Category Archives: supplements

Diet and Heart Disease – What Does the Science Say About What to Eat?

IMG_8348rt5x7bwIt is so hard to keep up with research on diet and disease prevention, especially with so many conflicting reports in the media. To try to sort through this, some researchers looked comprehensively at all of the high quality research available about diet and prevention of heart disease. They put together this nice summary table showing which foods show evidence of harm, which show evidence of benefit, and which are inconclusive.
It is important to remember that this is addressing heart disease specifically, not general health or general disease prevention.  And they limited their conclusions to the most thorough studies of heart disease outcomes.  For example, I think a diet which is low in wheat-based carbohydrates can be very beneficial for maintaining weight and preventing long-term health complications.
If you, or a family member, suffers from chronic heart disease, this table is a good starting point for a discussion with your physician and other health providers about the optimal diet to prevent future heart issues.

 

ACC food guide

Here are more of our articles on Nutrition and Heart Prevention.

Who Benefits from Fish, or Fish Oil? Some New Info on the Link to Heart Disease

IMG_8348rt5x7bwWhile we have known for some time about the potential benefits of fish in the diet, the specific role of supplements containing the beneficial component, omega-3 fatty acids, has been less clear, due to inconsistent results from various studies.

Fortunately, a new study released this month has clarified the link between supplementation with omega-3 fatty acids and the development of heart disease. This was actually a meta-analysis, meaning it summarized the data from multiple previous studies, in a manner that yields more information than the individual studies themselves. This was a very thorough analysis, specifically looking at the best quality studies (called randomized trials), and specifically looking at the useful component of omega-3 fatty acids, EPA and DHA. Moreover, the researchers were focused specifically on heart and circulatory complications.

What did they find? The intake of omega-3 fatty acids, either from food or supplements,fish-oil reduced the risk of heart disease by 6%. This reduction is mild, and was actually insignificant, but there was a significant decrease specifically patients who started out with high triglyceride levels (> 150 mg/dL) or LDL cholesterol (> 130 mg/dL). When the researchers included additional nonrandomized studies, the reduction in heart disease was 18%. Another important conclusion was that there does not appear to be any harmful effect of supplementation.

So what can we conclude?
First, supplementation with 1 g of omega-3 fatty acids daily, either from food or supplements, appears to be mildly beneficial in preventing heart and circulatory disease.
Second, the majority of the benefit is in patients who start out with elevation of triglyceride or LDL cholesterol. Previous studies (such as this) have shown that otherwise healthy patients derive minimal or no benefit from fish oil supplementation.
Third, there does not appear to be evidence of harm at this level of supplementation.

Also of note, more detailed studies are ongoing to determine the optimal level of supplementation and specific patients. Finally, keep in mind that there are other potential benefits of fish oil supplementation unrelated to heart disease, so if supplementation makes you feel better or healthier, it may be reasonable.  As always you should discuss your specific health situation with your doctor before considering any supplement or other therapy.

 

For more information, here as a video I recorded last year for the video blogging site Vidoyen.com, who asked me, Do Fish Oil supplements prevent heart disease? Here is a link to my 3 minute reply.

Reference to original article:

Alexander D, Miller P, Van Elswyk M, et al. A meta-analysis of randomized trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long chain omega-3 fatty acids and coronary heart disease risk. Mayo Clin Proc 2017;92:15-29

Which Supplements Improve Wellness and Prevent Heart Disease?

Grewal Kanny MD 2x3 web

Those of us who treat heart disease deal with controversies on a daily basis; but I am not sure that any topic provokes more passion and controversy than a discussion about the use of supplements for the treatment and prevention of cardiovascular (and other) disease.   As medical doctors, we are trained to promote therapies grounded in ‘evidence” – that is, clinical trials and investigation. Unfortunately, most supplements and minerals have never been studied as thoroughly as drugs, so the “evidence” either for or against their use is lacking. Confusing this picture is that the proponents of supplement use may have an economic bias for their use, or their preference is based on their personal experience with a limited number of patients.

I am not a pharmacologist or nutritionist, but I do have an immense interest in any and all therapies that can improve my patients’ long-term health. Unfortunately, there is just not the evidence to recommend any specific supplement for the long-term prevention of cardiovascular disease, or any disease or complication for that matter. The preponderance of evidence suggests that eating a healthy and balanced diet, and of course improving lifestyle through weight control and exercise, is far more important than the potential effect of any specific supplement. This is even the case for a general multivitamin. This editorial article, which was just published in the last few months, summarizes the largest analysis to date of all the major research involving supplements in healthy patients. It summarizes a new analysis in over 100,000 subjects, and reaches the conclusion that none of the studied supplements can clearly prevent chronic disease. Fortunately very few of them are harmful as well (the exceptions are B-carotene and possibly Vitamin E, which may cause cancer).  Here is a quote from the authors (including the Johns Hopkins School of Public Health):

In conclusion, β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.

For this reason, I do not recommend the routine use of supplements by any of my patients, including a daily multivitamin; but I don’t discourage their use, unless a specific interaction is seen that could be harmful. Certainly, for patients with a specific chronic condition, it is worth looking for nutritional deficiency that can contribute but that can only be done by your physician or care provider. Here is some information about specific supplements:

Folate, Vitamin B6, and B12:  A well done study recently showed that these agents did not prevent vascular disease or cancer.

Fish Oil (omega-3 fatty acids): Here is our video which addresses the potential role of Fish Oil in prevention of heart disease.

Vitamin D: Vitamin D deficiency, diagnosed by a low blood level, is a potentially serious condition that benefits from replacement therapy. For those without a true deficiency, there does not seem to be a benefit to taking supplemental doses. Here is a recent article from USA Today which references a recent large study which pooled the results from 40 earlier studies. The conclusion is that Vitamin D supplementation does not seem to prevent chronic disease, except in those with a true deficiency documented by a blood test.

Selenium: The conclusion form the lead researcher of a recent study: “At this time, we cannot support using selenium supplements as a means of preventing cardiovascular disease in healthy people”.

We will address other specific supplements in future posts. In the meantime, consider skipping some (or all) of those supplements,  and instead focus on daily activity (see article here)  and a heart healthy diet (see article here). As always, we appreciate your comments and are happy to provide references.

Our 10 tips for Healthy Eating. . . . and More

Photo courtesy of epSos.de

courtesy of epSos.de

Friends, family, patients, colleagues. . . . .so many people are interested in the cardiologist’s perspective on a heart-healthy diet. We’ve put together an article with what we think are the key components of a healthy diet. . . it is available right here.

We’d love your feedback and comments about our article, and any questions we can address in future posts.