Health Tips From The Professor Are Omega-3 Supplements Good For You?

Posted December 4, 2018 by Dr. Steve Chaney

Do Omega-3s Reduce Risk Of Heart Disease & Cancer?

Author: Dr. Stephen Chaney

 

Are omega-3 supplements good for you?

are omega-3 supplements good for you fish oilYou have every right to be confused. In the late 1990s and early 2000s several major clinical studies showed that omega-3 supplements reduced the risk of heart attacks and stroke. In contrast, a few months ago a major study called ASCEND was published that failed to find any benefit of omega-3s at reducing heart disease risk. The headlines said “Omega-3 Supplements Don’t Protect Against Heart Disease”. You were told that omega-3 supplements were worthless. I pointed out the weakness of that study in a previous issue  of “Health Tips From the Professor”.

In mid-November two more major clinical studies were published. However, if you rely on the media for your information on supplementation, you are probably still confused. Headlines ranged from “Omega-3 Supplements Do Not Prevent Cancer Or Heart Disease” to “Eating More Fish Or Taking Omega-3 Fish Oil Supplements Can Cut Heart Attack Risk.” 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 omega-3s.

Note: One of the clinical studies looked at the effect of omega-3s on both cancer and heart disease risk. I will discuss the cancer results briefly, but most of my focus will be on the heart disease findings.

 

How Were The Studies Designed?

are omega-3 supplements good for you heart disease

The VITAL STUDY (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403 )in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had pre-existing 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.
  • 38% were on cholesterol-lowering medications.
  • 50% had high blood pressure treated by medication.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 50% of the participants to determine omega-3 index at baseline and at the end of the first year. The participants were given a high purity omega-3 supplement (1 gram capsules containing 840 mg of total omega-3s, 460 mg of EPA, and 380 mg of DHA as the ethyl esters) or a placebo and followed for an average of 5.3 years.

There were two important characteristics of this study that distinguished it from the negative ASCEND study.

  • This study specifically excluded cardiovascular drugs other than statins and blood pressure medications because many of those drugs provide the same benefits as omega-3s. Patients in the ASCEND study were on 3-5 heart medications
  • The omega-3 status of participants at the beginning of this study was very low. The omega-3 status of participants in the ASCEND study was near optimal at the beginning of the study.

The REDUCE-IT study (DL Bhatt et al, New England Journal Of Medicine, DOI:10.1056/NEJMoa1812792 ): This study enrolled 8,179 participants (average age = 64) from several countries. The study participants were 70% male and 90% white. The average BMI was 31, which is considered obese. This study differed from the VITAL study in that all the patients were at high risk of heart disease.

  • 70% of them had preexisting heart disease.
  • The remaining 30% had diabetes plus at least one additional risk factor for heart disease.
  • In addition, all of them had elevated triglycerides, which is an independent risk factor for heart disease.

The participants were given a high purity EPA supplement (4 grams of EPA as the ethyl ester) or a placebo and followed for an average of 4.9 years.

 

Do Omega-3s Reduce The Risk Of Heart Disease?

 

are omega-3 supplements good for you heart attackThe VITAL Study: The primary end point for this study was something called “major cardiovascular events”, which was a composite every cardiovascular end point measured in the study. For this end point the results were negative. Omega-3 supplementation did not cause a significant decrease in major cardiovascular events compared to the placebo.

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 very positive. For example, major cardiovascular events were reduced by:

  • 26% in African-Americans.
  • 26% in patients with diabetes.
  • 17% in patients with a family history of heart disease.
  • 19% in patients with two or more risk factors for heart disease.
  • 19% in patients with low fish intake.

In other words, omega-3 supplementation caused a significant decrease in heart disease risk for high risk patients and for patients with a poor diet (low intake of omega-3s).

In addition, several individual cardiovascular events were significantly reduced by omega-3 supplementation. For example:

  • Heart attacks were reduced by 28% in the general population and by 70% for African-Americans.
  • Death from heart attacks was reduced by 50%.
  • Total coronary heart disease was reduced by 17%.
  • Death from coronary heart disease was reduced by 24%.

In short, headlines saying that omega-3 supplementation can decrease heart attack risk appear to be accurate. Saying that eating more fish can reduce heart attack risk is stretching it a bit. The study was not done with fish, and you would need to eat 2-4 servings of omega-3-rich fish a week to get an equivalent amount of omega-3s. That’s a lot of fish.

The authors attributed the positive results obtained in this study compared to the negative results obtained in several recent studies to four factors:

  • Many of the previous studies had fewer participants, used lower doses of omega-3s, and were shorter. There may not have been enough statistical power to demonstrate a benefit of omega-3s in those studies.
  • Participants in many of the previous studies were on multiple medications that mimicked the beneficial effects of omega-3s, making it more difficult to show a positive effect of omega-3 supplementation.
  • Most of the previous studies either did not measure the omega-3 status of participants or had a study population that started the study with near optimal omega-3 status. The VITAL study showed that omega-3s had a stronger beneficial effect for people who seldom ate fish.
  • African-Americans were underrepresented in most previous studies. The VITAL study showed that omega-3s were more beneficial for African-Americans than for other ethnic groups.

