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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Comments (2)

  • denise

    |

    is magnesium good for the heart

    Reply

    • Dr. Steve Chaney

      |

      Magnesium is indeed good for the heart. That doesn’t mean we need mega-doses of it. However, many Americans do not get the recommended intake of magnesium from their diet. For most people a multivitamin providing 50% of the DV for magnesium should be sufficient, although some people may need more.

      Reply

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Latest Article

Does Magnesium Optimize Vitamin D Levels?

Posted February 12, 2019 by Dr. Steve Chaney

The Case For Holistic Supplementation

Author: Dr. Stephen Chaney

 

Does magnesium optimize vitamin D levels?

magnesium optimize vitamin dOne of the great mysteries about vitamin D is the lack of correlation between vitamin D intake and blood levels of its active metabolite, 25-hydroxyvitamin D. Many people who consume RDA levels of vitamin D from foods and/or supplements end up with low blood levels of 25-hydroxyvitamin D. The reason(s) for this discrepancy between intake of vitamin D and blood levels of its active metabolite are not currently understood.

Another great mystery is why it has been so difficult to demonstrate benefits of vitamin D supplementation. Association studies show a strong correlation between optimal 25-hydroxyvitamin D levels and reduced risk of heart disease, cancer, and other diseases. However, placebo-controlled clinical trials of vitamin D supplementation have often come up empty. Until recently, many of those studies did not measure 25-hydroxyvitamin D levels. Could it be that optimal levels of 25-hydroxyvitamin D were not achieved?

The authors of the current study hypothesized that optimal magnesium status might be required for vitamin D conversion to its active form. You are probably wondering why magnesium would influence vitamin D metabolism. I had the same question.

The authors pointed out that:

  • Magnesium status affects the activities of enzymes involved in both the synthesis and degradation of 25-hydroxyvitamin D.
  • Some clinical studies have suggested that magnesium intake interacts with vitamin D intake in affecting health outcomes.
  • If the author’s hypothesis is correct, it is a concern because magnesium deficiency is prevalent in this country. In their “Fact Sheet For Health Professionals,” the NIH states that “…a majority of Americans of all ages ingest less magnesium from food than their respective EARs [Estimated Average Requirement]; adult men aged 71 years and older and adolescent females are most likely to have low intakes.” Other sources have indicated that magnesium deficiency may approach 70-80% for adults over 70.

If the author’s hypothesis that magnesium is required for vitamin D activation is correct and most Americans are deficient in magnesium, this raises some troubling questions.

  • Most vitamin D supplements do not contain magnesium. If people aren’t getting supplemental magnesium from another source, they may not be optimally utilizing the vitamin D in the supplements.
  • Most clinical studies involving vitamin D do not also include magnesium. If most of the study participants are deficient in magnesium, it might explain why it has been so difficult to show benefits from vitamin D supplementation.

Thus the authors devised a study (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018 ) to directly test their hypothesis.

 

How Was The Study Designed?

magnesium optimize vitamin d studyThe authors recruited 180 volunteers, aged 40-85, from an ongoing study on the prevention of colon cancer being conducted at Vanderbilt University. The duration of the study was 12 weeks. Blood was drawn at the beginning of the study to measure baseline 25-hydroxyvitamin D levels. Three additional blood draws to determine 25-hydroxyvitamin D levels were performed at weeks 1, 6, and 12.

Because high blood calcium levels increase excretion of magnesium, the authors individualized magnesium intake based on “optimizing” the calcium to magnesium ratio in the diet rather than giving everyone the same amount of magnesium. The dietary calcium to magnesium ratio for most Americans is 2.6 to 1 or higher. Based on their previous work, they considered an “ideal” calcium to magnesium ratio to be 2.3 to 1. The mean daily dose of magnesium supplementation in this study was 205 mg, with a range from 77 to 390 mg to achieve the “ideal” calcium to magnesium ratio. The placebo was an identical gel capsule containing microcrystalline cellulose.

Two 24-hour dietary recalls were conducted at baseline to determine baseline dietary intake of calcium and magnesium. Four additional 24-hour dietary recalls were performed during the 12-week study to assure that calcium intake was unchanged and the calcium to magnesium ratio of 2.3 to 1 was achieved.

In short this was a small study, but it was very well designed to test the author’s hypothesis.

 

Does Magnesium Optimize Vitamin D Levels?

 

does magnesium optimize vitamin d levelsThis was a very complex study, so I am simplifying it for this discussion. For full details, I refer you to the journal article (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018).

The most significant finding was that magnesium supplementation did affect blood levels of 25-hydroxyvitamin D. However, the effect of magnesium supplementation varied depending on the baseline 25-hydroxyvitamin D level at the beginning of the study.

  • When the baseline 25-hydroxyvitamin D was 20 ng/ml or less (which the NIH considers inadequate), magnesium supplementation had no effect on 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D was 20-30 ng/ml (which the NIH considers the lower end of the adequate range), magnesium supplementation increased 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D level approached 50 ng/ml (which the NIH says may be “associated with adverse effects”), magnesium supplementation lowered 25-hydroxyvitamin D levels.

