Even though millions of individuals take vitamins and supplements daily to prevent heart disease and cancer, recent analysis reveals that the data to support this practice is mostly missing. This article discusses the latest recommendations and pieces of evidence pertaining to multivitamins.

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Patients often inquire, "What supplements should I take?".They are squandering time and resources on the belief that a magical set of drugs would keep them healthy when instead they should be following the scientific-proof practices of eating healthily and exercising.

While some studies show that a daily multivitamin may somewhat lower the risk of cancer, there is insufficient evidence to conclude that vitamins might prevent heart disease and cancer. However, there is sufficient data to suggest that beta-carotene supplements may raise the risk of lung cancer, particularly among those at high risk and dying from heart disease. In addition, vitamin E offers little protection against cancer or cardiovascular disease.

That's the gist of a recent report from the U.S. Preventive Services Task Force, a team of specialists that give recommendations on preventative health measures based on rigorous scientific analysis. This study revises the group's 2014 position on the subject.

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Latest recommendations 

The U.S. Preventive Services Task Force recommended the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer.

The recommendations in this JAMA-published statement parallel those of the 2014 USPSTF recommendation statement on vitamin, mineral, and multivitamin supplements for the prevention of cardiovascular disease and cancer.

"The USPSTF finds once again that the evidence is inadequate to evaluate the balance of benefits and hazards of multivitamins and single- or paired-nutrient supplements (except beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. The USPSTF advises against supplementation with beta carotene or vitamin E for the prevention of cardiovascular disease or cancer.”

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Evidence 

There are no significant differences between the USPSTF's most current recommendations and those from 2014, which were based on 26 studies. The most recent report, published in JAMA in 2022, contains information from a total of 84 research, 52 of which are new, such as the big and impartial VITAL study.

1. There is adequate evidence that beta-carotene supplements provide no benefit in the prevention of CVD or cancer.
2. There is adequate evidence that vitamin E supplements provide no benefit in the prevention of CVD or cancer.
3. Evidence is inadequate regarding the benefits of supplementation with multivitamins for the prevention of CVD or cancer.
4. Evidence is inadequate regarding the benefits of supplementation with single or paired nutrients, other than beta carotene and vitamin E, for the prevention of CVD or cancer.

The Task Force said that there is sufficient evidence that beta carotene may enhance lung cancer risk in those who are already at high risk. According to the statement, there is evidence that vitamin E and multivitamins may cause minor effects; however, the data is insufficient to distinguish the risks of supplementing with single or paired nutrients. The American Heart Association advises healthy persons to get appropriate nutrition largely through a range of nutritious meals and drinks, as opposed to supplements.

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Pregnancy

According to the statement, this USPSTF guideline is meant to apply solely to community-dwelling, non-pregnant people. It does not apply to minors, pregnant women, women who may become pregnant, those with a chronic sickness, hospitalised patients, or those with nutritional deficiencies.

"Vitamins like folic acid are particularly important for pregnant women to take to ensure their babies grow and develop normally. Prenatal vitamins are the most popular strategy to achieve these nutritional requirements. More information is required to comprehend how vitamin supplementation may influence the risk of unfavourable pregnancy outcomes and cardiovascular problems during pregnancy.

Separately, the USPSTF advises that all persons who are capable of or want to become pregnant take a daily supplement containing 0.4 to 0.8 mg of folic acid.

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Lessons learnt

Particularly for heart disease, there are several helpful therapies, such as a balanced diet, exercise, keeping a healthy weight, the use of statin medication in the appropriate populations, blood pressure management, etc. We want to ensure that patients do not believe that taking a vitamin is a substitute for these established effective methods of preventing cardiovascular disease occurrences. Therefore, rather than seeing this as a negative, we believe it may be a good moment to highlight all the things individuals can take to lower their risk of heart disease.

Frequently, patients do not reveal to their doctors the supplements they are using. Physicians should inquire about them openly. We only inquire about the pharmaceuticals they're taking, but we also inquire explicitly about dietary supplements since they may interfere with many common prescription drugs, including those used in cardiology.

Clinicians should place more emphasis on lifestyle counselling to avoid chronic illness using evidence-based methods.

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Eating well and working out is easier said than done

In low-income households, healthy eating might be difficult. Adopting a nutritious diet and engaging in greater physical activity is easier said than done, particularly for low-income Indians. People may not always have the resources to locate places to exercise, nor do they always have access to healthy meals.

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Multivitamin usage in India 

There is a wide selection of vitamin supplement brands in India to choose from. It consists of both single-ingredient and multi-ingredient items. The increasing usage of vitamin supplements as "daily health pills" is concerning. Greater consumer awareness is essential to avoid the abuse and overconsumption of these dietary supplements.

Monitoring the availability and use/intake of multivitamins in patients/healthy populations is essential. These agents, although reasonably safe, may cause medication interactions, unpleasant reactions, and toxicity if they are used without monitoring. The practice of prescribing these dietary supplements to all patients for lengthy usage should be discontinued. The prescribing physician should be informed of the possible drug interactions and prescribe each medication separately. The use of supplements (with a high nutritional content) and several supplements increase the risk of toxicity. When analysing the patient's total nutrition and medicine usage, physicians must review the patient's diet.

They stated that eating fruits and vegetables is associated with a reduced risk of cardiovascular disease and cancer, so it is reasonable to assume that key vitamins and minerals could be extracted from fruits and vegetables, packaged as a pill, and save people the trouble and expense of maintaining a balanced diet. But, they say, entire fruits and vegetables include a combination of vitamins, phytochemicals, fibre, and other elements that likely work together to provide health advantages. Isolated micronutrients may operate differently in the body than when bundled naturally with a variety of other dietary components.

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A possibly hazardous distraction

The supplement industry's massive advertising expenditure drives consumer demand and, ultimately, billions in sales. Most individuals see supplements as innocuous preventatives at worst. The emphasis on supplements may be perceived as a costly and perhaps hazardous diversion. Instead of investing money, time, and attention in supplements, it would be preferable to promote activities with fewer risks and more rewards. Health systems and healthcare providers should prioritise USPSTF-recommended evidence-based preventive interventions, such as blood pressure management and behavioural counselling to promote physical activity and a balanced diet.

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.