As for side effects, there was no increased risk of bleeding or any other serious side effect from omega-3 supplementation.

The REDUCE-IT Study: This study of high-risk patients was even more positive than the VITAL study.

  • The composite of all cardiovascular end points was reduced by 25%.
  • The risk reduction was greatest for men, non-whites, and people over 65.
  • The risk reduction was also greatest for people with pre-existing heart disease, very high triglyceride levels, and people who required high-dose statin therapy to keep their cholesterol under control.

In other words, everyone benefited from omega-3 supplementation in this study because they were all at high risk, but those at the highest risk benefitted the most.

When they looked at individual cardiovascular events:

  • Fatal and non-fatal heart attacks were reduced by 31%.
  • Cardiovascular death was reduced by 20% and death from any cause was reduced by 23%.
  • Fatal and non-fatal stroke was reduced by 28%.
  • Hospitalization for unstable angina was reduce by 32%.

However, this very high dose of EPA was not completely without risk:

  • 1% of patients in the EPA group were hospitalized for atrial fibrillation versus 2.1% in the placebo group.
  • 7% of patients in the EPA group experienced a serious bleeding event compared to 2.1% in the placebo group.

 

Do Omega-3s Reduce The Risk Of Cancer?

 

are omega-3 supplements good for you cancerThe VITAL Study: The VITAL study also looked at the effect of omega-3s on cancer risk. The results from this study were uniformly negative. There was no effect of omega-3 supplementation on invasive cancer of any type, breast cancer, prostate cancer, colon cancer, or death from cancer. Does that mean omega-3s have no role in reducing cancer risk? That’s not clear.

If we look at previous animal studies and human association studies, reduced cancer risk is seen when omega-3s replaced saturated fats, trans fats, and/or omega-6 fats in the diet. The subjects in the VITAL study ate a typical American diet, and the study made no effort to change what they were eating. It just added an omega-3 supplement. There is relatively little evidence that you can eat burgers and fries and expect omega-3s to reduce cancer risk.

The VITAL study merely confirms what previous studies have suggested. You can’t continue to eat a typical American diet and expect omega-3s to make cancer go away. Omega-3s should be thought of as part of a holistic approach to reducing cancer risk. If they have any role in reducing cancer risk, it is likely to be as part of a primarily plant-based diet that substitutes omega-3s for the bad fats in the American diet.

For 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 several cancers, especially cancers of the breast and colon.

 

Are Omega-3 Supplements Good For You?

are omega-3 supplements good for you truthThere is a lot of confusion around the question of whether omega-3s are good for the heart. Some studies say yes. Others say no. If you average all the studies together, as some recent meta-analyses have done, it is easy to throw up your hands and conclude there is no definitive evidence that omega-3s reduce heart disease risk. However, if you look at why the studies differ a clear pattern emerges.

  • If the study subjects are on multiple heart medications that duplicate the beneficial effects of omega-3s, the studies tend to be negative. If the subjects are only on one or two medications, the studies tend to be positive. Since most people I know would prefer to minimize the number of medications they are on, the negative studies with multiple medications are simply not relevant to them.
  • If the study subjects are at low risk of heart disease, the studies tend to be negative. If the subjects are at high risk, the studies tend to be positive. This does not mean that omega-3s are of no benefit if you are at low risk of heart disease. It simply reflects the fact it is easier to show a beneficial effect of any intervention when you have a pool of high-risk patients who are likely to experience some sort of cardiovascular event during the time-period of the study.

For example, as discussed in my recent book, “Slaying The Supplement Myths,” this the same pattern you see with statin clinical studies. If patients are at high risk, statin drugs clearly save lives. If they are at low risk, it is almost impossible to show any benefit of statin drugs. Cardiologists extrapolate from the high-risk studies and prescribe statins to low-risk patients. I think it is time to take a similar approach with omega-3s.

  • If the subjects have a good omega-3 status at the beginning of the study, additional omega-3 supplementation usually has no benefit. If their omega-3 status is poor at the beginning of the study, the results of omega-3 supplementation tend to be positive. This is just common sense. Supplementation is meant to fill gaps in the diet – not to provide a surplus of nutrients. Of course, the reality is many Americans do not get enough omega-3s in their diet.

 

What Do These Studies Mean For You?

are omega-3 supplements good for you healthy heartOmega-3s Are Good For Your Heart: When you combine the latest studies with what we already know about omega-3s and heart disease, the results are clear-cut.

  • If you are at high risk of heart disease, don’t eat many omega-3-rich fish, and/or don’t want to be on a handful of heart medications, the evidence is strong that omega-3s reduce your risk of heart disease.
  • On the other hand, if you are at low risk of heart disease, eat 2-4 servings of omega-3-rich fish a week, and/or are happy taking multiple heart medications with all their side effects, it is difficult to prove that omega-3s have any benefits. That doesn’t mean that omega-3s don’t have benefits. It just means we can’t prove they do.

If you are still having trouble making up your mind whether omega-3 supplements are the right choice for you, I might remind you:

  • If you are like millions of Americans, the first sign you are at risk of heart disease might be sudden death.
  • If you are like most Americans, you are probably not getting enough omega-3s in your diet.
  • If you prefer taking drugs, you are probably not interested in supplements anyway.

