Supplements

Over 50% of Americans take supplements. And the non-scientific world has provided some remarkable insights and therapies. Digitalis, the ubiquitous cardiac drug that improves cardiac work without increasing its energy requirements, was originally found in the folk medicine foxglove. (Interestingly, foxglove was used as a diuretic as increased cardiac efficiency often improved kidney function.) Curare was a aboriginal hunting paralytic before it was used by anesthesia. A number of year ago, using the logic that more medicines were available in the world of folk medicine if we only looked harder, a research company called Shaman raised $50 million and started to explore the more primitive therapies in a search for drugs like foxglove and curare applicable to the new technological world.

Regrettably, Shaman went broke.

Yet the nonscientific world slogs on, underwritten by hope and ignorance. Much of that ignorance is legislated. If an over-the-counter therapy actually did the things implied, the FDA would break  the company's doors down and demand they invest $1 billon in trials to prove it. So, in our confused world, companies are dis-incentivized to prove their claims.

The world of supplements is less complex than a folk medicine as those therapies are actually part of our normal diet and not exogenous chemicals.

A paper titled "Supplemental Vitamins and Minerals for CVD Prevention and Treatment" was published in the Journal of the American College of Cardiology on May 28. Researchers from the University of Toronto and St. Michael's Hospital, Toronto, conducted a meta-analysis of relevant data and single randomized control trials published between January 2012 and October 2017. The findings showed some of the most common supplements either provided no benefit or actually increased risk in the prevention of cardiovascular disease, heart attack, stroke or premature death.

"We were surprised to find so few positive effects of the most common supplements that people consume," said lead author Dr. David Jenkins, professor in the Department of Nutritional Sciences at the university, interviewed by MSN. "Our review found that if you want to use multivitamins, vitamin D, calcium or vitamin C, it does no harm — but there is no apparent advantage either."


The U.S. Preventive Services Task Force (USPSTF) recently issued new recommendations for older adults to decrease the risk of falls. In their statement, the use of vitamin D supplements was discouraged due to mixed results from research. On the other hand, the review also linked niacin (vitamin B3) and antioxidants (vitamins A, C, and E) to an increased risk of all causes of death. Previously, a 2014 study by Northwestern University researchers expressed similar concerns about niacin.

"There might be one excess death for every 200 people we put on niacin," said preventive cardiologist Dr. Donald Lloyd-Jones from Northwestern Medicine. He called it "an unacceptable therapy" for most patients, explaining how it should only be reserved for those at very high risk for a heart attack or stroke, and are unable to take statins.


That said, the latest review did highlight one supplement that offered the benefit it promised. Folate did show a reduction in cardiovascular disease and stroke, according to the researchers. The effect was also observed in B-complex vitamins which contained folic acid. That is worth attention.


In addition, the paper highlighted the prevalent use of supplements in the United States. Most experts think supplements may only "plug dietary gaps" for certain people. Examples of people who would fall into the category include pregnant women, older adults, those with food allergies and dietary restrictions, etc.

"In the absence of significant positive data — apart from folic acid's potential reduction in the risk of stroke and heart disease — it's most beneficial to rely on a healthy diet to get your fill of vitamins and minerals," Dr. Jenkins said. "So far, no research on supplements has shown us anything better than healthy servings of less processed plant foods including vegetables, fruits, and nuts."


Nuts.