A Multivitamin

The seven supplements you’ll read about later in this chapter are intended for people who fit certain health profiles. But the Plan includes two supplements that everyone should take every day: a daily multivitamin/multimineral (which we’ll call a “multivitamin” from here on for the sake of simplicity) and fish oil. They’re safe,
they’re inexpensive, and they offer significant health benefits for all adults.

A Multivitamin

More Americans take a daily multivitamin than any other supplement. You will too on the Plan. It’s an easy, safe way to get numerous benefits from a variety of nutrients without having to pop a handful of pills every day. Taking a daily multi vitamin is especially important for older adults because as we age, our bodies become less efficient at absorbing vitamins and minerals from food. And if you follow a vegetarian diet, you may not be consuming enough of certain vitamins and minerals to begin with. When choosing a multivitamin, pick a brand with i high quality control, high reported bioavailability (thus means Thorne, PhytoPharmica, and Vital Nutrients. Don’t choose a multi that contains iron unless vou’re a woman who is still menstruating or your doctor has recommended that you take additional iron,

A Multitude of Benefits

Multivitamins got a boost in June 2002, when the Journal of the American Medical Association published two articles by Harvard doctors on their benefits. The doctors. recommended that everyone, regardless of age or health status, take one. We agree. Among the heart-related benefits you might reap are a lower homocysteine level and less oxidation of LDL. Some of the nutrients most likely responsible include:

B vitamins. One of the best reasons to take a multivitamin every day is to be certain to get your fill of B vitamins. This family of vitamins—thiamin, riboflavin (B,), pyridoxine (B,), macin (B:;), pantothenic acid (B;), cobalamin (B,.), folie acid, biotin, choline, inositol, and para-aminobenzoic acid—plays a critical role in every function inside your body. Bul the vitamins really shine when it comes to your heart. You already know from Chapter 2 that folate, B,, and B,» help prevent a dangerous buildup of the amino acid homocysteine. If homocysteine levels rise too high, they damage endothelial cells (which line the arteries), blocking the production of nitrie oxide and leaving arteries more prone to plaque buildup. Keeping homocysteine in check is a good enough reason by itself to take a multivitamin.

Another B vitamin, choline, helps your body process cholesterol, And Vitamin By can actually lower LDL and triglycerides and raise HDL, at least at high doses, The vitamin apparently works by reducing the amount of cholesterol your liver makes.

Generally, a multivitamin will give you all of the B vitarnins your body needs. But if you have elevated homocysteine levels, talk to your doctor about taking an additional B vitamin supplement. Should you decide to do so, don’t exceed the recommended dosages. Because they are fat soluble, many of these vitamins can build up in the body to toxie levels. Vitamin E. Vitarnin E is a powerful antioxidant. Whether or not it can help protect you against heart disease is a matter of great controversy, When researchers looked at large populations, it appeared that people who got the most vitamin E through their diets and/or supplements had significantly lower rates of heart disease. But in three large studies in which vitamin & supplements (in doses ranging from 400 International Units, or ILI, to 800 ID) were pitted against placebos (durmmy pills), the vitamin disappoiited—there was no effect on heart disease risk. Some studies even found that high doses of vitamin & could actually encourage the oxidation of LDL cholesterol.

But many researchers still believe in vitamin E, in part because the disappointing studies may have been less than perfect, Problems may have included the type of

Vitamin E used (the most common form is alpha-tocopherol, but a growing body of research suggests thal garmma-tocopherol is more potent and should be used together with alpha-tocopherol), the dose, and the participants themselves. Some participants may have neglected to take the vitamin daily, and others may not have taken it with food, which greatly facilitates absorption. (One study found thatvitamin E supplements taken with food were four times more powerful at preventingoxidation than vitamin E taken on an empty stomach.)

And there is some corupelling evidence for the vitamin’s effects on cholesterol and plaque. A 2000 study from Rome that focused on stroke victims and patients with high cholesterol found that those who took large doses (1,350 IU) of vitamin E daily not only experienced less severe artery blockages, but their cholesterol levels dropped to nearly normal. Fur

her, a study published in September 2002 in the American Journal of Clinical Nutrition found that healthy women with no history of heart disease who ate few vitamin E-containing foods were more than twice as likely to have signs of plaque in their arteries than those who ate more vitamin E-filled foods. The researchers con- cluded: “Low vitamin E intake is a risk factor for early atherosclerosis.”

Based on the current state of the research, we don’t think you need to take a separate vitamin E supplement. If your multi contains 100 to 200 IU, that’s sufficient- and not unimportant. Our ancestors got about 100 IU of vitamin E through food, but it’s difficult to get even that modest amount from diet alone (Even olive oil, one of the best sources of vitamin E, has just 1.74 IU per tablespoon. To get 100 IU, you’d need to drink 3.5 cups a day!)

If you do decide to take a separate vitamin E supplement, look for one labeled “assorted” or “mixed” tocopherols, usually available only at health food or specialty stores. The body absorbs mixed tocopherols better than alpha-tocopherol. Because vitamin E has blood-thinning properties, check with your doctor if you’re also taking a daily aspirin or other blood thinning medication.

Vitamin C. Vitamin C is another powerful antioxidant with mixed results when it comes to heart disease and cholesterol. Studies found no link between the vitamin C in people’s diets and their heart disease risk. But of the small handful of studies focusing on vitamin C supplements, some have found promising results

In one study 10 women who took 1,000 milligrams of vitamin C daily for four weeks saw their LDL, levels drop an average of 16 percent and their HDL levels improve slightly. A much larger study with 256 men and 221 women showed similar results. Vitamin © seems to have similar effects even at lower doses. Vitamins EB and C seem to work best in conjunction with one another, another reason to get these vitamins as part of a multivitamin, Look for one with 200 to 500 milligrams of vitarnin ©. (Most vitamins are measured in milligrams, but fat-soluble vitamins such as E and A, measured in IU, are exceptions.)