Perhaps somewhat lost (thank goodness) in the big news of the election and Superstorm Sandy this week was a study published in the November 7, 2012 issue of JAMA titled
Multivitamins in the Prevention of Cardiovascular Disease in Men
The Physicians’ Health Study II Randomized Controlled Trial
Quoting from the abstract, the study concluded “Among this population of US male physicians, taking a daily multivitamin did not reduce major cardiovascular events, MI, stroke, and CVD mortality after more than a decade of treatment and follow-up.”
Newspapers around the country had headlines like “Multivitamins Don’t Prevent Heart Disease.” In searching this study I found hundreds of articles that all reported this without one single article yet (as of the morning of 11/11/12) questioning these findings. But, as a medical doctor who specializes in Nutritional and Preventive Medicine I know, based on hundreds of other studies, that it has been shown time and time again that a wide variety of vitamins can and do prevent heart disease. Something doesn’t add up, so I decided to take a look at this study. It took quite a bit of searching to discover what the multivitamin used in this study was, as it is buried in the fine print. The multivitamin used was Centrum Silver. This is considered a perfectly adequate multivitamin by those with only cursory knowledge of nutrition, those who believe that the RDA is perfectly adequate, but for doctors who are knowledgeable about nutritional medicine it leaves a great deal to be desired.
Below is a list of the nutrients in the multivitamin used in this study:
Vitamin or Mineral Amount
Vitamin A (IU) 5000*
Vitamin C (mg) 60
Vitamin D (IU) 400
Vitamin E (IU) 45
Vitamin K (μg) 10
Thiamin (mg) 1.5
Riboflavin (mg) 1.7
Niacin (mg) 20
Vitamin B6 (mg) 3
Folic Acid (μg) 400
Vitamin B12 (μg) 25
Biotin (μg) 30
Pantothenic Acid (mg) 10
Calcium (mg) 200
Iron (mg) 4
Phosphorus (mg) 48
Iodine (μg) 150
Magnesium (mg) 100
Zinc (mg) 15
Selenium (μg) 20
Copper (mg) 2
Manganese (mg) 3.5
Chromium (μg) 130
Molybdenum (μg) 160
Chloride (mg) 72.6
Potassium (mg) 80
Boron (μg) 150
Nickel (μg) 5
Vanadium (μg) 10
More detail as to the form of the vitamins/minerals and excipients is here: calcium carbonate, potassium chloride, dibasic calcium phosphate, magnesium oxide, ascorbic acid, microcrystalline cellulose, dl-alpha tocopheryl acetate, pregelatinized cornstarch and modified food starch.
Centrum Silver contains less than 2 percent of the following ingredients: acacia, ascorbyl palmitate, beta-carotene, bht, biotin, boric acid, calcium pantothenate, calcium stearate, cholecalciferol, chromium picolinate, citric acid, cornstarch, crospovidone, cupric sulfate and cyanocobalamin. More ingredients include FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake.
Further, Centrum Silver contains folic acid, gelatin, hydrogenated palm oil, hypromellose, lutein, lycopene, manganese sulfate, medium-chain triglycerides, niacinamide, nickelous sulfate, phytonadione, polyethylene glycol, polyvinyl alcohol, potassium iodide and pyridoxine hydrochloride. It also contains riboflavin, silicon dioxide, sodium ascorbate, sodium benzoate, sodium borate, sodium citrate, sodium metavanadate, sodium molybdate, sodium selenate, sorbic acid, sucrose, talc, thiamine mononitrate, titanium dioxide, tocopherols, tribasic calcium phosphate, vitamin A acetate and zinc oxide.
I will now comment on some of the Vitamins and Minerals proven to prevent heart disease and what was given in this study:
One of the best ways to prevent cardiovascular disease is Vitamin C. In his very well-written book Prevent America’s #1 Killer, cardiologist Dr. Thomas Levy (also a lawyer) presents an excellent case that Vitamin C may be the single best way to prevent heart disease. This is because adequate Vitamin C is essential for creating healthy glycoproteins, a substance which plays a key role in the structural integrity of the endothelium (inner lining of our blood vessels). Inflamed/damaged endothelium is the ultimate pathology underlying cardiovascular disease. See http://www.drpasswater.com/levy.htm for a fine interview with Dr. Levy summarizing his research.
