I have never been a fan of dietary supplements pushed by Big Supplement, the less regulated, less evidence-based, more pseudoscientific mirror image of Big Pharma. Recently, a meta-review published in a respected journal examined whether there were any causal links between various dietary supplements and cardiovascular disease (CVD). They only found one, folic acid, that might have an effect on CVD, but, in that case, causality might not be so clear.
Just to be perfectly clear, no one on the side of real science-based medicine would dismiss using dietary supplements to treat chronic medical conditions. Many people have had surgeries, illnesses, and other medical conditions where certain supplements are necessary for the patient to survive. But these are highly specific requirements, not general quack claims that taking supplements will somehow miraculously treat colds and flues, prevent cancer, or some other nonsense.
Essentially, if you’re taking dietary supplements for no medical reason other than you believe it makes you healthier, let’s stick to facts – all that you are doing is having your kidneys create some very costly urine. Human physiology, based on a couple of billion years of evolution, automatically regulates its needs for micronutrients – excess amounts do not stick around to make you healthier, it just becomes a component of your pee.
It’s time to take a look at this article about dietary supplements and cardiovascular disease. Maybe I’ll convince you to save some money each month, and spend it on something like investing in a better diet.
Dietary supplements and CVD – the article
An article by David JA Jenkins et al., published in the Journal of the American College of Cardiology, confirms what we already know about dietary supplements – they are very popular, but they have little effect on cardiovascular diseases like stroke, heart attacks, and other types of heart and vascular diseases.
The study examined the effects of the following dietary supplements – vitamins A, B1, B2, B3 (niacin), B6, B9 (folic acid), C, D and E along with other micronutrients that include beta-carotene, calcium, iron, zinc, magnesium, and selenium. It also included multivitamins. According to data published in the Journal of Nutrition, more than 70% of Americans 60 and older use at least one dietary supplement. And 29% of these older Americans use four more dietary supplements per day.
The meta-analysis considered the pinnacle of biomedical research, included data from 179 randomized clinical trials, found no evidence that most of the vitamins and other micronutrients had any effect on cardiovascular disease, stroke, or premature death.
However, there was one exception – a recent study done in China showed that folic acid supplementation may be linked to prevention of stroke in adults. However, and this is very important, in most areas of the world, like the USA, Europe, and Japan, much of the food is fortified with folic acid. In China, on the other hand, the diet is folic acid deficient. Thus, the best we can derive from this research in China is that if the diet is deficient in folic acid, supplementation of that vitamin may be useful.
The authors concluded:
Antioxidant mixtures did not appear to benefit CVD but might increase all-cause mortality. Although sufficient studies on vitamin D exist, to be confident that there is no all-cause mortality effect, further studies on multivitamins, the most commonly used supplement, may still be useful, because of the marginal benefit seen in our analysis. In the absence of further studies, the current data on supplement use reinforce advice to focus on healthy dietary patterns, with an increased proportion of plant foods in which many of these required vitamins and minerals can be found.
It’s ironic that they actually found data that some supplements, like anti-oxidants, may, in fact, increase mortality from CVD. This should be a cause for concern for those who use supplements without medical need. Remember, everything has some level of risk, and if there is no benefit, then the overall benefit to risk calculation becomes quite small.
What we now know about dietary supplements
Just because this study adds to the body of evidence that dietary supplements, except to treat diagnosed medical conditions, provide no health benefits. But don’t take this to mean that you can ignore nutrition – the authors iterated that there is robust scientific evidence that certain diet patterns do lower the risks of CVD.
For example, the latest version of the USA’s dietary guidelines recommends three dietary patterns for protecting cardiovascular health:
- Traditional Mediterranean diet, which may reduce risks of some cancers (though I must state that 2/3 of cancers may be outside of your control).
- Vegetarian diet.
- “Healthy American diet,” which is low in red meat and high in fruits and vegetables.
The study authors stated that all three diets have common elements – emphasis on plant-based foods, like vegetables, fruits, nuts, and whole grains while limiting red meat and sugar. Lead author, University of Toronto professor of nutritional sciences, David Jenkins, stated:
There are big health benefits from a mostly plant-based diet. In my opinion, that’s the way to go.
Yes, a good diet is much more useful than forcing down a handful of expensive, and rather useless, dietary samples. As Dr. Jenkins put it, “Taking all those supplements really just makes your pee very expensive.” I love it when a scientist makes his point so clear.
The internet is flooded with memes and tropes about how humans will be a perfect machine just by taking a few vitamins and other dietary supplements. But real science says otherwise – it’s a huge waste of money.
Yes, there are occasions when dietary supplements are necessary for humans, but those cases are unusual and are part of a science-based treatment plan. But for the majority of us, a good diet, mostly plants, is a much better choice. And guess what – a “healthy” diet includes almost all of the micronutrients you need.
- Gahche JJ, Bailey RL, Potischman N, Dwyer JT. Dietary Supplement Use Was Very High among Older Adults in the United States in 2011-2014. J Nutr. 2017 Oct;147(10):1968-1976. doi: 10.3945/jn.117.255984. Epub 2017 Aug 30. PubMed PMID: 28855421; PubMed Central PMCID: PMC5610553.
- Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, Tang G, Wang B, Chen D, He M, Fu J, Cai Y, Shi X, Zhang Y, Cui Y, Sun N, Li X, Cheng X, Wang J, Yang X, Yang T, Xiao C, Zhao G, Dong Q, Zhu D, Wang X, Ge J, Zhao L, Hu D, Liu L, Hou FF; CSPPT Investigators.. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015 Apr 7;313(13):1325-35. doi: 10.1001/jama.2015.2274. PubMed PMID: 25771069.
- Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, Josse R, Vieth R, Blanco Mejia S, Viguiliouk E, Nishi S, Sahye-Pudaruth S, Paquette M, Patel D, Mitchell S, Kavanagh M, Tsirakis T, Bachiri L, Maran A, Umatheva N, McKay T, Trinidad G, Bernstein D, Chowdhury A, Correa-Betanzo J, Del Principe G, Hajizadeh A, Jayaraman R, Jenkins A, Jenkins W, Kalaichandran R, Kirupaharan G, Manisekaran P, Qutta T, Shahid R, Silver A, Villegas C, White J, Kendall CWC, Pichika SC, Sievenpiper JL. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. J Am Coll Cardiol. 2018 Jun 5;71(22):2570-2584. doi: 10.1016/j.jacc.2018.04.020. Review. PubMed PMID: 29852980.