Local doctors weigh in on supplements’ benefits

Posted: February 20, 2013

It seems as though someone is always pushing a new wonder supplement to restore health the natural way.

Is there good evidence that any actually work for people with heart disease or those at risk for it?

We asked four area cardiologists what they thought. They are: Daniel Rader, director of the University of Pennsylvania's Preventive Cardiovascular Program; David Shipon, who has a special focus on prevention and integrative medicine at Thomas Jefferson University Hospital; Sara Sirna, who directs Temple University Hospital's lipid clinic, and David Becker, who practices in Flourtown.

Although they expressed varying degrees of skepticism toward supplements, they mostly agreed about their top picks, such as fish oil.

For one thing, they noted, the quality of supplements varies widely, so pick the brand carefully. For another, these substances are not harmless. Patients should talk with a doctor before taking them.

And, lastly, nothing beats the really natural way to fight heart disease - living better. Sirna suggested that people get a good night's sleep, eat healthy food including five servings a day of fruits and vegetables, maintain a healthy weight, exercise and refrain from smoking.

"We clearly know that people who do that have a much lower risk of heart disease than people who don't do that," she said.

Shipon is also big on stress reduction.

Research on supplements has been spotty and generally has analyzed their ability to affect risk factors such as high cholesterol rather than whether they reduce heart attacks or lengthen life, the doctors said. There's also a lot of conflicting evidence.

With few exceptions, Rader said, "the data to support taking these things is basically weak to nonexistent."

All of the doctors agreed that fish oil has the most scientific support, even though a study in the Journal of the American Medical Association last September found that it did not prevent death or heart attacks in people who already had heart disease. Despite evidence to the contrary, the doctors still think the best evidence for its use is in this group. The evidence is murkier for people who do not have heart disease and want to prevent it.

Fish oil has been shown to lower triglycerides, a type of blood fat linked to heart problems, the doctors said. There are two types of prescription fish oil: Lovaza and Vascepa. Those, the doctors said, have the advantage of providing higher-quality cholesterol control than over- the-counter alternatives.

Red yeast rice delivers a low dose of the same type of substance that makes statins (drugs that lower cholesterol). "I treat it like it's a statin," Shipon said. It can have a modest effect, but also can have the same side effects as the prescription drugs.

Becker said studies have found a 200-fold difference in the amount of active ingredients in products. Two brands of red yeast rice that tested well were Cholestene and Sylvan, he said.

Rader pointed out that people using the supplement are "basically taking a low dose of a statin along with a bunch of other stuff that has not been well-studied." He thinks patients are better off taking a low dose of a prescription product unless they can't tolerate it. He doesn't think healthy people should take red yeast rice to prevent heart disease.

One side effect of statins is muscle pain. The supplement coenzyme Q10 may help this. Rader, who was the least impressed of the four with this supplement, said doctors in his practice have not seen good results. He said that some people believe it is good for them in a general sense but that there's no rationale for that.

Also spotty is the evidence for vitamin D being beneficial for heart health, the doctors said, but studies have suggested that low levels of D are associated with heart problems. Because the compound has other benefits, the doctors recommend supplements of it for patients known to have low levels.

Plant stanols and sterols got thumbs up from most of the doctors, and some considered soluble and insoluble fiber helpful.

The doctors saw no point in taking garlic supplements, or vitamins B, C and E for heart disease.

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Contact staff writer Stacey Burling at 215-854-4944 or sburling@phillynews.com.

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