In the best of all possible worlds we would know who was at high risk for heart disease and who was deficient in key nutrients. We would know who would benefit from supplements and who would not, but we don’t live in the best of all possible worlds.

  • Most people don’t know they are at risk for heart disease until it is too late. For far too many people the first symptom of heart disease is sudden death.
  • Genetics can greatly increase the need for key nutrients, and most people are completely unaware of those genetic predispositions until it is too late. In the future, we may be able to design genetic tests to determine individual nutritional requirements with precision, but we are decades away from that Utopian age at present.
  • Finally, many people are either blissfully unaware how unhealthy their diet is, or they just don’t want to do anything about it.

For all of the reasons above, I recommend a balanced supplementation program as part of a heart healthy lifestyle. The supplements most likely to be beneficial are a multivitamin-mineral supplement, antioxidants, omega-3s, and B vitamins. I have covered the evidence for the role of each of these nutrients in preserving heart health in previous issues of “Health Tips From the Professor”. Of course, I do not recommend supplementation as an alternative to a heart healthy lifestyle. Taking a multivitamin along with your Big Mac is probably not going to do much for your heart health.

 

The Bottom Line

 

  • A recent study reported that women who used a multivitamin – mineral supplement for 3 years or more decreased their risk of dying from heart disease over the next 18 years by 35%. The men in the study may have received some benefit from multivitamin – mineral supplementation, but the numbers were not large enough to be statistically significant.
  • This study is fully consistent with the results of a previous study with women. However, when we look at all of the available studies it is not possible to definitively conclude whether supplementation decreases the risk of heart disease or not.
  • All of the available evidence suggests that supplementation is most likely to be beneficial for those people who are at highest risk of heart disease and/or are most likely to be deficient in key nutrients.
  • In the best of all possible worlds we would know who was at high risk for heart disease and who was deficient in key nutrients. We would know who would benefit from supplements and who would not, but we don’t live in the best of all possible worlds.
  • Most people don’t know they are at risk for heart disease until it is too late. For far too many people the first symptom of heart disease is sudden death.
  • Genetics can greatly increase the need for key nutrients, and most people are completely unaware of those genetic predispositions until it is too late. In the future, we may be able to design genetic tests to determine individual nutritional requirements with precision, but we are decades away from that Utopian age at present.
  • Finally many people are either blissfully unaware how unhealthy their diet is, or they just don’t want to do anything about it.
  • For the reasons above, I recommend a balanced supplementation program as part of a heart healthy lifestyle. The supplements most likely to be beneficial are a multivitamin-mineral supplement, antioxidants, omega-3s, and B vitamins.
  • Of course,I do not recommend supplementation as an alternative to a heart healthy lifestyle. Taking a multivitamin along with your Big Mac is probably not going to do much for your heart health.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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The Truth About Vitamin D

Posted December 11, 2018 by Dr. Steve Chaney

Does Vitamin D Reduce Risk Of Heart Disease & Cancer?

Author: Dr. Stephen Chaney

 

the truth about vitamin dYou have every right to be confused. One day you are told that vitamin D reduces your risk of heart disease and cancer. The next day you are told vitamin D makes has no effect on those diseases. You are told vitamin D is a waste of money. What should you believe?  What is the truth about vitamin D?

In mid-November a major clinical study called VITAL was published. It examined the effect of vitamin D and omega-3s on heart disease and cancer risk. Last week I wrote about the omega-3 portion of the study. This week I will cover the vitamin D portion of the study.

Once again, if you rely on the media for your information on supplementation, you are probably confused. Headlines ranged from “Vitamin D Is Ineffective For Preventing Cancer And Heart Disease to “Vitamin D Lowers Odds Of Cancer Death.” What is the truth?

The problem is that reporters aren’t scientists. They don’t know how to interpret clinical studies. What they report is filtered through their personal biases. That is why I take the time to carefully evaluate the clinical studies, so I can provide you with accurate information. Let me sort through the dueling headlines and give you the truth about vitamin D, cancer, and heart disease.

How Was The Study Designed?

the truth about vitamin d studyThe VITAL study (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403) enrolled 25,871 healthy adults (average age = 67) in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had preexisting cancer or heart disease. The characteristics of the study group were typical of the American population at that age, namely:

  • The average BMI was 28, which means that most of the participants were significantly overweight.
  • 7% of them had diabetes.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 65% of the participants to determine 25-hydroxyvitamin D levels (a measure of vitamin D status) at baseline and at the end of the first year. The participants were given either 2,000 IU of vitamin D/day or a placebo and followed for an average of 5.3 years.

There were two important characteristics of the participants in this study that may have influenced the outcome.

  • The average 25-hydroxyvitamin D level of participants at the beginning of the study was 31 ng/ml (78 nmol/L). The NIH considers 20-50 ng/ml (50-125 nmol/L) to be the optimal level of 25-hydroxyvitamin D for most physiological functions. This means that study participants started in the middle of the optimal range with respect to vitamin D status.