Holistic Is Best: When you combine the VITAL study results with what we already know about omega-3s and cancer, it appears that adding omega-3s to a bad diet is unlikely to reduce your risk of cancer. However, a holistic approach that starts with a healthy, primarily plant-based diet and substitutes omega-3s for the bad fats in the American diet is likely to substantially reduce your cancer risk. The Mediterranean diet might be considered an example of that approach.

The same is likely true for heart health. While the latest two studies suggest that adding omega-3 supplements to your regular diet reduces your heart disease risk, those omega-3 supplements are likely to be even more effective if you also adopt a heart-healthy diet and lifestyle.

Omega-3 Supplements vs Omega-3 Drugs: The Omega-3 preparations used in this study are pharmaceutical-grade omega-3 preparations and are marketed as drugs. Thus, it is likely that many doctors will recommend them rather than less expensive omega-3 supplements. Which choice is best for you?

The preparation used in the VITAL study is similar in composition to many commercially available omega-3 supplements. The main difference is that it is high purity and is subject to the quality control standards required for pharmaceutical drugs. Many omega-3 supplements do not meet these standards, but some do. If you wish to use an omega-3 supplement, do your research. Inquire about their quality control standards and only buy high purity supplements.

The preparation used in the REDUCE-IT study used ultra-pure EPA only. That preparation did not contain any other omega-3s, so a commercially available omega-3 supplement would not be comparable. However, I do not recommend an EPA-only supplement for three reasons.

  • The results for high risk patients in the REDUCE-IT study were similar to those for high risk patients in the VITAL study. This suggests that removing DHA and other omega-3s may not provide additional protection against heart disease. A head to head comparison of the two supplements would be required to prove the superiority of an EPA-only supplement.
  • I have the same concern for this high-dose EPA supplement as I have for any high-dose single nutrient supplement. DHA and other omega-3s provide benefits such as cognitive health that EPA does not. Very high dose EPA is likely to interfere with the uptake and utilization of the other omega-3s.
  • The EPA only supplement used in the REDUCE-IT study had side effects that were not seen with the mixed omega-3 supplement used in the VITAL study. It is not clear whether those side effects were due to differences in dose or differences in formulation.

Omega-3 Ethyl Esters vs Omega-3 Triglycerides: There has been a lot of hype about the superiority of omega-3 triglyceride preparations recently. These studies were both done with omega-3 ethyl esters and proved to be very effective. Until someone shows that omega-3 triglyceride preparations provide better results at reducing heart disease risk than omega-3 ethyl esters, I would leave omega-3 triglyceride supplements on the shelf.

How Much Omega-3s Do You Need? We have too few dose-response studies to reliably predict how much omega-3s are optimal for reducing heart disease risk. The 1 gram/day dose used in the VITAL study gave good results, so that is an excellent starting point. The 4 gram/day dose used in the REDUCE-IT study seemed to provide little additional benefit.

Of course, the optimal dose is likely to be different for each of us. Once the omega-3 index blood test becomes more widely available I would recommend getting your omega-3 index determined on an annual basis and aiming for an omega-3 index of 8 or above, since that is the level associated with a low risk of heart disease.

 

The Bottom Line

 

There is a lot of confusion around the question of whether omega-3s are good for the heart. Some studies say yes. Others say no. If you average all the studies together, as some recent meta-analyses have done, it is easy to throw up your hands and conclude there is no definitive evidence that omega-3s reduce heart disease risk.

However, two recent studies support the effectiveness of omega-3s for reducing heart disease risk. When you combine the latest studies with what we already know about omega-3s and heart disease, the results are clear-cut.

  • If you are at high risk of heart disease, don’t eat many omega-3-rich fish, and/or don’t want to be on a handful of heart medications, the evidence is strong that omega-3s reduce your risk of heart disease.
  • On the other hand, if you are at low risk of heart disease, eat 2-4 servings of omega-3-rich fish a week, and/or are happy taking multiple heart medications with all their side effects, it is difficult to prove that omega-3s have any benefits. That doesn’t mean that omega-3s don’t have benefits. It just means we can’t prove they do.

If you are still having trouble making up your mind whether omega-3 supplements are the right choice for you, I might remind you:

  • If you are like millions of Americans, the first sign you are at risk of heart disease might be sudden death.
  • If you are like most Americans, you are probably not getting enough omega-3s in your diet.
  • If you prefer taking drugs, you are probably not interested in supplements anyway.

In addition, one of the studies confirmed what we already know about omega-3s and cancer. Adding omega-3s to a bad diet is unlikely to reduce your risk of cancer. However, a holistic approach that starts with a healthy, primarily plant-based diet and substitutes omega-3s for the bad fats in the American diet is likely to substantially reduce your cancer risk. The Mediterranean diet might be considered an example of that approach.

The same is likely true for heart health. While the latest two studies suggest that adding omega-3 supplements to your regular diet reduces your heart disease risk, those omega-3 supplements are likely to be even more effective if you also adopt a heart-healthy diet and lifestyle.

