B Vitamins, Fish Oil & Cardiovascular Disease: What’s the Link?

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B vitamins continue to receive lots of press, deservedly or not.  Same for fish oil.  Most of the studies look at an association with heart disease.  While the observational studies are at least suggestive, if not supportive, the randomized controlled trials are not.  But perhaps we’re looking for the wrong link.  Unfortunately, a secondary analysis of the Supplementation With Folate, Vitamins B6 and B12 and/or Omega-3 Fatty Acids (SU.FOL.OM3) demonstrated no association with cancer outcomes either, as published in the Archives of Internal Medicine in April.

In case you’re not familiar with SU.FOL.OM3 (neither was I), it was a fascinating double-blind placebo-controlled trial wherein 2,501 French men and women with an average age of 61 years and with cardiovascular disease were randomized to either B vitamins alone, omega 3 fatty acids alone, both B vitamins and omega 3 fatty acids, or placebo in a 2×2 factorial design and then followed for 5 years.  To cut to the chase, the authors found no benefit in cancer or cardiovascular outcomes from supplementation with what they admitted were “relatively low doses of B vitamins and/or omega-3 fatty acids”.

So what did we learn from this study?  Strict interpretation of the data tells us that 0.56mg of 5-methyl-tetrahydrofolate, 3mg of pyridoxine hydrochloride, and 0.02mg of cyanocobalamin and/or 600mg of omega-3 fatty acids made no difference over 5 years. But while this finding as stated is consistent with other randomized controlled trials, they tell us nothing of what might happen from larger doses for longer periods of time.  More importantly, we should consider if we’re actually taking the proper supplements.

For instance, a good portion of the population is unable to convert 5-methyl-tetrahydrofolate into L-methylfolate, the active form.  And what of the conversion of pyridoxine into pyridoxal-5-phosphate, its active form?  Likewise, cyanocobalamin versus methylcobalamin?  In fact, while I do not shill for any pharmaceutical company or manufacturer of medical foods, I do know that there is at least one supplement composed of 3mg of L-methylfolate, 35mg of pyridoxal-5-phosphate, and 2mg of methylcobalamin.  It seems to me that this would be the better, if not optimal, supplement to study.

Although 600mg of fish oil is better than none, consider that 4g (4,000mg) are indicated and approved by the Food & Drug Administration for those with hyper-triglyceridemia.  In other words, much larger doses are used in other situations.

Don’t get me wrong.  I don’t advocate taking one or more handfuls of pills every day. Instead, I recommend to my patients that we attempt to eat right in the first place and only consider supplementation if deemed necessary.  So before you throw the baby out with the bath water when reading glib headlines and listening to 10 second sound bites, take the time to critically read the actual study.

About the author: Dr. Alvin B. Lin served as a Clinical Assistant Professor in the Department of Family and Community Medicine at the University of Nevada, School of Medicine since 2004 and recently became an Adjunct Assistant Professor of Family Medicine and Geriatrics at the Touro University Nevada College of Medicine.  Along the way, he has written many articles, given many presentations, and made himself available to both patients and colleagues.  He plans to continue more of the same (but without the middle-man!). More of his blogs can be found on My 2 Cents.

This article was published previously on Dr. Lin’s blog and re-posted with permission.

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