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Mortality in Randomized Trials of Antioxidant Supplements

Mortality in Randomized Trials of Antioxidant Supplements | Heart and Vascular Health | Scoop.it

 All randomized trials involving adults published by October 2005 comparing beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E, and selenium either singly or combined vs placebo or vs no intervention were included. The effect of antioxidant supplements on all-cause mortality was analyzed We included 68 randomized trials with 232 606 participants (385 publications).

Conclusions Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.

Seth Bilazarian, MD's insight:

Oxidative stress is implicated in most human diseases so antioxicants mae theoretical sense. . Many primary or secondary prevention trials of antioxidant supplements have been conducted to prevent several diseases.   This trial review found that antioxidant supplements, with the potential exception of selenium, were without significant effects on gastrointestinal cancers and increased all-cause mortality. This review of antioxidant trials not only found that taking them is not beneficial but may be harmful.

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How Can We Know if Supplements Are Safe if We Do Not Know What Is in Them?

How Can We Know if Supplements Are Safe if We Do Not Know What Is in Them? | Heart and Vascular Health | Scoop.it

Americans spend over $20 billion annually on dietary supplements.1 Although supplements are regulated by the US Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act, there is no requirement for supplement manufacturers to demonstrate efficacy or safety of their products prior to marketing them. However, companies may not include unapproved ingredients. It turns out that even this minimal requirement is not fulfilled. Harel et al identified 237 dietary supplements that were recalled by the FDA owing to inclusion of unapproved drug ingredients. Given the limited regulation of these products, it is likely that the number of recalls grossly underestimates the number of products on sale with unapproved ingredients. Dietary supplements should be treated with the same rigor as pharmaceutical drugs and with the same goal: to protect consumer health.

Seth Bilazarian, MD's insight:

Over 50% of Americans use supplements.  The purity and potency of these supplements is nto closely regulate so the safety of this common practice amongst Americans is questionable at best.  The full NIH report is here http://goo.gl/bUwpy  ;

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Steve S Ryan, PhD's curator insight, June 15, 2013 11:01 PM

Steve S Ryan, PhD's insight:        

This is the author's summary from a medical journal article by Mitchell H. Katz, MD.JAMA Intern Med. 2013;173(10):928. doi:10.1001/jamainternmed.2013.415.

The full article is not yet available from Pub/Med.gov. Check this page: http://www.ncbi.nlm.nih.gov/pubmed/23588233

 

Want to know about about mineral deficiencies in A-Fib patients? Read by article: ‘Natural’ Supplements for a Healthy Heart, at http://a-fib.com/treatments-for-atrial-fibrillation/mineral-deficiencies/supplements-for-healthy-heart/

 

For my recommended products by brand, see

http://a-fib.com/a-fib-minerals-supplements-astore/

Dorothy Hale's curator insight, June 16, 2013 8:52 PM

Could supplement makers be unethical by not demonstrating efficacy or saftey prior to hitting retail stores?

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Multivitamins Modestly Lower Cancer Risk

Multivitamins Modestly Lower Cancer Risk | Heart and Vascular Health | Scoop.it

Daily use of a common multivitamin modestly reduced the risk for cancer in a long-term study of nearly 15,000 men.

Researchers cautioned the reduction in risk in the new study was small and that the mainstay prevention strategies against the disease remained quitting smoking, avoiding obesity, eating a healthy diet and keeping physically active.

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Vitamin D — Baseline Status and Effective Dose

Vitamin D — Baseline Status and Effective Dose | Heart and Vascular Health | Scoop.it

Take Home Message: Vitamin Supplements are useful for individuals who are deficient.  For now treatment with Vitamin D supplements to a bood level of Vitamin D-25 greater than 30 is reasonable and recommended. More is not better. It's easy to have the blood level checked.

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An editorial that accompanies a meta anlaysis in NEJM which shows a modest benefit of Vitamin D on fracture risk.  Robert Heaney does an excellent job explaining why we see diiferent results in many vitamin or nutrient trials.

 

Evaluating a certain dose of a Vitamin will not assess the benefit if the patients tested are not deficient.  In the meta analysis the baselinie Vitamin D level in the placebo and different doses of Vitamin D all had a baseline level > 40 (< 30 is deficient)

 

"giving additional amounts of a nutrient to persons who already have enough, or not giving enough to push a person with a deficiency up onto the ascending limb of the response curve, is likely to produce a null response"

 

See the article here http://goo.gl/XG59l (requires subscription)

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Ask Well: CoQ10 Drug Interactions?