The amount of Vitamin C used in the study was 60 mg a day. I believe everyone should take a minimum of 500 mg twice a day to get the benefits of Vitamin C, and many people may need to take 5-10,000 mg a day in divided doses for optimal health. Taking a form of vitamin C known as lypsospheric C is likely to be much more effective due to enhanced absorption, in which case 1,000 mg/day may be adequate for most. See http://www.livonlabs.com/
The 60 mg of Vitamin C used in this study likely has virtually no benefit in preventing heart disease.
Another key nutrient in preventing cardiovascular disease is Vitamin E. Everyone knows that cholesterol plays a role in heart disease. However, the role is a bit more complex than commonly thought. Cholesterol only causes problems if the wall of the arteries are damaged (via inflammation/oxidative stress in situations where Vitamin C levels are suboptimal) and if LDL cholesterol is oxidized, in which case the LDL will bind to or enter the arterial wall. Vitamin E prevents LDL cholesterol from being oxidized and also protects the arterial wall from oxidative stress.
The study used 45 IU of Vitamin E in the form of dl-alpha tocopherol, a synthetic form of Vit E that has been shown to be toxic in several previous research studies. Unlike synthetic E, which contains the synthetic chemical l-alpha tocopherol, natural E has only d-alpha tocopherol as well as delta, beta and gamma tocopherols. Doses of 400-1200 units of natural E have been proven to be highly effective in preventing heart disease. 45 units of synthetic E may do more harm than good! See http://www.healthy.net/scr/article.aspx?Id=557 for more on the research proving that Vit. E prevents heart disease.
Another key factor in the cause of heart disease is homocysteine, a toxic metabolite of the amino acid methionine. Vitamins B6, B12 and Folate have been shown to significantly lower homocysteine, reducing risk of both heart attack and stroke. The amount of B6 used in this study was a woefully inadequate 3 mg. A much more reasonable dose to reduce homocysteine is 25-50 mg. Many people may benefit even more from pyridoxal-5-phosphate, the activated form of B6. The form of B12 used in this study was 25 mcg of the cyanocobalamin form of B12. B12 is poorly absorbed by many, and cyanocobalamin is the least beneficial of the 3 common forms of B12. At least 1000 mcg of the methycobalamin form is advisable. While the 400 mcg dose of folic acid used is relatively reasonable, about one-third of the population has genetic difficulties converting folic acid to the active form, L-5-methyltetrahydrofolate (5-MTHF). There is also evidence that folic acid, a synthetic chemical, may increase risk of certain cancers including breast, prostate and colon. I thus advise taking at least 800 mcg of 5-MTHF to prevent heart disease and stroke.
For more on homocysteine and heart health see http://www.lef.org/protocols/heart_circulatory/homocysteine_reduction_01.htm
Vitamin D has also been shown to dramatically lower heart disease risk. A recent study done in Denmark involving more than 10,000 people found that those with the lowest levels of vitamin D experienced a 64 percent higher risk of heart attack, 57 percent higher risk of early death, 40 percent higher risk of ischemic heart disease and at least an 81 percent higher risk of death from heart disease. See
The study used the RDA of 400 IU of Vitamin D. However, to achieve optimal levels of 50-100 nanomoles per liter most adults need to take at least 4000-5000 IU/day.
Another key nutrient that helps to prevent heart disease is Vitamin K. Whereas Vitamin D is necessary for us to absorb calcium, vitamin K makes sure that the calcium we absorb winds up in our bones and not in our arteries. Research has shown that Vitamin K both prevents and reverses atherosclerosis. Doses used in these studies are around 1 mg which is 1000 mcg. Doctors in this study were given 10 mcg.
Minerals can also be helpful. Magnesium has many benefits but Centrum Silver has only 100 mg of magnesium oxide, which is poorly absorbed. At least 200 mg of a well-absorbed form like taurate, citrate or glycinate would undoubtedly help more.
