From the Organic & Natural Health Association @OrgNatHealth
This U.S. News & World Report headline might have grabbed your attention. It’s a great example of how these reports can generate confusion on research and the impact on vitamins and minerals have on health conditions. Here are some tips for critically evaluating news reports, and the research itself, on dietary supplements.
The study actually concludes that folic acid and B vitamins do play a role in reducing strokes (That seems like a health benefit to me). However, the study authors’ analysis also determined that the “the four most commonly used supplements—multivitamins, vitamin D, calcium and vitamin C — showed no consistent benefit for the prevention of cardiovascular disease, myocardial infarction or stroke, nor was there a benefit for all-cause mortality.”
Generally speaking, practitioners do not rely on these four commonly used supplements for prevention of cardiovascular disease or stroke. The chosen headline, designed to capture attention, misrepresents the body of work itself and ignores data that demonstrates the effectiveness of folic acid and B vitamins.
RCTs Aren’t Always Gold
Understand that using the RCT (randomly controlled trial) model for nutrient research is challenging. Pharmacologic intervention can be measured with safety and efficacy standards since you are introducing a foreign object (drug) into the body. Nutrients are more complex. They exist in the body, are often consumed through food and supplementation, and have complex, healthy interactions that warrant additional study.
Virtually all nutrient RCTs are focused on the dose consumed, overlooking the level of the nutrient in your body. I take 5,000 IUs of vitamin D every day and my level is greater than 50 ng/ml. You may need 1,000 IUs or 10,000 IUs – only by measuring serum levels will you know.
For the sake of sound science, the late internationally renowned researcher, Robert P. Heaney articulated specific study requirements. Initial nutrient levels must be measures and monitored, and the intervention (consumption) must be enough to change that level so that it can be analyzed. Steps also need to be taken to ensure the nutrient is the only rate limiting factor in the response. This is not the case for all of the RCTs in this study.
Beware of Meta-Analysis
A meta-analysis is a review of previously published studies. This review of 179 RCTs was published in the Journal of the American College of Cardiology. Harmonization of RCTs is futile if certain very specific design elements are contained in each study. Standardizing the RCTs is step one. Select studies must also use same, or similar dosing, use the same chemical form of the nutrient, evaluate co-nutrient status and be measured for the same duration.
What happens when researchers don’t use such standards?
We are told people who are not nutrient deficient do not need supplementation when in fact no documentation of nutrient level has been evaluated.
We read that multivitamins, vitamins C and D and calcium do nothing to reduce cardiovascular disease, an answer to the wrong question. Better to know health status of people when they are deficient in each of the nutrients and the change in status with supplementation.
My advice? Be wary of studies that compare apples to artichokes. You’re a busy person, most meta-analyses don’t warrant much attention.
Karen Howard, CEO and Executive Director of Organic & Natural Health Association is a visionary and results-focused leader who has spent more than 30 years working with Congress, state legislatures and healthcare organizations to develop innovative healthcare policy and programs. She has held a variety of executive positions, including serving as professional staff for a Congressional committee, and has policy expertise in the diverse areas of integrative and complementary medicine, managed care, healthcare technology and mental health. An advocate at heart, she has worked to strategically advance the mission and vision of organizations through effective advocacy and strong collaboration. Prior to Organic & Natural Health, Howard served as executive director for both the American Association of Naturopathic Physicians (AANP) and the Association of Accredited Naturopathic Medical Schools. During her nearly 10-year tenure at AANP, she built a sustainable infrastructure, significantly improved financial performance, established a strong federal presence and supported multiple state association advocacy efforts for licensure. Also during this time, the naturopathic medicine profession established itself as a key component of comprehensive healthcare for the future. www.organicandnatural.org