You've seen the headlines. Several studies of high dose, single antioxidant supplements have failed to show a protective effect against heart disease. Perhaps we shouldn't be surprised. In nature there are thousands of antioxidants in our food supply, and they interact synergistically. Until now no one has investigated how the total antioxidant capacity of the diet is associated with the incidence of heart disease.
This study (Rautiainen et al, American Journal of Medicine, 125: 974-980, 2012) did just that. The scientist in charge of this study evaluated data collected in the Swedish Mammography Cohort study. They randomly selected 32,561 women aged 49 to 83 who had no evidence of cardiovascular disease at the start of the study and followed them for an average of 9.9 years.
They did a comprehensive diet analysis at the start of the study and, based on the known antioxidant potential of the individual foods, they calculated the total antioxidant capacity of the diet.
The women were divided into five groups based on the total antioxidant capacity of their diet. The scientists directing the study were able to determine the total number of fatal and nonfatal heart attacks in each group of women because Sweden keeps a comprehensive health record of everybody in the country. In analyzing these data the frequency of heart attacks in each group was adjusted according to weight, smoking, alcohol consumption, physical activity, hormone replacement therapy use, hypercholesterolemia, family history of heart disease, and food supplement use.
The results were clear cut. The women with the highest antioxidant intake were 20% less likely to have a heart attack during the 9.9 year follow-up than women with the lowest antioxidant intake.
The bottom line is pretty simple and non-controversial. It really is a pretty good idea to consume a healthy diet rich in antioxidants from a variety of sources.
The women in this study with the highest antioxidant intake were getting 44% of their antioxidants from 6 to 7 servings of fruits and vegetables per day, 18% of their antioxidants from 3 to 4 servings of whole grains per day, 14% of their antioxidants from consuming 3 to 4 servings of coffee a day, and 4% of their antioxidants from consuming less than one serving of chocolate per week.
And, just consuming one kind of food just won't do. While this study showed a highly significant correlation between total antioxidant intake and heart disease, the correlations became non-significant when the investigators looked at any single food category such as fruits and vegetables, whole grains, or coffee.
Of course, since the data were normalized for supplement use, this study doesn't really speak to whether antioxidants supplements might provide any benefit. It's pretty clear that high-dose, single antioxidant supplements provide little protection against heart disease. But what about antioxidant supplements that provide a full-spectrum of naturally occurring antioxidants? Is there any evidence that they might provide benefit?
In fact there is such a study. The Landmark Study (Block et al, Nutrition Journal 2007, 6:30doi:10.1186/1475-2891-6-30) looked at people who were consuming a complete spectrum of antioxidants from supplements along with a multivitamin, B vitamins and omega-3 fatty acids (something I call a holistic approach to supplementation) for 20 years* and compared the prevalence of heart disease in that group to matched groups - one who consumed just a multivitamin for 20 years and the other who consumed no supplements whatsoever. The participants in this study who were pursuing a holistic approach to supplementation had a three-fold lower prevalence of heart attacks, angina, and congestive heart failure than the other two groups.
So the recommendations are pretty clear:
To Your Health!
Dr. Stephen G Chaney
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.
*This group used supplements from Shaklee Corporation for 20 years or more.
**Vitalizer is a convenient source of the nutrients that Dr. Chaney suggests.
They did a comprehensive diet analysis at the start of the study and, based on the known antioxidant potential of the individual foods, they calculated the total antioxidant capacity of the diet.
The women were divided into five groups based on the total antioxidant capacity of their diet. The scientists directing the study were able to determine the total number of fatal and nonfatal heart attacks in each group of women because Sweden keeps a comprehensive health record of everybody in the country. In analyzing these data the frequency of heart attacks in each group was adjusted according to weight, smoking, alcohol consumption, physical activity, hormone replacement therapy use, hypercholesterolemia, family history of heart disease, and food supplement use.
The results were clear cut. The women with the highest antioxidant intake were 20% less likely to have a heart attack during the 9.9 year follow-up than women with the lowest antioxidant intake.
The bottom line is pretty simple and non-controversial. It really is a pretty good idea to consume a healthy diet rich in antioxidants from a variety of sources.
The women in this study with the highest antioxidant intake were getting 44% of their antioxidants from 6 to 7 servings of fruits and vegetables per day, 18% of their antioxidants from 3 to 4 servings of whole grains per day, 14% of their antioxidants from consuming 3 to 4 servings of coffee a day, and 4% of their antioxidants from consuming less than one serving of chocolate per week.
And, just consuming one kind of food just won't do. While this study showed a highly significant correlation between total antioxidant intake and heart disease, the correlations became non-significant when the investigators looked at any single food category such as fruits and vegetables, whole grains, or coffee.
Of course, since the data were normalized for supplement use, this study doesn't really speak to whether antioxidants supplements might provide any benefit. It's pretty clear that high-dose, single antioxidant supplements provide little protection against heart disease. But what about antioxidant supplements that provide a full-spectrum of naturally occurring antioxidants? Is there any evidence that they might provide benefit?
In fact there is such a study. The Landmark Study (Block et al, Nutrition Journal 2007, 6:30doi:10.1186/1475-2891-6-30) looked at people who were consuming a complete spectrum of antioxidants from supplements along with a multivitamin, B vitamins and omega-3 fatty acids (something I call a holistic approach to supplementation) for 20 years* and compared the prevalence of heart disease in that group to matched groups - one who consumed just a multivitamin for 20 years and the other who consumed no supplements whatsoever. The participants in this study who were pursuing a holistic approach to supplementation had a three-fold lower prevalence of heart attacks, angina, and congestive heart failure than the other two groups.
So the recommendations are pretty clear:
- Don't rely on a single food or food category to get your antioxidant nutrients; consume a wide variety of antioxidant rich foods. Based on this clinical study you might want to aim for 6 to 7 servings of fresh fruits and vegetables and 3 to 4 servings of whole grains on a daily basis. Coffee or tea can add your total antioxidant intake, and even an occasional piece of chocolate is okay.
- Similarly, if you choose an antioxidant supplement, look for a full-spectrum of naturally occurring antioxidants rather than one or two high dose, single antioxidant supplements. I would look for a supplement that provides all of the naturally occurring forms of vitamin E, all the naturally occurring carotenoids, vitamin C, flavonoids and polyphenols. And if you're over 50 I'd also recommend N-acetylcysteine and coenzyme Q10. Of course, based on the Landmark study, it wouldn't hurt if that same supplement also provided B vitamins and omega-3 fatty acids.**
To Your Health!
Dr. Stephen G Chaney
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.
*This group used supplements from Shaklee Corporation for 20 years or more.
**Vitalizer is a convenient source of the nutrients that Dr. Chaney suggests.