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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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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HEART DISEASE

Heart Disease Reduction by Reducing Salt
"Across populations, the level of blood pressure, the...rise in blood pressure with age, and the prevalence of 'high blood pressure disease] are directly related to sodium 'salt] intake...
"In the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower 'salt] concentrations in processed and prepared foods."
Editor's Comment: Whether or not one calls it Alternative Health, reducing salt and in a more concerted effort, adding to your intake of potassium-rich foods (potassium reduces sodium in the body) such as beans, orange juice and coffee should be helpful. Bananas are widely believed to contain much potassium and they are over-rated as an Alternative Health adjunct, though not useless.
From: Archives of Internal Med., vol. 167, July 23, 2007. By: Drs. Dickinson & Havas, for the Council on Science & Pub. Health, Amer. Med. Assn.

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