Don't Ask Your Cardiologist
By Will Block

f you're interested in the latest information on vitamins, don't ask your cardiologist. It's not that cardiologists don't know anything about vitamins. They may know a lot, but they're not talking, not recommending, and they're certainly not prescribing.

The survey from which the above conclusion is drawn was conducted - I kid you not! - by a ninth-grade Florida student, Jason Mehta, and was published in the June issue of The American Journal of Cardiology.1 This may sound a little like the story of "The Emperor's New Clothes," but then, Jason's father, Dr. Jawahar L. Mehta, is professor of medicine and physiology at the University of Florida's College of Medicine in Gainesville. He helped his son conduct the survey, so there are others who see the paucity of the official clothing too.

Jason (and his dad) found that, while many heart doctors use antioxidant supplements themselves because of their potential health benefits, a minority of these doctors endorse and recommend these same supplements to their patients. According to the survey results, 44% of 181 American cardiologists responding reported taking supplements - vitamin E, vitamin C, and/or beta carotene - yet only 37% endorsed patient usage.2 What's going on here? Are these doctors experimenting on themselves? Should we join in? Are they reckless? Does the possibility of side effects outweigh the benefits?

Ask Dr. Daniel Steinberg (University of California, San Diego), a researcher who has found that supplements have important clinical benefits.3 Despite the fact that he heads the team that originally proposed the "LDL oxidation theory" of atherosclerosis, he thinks it's unfortunate that any docs are taking vitamins now, because "we'll have the answer in about 4 or 5 years. People can wait. If it turns out to be good, you will have lost only a few years, and we're talking about a disease that develops over 30 years. It's not like people are going to start dropping like flies if they're not taking Vitamin E."4

Although he thinks any adverse effects of taking supplements are probably minimal, he still cautions against taking them. Haven't we heard this before: Wait a few years - it probably won't hurt if you're not taking supplements (!) - as soon as "we" have the answer "we'll" tell you whether it's all right to take them.

Controversial? Well, is there anything in medicine (or elsewhere, for that matter) that is absolutely certain? Yes, there is. Unless we do something about aging, we are all going to die - and sooner, rather than later.

Young Jason's survey found that about 42% of the cardiologists surveyed also take aspirin. The most common daily doses of vitamins taken by these physicians are: vitamin E, 400 IU (I believe 800 to 1,200 IU is better); vitamin C, 500 mg (I recommend at least 3000 mg spread over the day); beta carotene, 20,000 IU (this is closer to my recommendation of 25,000 to 100,000); aspirin, 325 mg (I think this is too much even if you're not sensitive. Studies have shown that optimal levels may be as low as one-fourth to one-eighth this much; too much aspirin suppresses prostacyclin production which is needed for arterial elasticity5 and may cause gastrointestinal bleeding in sensitive people, with no increase in efficacy over the lower dose).

"There are a lot of bits of information that suggest [antioxidants] would be very effective in preventing the onset of disease," wrote Jason's father, which could explain why doctors take these supplements, But, says Dr. Daniel Levy, director of the Framingham Heart Study of the National Heart, Blood, and Lung Institute in Framingham, Massachusetts, "[Whereas] some physicians might want to spend their money on these supplements, that's not the message we want to send to our patients." Levy then goes on to say that doctors should recommend that their patients spend their money only on "proven" (i.e., FDA-approved) treatments such as aspirin therapy.

Who Else Is Not Talking?
A recent report urged patients using alternatives to traditional medicine to talk to their doctors about what they are doing.6 Nearly 60 million Americans have turned to some sort of alternative therapy, but only 30 percent of these patients are talking to their orthodox physicians about their unorthodox practices, including their use of vitamins and other supplements. Is this because they feel uncomfortable about possible negative responses from their physicians? Could be. Thank Jason for helping to validate this "paranoia."

References

  1. Mehta J. Intake of antioxidants among American cardiologists. Am J Cardiol. 1997;79:1558-1560.
  2. Modica P. Many docs take vitamins, fewer prescribe them. Med Trib News Serv. June 17, 1997.
  3. Steinberg, D et al. Antioxidants in the prevention of human atherosclerosis. Circulation. 1992;85:2338-2344.
  4. What's so hot about vitamin E? The Washington Post. May 18, 1993.
  5. Forster W, Parratt JR. The case of low-dose aspirin for the prevention of myocardial infarction: but how low is low? Cardiovasc Drugs Ther. 1997;10:727-734.
  6. Eisenberg D. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997;127:61-69.

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