By Alan R. Gaby, MD
Healthnotes Newswire (March 30, 2006)—Two studies published in the New England Journal of Medicine (www.nejm.org e-pubs: 10.1056/NEJMoa060900 and 10.1056/NEJMoa055227) have concluded that supplementing with certain B vitamins does not prevent heart disease and that some combinations of B vitamins may even increase a person’s risk of heart attack or stroke. Though the studies were well designed from a technical perspective, the treatment did not make sense from a nutritional perspective, so it is unfortunate that the results will now convince many doctors that vitamins do not help heart disease. Studying these vitamins in isolation from the network of vitamins and minerals known to impact heart health does not shed light on optimal nutritional therapy for heart disease, and would not have been recommended by practitioners familiar with basic nutrition principles.
The new research
One of the new studies examined the effect of supplementing daily with vitamin B6 (50 mg), vitamin B12 (1 mg), and folic acid (2.5 mg) in patients with diabetes or hardening of the arteries (atherosclerosis). These three vitamins are known to lower blood levels of homocysteine, a compound that is believed to contribute to heart disease risk. The use of these vitamins reduced homocysteine levels, but after five years of supplementation the number of deaths from heart disease and stroke did not differ between patients receiving B vitamins and those taking a placebo.
In the other study, people who had recently suffered a heart attack were randomly assigned to receive daily either a placebo or various combinations of folic acid (0.8 mg), vitamin B12 (0.4 mg), and vitamin B6 (40 mg). As in the other study, B-vitamin supplementation reduced homocysteine levels. However, during a follow-up period of a little over three years, no significant reduction was found in the incidence of heart attacks, strokes, or death from cardiovascular disease in the groups receiving B vitamins, compared with those receiving the placebo. On the contrary, there was a trend toward increased risk in people treated with B vitamins, and this trend was statistically significant in the group that received all three of the vitamins.
The bigger nutritional picture
These studies were technically well designed and therefore provide fairly definitive answers to the narrow question of whether supplementing with these three nutrients by themselves is of any value to people at risk of heart disease. However, supplementing with only one or a few specific nutrients out of the several dozen that are essential for humans is not a logical way to provide nutritional support. Nutrients work as a team in the body, and the beneficial effects of individual nutrients may not be realized if a person is deficient in other essential nutrients.
Even more important, supplementing with large doses of a single nutrient will in some instances deplete other nutrients. Most people living in Western societies have marginal deficiencies of a wide range of essential nutrients, as a result of extensive food refining and processing, nutrient-depleting farming techniques, and unwise food choices. Against this backdrop of borderline-low overall nutritional status, supplementing with relatively large amounts of one or a few vitamins or minerals could in some instances have adverse health consequences. There is circumstantial evidence that taking large amounts of vitamin B6 increases the need for magnesium, a nutrient that protects the heart and blood vessels in many different ways. While other studies have shown that vitamin B6 supplements improve magnesium status, there is no way to predict how magnesium and vitamin B6 would interact in humans at risk for heart disease.
Low magnesium status is very common in the general population. It is even more prevalent in people with heart disease, as a result of both the disease itself and of some of the drugs that are used to prevent or treat heart disease. Magnesium deficiency is probably a much more significant contributing factor to heart disease than is B vitamin deficiency, particularly since food producers have begun fortifying foods with folic acid and other B vitamins. It is possible that B vitamin supplementation would be shown to be beneficial when given to people who are consuming adequate amounts of magnesium and of all other nutrients known to play a role in cardiovascular health.
There is also evidence, some conflicting, that folic acid interferes with zinc absorption, another nutrient necessary for cardiovascular health. The average Western diet contains substantially less than the RDA for zinc, and it is possible that the beneficial effect of folic acid on heart health would be counterbalanced by a worsening of zinc status.
When medical nutritionists recommend a high dose of a single nutrient, it is usually given in combination with a broad-spectrum multivitamin-multimineral preparation and a nutrient-dense diet. The positive results that I and others have seen in people receiving comprehensive nutritional support far exceed what can be achieved by merely adding one or a few nutrients to a diet high in refined sugar, white flour, and other nutrient-depleted foods.
An expert in nutritional therapies, Chief Medical Editor Alan R. Gaby, MD, is a former professor at Bastyr University of Natural Health Sciences, where he served as the Endowed Professor of Nutrition. He is past-president of the American Holistic Medical Association and gave expert testimony to the White House Commission on Complementary and Alternative Medicine on the cost-effectiveness of nutritional supplements. Dr. Gaby has conducted nutritional seminars for physicians and has collected over 30,000 scientific papers related to the field of nutritional and natural medicine. In addition to editing and contributing to The Natural Pharmacy (Three Rivers Press, 1999), and the A–Z Guide to Drug-Herb-Vitamin Interactions (Three Rivers Press, 1999), Dr. Gaby has authored Preventing and Reversing Osteoporosis (Prima Lifestyles, 1995) and B6: The Natural Healer (Keats, 1987) and coauthored The Patient's Book of Natural Healing (Prima, 1999).
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