A mixed bag of supplement studies

Multivitamins for memoryYou know I love a good multivitamin clinical trial—my bias is well-known. That is why the results of the COSMOS (COcoa Supplement and Multivitamin Outcomes Study) caught my eye.1 This study was part of a larger trial that followed over 21,000 adults over 60 years old for two years. Subjects either received placebo or cacao extract (500mg flavanols) and/or multivitamin with the intention of monitoring their effects on cardiovascular disease and cancer prevention. Apparently the cacao part of the trial didn’t go so well. But the sub category of patients who had taken multivitamins and who completed neuropsychological assessments showed some benefit. Those who took a multivitamin for two years experienced significant improvements in episodic memory and global cognition. The authors felt this favourable change in memory scores was equivalent to reducing cognitive aging by two years.So should you recommend that your patients who are concerned about their memory take a multivitamin? This study suggests that long-term use can provide some benefits. I also use the argument that you spend about $2 per day on maintaining your car that you use for about an hour a day and trade in after 10 years; is it worth investing 20 cents daily on a multivitamin to help your body that you will have forever. . ..Can probiotics help with food allergies?Again with the idea that there is nothing probiotics and increased dietary fiber can’t help with health-wise. This review article details the theory that gut microflora can assist with food allergies (FA).3 The premise is simple. One's intestinal barrier prevents absorption of harmful allergenic food substances.4 This intestinal barrier consists of both your own intestinal cells as well as a layer of mucus proteins. Within these layers are the expected digestive enzymes, microbiota and immune system cells. The usual suspects can disrupt this healthy barrier: diet, cirrhosis, IBD, alcohol consumption and diets high in saturated fats. However, what caught my eye was the evidence that shows that a diet low in fiber leads to microbiota feeding on intestinal mucus proteins leading to increased gut permeability.5 Also when microbiota ferment prebiotics they produce short chain fatty acids (SCFA). And these SCFA are associated with integrity of the intestinal barrier and reduction in FA reactions. This sounds promising, but the evidence is mostly from in vitro and animal models. So what should you tell patients with severe FA? Should they take probiotics? There is evidence to suggest that this could be, in theory, an effective option, and there is little harm in it. The suggestion that prebiotics might help is promising. While there are dietary sources of prebiotics (Fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), etc) they might be difficult to find in large enough quantities in the diet of be effective.6 But increasing one’s intake of dietary fiber from fruits and veggies could help your microbiota maintain the intestinal mucus layer.Read: Pharmacy techs could play a larger role in safe use of complementary medicines Magnesium associated with long-term survival of heart attack patientsMagnesium is perhaps the most overlooked macromineral. We all focus on getting enough calcium, but perhaps we should focus some attention on magnesium. This cohort study followed over 4500 patients who experienced a non-ST-elevation myocardial infarction (NSTEMI) over 4 years.7 What the researchers found was that those patients that had lower serum magnesium levels had a 24% increased risk of death compared to patients that had higher serum magnesium levels. These results were independent of other comorbidities (sex, diabetes, hypertension, etc.) There were several reasons why this may occur. Low magnesium is associated with inhibition of nitric oxide release (a vasodilator and inhibitor of platelet aggregation.) Magnesium also antagonizes the effects of calcium, and promotes vascular relaxation, blood pressure reduction and has antiarrhythmic properties. What I also