When you face the bathroom mirror with your pills in hand, chances are you are preparing to take some vitamins and mineral supplements that you believe will improve your heart health. Fish oil, vitamin D, red yeast rice extract, niacin, vitamin E and others might be on your daily supplement menu.
But perhaps it’s time to reconsider.
“I believe people overestimate the benefits and underestimate the potential dangers of supplements. And that can really become a problem,” says Dr. Theodore Feldman, a cardiologist and the medical director of both the South Miami Heart Center and Baptist Health’s Center for Prevention and Wellness.
More than half of U.S. adults take dietary supplements, including multivitamins, minerals and herbs, according to the U.S. Centers for Disease Control and Prevention. And they spend more than $25 billion a year on them.
When it comes to supplements taken for heart health, about 25 percent of them are fish oil, 20 percent are CoQ10 and 15 to 17 percent are multivitamins.
“But there is barely a shred of hard evidence that taking these or any other supplements leads to reductions in cardiovascular disease or death in the general population,” Feldman says.
Neither the American Heart Association, the American College of Cardiology nor any government agency recommends that the general population take any specific nutritive supplement to prevent heart disease. Not vitamin A, vitamin D, vitamin E or niacin. Not a one.
“There’s no magic pill we can give to everybody,” says Dr. Roberto Miki, assistant professor of clinical medicine and cardiology for the Miller School of Medicine at the University of Miami.
In fact, the U.S. Food and Drug Administration estimates there are about 50,000 adverse reactions to dietary supplements each year.
This is not to say that you should never take supplements for heart health. It all depends on your individual needs and whether you have shown signs of cardiovascular disease.
For example, the body requires folate, vitamin B6 and vitamin B12 to convert homocysteine found in the blood into amino acid, the building block for new proteins. Without enough of the B-complex vitamins, your blood levels of homocysteine will increase and some studies, according to the Harvard School of Public Health, have linked high levels of homocysteine in the blood with a modest increase in the risk of heart disease and stroke.
So for a patient with high homocysteine levels, a doctor might recommend a B-complex vitamin supplement.
Studies also have found that people who have already suffered heart disease such as a heart attack or stroke can benefit from taking fish oil to prevent sudden death from arrhythmia — an irregular heartbeat — as well as to lower their triglycerides.
“But there is absolutely no recommendation for people in the general population to take it,” says Feldman.
And there is evidence that taking a soy supplement can lower cholesterol in some people — but it can also function much like estrogen, so it has the potential to promote breast cancer.
Although taking reasonable amounts of most dietary supplements won’t necessarily hurt you, they, like any medication, can trigger drug interactions and allergic reactions. For example, some people who take niacin supplements to help manage their cholesterol develop flushing, itching, dizziness, headaches, an upset stomach or even liver damage or diabetes.
That is why niacin is suitable for people who can benefit from its effects on HDL cholesterol and triglycerides, but is not recommended for the public at large.
“I strongly discourage people from taking niacin — or any other supplement — without a doctor’s recommendation,” says Feldman.
If you go online, read newspapers and magazines or watch television news, you will discover plenty of information about the benefits of using supplements. But before you head to the store, you and your doctor need to determine how strong those recommendations really are.
“The Internet is great, but anybody can post anything on it, so you need to be careful where the information originated,” says Miki.
What’s more, the FDA does not regulate the production of supplements the way it regulates pharmaceutical drugs. Even if you decide a nutritive supplement can be beneficial to your heart, it is difficult to be certain that what you are taking is pure and safe.
The FDA has sometimes found supplements contaminated with rat feces and urine. And Feldman quotes one study that asserted that 20 percent of all over-the-counter supplements contain harmful levels of lead, mercury or arsenic.
But there are a couple of things you can do to assure yourself that you are getting a safe, high-quality supplement that is free from contaminants and accurately labeled.
Begin by looking for evidence that the manufacturer is following what the FDA calls Good Manufacturing Practices (GMP). The FDA also supplies some manufacturers with a Certificate of Analysis (COA) assuring that what is on the label is actually in the bottle.
Then look for verification that the manufacturer is using U.S. Pharmacopeial Convention standards for determining product identity, strength, quality and purity. Check for references to all of these certifications and standards on the product label or the manufacturer’s website.
But only about 1 percent of the 55,000 supplements on the market meet all of these criteria. That’s why doctors and dietitians prefer that you get your nutrients from a healthy diet.
Leslie Burman, a registered dietitian at the Zachariah Family Wellness Pavilion at Holy Cross Hospital in Fort Lauderdale, suggests that her cardiac patients eat a diet that she describes as “gathered from the ground.” It includes plenty of nuts, whole grains, seeds, beans, fruits and vegetables while limiting your intake of fat and animal protein.
She prefers whole foods over supplements because of the “yin and yang” effect of the nutrients in them. She explains that many of the nutrients in whole foods work synergistically to provide more benefits than those taken as isolated nutrients in pill form.
“When it comes to taking supplements for heart health, the whole key is moderation and looking at your own specific nutrient needs,” Burman says.