AUGUST 2018 – Vol. 12, Issue 7

In This Issue…    

·         Do multivitamins improve heart health?

·         Intravenous vitamin B1 improves survival in patients with septic shock

·         This lipoprotein is a better predictor of cardiovascular risk than LDL cholesterol in certain people

·         Vitamins C and E help elite athletes recover after competition

·         Is gray hair caused by a weakened immune system?




CLINICAL UPDATE – Do multivitamins improve heart health?
A new study suggests the answer is no, but a closer look at the data may tell a different story. In this review paper, a total of 18 studies that evaluated the association of multivitamin/mineral supplementation on cardiovascular outcomes such as stroke and heart attack were reviewed.  The studies spanned an unusually large time frame – from 1970 to 2016 – indicating some of the data may have gone back 46 years. Although the scope of this review was particularly large with over 2 million total participants across all eighteen studies, important details remain elusive. 
           For example, only five of the eighteen reviewed studies actually specified the dose and type of supplement studied.  This means that for the majority of the studies on which the authors based their conclusion, there is no actual data on how much or even what type of vitamin or mineral was taken.  To complicate things further, multivitamins vary dramatically on dose, quality and even the nutrients contained within them, even when this information is known.
           Ironically, the scope of this review paper is so broad that the conclusion that multivitamins do not improve cardiovascular health is not surprising, given the nature of how nutrients work.   In fact, the lack of association between a general multivitamin and heart health gives credence to the notion that targeted supplementation of actual micronutrient deficiencies may be more likely to improve patient outcomes than blind supplementation with a general multivitamin.  This paper concludes multivitamins don’t improve cardiovascular health, but the implication that nutrients don’t affect heart health may be too simplistic.
           (Circulation, Cardiovascular Quality and Outcomes, July 2018)
LINK to ABSTRACT Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis.





CLINICAL UPDATE – Intravenous vitamin B1 improves survival in patients with septic shock
            Evidence has shown that critically ill hospitalized patients are commonly deficient in vitamin B1, also known as thiamine. In this study, patients were studied who had been admitted to a hospital with a diagnosis of septic shock.  A total of 123 patients with septic shock were given vitamin B1 intravenously within 24 hours of hospital admission.  They were compared to 246 similar patients with septic shock that were not given vitamin B1 in the hospital. 
           Since deficiency of vitamin B1 impairs a cell’s oxidative metabolism ability, those who are deficient in B1 may have an impaired ability to remove toxins from the bloodstream.  In septic shock, lactate accumulates in the blood indicating that the cells cannot perform basic energy metabolism.   After 28 days, patients who were given vitamin B1 had lower death rates (28-day mortality) which the authors suggest was likely due to their improvement in lactate clearance. Since elevated blood lactate is an indication of tissue hypoxia (cells dying due to lack of oxygen) and occurs during sepsis, if the body can clear lactate from the blood, chances of survival increase.   In this study, vitamin B1 improved survival of hospitalized sepsis patients.
           (Critical Care Medicine, Epub ahead of print)
LINK to ABSTRACT Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock.






CLINICAL UPDATE – This lipoprotein is a better predictor of cardiovascular risk than LDL cholesterol in certain people
            Although the development of atherosclerosis (clogging of the arteries) occurs to some degree in most people over the course of their lifetime, there are certain genetic mutations that predispose some people to very early onset of atherosclerosis.  This disorder, called familial hypercholesterolemia, is characterized by unusually high cholesterol levels in young people, even children.  A group of pediatric patients (129 children) with a family history of early heart disease (atherosclerosis) were identified for this study.  Two things were measured: (1) low density lipoprotein cholesterol (LDL-C) – a commonly measured albeit sometimes misleading biomarker for heart disease and (2) lipoprotein(a), a less commonly measured but clinically useful biomarker that is cited by the National Cholesterol Education Program as an emerging risk factor for measurement.  Lipoprotein(a) – called Lp “little a” – is involved in the formation of plaque (atherosclerosis) and is also linked to thrombosis (blood clots), both of which occur in heart disease.
           The authors of this study found that LDL-C was not elevated in children whose family had a history of premature heart disease but children with family history of early onset heart disease were three times more likely to have high levels of lipoprotein(a).  In fact, the authors concluded that measurement of Lp(a) in children with familial hypercholesterolemia is a better risk predictor than LDL-C, particularly when family history is limited.
           (Journal of Clinical Lipidology, August 2018)
LINK to ABSTRACT In pediatric familial hypercholesterolemia, lipoprotein(a) is more predictive than LDL-C for early onset of cardiovascular disease in family members.



CLINICAL UPDATE – Vitamins C and E help elite athletes recover after competition
            In this randomized, placebo-controlled, double-blind study, eighteen elite athletes were divided into two groups to measure the effects of short term but high dose vitamin C and E supplementation on recovery after intense competition.   Group 1 was given vitamin C (2000 mg) and vitamin E (1400 U) daily for three days prior to competition plus the day of competition, for a total of four days taking supplements.   Group 2 was given placebo. 
            On the day of competition, each athlete competed in four consecutive Olympic Taekwondo matches and blood samples were taken five times – before each of the four taekwondo matches on competition day and then 24 hours later.  Three markers of recovery were measured: muscle damage, hemolysis (breakdown of red blood cells) and systemic inflammation.  Those receiving the vitamin C and E supplements had less muscle damage (meaning better muscle recovery) and lower levels of inflammation than the group taking placebo.  This study showed that short term supplementation with vitamin C and E effectively mitigated exercise-induced muscle damage in elite athletes.       
           (International Journal of Medical Sciences, July 2018)
LINK to ABSTRACT Short-Term High-Dose Vitamin C and E Supplementation Attenuates Muscle Damage and Inflammatory Responses to Repeated Taekwondo Competitions: A Randomized Placebo-Controlled Trial.
           LINK to FREE FULL TEXT




CLINICAL UPDATE – Is gray hair caused by a weakened immune system?
            New research suggests the link between premature gray hair and our immune system is stronger than we think. A team of researchers from the University of Alabama and the National Institutes of Health found a link between gray hair and immunity.  That link is called MITF (MIcrophthalmia associated Transcription Factor), which is unique protein that regulates both pigment producing cells (melanocytes) and some immune cells. Specifically, MITF controls the genes that regulate melanin synthesis.  Melanin is the pigment that is found in skin that causes a tan when exposed to sunlight.  Lack of melanin in hair makes it gray.
            The researches discovered that the genes that control hair pigmentation also control part of the normal immune response humans have against invading bacteria and viruses.  They actually demonstrated that a virus introduced into mice could make them more genetically susceptible to premature gray hair.   The protein MITF has functions in immunity and pigmentation that apparently overlap, suggesting that weakened immunity and gray hair are linked after all.  In other words, those with premature gray hair may be more likely to have lowered immune function.
            (Public Library of Science Biology, May 2018)
LINK to ABSTRACT A direct link between MITF, innate immunity, and hair graying.
            LINK to FREE FULL TEXT