For more details read the article above. In addition, the article covers topics like omega-3 supplements versus omega-3 drugs, omega-3 ethyl esters versus omega-3 triglycerides, and how much omega-3s we need. It also discusses why several recent studies have failed to find a benefit of omega-3s for reducing heart disease risk.

 

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.

Health Tips From The Professor Are Vitamin D Supplements Worthless?

Posted October 30, 2018 by Dr. Steve Chaney

Are We Asking The Right Question?

Author: Dr. Stephen Chaney

 

are vitamin d supplements worthlessWe have been told that vitamin D is a miraculous “must have” vitamin. We have been told it’s not just important for healthy bones. It’s also important for a strong immune system, heart health, protection from cancer, and many other health benefits. We have been told that we should get our 25-hydroxy vitamin D levels tested and supplement with extra vitamin D if they are low.

Now, the latest headlines are saying all of that is wrong. They are telling us vitamin D supplements do not improve bone density or protect against falls and bone fractures. They are telling us to forget all the other claimed benefits of vitamin D. Those claims have been disproved. Forget about the 25-hydroxy vitamin D tests. They are a waste of money.

What is the truth? Why is it so confusing? Are vitamin D supplements worthless?  Let me guide you through the claims and counterclaims so you can discover the truth for yourself.

How Did Vitamin D Become So Popular?

are vitamin d supplements worthless popularLet’s start with a brief history of vitamin D. It all started with the industrial revolution in Northern Europe. Suddenly, children and adults in the large cities were spending the bulk of their waking hours in dark factories rather than outdoors on the farm. They were already living in northern latitudes where sunlight was weak during the winter months. To make matters worse pollution from the factories was creating a haze that blocked the sunlight.

That lead directly to the discovery that sunlight was crucial to our body’s ability to synthesize vitamin D and that vitamin D was essential for building strong bones. The solution to the public health crisis of rickets and osteomalacia was to fortify dairy products with vitamin D. The almost universal adaptation of vitamin D fortification virtually eliminated rickets and osteomalacia except in association with certain rare diseases. The two important lessons learned from this experience were:

  • Vitamin D is essential for healthy bone formation.
  • Vitamin D supplementation improves bone health for individuals who are deficient in vitamin D

As we discuss the latest findings, we need to keep in mind that these fundamental principles have not changed.

In the late 20th century our understanding of vitamin D took another leap with the discovery that vitamin D receptors were not restricted to bone cells. Almost every cell in our body contained vitamin D receptors. That lead to studies showing that people with low vitamin D intakes were more likely to experience heart disease, cancer, some autoimmune diseases, and infectious diseases such as flu than people with high vitamin D intakes.

The final leap in our understanding of vitamin D took place when the medical profession started routinely testing blood levels of 25-hydroxy vitamin D. That is when we discovered that some people who appeared to have adequate intake of vitamin D and/or adequate exposure to sunlight had low blood levels of 25-hydroxy vitamin D. Furthermore, follow-up studies showed that low 25-hydroxyvitamin D levels correlated with an increased risk of heart disease, cancer, and infectious disease. The important lessons learned from these experiments were:

  • Vitamin D deficiency is associated with increased risk of multiple diseases.
  • 25-hydroxy vitamin D tests are the best way to measure vitamin D deficiency.

Once again, these fundamental principles have not changed.

What Did The Study Show?

are vitamin d supplements worthless studyThe study (MJ Bolland et al, Lancet Diabetes Endocrinology 2018) behind the headlines was a meta-analysis of 81 randomized, placebo-controlled studies with a total of 53,537 subjects that looked at the effect of vitamin D supplementation in elderly populations on bone mineral density, bone fractures, and falls.

The meta-analysis only included studies in which vitamin D intake was the sole variable. In many cases the subjects were not taking a calcium supplement. If they were taking a calcium supplement, both the vitamin D group and placebo group were taking the same amount of calcium.

 

The results were unequivocal. In this study vitamin D supplementation had no effect on bone mineral density, bone fractures, or falls in elderly populations. The authors concluded “There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health.”

 

Is this conclusion justified? Let’s put the findings of this study into a broader perspective.

 

Are We Asking The Right Questions?

are vitamin d supplements worthless holistic approachBefore throwing out our vitamin D supplements let’s ask whether this study is asking the right question. I have covered this topic in detail in my new book “Slaying The Supplement Myths” (https://slayingthesupplementmyths.com) with respect to similar studies that had called into question the value of calcium supplements for bone health. Let me cover the highlights here.

In my book I created the graphic on the right to put the question of who benefits from supplementation into perspective. For the purposes of this discussion, I will just focus on poor diet (or, in the case of vitamin D, poor exposure to sunlight). As I discussed above, science shows that people who are not getting enough vitamin D from diet and sunlight benefit from vitamin D supplementation. Unfortunately, vitamin D enthusiasts and some supplement companies have muddied the waters by going beyond what good science shows and suggesting or implying that everyone will benefit from vitamin D supplementation.

This is part of the problem. Once you have created a paradigm that everyone will benefit from vitamin D supplementation, that paradigm is easy to disprove. If someone already has adequate, or nearly adequate, levels of 25-hydroxy vitamin D, would we expect additional vitamin D to make a difference? Of course not, but that is exactly the question the most recent study was asking.

