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Dissecting a Study Disproving Vitamin B's Role in Preventing Heart Disease 6-30-08
A new study published in the Journal of the American Medical Association [JAMA
2008;299(17):2027-36] has revealed that supplementation with the B vitamins,
folic acid, B6 and B12, did not prevent cardiovascular disease (CVD) in women at
risk.
Despite lowering homocysteine levels by 18%, this large-scale,
placebo-controlled, randomized trial found no significant effects from high
levels of three B vitamins on CVD events over seven years. Women in the
treatment group received daily supplements containing folic acid (2.5 mg),
vitamin B6 (50 mg), and vitamin B12 (1 mg), which exceeded the recommended daily
allowance for these nutrients. The results go against observational studies
linking increased levels of the amino acid homocysteine to an increased risk of
CVD.
While it is possible that the treatment truly had no effect on vascular risk,
there are several questions left unanswered from this study. For one, there are
other vitamins and minerals that affect homocysteine levels, including choline
and magnesium. Choline has been shown to reduce inflammation by 20 per cent.
Magnesium may be the most deficient mineral in the American diet. It has also
been shown to reduce blood pressure, strokes, and improve blood sugar and
insulin health. Unfortunately, even most supplements containing magnesium do not
help, since they utilize cheap ingredients, such as magnesium oxide.
Alternatively, organic, chelated forms of magnesium, such as magnesium citrate,
malate or taurate, can make a major impact on heart health.
Perhaps it is not possible to correct a lifetime of poor nutrition with just a
smattering of nutrients. Heart disease results from oxidative processes that
accrue over many decades. Homocysteine is a pro-oxidant derived from incomplete
protein metabolism. However, it is only one of many problems. More detrimental
to heart health is faulty carbohydrate metabolism, due to a lifetime of
consuming refined foods. This also produces a pro-oxidant condition that damages
blood vessels. It also oxidizes cholesterol, the substance used to help plug the
cracks in blood vessels caused by free radicals. Correcting faulty carbohydrate
metabolism starts with a good diet that restricts carbohydrate consumption, and
limits it to whole grains, beans and non-starchy fruits and veggies. A poor diet
must be supported by supplementation with minerals, such as chelated magnesium,
chromium picolinate, zinc and a high-quality multivitamin. Inflammation in blood
vessels is also reduced significantly by omega-3 fatty acids from fish, flax,
walnuts and hemp. Everyone should be taking a pharmaceutical-grade, fish oil
supplement.
Antioxidants are also vital to the equation. A diet high in fruits and
vegetables provides an assortment of antioxidants that, when taken with a
pro-oxidative meal, can reduce the free radical damage caused by these foods.
There are also a variety of antioxidant supplements and exotic juices (e.g.,
pomegranate) that have been shown to protect against oxidation. Vitamin C works
synergistically with vitamin E and alpha-lipoic acid to protect blood vessel
membranes and improve circulation. Vitamin E prevents oxidation of fat,
including cholesterol. These fruits and veggies also provide fiber, which
reduces the negative impact of refined foods.
Another missing ingredient is vitamin D, which improves the ability of the heart
muscle to contract, helps prevent and reverse inflammation in blood vessels, and
helps to maintain proper blood pressure. People with the lowest vitamin D blood
levels had twice the risk for heart attack, heart failure, stroke, and other
types of heart disease over a five-year period than those with the highest blood
levels. Many Americans do not get enough of this important vitamin. In a recent
study, 34 percent of white people, 40 percent of Latinos, and 84 percent of
African-Americans over the age of 50 were vitamin D deficient.
Participants in the JAMA study were all mature women with significant problems
such as high blood pressure, high cholesterol levels, diabetes and smoking. They
are not likely to respond readily to a few vitamins at this stage, but possibly
to a comprehensive regimen of high quality nutrients. Even the forms of the B
vitamins taken may be called into question, since not all folate, B6 and B12
supplements are alike; some are more bioavailable and useful than others.
Furthermore, these women may already be receiving enough folate from fortified
foods, leaving no difference between treatment and placebo groups. At this stage
in the game, these women are more likely to respond to conditionally-essential
nutrients like Co-Q10, acetyl-L-carnitine and alpha lipoic acid, which improve
mitochondrial function. While they cannot replace the foundational nutrients,
these remedies can profoundly improve heart health and boost energy, especially
in the short term, without side effects.
Vitamins and minerals are best used to prevent disease. They should be plentiful
in food and supplements to support health throughout life, and not as stop gap
measures to correct a life defined by poor nutrition and a sedentary lifestyle.
Sound nutritional treatment for aging people with CVD must be comprehensive, and
address all the defects in oxidative metabolism. It must also utilize the
highest quality supplements available, and not synthetic or poorly absorbed
vitamins and minerals that do not help the body function efficiently. The JAMA
study merely tells us that sound nutrition is not simple.
About the author
Dr. Phil Domenico is a nutritional scientist and educator with a research
background in biochemistry and microbiology. Formerly an infectious disease
scientist, he now works as a consultant for supplement companies and the food
industry.