Consumer Health Digest #18-25
Your Weekly Update of News and Reviews
June 24, 2018
Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H., with help from Stephen Barrett, M.D. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.
Evidence for cardiovascular benefit of vitamin and mineral supplementation remains elusive. A systematic review of randomized controlled trials (RCTs) after 2011 as well as previous reviews and meta-analyses has found no conclusive evidence of cardiovascular benefits from vitamin and mineral supplementation. [Jenkins DJA and others. Supplemental vitamins and minerals for CVD prevention and treatment. Journal of the American College of Cardiology, 71:2570-2584, 2018] Key findings concluded:
- No consistent benefit was found for supplementing with multivitamins, vitamin D, calcium, and vitamin C in preventing cardiovascular disease, heart attacks, or strokes or reducing the risk of death.
- Supplemental use of vitamins A, B6, and E; beta-carotene; zinc; iron; magnesium; and selenium did not affect the risk of dying or any specific cardiovascular outcome.
- Niacin (nicotinic acid) or vitamin B3 taken at doses far greater than needed to meet nutritional requirements was associated with a 10% increased risk of death among people taking statin drugs.
- Antioxidant supplementation was not associated with any specific cardiovascular outcome investigated, but was associated with a small increased risk of death.
- In 2 of 7 RCTs providing moderate quality evidence, folic acid supplementation reduced risk of stroke with a risk reduction estimate of 20% from pooling the data from the RCTs. The finding was largely driven by the large China Stroke Primary Prevention Trial, which might reflect the lack of folic acid fortification of foods in China.
- An estimated 17% reduction in the risk of cardiovascular disease overall was found based on a meta-analysis of 5 RCTs. However, based on a meta-analysis of 10 RCTs, the risk of mortality overall was not reduced.
- In 9 of 12 RCTs providing moderate-quality evidence, B-complex supplementation containing folic acid reduced risk of stroke with a risk reduction estimate of 10%, but there was no evidence that B-complex supplementation affected any other cardiovascular outcome or risk of dying.
Evidence from large clinical trials is lacking to support recommendations of folic acid and B-vitamin supplementation where foods are already fortified (e.g., North America). Some clinical trials have found rare but severe harms that include hip fracture with vitamin A supplementation and an increased rate of prostate cancer with folic acid supplementation. The authors concluded that the focus of advice for meeting vitamin and mineral needs should be on healthy dietary patterns with an increased proportion of plant foods.
Fish oil supplementation not supported in new meta-analysis. A meta-analysis of 10 randomized controlled trials involving 77,917 individuals found no evidence that a mean of 4.4 years of supplementation with marine-derived omega-3 fatty acids was effective in preventing fatal or nonfatal coronary heart disease, strokes, or the need for procedures to restore circulation. The supplementation was also ineffective in preventing these cardiovascular outcomes in subgroups of individuals at elevated risk. [Aung T. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks. JAMA Cardiology 3:225-234, 2018] The findings do not support the conclusion of a 2017 science advisory from the American Heart Association which suggested that fish oil supplementation is reasonable treatment for people with coronary heart disease but was based on only one trial of patients with heart failure. Both the 2017 science advisory and the new meta-analysis agreed that there is no evidence of benefit from fish oil supplementation for patients at high-risk of heart disease who have had no clinical symptoms. Four more large randomized controlled trials of fish oil supplementation are currently underway. [Abbasi J. Another nail in the coffin for fish oil supplements. JAMA 319:1851-1852, 2018]
Drug company influence on patient advocacy groups questioned. In 2015, according to Pre$cription for Power, a database compiled by Kaiser Health News with information from drug company Web sites and nonprofit organization Form 990 filings, 14 drug companies contributed $116 million to patient advocacy groups. Questions have been raised about whether such donations can make nonprofit groups that have pledged to help patients less likely to criticize drug companies about prices and inform patients about the full range of viable treatment options. [Patient advocacy groups take in millions from drugmakers. Is there a payback? NBC News, Apr. 8, 2018] Open Secrets, which tabulates politically-related spending, indicates that during 2015 the same companies companies spent far less ($63 million) on lobbying activities.
Lotus birth scrutinized. Health and science writer Kavin Senapathy has provided an informative overview of the practice of lotus birth "in which the umbilical cord is not cut after birth, leaving the baby attached to the placenta until the cord dries and eventually detaches from the navel—usually a period of three to ten days." [Senapathy K. Lotus birth. Skeptical Inquirer, April 13, 2018] Senapathy concludes:
Lotus birth is poorly studied, and experts largely agree that this is for good reason—there is no need to legitimize a high-risk, no-benefit phenomenon that didn't start until the 1970s. Nevertheless, awareness of lotus birth, the reasons proponents cite for doing it, and management of those who choose it, should be on the radars of medical practitioners. Along with refusal of other newborn nursery protocols, including refusal of intramuscular vitamin K, erythromycin eye ointment, newborn screening for congenital conditions, hepatitis B vaccination, discharge timing, and recommended sleep position, "providers need to be aware of alternative practices and know how to respond to them with patient-centered yet medically safe care."
This page was posted on June 25, 2018