Texas Family Medicine January 2023 Blog

Vitamin Supplement

A lot of our patients take vitamins for health reasons. They also have questions about them.

Can they prevent heart disease?

Can they help with osteoporosis (thinning of the bones)?

Let’s look at these two questions.

Preventing heart disease

Cardiovascular disease (CVD) is the number one cause of death in the United States. It's no wonder we are always looking for ways to prevent CVD!

Proven contributing factors are elevated cholesterol, hypertension, diabetes, obesity, inactivity, smoking, kidney disease, family history, and age. Addressing these risk factors (except age which we don’t have any control over) is the best way to prevent CVD.

Excitement grew when a 2019 landmark study published in the New England Journal of Medicine found that beta-carotene supplementation might confer protection against heart attack. These results surprised the scientific community because all previous beta-carotene studies showed no benefit.

But the 2019 study quickly lost its luster. Scientific review of the study found that there were some flaws in it and in 2022 the U.S. Preventive Task Force recomended against using beta-carotene for CVD protection. Most clinicians pay very close attention to the U.S. Preventive Task Force since we can count on them to allow the data to drive their recommendations.

Older studies that looked at vitamin E and omega-3 fatty acids like fish oil tablets also showed no CVD protection benefit.

Preventing fractures in patients with osteoporosis.

A lot of our patients take vitamin D supplements and we physicians often check a blood test to screen our patients for vitamin D deficiency. Historically, we have urged our patients to take Vitamin D3 in order to prevent deficiency and fractures.

If we are going to follow the data, though, we should stop pressing our patients to take vitamin D supplements. Recent studies looking at vitamin D supplementation showed no benefit in patients with osteoporosis (thin bones and at risk for fracture). That is a bummer. If your vitamin D level is low, you should probably take vitamin D3, maybe 2,000 units a day. But doing so won’t protect you from a fracture.

It is possible to hurt yourself with vitamin D. Vitamin D hypervitaminosis causes mental confusion, dehydration and some skin changes. Be careful when taking supplements for vitamins A, D, E, and K which can amass in your system if you take too much.

The only way to protect against fractures in adults is to stay active, ask your physician to send you to physical therapy if you are having balance issues or have fallen, and take one of the several medications that are proven to prevent fractures.

There are oral medications such as alendronate and raloxifene that prevent fractures. Alendronate pushes the cells in our bones to reproduce and, like a street construction crew, pave our bones with more calcium and bone cells. Raloxifene works like estrogen in stimulating the bones to remain strong.

Injectable and infusion medications like Prolia and Zometa are more powerful than the oral medications and reserved for patients who fail the oral medications.

If you are a woman over 65 you should have a bone density exam every 2-3 years to screen for osteoporosis.

Overall Recommendation

I rarely recommend vitamin supplementation for my patients. So long as you are eating a balanced diet you shouldn’t experience a vitamin deficiency. And so far the studies show that no vitamins successfully prevent CVD or fractures in patients with osteoporosis.

The exceptions for vitamin supplementation are in patients who have an unusual medical problem that prevents their GI system from absorbing vitamin B12. Also, patients who regularly drink too much alcohol are unable to absorb folate and vitamin B12 and require supplementation.

Dr. Brian Byrd