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The supplements, which currently represent a $ 30 billion industry, are the best example of what "it could not hurt". A meta-analysis of meta-analyzes has shown, once again, that the supplements have no impact on the major cardiovascular disease. Published in Annals of Internal Medicine, the study examined randomized controlled trials (RCTs) on adult mortality and estimated cardiovascular outcomes. [1], written in English. The nine meta-analyzes and the four new RCTs remaining after the research reduction focused on 16 different supplements and eight dietary interventions involving close to one million people.
Here in a graph, the results
- Only a reduction in salt intake in patients without high blood pressure reduced the risk of all-cause mortality by 10%, with "moderate certainty". [2]
- Only a reduction in salt intake in hypertensive patients reduced the risk of cardiovascular death by 33%, with a "medium certainty".
- Only fish oil reduced the risk of heart attack by 8% with "little certainty".
- Folic acid supplements reduced the risk of stroke by 20% with "little certainty", while the combination of vitamin D and calcium increased the risk of stroke. 17% with "moderate certainty".
- Only fish oil reduced the risk of coronary heart disease by 7% with "little certainty".
No study is perfect. this study is no exception. More importantly, this concerns populations and not individuals, so yes, some people could benefit from a supplement. Usually these are individuals with deficiencies, but otherwise, it is difficult to determine which is best served by taking supplements if they exist apart from anecdotes.
Salt remains problematic. As I wrote earlier, the effect of salt on health seems more U-shaped or J than linear, too much or too little are both bad. However, as the accompanying editorial of this article points out, salt has reduced all-cause mortality only in people who do not have high blood pressure, while the number Coronary death was reduced only in people with hypertension. So maybe only really-at-risk individuals, those with hypertension, should monitor their salt intake.
Fish oil as a supplement remains a hot mess. This study shows a very small effect with little certainty that it is correct. But a recent test of a highly purified form of fish oil, icosapent ethyl [3], showed a 25% improvement in cardiovascular outcomes. But it's not a supplement, it's a prescribed drug, regulated by the FDA; and its efficacy has been demonstrated in these patients experiencing cardiovascular disease or diabetes, on a statin, with high triglyceride levels and fish oil doses in question four times greater than that found in supplements.
The finding on folate indicates another problem for understanding the scientific truth about supplements: the reduced risk of stroke was "largely motivated" by a study conducted among Chinese people with high blood pressure . This may reflect a dietary difference. there is far less folate-enriched food in China than in the United States, or perhaps a genetic variability. Your diet and your genetics influence the effect of supplements – in other words; if your dietary needs are greater than your consumption, it is useful to correct the imbalance.
Finally, multivitamins and dietary interventions adjusting the type and amount of fats consumed were of no benefit.
The accompanying editorial highlights several important points. it's, in my opinion, the most salient
"It is only recently that machine learning of large data sets, including multimodal data on physical activity, sleep, medication, demographics, consumption and timing of all foods and beverages and constituents of the intestinal microbiome, allowed us to learn that the use of any diet or supplement is likely to have markedly heterogeneous effects. Testing a diet or supplement in a large population without recognizing interindividual variability seems to be the recipe for failureespecially because most trials are not randomized, do not last long enough, or do not have enough dubious events, "he says.
There is no magic supplement, no superfood, no old secret hidden by unscrupulous capitalists. You need a diet that meets all your needs, needs that change over time. The most common problem facing precision health is diet, not disease treatment. We spend more than $ 350 a year [4] on supplements, a quarter of what we spend on autonomous pharmaceuticals. If you want to reduce your health costs, stop taking supplements, nothing proves that they help; and "it can not hurt" seems to be such a bad reason to spend money.
[1] Heart attack, stroke or coronary heart disease
[2] "We have a moderate confidence in the estimation of the effect: the true effect will probably be close to the estimate of the effect, but it is possible that it is substantially different . "
[3] It is fish oil that reduces triglycerides without causing LDL increase. Not surprisingly, manufacturers are trying to characterize their product as very different from fish oil supplements.
[4] Americans spend $ 30 billion a year on complementary approaches to health, National Institute of Health
Source: Effects of nutritional supplements and dietary interventions on cardiovascular outcomes Annals of Internal Medicine DOI: 10.7236 / M19-0341
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