In discussing the limitations of their study, the authors said: “It is possible that trials of populations with low baseline 25-hydroxy vitamin D might produce different results because only 4 trials, involving 831 participants (1.6% of all participants), reported mean baseline 25-hydroxy vitamin D levels lower than 25 nmol/L (the level indicating vitamin D deficiency).

In other words, the study did not measure the effect of vitamin D supplementation for people who were vitamin D deficient. The only take-home lesson from this study is that people with adequate, or near adequate, vitamin D status do not benefit from vitamin D supplementation. That is a “no-brainer.”

 

Vitamin D And A Bone Healthy Lifestyle

are vitamin d supplements worthless garbage in outThe other glaring deficiency of this study is that it was only measuring the effect of vitamin D on bone health. They purposely excluded any other factor that might influence bone health. That was a fatal flaw because healthy bone requires a holistic approach, not individual nutrients. In my book Slaying the Supplement Myths  I refer to this as a “bone healthy lifestyle.”

The most important feature of a “bone healthy lifestyle” is this:

  • Calcium, vitamin D, and resistance (weight bearing) exercise are all essential for healthy bones.
  • However, none of them is sufficient by itself. You need all three. You need a holistic approach if you wish to build strong bones.

Simply put, that means unless you include adequate calcium and exercise there is no reason to expect vitamin D supplementation to help build strong bones. Unfortunately, none of the studies included in the recent meta-analysis took a holistic approach to bone health. Some included calcium, but many didn’t. Resistance exercise was never considered. The studies were doomed to failure.

When you include flawed studies in your meta-analysis, you have what computer programmers call “Garbage in. Garbage out.” A meta-analysis can never be stronger than the individual studies it includes.

Other features of a “bone healthy lifestyle” include:

  • We need more than calcium and vitamin D for strong bones. We need magnesium, zinc, copper, manganese, vitamin C and vitamin K. If we are deficient in any of these, calcium will not be utilized as efficiently.
  • The foods we eat are also important. Our bones serve as a buffer system to keep our bodies slightly alkaline. Every time we eat acid-forming foods a little bit of bone is dissolved to neutralize the acid. For optimal bone health we need to minimize acid-forming foods and eat more alkaline-forming foods. That means we need to avoid sodas, sweets and refined grains. We also need to minimize meats, eggs, and dairy. Instead, we should focus on fruits, vegetables, peas, beans, lentils, seeds, and nuts.
  • Beware of drugs. The list of common medications that dissolve bones is a long one. Some of the worst offenders are anti-inflammatory steroids such as cortisone and prednisone, drugs to treat depression, drugs to treat acid reflux, and excess thyroid hormone. I am not suggesting that you should avoid properly prescribed medications. I would suggest you ask your doctor or pharmacist whether the drugs you are taking adversely affect bone density. If they do, you should pay a lot more attention to the other aspects of a “bone healthy lifestyle.”

 

Are Vitamin D Supplements Worthless?

are vitamin d supplements worthless bone healthNow we can come back to the question “Are vitamin D supplements worthless?” as the recent headlines have suggested. If you phrase the question as “Does everyone benefit from vitamin D supplementation?” or “Is vitamin D supplementation alone sufficient to build strong bones?” the answer is a clear no.

However, those are the wrong questions. If you ask: “Does vitamin D supplementation benefit people who are vitamin D-deficient?” the answer is a clear yes. If you ask: “Does a holistic approach that includes resistance exercise, adequate calcium, and adequate vitamin D improve bone health?” the answer is likely to be yes as well.

What about the headlines claiming that vitamin D is also worthless for strengthening the immune system and reducing the risk of heart disease, cancer, and auto-immune diseases?  The studies on which these claims are based suffer from the same flaws. They are asking the same wrong questions.

My recommendations:

  • Have your blood levels of 25-hydroxy vitamin D tested on a regular basis. I have them tested each year when I get my physical.
  • If your blood levels of 25-hydroxy vitamin D are below 25 nmol/L (which the NIH considers deficient), you are likely to benefit from vitamin D supplementation. If they are above 50 nmol/L (which the NIH considers sufficient), vitamin D supplementation is unlikely to provide additional benefit. However, that level of vitamin D doesn’t guarantee that you will have strong bones. You also need sufficient calcium and resistance exercise.
  • If your blood levels are in the insufficient range (between 25 nmol/L and 50 nmol/L), the situation is more complicated. If you are close to 50 nmol/L, you may benefit slightly from adding a vitamin D supplement, but the benefit will be too small to show up in a clinical study such as the one that resulted in the recent headlines. My advice is to look at your diet and medication use. If they put you at risk for low bone density, my recommendation would be to add a vitamin D supplement – along with adequate calcium and resistance exercise, of course. If you are closer to 25 nmol/L, you will likely benefit from a vitamin D supplement along with adequate calcium and exercise.
  • Don’t think of vitamin D supplementation as a “magic bullet” that will solve all your ills. Instead, think of it as just one component of a holistic approach to a bone healthy lifestyle.

 

The Bottom Line

 

A recent meta-analysis concluded that vitamin D supplementation did not improve bone mineral density, reduce bone fractures, or reduce falls in the elderly. While this conclusion was definitive, the study was asking the wrong questions.

