The following article, hot off the press, assessed the benefits of “natural” supplements for cardiovascular disease risk and found that most supplementation either had no effect or potential for increased risk for all cause mortality, except folic acid and/or B Vitamins. Although studies like this are helpful, they certainly cannot be taken verbatim as studies of this design are not assessing individuals but the supplemental affects of specific nutrients on a disease process. Having said that, there is a very important lesson here, which is that simply going to your local health food store or pharmacy and picking supplements off the self may not be the best solution for your health problem.
Although most supplements are considered safe to use, and proponents of supplementation will tend to have people believe this notion, articles such as this suggest otherwise and bring into question that general notion. These are also the studies that ones medical doctor might read and take away that all supplements are useless or even bad, when that is also not the right conclusion. The really answer to these complex questions lies in the individual.
Although this is not the current standard, future study designs will assess subjects using biochemistry chemistry and/or genetics to best match a prescribed treatment to the individual and, in turn, provide that individual with the best possible outcome. This is really the basis of functional medicine and is currently being used more and more in conventional medicine, primarily in the area of oncology. More often than not, in oncology today, patients are being assessed for genetic variations in different cancers and provided more specialized treatments to these specific variations with much better outcomes than we have had for cancer treatments in the past.
With respect to the current article, can folic acid and B vitamins impact your cardiovascular outcome? Is it worth going out and grabbing the first folic acid and/or b complex off the shelf. As a functional medicine guy, I would certainly say “NO”, because simple lab assessments like MCV and homocysteine can be used to determine whether such a treatment is right for you. Genetics can also be used to make sure that some one is taking the right forms of these vitamins as polymorphisms (genetic irregularities) for genes like MTHFR (methyltetrahydrofolate reductase) can dictate what type of folic acid one would need. Yes … it sounds complicated … but its actually not that bad.
As a summary, if I where to give general advice to someone at risk of a cardiovascular event or with a history of cardiovascular disease, such as a past heart attack or stroke I would say …. forget the supplements and look at your diet. Refined foods (and smoking) are the number one cause of cardiovascular disease. If you are into supplementation, go out and buy a masticating juicer or a blender … put anything green into it (except apples) and turn it on. That will give you all the folic acid you need and is more likely to reverse your cardiovascular disease risk than any supplementation out there.
Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. J Am Coll Cardiol. 2018 Jun 5;71(22):2570-2584. doi: 10.1016/j.jacc.2018.04.020. (Review) PMID: 29852980
The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, ß-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.