Ask Well: CoQ10 Drug Interactions? | Heart and Vascular Health | Scoop.it

Coenzyme Q10, or CoQ10 as it is often called, is commonly taken in supplement form to counteract the muscle pain and weakness associated with cholesterol-lowering statin drugs. 

Statins do appear to lower levels of CoQ10, a substance that is naturally produced in almost every cell in the body, where it helps convert food to energy and acts as an antioxidant. Organs that have particularly great energy demands, like the heart and the brain, contain the highest concentrations of it, said Dr. Robert Bonakdar of the Scripps Center for Integrative Medicine in California.

There is no doubt that coenzyme Q10 has several important roles in the body. But those who take it should do so carefully, because in some cases it can blunt or amplify the effects of other drugs, particularly those that are used to control blood sugar and blood pressure.

In roughly half of people who take it, CoQ10 has a relaxing effect on blood vessels that can lower blood pressure levels, said Dr. Roxanne Sukol, a preventive medicine specialist at the Cleveland Clinic’s Wellness Institute. But it takes about eight weeks for this effect to kick in, she said, and those who are already on blood pressure medications and choose to take CoQ10 should do so under the guidance of a doctor.

Taking CoQ10 can lower blood sugar levels as well, which can be problematic for people with diabetes and anyone using medication to control hyperglycemia.

It can also interact with blood thinners, so people who use drugs like aspirin or warfarin should be particularly cautious, Dr. Sukol said.

Seth Bilazarian, MD's insight:

Another example of how the unknowns of "safe: and "natural" therapies have risks that can be unknown and difficult to identify and evaluate since there is no formal testing of these naturopathics.

My recommendation: Eat a well balanced diet enriched with fresh fruits and vegetables and skip the vitamins.

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Tina Bilazarian's curator insight, November 5, 2013 12:51 PM

Never enough info for intelligent decisions.

 

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Another caution about "natural" therapies: toxins in Red Yeast Rice extracts

Another caution about "natural" therapies: toxins in Red Yeast Rice extracts | Heart and Vascular Health | Scoop.it

Red yeast rice (RYR) is a commonly used dietary supplement for the management of dyslipidemia. In 2007, the Food and Drug Administration (FDA) issued a consumer warning to avoid RYR products because they may contain unauthorized drug (lovastatin) and also implemented Current Good Manufacturing Practices (CGMP) requiring that proper controls be in place by dietary supplement companies to ensure products are manufactured and processed in a consistent manner and produce high-quality products that are not adulterated with impurities or contaminants and are accurately labeled.

In this paper in Journal of Clinical Lipidology it is reported that the FDA had no information on the number of RYR manufacturers and their compliance with CGMP regulations. A total of 101 products containing RYR were reviewed. No product could be confirmed as passing any independent laboratory verification testing. Nearly one-half (42.6%) of the RYR product labels contained statin-related warnings (ie, potential for muscle pain or weakness, etc).

Currently, the FDA is not regulating manufacturers of RYR products and as a result, many of these products may contain monacolin K and toxins such as citrinin.

Seth Bilazarian, MD's insight:

Many patients have a false belief that "natural" therapies are safe, healthy and pure.  The FDA does not assess these products for potency, purity or safety.  Many of these products are produced outside the US.  People using these products should have a cautious skepticism about the benefits (unrpoven) but more importantly a significant hazard of impurities and toxins. Caveat Emptor.

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Nancy Rosas Delgadillo's curator insight, February 18, 2013 7:54 PM

Interesante artículo, sin embargo muy avanzado. 10 de 10

Ellen Diane's curator insight, February 20, 2013 8:09 AM

thank you for this

Rehabmyheart's comment, February 20, 2013 8:12 AM
I would come across many patients who were on statins plus the red yeast rice, talk about compounding effects!
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Vitamins Herbal & Natural - A Cardiologists Perspective

Pentucket Medical cardiologists Seth Bilazarian and Sunny Srivastava discuss vitamins and dietary supplements as alternative, complimentary and natural therapies.

Patients often think doctors are "against" the use of vitamin or herbal therapies.  I try to explain on our community program "Matters of the Heart"  the doctors viewpoint on Vitamin supplements - cautions and recommendations.  I speak about Vitamin D deficiency and its treatment.

Because its a VItamin or because it says its natural doesn't mean its good.

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