  • We know that vitamin D improves bone health for people who are vitamin D-deficient. However, only 1.6% of the people in this study were vitamin D-deficient at the beginning of the study. That means the study was really asking: “If people have adequate, or near adequate, vitamin D status, does vitamin D supplementation provide any additional benefit?”  The answer to that question is a “no-brainer.”  There is no reason to expect that additional vitamin D would provide benefit.
  • We know that while vitamin D is essential for building strong bones, it is not sufficient by itself. Strong bones require a holistic approach that includes resistance exercise, adequate calcium, and adequate vitamin D. However, this study only looked at the effect of vitamin D on bone health. Calcium and exercise were excluded from consideration. That means the study was really asking: “Is vitamin D a “magic bullet” that can build strong bones by itself?” Again, there is no reason to expect vitamin D to provide much benefit under those conditions.

My recommendations:

  • Have your blood levels of 25-hydroxy vitamin D tested on a regular basis. I have them tested each year when I get my physical.
  • If your blood levels of 25-hydroxy vitamin D are low, you are likely to benefit from vitamin D supplementation. If they are already optimal, vitamin D supplementation is unlikely to provide additional benefit.
  • Don’t think of vitamin D supplementation as a “magic bullet” that will keep your bones strong by itself. Instead, think of it as just one component of a holistic “bone healthy lifestyle.”

 

For more details and to see my detailed recommendations, 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.

Health Tips From The Professor How Long Do the Benefits of Supplements Last?

Posted October 23, 2018 by Dr. Steve Chaney

Can Supplements Set You On A Path Towards A Healthier Life?

Author: Dr. Stephen Chaney

 

benefits of supplements heartA recent study (U Alehagen et al, PLOS One, April 11, 2018, 1-15 ) reported that the heart benefits of supplementation with coenzyme Q10 and selenium persisted for 12 years after supplementation ended. You would have thought a story like that would have made the headlines. Nope. Hardly a mention. Perhaps it did not match the narrative of the media and health professionals that supplements are worthless.

This study broke new ground. Most studies last a year or two and report whether there were any benefits of supplementation. A few studies have been extended a few years beyond the original supplementation period and have reported continued benefits of supplementation. However, in those studies the intervention group was still taking supplements. The intervention period was simply extended.

However, this study was unique in that supplementation was discontinued after 4 years. However, the positive effects of supplementation during that four-year period persisted for another 12 years without additional supplementation.

 

How Was The Study Done?

benefits of supplements monitoring heartIn this study 443 elderly individuals (average age =78) were recruited from a rural village in Sweden. They were given either supplements providing 200 mg/day of coenzyme Q10 and 200 mcg/day of selenium yeast or placebo pills. They were followed for four years. At this point the intervention phase of the trial ended, and the participants were followed for another 12 years without supplementation.

Cardiovascular deaths and all-cause mortality were recorded at 4 years (the end of the original intervention period), 10 years, and 12 years. The Swedish health care system is incredibly efficient. None of the participants were lost to follow-up.

Note on study design: Both coenzyme Q10 and selenium have heart health benefits and they compliment each other. Coenzyme Q10 was included in this study because our bodies lose the ability to make coenzyme Q10 as we age. By the time we reach age 80, we only make around half the coenzyme Q10 we made when we were younger. Selenium was included in the study because most Swedes are selenium deficient.

This study measured selenium levels and confirmed that all participants were selenium deficient at the beginning of the study. Selenium levels increased to near optimal in the supplemented group during the 4-year intervention period. In contrast, the placebo group remained selenium deficient.

 

How Long Do the Benefits of Supplements Last?

benefits of supplementationThe results of the study were truly amazing.

When you compared the group that had received coenzyme Q10 and selenium during the first 4 years of the study with the placebo group:

  • Cardiovascular mortality was 38% less and all-cause mortality was 24% less 12 years later in the supplement group.
  • The decrease in cardiovascular mortality lessened slightly with time (53% lower at 4 years, 46% lower at 10 years, and 38% lower at 12 years.
  • In contrast, the decrease in all-cause mortality remained relatively constant.
  • The effect was greater for women (who have lower coenzyme Q10 levels than men) than it was for men.
  • The decrease in cardiovascular mortality was 57% for women and 22% for men.
  • Cardiovascular mortality was decreased by 40-50% for people at high risk of cardiovascular death because of atherosclerosis, diabetes, high blood pressure, or impaired heart function.

Putting This Study Into Perspective

benefits of supplements wellnessI don’t want to read too much into this study. It has multiple limitations:

  • It is a very small study.
  • It is the first study I am aware of that has followed study participants years after supplementation has ended. More studies like this are clearly needed before any firm conclusions can be drawn.
  • It may be unique to Sweden where selenium deficiency is widespread. Selenium deficiency is much less prevalent in some other countries such as the United States.
  • It is possible that once the study population heard about the results of the initial 4-year study they started self-supplementing with coenzyme Q10 and selenium. However, since the participants did not know whether they were in the supplement or placebo group, that would likely affect both groups equally.

However, it is the implications of the study that fascinate me.

