Why shouldn't Scruvy exist?
Multivitamin Supplements A sacrilege?
Dtsch Arztebl 2001; 98 (17): A-1100 / B-934 / C-877The general awareness of the dangers of atherosclerosis is disproportionate to its actual effects. Up to that phase in the last years of life in which, following a hectic fast-attac strategy (PTCA / stents, bypass surgery, stroke unit), attempts are made to compensate for damage that takes decades to develop. Short-term effects are undoubtedly present here, but rarely life-prolonging. Why is it almost sacrilege to take micronutrient supplements as a “determined” measure to suppress atherosclerosis that takes cardiovascular diseases into account as a mortality factor (USA: 44 percent)?
That cybernetic approach - we are researching the possibility of delaying senescence processes by varying the endogenous concentrations of micronutrients, amino acids, hormones and secondary plant constituents - has hardly been supported so far. As agreed in an invisible convention, thinking about the optimal proportions of these compounds in the metabolism has stopped here: "We prevent deficiencies, more is unhealthy or at least useless!"
Anyone who, as a critic (1, 2), does not consider that modern high-potency supplements contain high doses of folate, vitamins B2, B6, B12, lysine and many other nutraceuticals in addition to vitamins A, C, E, whose regular intake leads, among other things, to the suppression of plasma homocysteine in "safe" areas, falls short of the mark. Hyperhomo-cysteinemia and low vitamin B6 levels are considered risk factors for vascular occlusive processes (3–9).
Attributing “toxic side effects” to vitamin C (1) and citing a controversial research letter from Nature (10) on indirect markers for DNA damage is unacceptable. Those Nature authors later published further works in which ascorbate even had a DNA reparative effect (11) and protected against harmful protein oxidation (12). Bruce Ames called the Nature article "bad science". M. Levine of the National Institutes of Health finds: "Harmful effects have been mistakenly attributed to vitamin C, including hypoglycemia, rebound scurvy, infertility and muta-genesis. Health professionals should recognize that vitamin C does not produce these effects ”(3).
The statement that “there is no connection between the vitamin C status and the risk of dying from CHD”, quoting a study in which only 14/730 people took supplements (14), is incorrect (1). Positive effects from additional vitamin C doses, and that's what it is all about, could not be recorded in this way. In recent years, significantly more positive studies on the effects of Askor-bat on surrogate parameters for cardiovascular diseases (9, 15–44) than neutral results (45–53) have appeared.
The lack of effects of vitamin E monotherapy in prospective studies with hard endpoints cannot be ignored (54, 55). The usable potential of a balanced, high-dose mix of micronutrients is derived from the synergisms of antioxidant effects, lowering homocysteine levels and direct effects on the immune system, endothelium, blood pressure and coagulation and should not be described defeatistically as "application according to the watering can principle" ( 1). It is distorting to re-iterate the side effects of high vitamin A doses to create the impression that these can be applied across the board to micronutrient supplements (1). There is a lack of coherence between the warning about vitamin A toxicity, studies on pregnant women, osteoporosis and the criticism of a micronutrient formula that does not contain active vitamin A, but only a relatively low dose of β-carotene (2).
Since the results of large endpoint studies testing modern high-potency supplements do not exist, it may be premature to make generally positive recommendations. However, this is different in certain situations. According to reports, the Cochrane Foundation “Evidence Based Medicine is not limited to randomized, controlled studies and meta-analyzes either. If no controlled study has been carried out for the particular situation of our patient, we have to find and consider the next best external evidence ”(56).
Ergo, seriously ill coronary patients with a short life expectancy no longer have the time to wait for large endpoint studies. Positive effects on “softer” CHD markers must be sufficient and, in accordance with the above quotation, represent the “next best external evidence”. The consumption of high-dose supplements in the USA and Europe is high and increasing. It may soon be too late to get started with double-blind studies
To test polyvalent supplements plus “best possible treatment” versus “best possible treatment” alone in order to find out whether there is really something to it.
The numbers in brackets refer to the bibliography, which is available on the Internet (www.aerzteblatt.de).
Dr. med. Markus P. Look
Medical Clinic I of the University of Bonn
Sigmund-Freud-Strasse 25, 53105 Bonn
Email: [email protected]
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