[Note: The NIH defines the 20-50 ng/ml range as “adequate.”  However, I know many of my readers like to aim beyond adequate to reach what they consider to be “optimal.”  In the case of vitamin D, that might not be a good idea. The NIH considers anything above 50 ng/ml as associated “with potentially adverse effects.”  For that reason, I will refer to the 20-50 ng/ml range as optimal for this article. I wouldn’t want to encourage my readers to be aiming for above 50 ng/ml.]

  • Only 12.7% of participants had 25-hydroxyvitamin D levels below 20 ng/ml, which the NIH considers to be inadequate. The results with this group were not statistically different from the study participants with optimal vitamin D status, but it is not clear that there were enough people in this subgroup for a statistically valid comparison with participants starting with an optimal vitamin D status.
  • At the end of the first year, 25-hydroxyvitamin D levels in the treatment group increased to 42 ng/ml (105 nmol/L), which is near the upper end of the optimal range. Thus, for most of the participants, the study was evaluating whether there was a benefit of increasing vitamin D status from the middle to the upper end of the optimal range.
  • The study allowed subjects to continue taking supplements that contained up to 800 IU of vitamin D. While the authors tried to correct for this statistically, it is a confounding variable.

Does Vitamin D Reduce The Risk Of Cancer?

 

the truth about vitamin d and cancerYou may remember from last week that omega-3s were more effective for reducing heart disease risk than for reducing cancer risk. What is the truth about vitamin D and cancer risk?   The results are reversed for vitamin D, so I will discuss cancer first.

The study reported that vitamin D supplementation did not reduce a diagnosis of invasive cancer of any type, breast cancer, prostate cancer, or colon cancer during the 5.3-year time-period of this study. This was the result that was reported in the abstract and was what lazy journalists, who never read past the abstract, reported.

However, the rest of the study was more positive. For example, occurrence of invasive cancer of any type was reduced by:

  • 23% in African-Americans.
  • 24% in patients with a healthy body weight.

Several previous studies have suggested that vitamin D may be more effective at preventing cancer in people with a healthy body weight, but the mechanism of this effect is currently unknown.

Most previous studies have not included enough African-Americans to determine whether they respond more favorably to vitamin D supplementation. However, African-Americans have a higher risk of cancer, so this finding deserves follow-up.

In addition, when the study looked at deaths from cancer, the results were very positive. For example:

  • Cancer deaths during the 5.3-year study period were reduced by 17%.
  • The longer vitamin D supplementation was continued the more effective it became at reducing cancer deaths. For example,
  • When the authors excluded cancer deaths occurring during the first year of supplementation, vitamin D reduced cancer deaths by 21%.
  • When the authors excluded cancer deaths occurring during the first two years of supplementation, vitamin D reduced cancer deaths by 25%.

Finally, no side effects were noted in the vitamin D group.

 

Does Vitamin D Reduce The Risk Of Heart Disease?

 

the truth about vitamin d and heart diseaseThe VITAL study also looked at the effect of vitamin D on heart disease risk. What is the truth about vitamin D and heart disease?  The results from this study were uniformly negative. There was no effect of vitamin D supplementation on all major cardiovascular events combined, heart attack, stroke, or death from heart disease. Does that mean vitamin D has no role in reducing heart disease risk? That’s not clear.

The authors had a thought-provoking explanation for why the results were negative for heart disease, but positive for cancer. Remember that the participants in this trial started with a 25-hydroxyvitamin D level of 31 ng/ml and increased it to at least 42 ng/ml with vitamin D supplementation.

The authors stated that previous studies have suggested the 25-hydroxyvitamin D level associated with the lowest risk for heart disease is between 20 and 25 ng/ml. If that is true, most of the participants in this trial were already in the lowest possible risk for heart disease with respect to vitamin D status before the study even started. There would be no reason to expect additional vitamin D to further reduce their risk of heart disease.

In contrast, the authors said that previous studies suggest the 25-hydroxyvitamin D level associated with the lowest risk of cancer deaths is above 30 ng/ml. If that is true, it would explain why vitamin D supplementation in this study was effective at reducing cancer deaths.

However, previous placebo-controlled clinical studies have also been inconclusive with respect to vitamin D and heart disease. My recommendation would be to think of adequate vitamin D status as part of a holistic approach to reducing heart disease – one that includes a heart-healthy diet and a heart-healthy lifestyle – rather than a “magic bullet” that decreases heart disease risk by itself.

As for heart-healthy diets, I discuss the pros and cons of various diets in my book, “Slaying The Food Myths.”  As I discuss in my book, the weight of scientific evidence supports primarily plant-based diets that include omega-3s as heart healthy. As an example, the Mediterranean diet is primarily plant-based and is rich in healthy oils like olive oil and omega-3s. It is associated with reduced risk of both heart disease and cancer.

