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Vitamin B, Folate Supplements Won’t Help Heart
By Ed Edelson
HealthDay Reporter
TUESDAY, Aug. 19 (HealthDay News) — A study to determine whether folic acid and vitamin B supplements help the heart has been cut short, because the pills weren’t doing any good and might have even caused participants harm.
“This confirms what a lot of recent studies have found — no benefit of taking vitamin B supplements to reduce the risk of heart disease, and it raises a few red flags,” said Alice H. Lichtenstein, Gershoff professor of nutrition at Tufts University, Boston.
In the new study, reported in the Aug. 20 issue of the Journal of the American Medical Association, physicians at Haukeland University Hospital in Bergen, Norway, enrolled almost 3,100 volunteers. Three-quarters of them took various doses of vitamin B and folic acid (which is chemically a B vitamin), while the others got a placebo, an inactive substance.
The study was ended early, after an average follow-up of 38 months, because “we could not detect any preventive effect of intervention with folic acid plus vitamin B12 or with vitamin B6 on mortality or major cardiovascular events,” the researchers reported.
They did find a slight reduction of stroke, but also a slight increase of cancer in those taking folic acid, but neither of these results reached statistical significance. The study was ended, because another Norwegian study of folic acid and vitamin B supplementation has also hinted at an increased incidence of cancer among users.
But the real bottom line here, according to Lichtenstein, is that “there is no evidence that individuals should take B vitamins to decrease the risk of heart disease, and there may be some evidence that they shouldn’t.”
The trials were initiated, because observational studies did link high blood levels of a protein called homocysteine with an increased risk of cardiovascular disease. In the new study, homocysteine levels did go down by 30 percent over the course of three years in people taking folic acid and vitamin B. However, there was no related effect on the risk of cardiovascular events.
So, “the observational data was great, but the interventional studies were negative,” Lichtenstein said.
Food in the United States is routinely fortified with folic acid, because it reduces the incidence of a specific class of birth defects called neural tube defects. Folic acid is a synthetic form of folate, a B vitamin found in many fruits and vegetables.
“We have been optimistic about the role of antioxidants such as vitamin B in preventing heart disease, yet many of these large trials have shown that there is no benefit,” said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City.
It’s hard to say whether the reduction in cardiovascular disease seen in some observational trials was caused by vitamin supplementation or because “people taking the supplements have good lifestyles in general,” Steinbaum said.
It is also possible that the benefits of vitamin supplements show up only after many years, Steinbaum said. She does recommend a daily multivitamin pill. “But at this point, it is certainly hard to recommend extra supplements when we don’t have proof of benefit,” Steinbaum said. “What we can recommend is a diet with fruits and vegetables that have antioxidant vitamins in them,” she said.
Eating Well on a Downsized Food Budget
Now may be a good time to bring back the basics — the nutritious and affordable foods that have been all but forgotten by many affluent families since the Great Depression.
I’m not going to suggest a nightly diet of stone soup or the cheap fat- and sugar-rich menus of the urban poor. But many people who once gave little thought to dining on steak, lobster, asparagus, baby spinach or crème brûlée are now having to spend less on just about everything, including food.
Those who have lost jobs may be able to turn some of their unwanted spare time toward the grocery and kitchen. Others, like families with two working parents or working single parents, have to carve out time to provide economical, nourishing meals.
Not only is it possible, but it can improve the health and reduce the girth of Americans, regardless of socioeconomic status.
A Little Effort Goes a Long Way
“We need to look at real foods for real people, the foods that got us through the last depression,” said Adam Drewnowski, an epidemiologist at the University of Washington’s Center for Public Health Nutrition. “We must avoid the temptation to turn to cheap, empty calories — the refined grains, added sugars and added fats that give you the most calories you can get for your food dollar.”
Instead, Dr. Drewnowski said, “there are many foods that are affordable and nutrient-rich and not loaded with empty calories.”
And eating for good health does not have to mean eating less. “If you have equal portions of foods that are nutrient-dense, you will end up eating fewer calories,” he said.
For families accustomed to eating out and ordering in, shopping for and preparing meals can take more time. According to the Economic Research Service of the United States Department of Agriculture, low-income women who work full time spend just over 40 minutes a day on meal preparation. With a little planning, another 20 or 30 minutes can provide healthy, economical fare.