  • The authors of the study speculated that the improvement in endothelial cell function (Endothelial cells line the arteries and play an important role in arterial health) and/or decreased inflammation may have persisted long after supplementation stopped.
  • A more interesting idea is that supplementation (or the effects of supplementation) caused modifications to the DNA that were persistent (something we refer to as epigenetics). Moreover, those DNA modifications may have altered gene expression in a manner that reduced heart disease risk.

Much more work needs to be done before we know whether epigenetic modifications were responsible for the persistent benefit of supplementation in this, or any other, study. However, the ramifications of this idea are substantial. We think of supplementation as something that provides benefit only while we are taking the supplement. What if, under the right conditions, supplementation could send us down an entirely different path to better health? That would be worth major headlines.

 

The Bottom Line

 

A recent study in Sweden looked at the effects of supplementation with coenzyme Q10 and selenium on heart health 12 years after supplementation had ended.

  • The study reported that cardiovascular mortality was 38% less and all-cause mortality was 24% less 12 years later in the group that supplemented during the first 4 years.

The study has multiple limitations and needs to be repeated before drawing any definite conclusions. However, if true, it has interesting implications. What if the benefits of supplementation didn’t stop when you stopped supplementing? What if supplementation sent you down an entirely different path, a path towards better health?

For more details, 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.

 

Health Tips From The Professor Should We Use Supplements For Cardiovascular Health?

Posted July 10, 2018 by Dr. Steve Chaney

Are You Just Wasting Your Money On Supplements?

Author: Dr. Stephen Chaney

 

supplements for cardiovascular health wast moneyYou’ve seen the headlines. “Recent Study Finds Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.”  You are being told that supplements are of no benefit to you. They are a waste of money. You should follow a healthy diet instead. Is all of this true?

If I were like most bloggers, I would give you a simple yes or no answer that would be only partially correct. Instead, I am going to put the study behind these headlines into perspective. I am going to give you a deeper understanding of supplementation, so you can make better choices for your health.

 Should we use supplements for cardiovascular health?

In today’s article I will give you a brief overview of the subject. Here are the topics I will cover today:

  • Is this fake news?
  • Did the study ask the right questions?
  • Is this a question of “Garbage In – Garbage Out?
  • Reducing Heart Disease Risk. What you need to know.

All these topics are covered in much more detail (with references) in my book “Slaying The Supplement Myths”, which will be published this fall.

 

How Was This Study Done?

supplements for cardiovascular healthThis study (D.J.A. Jenkins et al, Journal of the American College Of Cardiology, 71: 2540-2584, 2018 ) was a meta-analysis. Simply put, that means the authors combined the results of many previous studies into a single database to increase the statistical power of their conclusions. This study included 127 randomized control trials published between 2012 and December 2017. These were all studies that included supplementation and looked at cardiovascular end points, cancer end points or overall mortality.

Before looking at the results, it is instructive to look at the strengths and weaknesses of the study. Rather than giving you my interpretation, let me summarize what the authors said about strengths and weaknesses of their own study.

The strengths are obvious. Randomized control trials are considered the gold standard of evidence-based medicine, but they have their weaknesses. Here is what the authors said about the limitations of their study:

  • “Randomized control trials are of shorter duration, whereas longer duration studies might be required to fully capture chronic disease risk.”
  • “Dose-response data were not usually available [from the randomized control studies included in their analysis]. However, larger studies would allow the effect of dose to be assessed.”

There are some other limitations of this study, which I will point out below.

Is This Fake News?

supplements for cardiovascular health fake newsWhen I talk about “fake news” I am referring to the headlines, not to the study behind the headlines. The headlines were definitive: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” However, when you read the study the reality is quite different:

  • In contrast to the negative headlines, the study reported:
    • Folic acid supplementation decreased stroke risk by 20% and overall heart disease risk by 17%.
    • B complex supplements containing folic acid, B6, and B12 decreased stroke risk by 10%.
    • That’s a big deal, but somehow the headlines forgot to mention it.
  • The supplements that had no significant effect on heart disease risk (multivitamins, vitamin D, calcium, and vitamin C) were ones that would not be expected to lower heart disease risk. There was little evidence from previous studies of decreased risk. Furthermore, there is no plausible mechanism for supposing they might decrease heart disease risk.
  • The study did not include vitamin E or omega-3 supplements, which are the ones most likely to prove effective in decreasing heart disease risk when the studies are done properly (see below).

Did The Study Ask The Right Question?

Most of the studies included in this meta-analysis were asking whether a supplement decreased heart disease risk or mortality for everyone. Simply put, the studies started with a group of generally healthy Americans and asked whether supplementation had a significant effect on disease risk for everyone in that population.

That is the wrong question. We should not expect supplementation to benefit everyone equally. Instead, we should be asking who is most likely to benefit from supplementation and design our clinical studies to test whether those people benefit from supplementation.

supplements for cardiovascular health diagramI have created the graphic on the right as a guide to help answer the question of “Who is most likely to benefit from supplementation?”. Let me summarize each of the points using folic acid as the example.

 

Poor Diet: It only makes sense that those people who are deficient in folate from foods are the most likely to benefit from folic acid supplementation. Think about it for a minute. Would you really expect people who are already getting plenty of folate from their diet to obtain additional benefits from folic acid supplementation?

