Is your multivitamin hurting you?

Do you take antioxidants or a regular multivitamin? Turns out you might not need to, according to new research in the Cochrane Review that refutes the long-held belief that antioxidants prevent disease or cancer.
Researchers conducted a meta-analysis of existing studies, pertaining to more than 200,000 people, and found that antioxidant supplements--vitamins A, C, and E; beta-carotene; and selenium--do not prevent heart disease or cancer, do not forestall death, and may even increase mortality risk slightly.

But the phrase "may increase mortality risk slightly" is important to put any risk in context. Given the large pool of people analyzed, researchers would have noticed right away if there was any significant risk of death associated with the supplements. So if all we have is a hint of modest harm, the risk is clearly quite small.

This finding is disappointing and counter-intuitive. How can antioxidant supplements fail to help us and maybe even harm us slightly?

There are several likely answers. First, we may have the doses wrong. Just because some of a thing is good does not mean more is better. Second, maybe we have the wrong combinations. Antioxidants in foods come packaged with many other nutrients, and they all work together. When we separate that harmony, we may wind up with sour notes. Third, the participants in most of these trials were already ill. Perhaps antioxidants have different effects before chronic disease begins. They might even help prevent disease if taken earlier.

In general, my advice about a supplement is to remember it's not a substitute for a healthy diet and lifestyle. Use supplements thoughtfully. Talk to your doctor to be sure there is a sound reason, tailored to your health, for each one you take. Don’t assume that just because a clever ad makes a supplement sound good that it truly is.

I take an Omega-3 fish oil supplement every day, and recommend the same for most of my patients. I believe a multivitamin or mineral supplement is a good idea for many of us, despite a lack of research that shows a clear benefit. (I also like a supplement called Juice Plus, which compresses the nutrients from fruits and vegetables into capsule form, while preserving their native proportions.) Based on the science we have at present, there is no reason to fear any antioxidant supplements you may have been taking--the potential for harm is minimal. But remember: No pill bottle holds an alternative for a healthy, active lifestyle.

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Vitamin Supplements Found Ineffective Against Lung Cancer

The development of lung cancer appears to overwhelm any putative protective effects of prolonged use of vitamins C, E, and folate supplements, found researchers here.

Moreover, extended use of vitamin E supplements was associated with a small increased risk of lung cancer, more so in smokers, Christopher G. Slatore, M.D., of the University of Washington here, and colleagues reported in the first March issue of the American Journal of Respiratory and Critical Care Medicine.

The findings came from a prospective cohort of 77,126 men and women, ages 50 to 76, in Washington state who participated in the VITAL (VITamins And Lifestyle) study. If patients ask, explain that vitamins C, E, and folate supplements failed to reduce the risk of lung cancer and vitamin E supplements may actually be harmful.Explain that eating two daily helpings of fruit and not smoking may be the best form of protection. From October 2000 to December 2002, patients were identified through the Seattle-Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry. In a mean of four years, 521 individuals developed lung cancer. Non-small-cell lung cancer accounted for 75% of the total. After adjustment for smoking, age, and sex, after an average 10 years' use, no benefit was found for any of the supplements But when modeled continuously, the researchers found that over 10 years, for every 100 mg/d of supplemental vitamin E, there was a small increased risk of lung cancer.
This translated to a 28% increased risk of non-small-cell lung cancer at a vitamin E dose of 400 mg/d for 10 years, the investigators said. The lung cancer risk of supplemental vitamin E was largely confined to current smokers. When analyzed by current smoking status, the researchers found an increased risk over 10 years for every 100 mg/d increase in vitamin E value for interaction of 0.06. The risk was greatest for non-small-cell lung cancer. Current smokers in the highest dose category (>215 mg/d) had a significantly increased risk of lung cancer One possible mechanism for this effect is that although vitamin E is considered an antioxidant, it might act as a pro-oxidant, as well, the researchers said. After adjusting for intake of vitamin E from food sources, the point estimate for supplemental vitamin E was unchanged, although the results were no longer significant. The risks for supplemental vitamin C and folate did not change substantially when adjusted for dietary intake. Among the study limitations the researchers noted that residual confounding, such as education and BMI, might have biased the results, although after adjustment, the results did not change. Other limitations included the fact that the cohort was mainly white and there were fewer current smokers than in the U.S. as a whole. Future studies may focus on other components of fruits and vegetables that may explain the decreased risk of lung cancer associated with fruits and vegetables, Dr, Slatore said. Meanwhile, he said, these results, in combination with other studies, should prompt clinicians to counsel patients that these supplements are unlikely to reduce the risk of lung cancer and vitamin E supplements may be harmful, especially for smokers. In an accompanying editorial, Tim Byers, M.D., M.P.H., of the University of Colorado, wrote, "How could a beneficial effect of consuming fruits be consistent with adverse effects of a nutrient derived in large part from the same food group?" The answer, he said, is that fruit contains not only vitamins but also many hundreds of other phytochemicals whose functions are not well understood. Recommendations advising eating at least two servings of fruit each day would likely lead to a reduced risk for lung cancer as well as a reduced risk for other cancers. However, Dr. Byers said, any benefit to smokers from increasing fruit intake would be more than offset if even a small proportion of smokers decided to continue tobacco use.

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Diabetes Drug Helped Slow Heart Disease

Doctors say they have shown for the first time that a diabetes drug can prevent the progression of coronary heart disease.
The Cleveland Clinic-led study involved 543 patients with Type 2 diabetes. It compared two drugs, Actos and Amaryl, which act in opposite ways: Actos is part of a newer class of drugs that reduce insulin resistance, while Amaryl is an older drug that increases insulin production.
Using intravascular ultrasound, researchers found that after 18 months, Actos was significantly better at reducing progression of plaque buildup in arteries of the heart.

"Seventy-five percent of diabetics will die of a cardiovascular-related cause," study leader Dr. Steven Nissen, the Clinic chief of cardiovascular medicine, said in an interview Monday. "If you can find a therapy that reduces progression of heart disease and atheroslcerosis, that will potentially have a very big impact."

The study is published in Wednesday's Journal of the American Medical Association. Results were released Monday, after presentation at the American College of Cardiology scientific conference in Chicago.
Previous studies have shown that Actos may lower risk of heart attack and stroke. The drug also carries increased risk of heart failure and bone fractures.
The question of whether blood-sugar control can reduce heart disease has been controversial, an editorial that accompanied the study said. Part of a federally sponsored trial was stopped earlier this year, after an unexpected number of patients died while undergoing aggressive therapy to lower blood sugar.
Warnings have also been raised about the diabetes drug Avandia -- a chemical relative of Actos -- after Nissen last year tied Avandia to increased risk of heart attack.
Doctors said the new results suggest that lowering blood sugar may not be as important for heart health as the choice of drug.
"There's clearly more to the story than just getting the sugars down," said Dr. Emil Hayek, medical director of Akron General Medical Center's Heart and Vascular Center. "I think it should change clinical practice. There's clearly a benefit to using some of the more novel ways to treat diabetes."
Hayek added that the results suggest Actos may prevent heart attacks and strokes, but "that's a much more difficult question to answer."
Takeda Pharmaceuticals North America Inc., which makes Actos, paid for the study.

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