The simplest interpretation of these results is:

  • When vitamin D intake is inadequate, magnesium cannot magically create 25-hydroxyvitamin D from thin air.
  • When vitamin D intake is adequate, magnesium can enhance the conversion of vitamin D to 25-hydroxyvitamin D.
  • When vitamin D intake is too high, magnesium can help protect you by lowering 25-hydroxyvitamin D levels.

The authors concluded: “Our findings suggest that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. Further dosing studies are warranted…”

 

What Does This Study Mean For You?

magnesium optimize vitamin d for youThis was a groundbreaking study that has provided novel and interesting results.

  • It provides the first evidence that optimal magnesium status may be required for optimizing the conversion of vitamin D to 25-hydroxyvitamin D.
  • It suggests that optimal magnesium status can help normalize 25-hydroxyvitamin D levels by increasing low levels and decreasing high levels.

However, this was a small study and, like any groundbreaking study, has significant limitations. For a complete discussion of the limitations and strengths of this study I refer you to the editorial (S Lin and Q Liu, American Journal of Clinical Nutrition, 108: 1159-1161, 2018) that accompanied the study.

In summary, this study needs to be replicated by larger clinical studies with a more diverse study population. In order to provide meaningful results, those studies would need to carefully control and monitor calcium, magnesium, and vitamin D intake. There is also a need for mechanistic studies to better understand how magnesium can both increase low 25-hydroxyvitamin D levels and decrease high 25-hydroxyvitamin D levels.

However, assuming the conclusions of this study to be true, it has some interesting implications:

  • If you are taking a vitamin D supplement, you should probably make sure that you are also getting the DV (400 mg) of magnesium from diet plus supplementation.
  • If you are taking a calcium supplement, you should check that it also provides a significant amount of magnesium. If not, change supplements or make sure that you get the DV for magnesium elsewhere.
  • I am suggesting that you shoot for the DV (400 mg) of magnesium rather than reading every label and calculating the calcium to magnesium ratio. The “ideal” ratio of 2.3 to 1 is hypothetical at this point. A supplement providing the DV of both calcium and magnesium would have a calcium to magnesium ratio of 2.5, and I would not fault any manufacturer for providing you with the DV of both nutrients.
  • If you are taking high amounts of calcium, I would recommend a supplement that has a calcium to magnesium ratio of 2.5 or less.
  • If you are considering a magnesium supplement to optimize your magnesium status, you should be aware that magnesium can cause gas, bloating, and diarrhea. I would recommend a sustained release magnesium supplement.
  • Finally, whole grains and legumes are among your best dietary sources of magnesium. Forget those diets that tell you to eliminate whole food groups. They are likely to leave you magnesium-deficient.

Even if the conclusions of this study are not confirmed by subsequent studies, we need to remember that magnesium is an essential nutrient with many health benefits and that most Americans do not get enough magnesium in their diet. The recommendations I have made for optimizing magnesium status are common-sense recommendations that apply to all of us.

 

The Case For Holistic Supplementation

 

magnesium optimize vitamin d case for holistic supplementationThis study is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No”. Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are they didn’t also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal.

That’s because most doctors and nutrition experts still think of nutrients as “magic bullets.” I cover holistic supplementation in detail in my book “Slaying The Supplement Myths.”  Other examples that make a case for holistic supplementation that I cover in my book include:

  • A study showing that omega-3 fatty acids and B vitamins may work together to prevent cognitive decline. Unfortunately, most studies looking at the effect of B vitamins on cognitive decline have not considered omega-3 status and vice versa. No wonder those studies have produced inconsistent results.
  • Studies looking at the effect of calcium supplementation on loss of bone density in the elderly have often failed to include vitamin D, magnesium, and other nutrients that are needed for building healthy bone. They have also failed to include exercise, which is essential for building healthy bone. No wonder some of those studies have failed to find an effect of calcium supplementation on bone density.
  • A study reported that selenium and vitamin E by themselves might increase prostate cancer risk. Those were the headlines you might have seen. The same study showed Vitamin E and selenium together did not increase prostate cancer risk. Somehow that part of the study was never mentioned.
  • A study reported that high levels of individual B vitamins increased mortality slightly. Those were the headlines you might have seen. The same study showed that when the same B vitamins were combined in a B complex supplement, mortality decreased. Somehow that observation never made the headlines.
  • A 20-year study reported that a holistic approach to supplementation produced significantly better health outcomes.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. When we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to our diet. I mentioned earlier that whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies of nutrients, phytonutrients, specific types of fiber, and the healthy gut bacteria that use that fiber as their preferred food source.

The Bottom Line

 

A recent study suggests that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. This is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No.”  Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are he or she did not also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal. That may be why so many of those studies have failed to find any benefit of vitamin D supplementation.

I cover holistic supplementation in detail in my book “Slaying The Supplement Myths” and provide several other examples where a holistic approach to supplementation is superior to taking individual supplements.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. Whenever we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to what we eat. For example, whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies.

For more details about the current study and what it means to 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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