The NIH estimates that around 20% of US women of childbearing age are deficient in folic acid. For other segments of our population, dietary folate insufficiency ranges from 5-10%. Yet, most studies of folic acid supplementation lump everyone together – even though 80-95% of the US population is already getting enough folate through foods, food fortification, and supplementation. It is no wonder most studies fail to find a beneficial effect of folic acid supplementation.

The authors of the meta-analysis I discussed above said that the beneficial effects of folic acid they saw might have been influenced by a very large Chinese study, because a much higher percentage of Chinese are deficient in folic acid. They went on to say that the Chinese study needed to be repeated in this country.

In fact, the US study has already been done. A large study called “The Heart Outcomes Prevention Evaluation (HOPE)” study reported that folic acid supplementation did not reduce heart disease risk in the whole population. However, when the study focused on the subgroup of subjects who were folate-deficient at the beginning of the study, folic acid supplementation significantly decreased their risk of heart attack and cardiovascular death.  This would seem to suggest using supplements for cardiovascular health is a good idea.

Increased Need: There are many factors that increase the need for certain nutrients. However, for the sake of simplicity, let’s only focus on medications. Medications that interfere with folic acid metabolism include anticonvulsants, metformin (used to treat diabetes), methotrexate and sulfasalazine (used to treat severe inflammation), birth control pills, and some diuretics. Use of these medications is not a concern when the diet is adequate. However, when you combine medication use with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial.

Genetic Predisposition: The best known genetic defect affecting folic acid metabolism is MTHFR. MTHFR deficiency does not mean you have a specific need for methylfolate. However, it does increase your need for folic acid. Again, this is not a concern when the diet is adequate. However, when you combine MTHFR deficiency with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial. I cover this topic in great detail in my upcoming book, “Slaying The Supplement Myths”. In the meantime, you might wish to view my video, “The Truth About Methyl Folate.”

Diseases: An underlying disease or predisposition to disease often increases the need for one or more nutrients that help reduce disease risk. The best examples of this are two major studies on the effect of vitamin E on heart disease risk in women. Both studies found no effect of vitamin E on heart disease risk in the whole population. However, one study reported that vitamin E reduced heart disease risk in the subgroup of women who were post-menopausal (when the risk of heart disease skyrockets). The other study found that vitamin E reduced heart attack risk in the subgroup of women who had pre-existing heart disease at the beginning of the study.

Finally, if you look at the diagram closely, you will notice a red circle in the middle. When two or three of these factors overlap, that is the “sweet spot” where supplementation is almost certain to make a difference and it may be a good idea to use supplements for cardiovascular health.

Is This A Question Of “Garbage In, Garbage Out”?

supplements for cardiovascular health garbage in outUnfortunately, most clinical studies focus on the “Does everyone benefit from supplementation question?” rather than the “Who benefits from supplementation?” question.

In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.

Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.

 

Should We Use Supplements For Cardiovascular Health?

 

If you want to know whether supplements decrease heart disease risk for everyone, this meta-analysis is clear. Folic acid may decrease the risk of stroke and heart disease. A B complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but the analysis did not include vitamin E and/or omega-3s.

However, if you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.

I would be remiss, however, if I failed to point out that we know healthy diets can decrease heart disease risk. In the words of the authors: “The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with [heart disease] risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and meat, but high in fruits and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet. These diets, with their accompanying recommendations, continue the move towards more plant-based diets…” I cover the effect of diet on heart disease risk in detail in my book, “Slaying The Food Myths”.

 

The Bottom Line

 

You have probably seen the recent headlines proclaiming: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” The study behind the headlines was a meta-analysis of 127 randomized control trials looking at the effect of supplementation on heart disease risk and mortality.

  • The headlines qualify as “fake news” because:
    • The study found that folic acid decreased stroke and heart disease risk, and B vitamins decreased stroke risk. Somehow the headlines forgot to mention that.
    • The study found that multivitamins, vitamin D, calcium, and vitamin C had no effect on heart disease risk. These are nutrients that were unlikely to decrease heart disease risk to begin with.
    • The study did not include vitamin E and omega-3s. These are nutrients that are likely to decrease heart disease risk when the studies are done properly.
  • The authors of the study stated that a major weakness of their study was that that randomized control studies included in their analysis were short term, whereas longer duration studies might be required to fully capture chronic disease risk.
  • The study behind the headlines is of little use for you as an individual because it asked the wrong question.
  • Most clinical studies focus on the “Does everyone benefit from supplementation question?” That is the wrong question. Instead we need more clinical studies focused on the “Who benefits from supplementation?” question. I discuss that question in more detail in the article above.
  • In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.
  • Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.
  • If you want to know whether supplements decrease heart disease risk for everyone, this study is clear. Folic acid may decrease the risk of stroke and heart disease. A B-complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but they did not include vitamin E and/or omega-3s in their analysis.
  • If you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.
  • However, we do know that healthy, plant-based diets can decrease heart disease risk. I cover heart healthy diets in detail in my book, “Slaying The Food Myths.”

 

For more details, 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.