Households not accustomed to home cooking may have to make small investments in kitchen equipment and ingredients that can speed food preparation and will remain useful long after the economy improves. Even families using food stamps can afford the foods discussed below to make recipes like those posted with this column at nytimes.com/health. And no one need go hungry.
Value-Added Foods
To assess which foods provide the best value of balanced nutrients for less money, Dr. Drewnowski said, “we need to calculate nutrients per calorie and nutrients per dollar and make those foods part of the mainstream diet.”
Researchers at the State University of New York at Buffalo who studied families in a program for overweight children found that basing the family diet on low-calorie, high-nutrient foods not only improved the health of the entire family but also reduced the amount spent on food.
One myth to dispel is that fruits and vegetables must be fresh to be nutritious. Not only do canned and frozen versions usually cost less and require less preparation, but nutrient value is as good or better and less food is wasted. Fresh produce is often harvested before it is fully ripe and so comes to the consumer with fewer than optimal nutrients. But fruits and vegetables that are canned or frozen are picked at the peak of ripeness. There is more vitamin C in a glass of orange juice made from frozen concentrate than in freshly squeezed juice.
So let’s welcome back to the American table meals made from potatoes, eggs, beans, low-fat or nonfat yogurt and milk (including reconstituted powdered milk), carrots, kale or collards, onions, bananas, apples, peanut butter, almonds, lean ground beef, chicken and turkey, along with canned or frozen corn, peas, tomatoes, broccoli and fish. For nutrient-dense beverages, Dr. Drewnowski suggests 100 percent fruit juice blends and fruit-and-vegetable juice blends.
To his suggestions I would add pasta and rice (the whole-wheat kinds cost just pennies more), which can be a base for many quick, nutritious meals. Combining leftover vegetables and meat or poultry with a pot of pasta or rice takes just minutes, and has the added benefit of reducing potential waste.
For dessert, try frozen yogurt or low-fat ice cream topped with seasonal fruit for the best nutrient-to-calorie ratio and value.
Potatoes: One of the Good Guys
Some perfectly good foods have been unfairly smeared by a broad brush. Potatoes are an example, deplored by nutrition advocates for how they are most often consumed — fried and heavily salted — and by the low-carb set for their high glycemic index.
In fact, potatoes are highly versatile, they are easily prepared in many delicious ways with little or no added fat, and they are nearly always consumed with other foods, which greatly reduces their effect on blood sugar. And they are nutritious. A five-ounce potato provides just 100 calories, for which you get 35 percent of a day’s recommended vitamin C, 20 percent of the vitamin B6, 15 percent of the iodine, 10 percent each of niacin, iron and copper, and 6 percent of the protein.
Try potatoes baked, boiled or steamed and topped with low-fat yogurt or sour cream seasoned with your favorite herbs or spices.
Beans, whether prepared from scratch (soaked overnight and then cooked) or taken from a can, are a low-cost nutritional powerhouse. They are low in fat, rich sources of B vitamins and iron, and richer in protein than any other plant food. When combined in a meal with a grain like rice (preferably brown), bulgur or whole-wheat bread, the protein quality is as good as that of meat.
Cabbage, too, gives you more than your money’s worth of nutrients, including vitamin C and potassium, at only 17 calories a cup eaten shredded and raw, 29 calories a cup when cooked. Collards are high in vitamins A and C, potassium, calcium (cup for cup, on a par with milk), iron, niacin and protein, and yet low in sodium and calories. Kale has only 43 calories a cup when cooked.
In the fruit category, it’s hard to beat apples for year-round, economical, nutritious and versatile fare that can be a part of any meal or served as a snack or dessert (as in baked apples). Bananas are also handy; even when overripe, they can be mashed and used to make banana bread or a smoothie.
Here are some other tips for busy cooks concerned about nutrition and cost:
¶Buy family-size packages of meat or poultry; divide them up and freeze meal-size portions, labeled and dated.
¶Choose the less expensive store brands of canned and frozen produce.
¶Use powdered reconstituted milk for cooking.
¶Cook in batches, enough for two or more meals, and freeze single portions for lunch.
¶Use meat, poultry and fish as a condiment, in small amounts added to main-dish salads, soups and sauces.
¶Try main-dish soups and salad for filling yet low-calorie meals. Soups can also be made in large amounts and frozen.
¶Consider buying a slow cooker for efficient, one-dish meals.
By JANE E. BRODY (NY Times)