Wednesday, April 16, 2008

Statins and Supplements

Why do some people take vitamin and mineral supplements? Why do some people (usually on the advice of their doctor) take statins?

Both are thought to improve health. Supplements such as Vitamins A, C and E, together with beta-carotene and selenium, are thought to have an antioxidant effect, attacking so-called free radicals; meanwhile statins are supposed to reduce levels of cholesterol. Both free radicals and cholesterol are commonly blamed for various causes of ill-health and premature death.

Huge amounts of money are spent on both supplements and statins. In Britain, the NHS apparently sees statins as some kind of wonder-drug; Professor Roger Boyle, National Director for Heart Disease in England, hopes to increase the number of people on statins from roughly 3 million at the moment to around 6 or 7 million people. [BBC News, 2 April 2008]

Howeve, there seems to be no evidence that either supplements or statins actually increase life expectancy for the general population, although statins do appear to improve life expectancy for a small number of men (generally those who have already had heart attacks). Some research suggests that vitamins 'may shorten your life' [BBC News, 16 April 2008].

Advocates of both supplements and statins tend to shift their ground at this point. Even if it doesn't increase the length of life, which of course they don't necessarily concede, then it certainly improves the quality of life. (This is of course a much more difficult claim to disprove, since quality of life is more difficult to measure objectively, and the data are harder to come by.)

For my part, I can't see much difference between the supplement debate and the statin debate. I don't understand how people can be strongly in favour of one kind of pill, and strongly against another kind of pill, when they are produced in the same kind of factories and sold on the same kind of logic.

Perhaps we shouldn't be surprised if the benefits of supplements and statins aren't easy to prove. After all, free radicals and cholesterol occur naturally in the human body, and are necessary for life. The idea that you can improve health by simply taking some pill that will reduce the level of a naturally occurring substance seems to conflict with the idea of the human body as a complex, interconnected, largely self-regulating system. I am particularly astonished that many people who think of themselves as "holistic" either don't seem to appreciate the consequences of meddling with this complexity, or they imagine that popping pills can establish a better all-round balance than the body can achieve on its own.

Sources

Wikipedia on Cholesterol: Cholesterol is a lipid found in the cell membranes of all animal tissues. ... Most of the cholesterol in the body is synthesized by the body and some has dietary origin. ... Biosynthesis of cholesterol is directly regulated by the cholesterol levels present, though the homeostatic mechanisms involved are only partly understood.

Wikipedia on Free Radicals: Free radicals play an important role in a number of biological processes, some of which are necessary for life. ... The body has a number of mechanisms to minimize free radical induced damage and to repair damage which does occur.

Wikipedia on the Statin Controversy
: Some scientists take a skeptical view of the need for many people to require statin treatment. Given the wide indications for which statins are prescribed, and the declining benefit in groups at lower baseline risk of cardiovascular events, the evidence base for expanded statin use has been questioned by some researchers. A much smaller minority ... question the "lipid hypothesis" itself and argue that elevated cholesterol has not been adequately linked to heart disease. These groups claim that statins are not as beneficial or safe as suggested.

Wikipedia on Antioxidants: Despite the clear role of oxidative stress in cardiovascular disease, controlled studies using antioxidant vitamins have observed no reduction in either the risk of developing heart disease, or the rate of progression of existing disease. This suggests that other substances in fruit and vegetables (possibly flavonoids), or a complex mix of substances, may contribute to the better cardiovascular health of those who consume more fruit and vegetables.

[all articles accessed 16 April 2008]


Update

Antioxidants prevent health-promoting effects of physical exercise in humans (May 2009). hahahahahaaa says Ben Goldacre

2 comments:

Anonymous said...

there are supplements out there that can be very beneficial in monitoring cholesterol levels! Nutrients such as soy, fiber, vitamins C, B6, and E can all help promote healthy living. You can read up more on supplements for cholesterol over at the Dietary Supplement Information Bureau.

Richard Veryard said...

According to its website (I just checked to save my regular readers the trouble) the Dietary Supplement Information Bureau "was formed by stakeholders representing all aspects of the dietary supplement industry ... to promote the responsible use of vitamins, minerals, herbs and specialty supplements". The Bureau is "committed to ensuring that consumers, the media, health professionals, and policymakers have the complete facts about dietary supplements". And yet when I looked on the News page, I couldn't see any mention of the recent research reported by the BBC, or any other negative facts about supplements. Not exactly complete then, is it?