Selenium is also a useful antioxidant but the 20 mcg of sodium selenate is not nearly as beneficial as 100 mcg of selenium monomethionine might. 15 mg of zinc is reasonable but the zinc oxide form is, once again, relatively poorly absorbed compared to other forms of zinc.
Centrum silver also contains 4 mg of iron. This is, fortunately, a tiny amount, as iron is a pro-oxidant that is best avoided by all men and post-menopausal women as the evidence suggests that iron actually increases cardiovascular risk!
Added to the inadequacies of the quantities and forms of the nutrients in Centrum Silver, it also contains FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake, hydrogenated palm oil, polyethylene glycol, polyvinyl alcohol, sodium benzoate, pregelatinized cornstarch (undoubtedly of GMO origin), sucrose, talc and titanium dioxide, ingredients that I strongly recommend avoiding.
So, with the above in mind, is it fair to conclude that “multivitamins do not prevent heart disease?” The only thing that can be concluded is that incredibly inadequate/subtherapeutic doses of vitamins in poorly absorbed forms mixed with a variety of toxic excipients do not prevent heart disease. I could have told you that before this study.
But, unfortunately, the message the general public is receiving is that “Vitamins Don’t Prevent Heart Disease!” This is, as demonstrated, TOTALLY WRONG and I am concerned that the blind acceptance/uncritical reporting of studies like this will lead many people who are taking one of the many high quality multivitamins that do have reasonable doses and forms of these nutrients to stop taking them out of the mistaken belief that they have been shown to be ineffective. This would be tragic.
Of interest, another finding of this same study, published separately in the JAMA on 11/14/12 under the title Multivitamins in the Prevention of Cancer in Men (see http://jama.jamanetwork.com/article.aspx?articleid=1380451 ) showed an 8% reduction in cancer risk. The same critiques I have mentioned above apply. This means that a better quality multivitamin, ideally enhanced with about 5000 units of Vitamin D a day, would almost certainly show a MUCH greater degree of cancer prevention. A nice summation of this study is at http://www.nytimes.com/2012/10/18/health/daily-multivitamin-may-reduce-cancer-risk-clinical-trial-finds.html?_r=0
While this post has focused on the research proving that vitamins and minerals can prevent heart disease, there are many other nutrients that also help prevent cardiovascular disease. These include amino acids like Lysine, Proline and Taurine, antioxidant flavonoids like Anthocyanins and Proanthocyanins, healthy sugars like D-Ribose, enzymes like CoQ10 and Omega 3 and 6 Essential Fatty Acids. Herbs like Hawthorne and Turmeric and supplements like Resveratrol are also useful.
As important a role as the right vitamins and minerals can play in reducing heart disease, these will work much better in the context of a comprehensive holistic approach. Chronic infections, especially periodontal disease and chronically infected root canals, contribute to heart disease, as do heavy metals like lead and mercury, so treating those conditions can be quite important. It is obviously crucial to minimize our exposure to tobacco smoke and other avoidable toxins. Minimizing dietary sugars and starches and trans-fatty acids (found in most fried foods) is also important, as is avoiding foods from animals fed GMO’s and loaded with hormones and antibiotics, including dairy and eggs. Grass-fed beef, low-mercury wild seafood, organically-raised poultry, eggs and dairy are fine in moderation, but one should emphasize organic vegetables and fruits, nuts, seeds and beans. Obviously exercise and stress-reduction also play important roles in preventing heart disease. And perhaps the best medicine of all for preventing heart disease is LOVE.
However, even though love may be the most powerful force in our universe, it would take a whole lotta love to counteract the effects of toxic foods and vitamin deficiencies!
If you like this post please check out my other blog posts and the many posts on my Randy Baker MD facebook page: https://www.facebook.com/pages/Randy-Baker-MD/118815558232253 . Also, an extensive collection of articles I have written in recent years can be found at http://www.drrandy.org
Wishing you optimal health!
Randy Baker MD