 

What Is The Truth About Vitamin D?

 

the truth about vitamin d signThere is a lot of confusion around the question of whether vitamin D reduces the risk of cancer. This study strengthened previous observation suggesting that vitamin D supplementation decreases cancer deaths. However, it is also consistent with previous studies that have failed to find an effect of vitamin D on cancer development. How can we understand this apparent discrepancy? The authors provided a logical explanation. They pointed out that:

  • Cancer development takes 20-30 years while this clinical study lasted only 5.3 years. That means that vitamin D supplementation only occurred at the tail end of the cancer development process. In fact, the cancer was already there in most of the patients in the study who developed cancer. It just had not been diagnosed yet. In the words of the authors: “Given the long latency for cancer development, extended follow-up is necessary to fully ascertain potential effects [of vitamin D supplementation].”
  • In contrast, none of the patients had been diagnosed with cancer when they entered the trial. That means that the patients were diagnosed with cancer during the 5.3-year study period. They were receiving extra vitamin D during the entire period of cancer treatment. Thus, the effect of vitamin D on reducing cancer deaths was easier to detect.

What Does This Study Mean For You?

the truth about vitamin d questionsVitamin D Is Likely To Decrease Your Risk Of Dying From Cancer: When you combine the results of this study with what we already know about vitamin D and cancer, the results are clear. Vitamin D appears to reduce your risk of dying from cancer. More importantly, the longer you have been supplementing with vitamin D, the greater your risk reduction is likely to be.

Vitamin D May Decrease Your Risk Of Developing Cancer: Association studies suggest that optimal vitamin D status is associated with decreased cancer risk, especially colon cancer risk. However, the long time for cancer development means that we may never be able to prove this effect through double-blind, placebo-controlled clinical trials.

Holistic Is Best: When you combine the VITAL study results with what we already know about vitamin D and heart disease, it appears that supplementing with vitamin D is unlikely to reduce your risk of developing heart disease unless you are vitamin D deficient. However, a holistic approach that starts with a healthy, primarily plant-based diet and makes sure your vitamin D status is adequate is likely to be effective.

The same is likely true for cancer. While the latest study suggests that vitamin D supplementation reduces your risk of dying from cancer, those vitamin D supplements are likely to be even more effective if you also adopt a healthy diet and lifestyle.

How Much Vitamin D Do You Need? The optimal dose of vitamin D is likely to be different for each of us. One of the things we have learned in recent years is that there are significant differences in the efficiency with which we convert vitamin D from diet and/or sun exposure into the active form of vitamin D in our cells. Fortunately, the blood test for 25-hydroxyvitamin D is readily available and is widely considered to be an excellent measure of our vitamin D status.

I recommend that you have your blood level of 25-hydroxyvitamin D tested on an annual basis. Based on the best currently available data, I recommend you aim for >20 ng/ml (50 nmol/L) if you wish to minimize your risk of heart disease and >30 ng/ml (75 nmol/L) if you wish to minimize your risk of cancer. If you can achieve those levels through diet and a multivitamin supplement, that is great. If not, I would recommend adding a vitamin D supplement until those levels are achieved.

Finally, you shouldn’t think of vitamin D as a magic bullet. If you are a couch potato and eat sodas and junk food, don’t expect vitamin D to protect you from cancer and heart disease. You should think of maintaining adequate 25-hydroxyvitamin D levels as just one component of a holistic approach to healthy, disease-free living.

 

The Bottom Line

 

There is a lot of confusion around the question of whether vitamin D reduces the risk of cancer and heart disease. A major clinical study has just been published that sheds light on these important questions. It reported:

  • Vitamin D did not decrease the risk of developing cancer during the 5.3-year study duration. The authors pointed out that cancer takes 20-30 years to develop, which means their study was probably too short to detect an effect of vitamin D on the risk of developing cancer.
  • Vitamin D did decrease the risk of dying from cancer, and the longer people were supplementing with vitamin D the bigger the protective effect of vitamin D was.
  • Vitamin D did not decrease the risk of heart disease. However, most study participants had a level of 25-hydroxyvitamin D that was optimal for reducing the risk of heart disease at the beginning of the study. There was no reason to expect that extra vitamin D would provide additional benefit.
  • With respect to both cancer and heart disease the best advice is to:
    • Get your 25-hydroxyvitamin D levels tested on an annual basis and supplement, if necessary, to keep your 25-hydroxyvitamin D levels in what the NIH considers to be an adequate range (20-50 ng/ml).
    • We do not have good dose response data for the beneficial effects of vitamin D on heart disease and cancer. However, according to this article, previous studies suggest you may want to am for 25-hydroxyvitamin D levels above 20 ng/ml to reduce the risk of heart disease and above 30 ng/ml to reduce your risk of cancer.
    • Consider vitamin D as just one component of a holistic approach to healthy, disease-free living.

For more details about the interpretation of these studies and what they mean for you, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

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