found interesting was that there is no international consensus on normal serum magnesium levels.8I generally recommend my calcium-taking patients to take it along with magnesium, if only to reduce the constipation side effects of calcium. Another big question about magnesium and concurrent calcium absorption: does calcium affect magnesium absorption? There are mixed results on this subject; some evidence shows no effect,9 while other evidence suggests that it does.10 I always recommend that the best vitamin supplements is the one that you remember to take. Take calcium and magnesium together if that will ensure adherence. Also, some magnesium is absorbed passively. Read: Which type of magnesium is best?Portuguese and Brazilian esports players have unhealthy dietary habits11I’m sorry about reviewing this article; it has very little to do with pharmacy practice. However, I highly recommend everyone read it—it’s full of quick and easy dietary advice. If you don’t know what some of the terms are (Twitch, FPS, Counter-Strike or Valorant) ask a younger colleague. I had to Google some of the terms myself. Not surprisingly, esports athletes' dietary habits were not optimal—lower intake of fruits and vegetables, higher in processed and salty foods with a higher intake of caffeine than a reference population. What was interesting was that the top three supplements these players took were whey protein, creatine and a multivitamin (30%). I was also impressed by the volume of references highlighting the data on the health of esports players. If nothing else, parents with young male children (91.4%)of respondents were male) should be aware of what external influences might impact their lives. REFERENCESVyas CM, Manson JE, Sesso HD, Cook NR, Rist PM, Weinberg A, Moorthy MV, Baker LD, Espeland MA, Yeung LK, Brickman AM, Okereke OI. Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS. Am J Clin Nutr. 2024 Jan 18:S0002-9165(23)66342-7. doi: 10.1016/j.ajcnut.2023.12.011. Epub ahead of print. PMID: 38244989.Poto, R.; Fusco, W.; Rinninella, E.; Cintoni, M.; Kaitsas, F.; Raoul, P.; Caruso, C.; Mele, M.C.; Varricchi, G.; Gasbarrini, A.; et al. The Role of Gut Microbiota and Leaky Gut in the Pathogenesis of Food Allergy. Nutrients 2024, 16, 92. https://doi.org/10.3390/nu16010092Poto, R.; Fusco, W.; Rinninella, E.; Cintoni, M.; Kaitsas, F.; Raoul, P.; Caruso, C.; Mele, M.C.; Varricchi, G.; Gasbarrini, A.; et al. The Role of Gut Microbiota and Leaky Gut in the Pathogenesis of Food Allergy. Nutrients 2024, 16, 92. https://doi.org/10.3390/nu16010092 Vancamelbeke, M., & Vermeire, S. (2017). The intestinal barrier: a fundamental role in health and disease. Expert Review of Gastroenterology & Hepatology, 11(9), 821–834. https://doi.org/10.1080/17474124.2017.1343143Desai, Mahesh S., et al. "A dietary fiber-deprived gut microbiota degrades the colonic mucus barrier and enhances pathogen susceptibility." Cell 167.5 (2016): 1339-1353.Davani-Davari D, Negahdaripour M, Karimzadeh I, Seifan M, Mohkam M, Masoumi SJ, Berenjian A, Ghasemi Y. Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications. Foods. 2019 Mar 9;8(3):92. doi: 10.3390/foods8030092. PMID: 30857316; PMCID: PMC6463098.Segev, A.; Shechter, M.; Tsur, A.M.; Belkin, D.; Cohen, H.; Sharon, A.; Morag, N.K.; Grossman, E.; Maor, E. Serum Magnesium Is Associated with Long-Term Survival of Non-ST-Elevation Myocardial Infarction Patients. Nutrients 2023, 15, 4299. https://doi.org/10.3390/nu15194299Rosanoff, A.; West, C.; Elin, R.J.; Micke, O.; Baniasadi, S.; Barbagallo, M.; Campbell, E.; Cheng, F.-C.; Costello, R.B.; Gamboa-Gomez, C.; et al. Recommendation on an updated standardization of serum magnesium reference ranges. Eur. J. Nutr. 2022, 61, 3697–3706Food and Nutrition Board, Institute of Medicine. Magnesium. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, D.C.: National Academy Press; 1997:190-249Hardwick LL, Jones MR, Brautbar N, Lee DB. Magnesium absorption: mechanisms and the influence of vitamin D, calcium and phosphate. J Nutr. 1991;121:13–23.Ribeiro, F.J.; Teixeira, R.; Poínhos, R. Dietary Habits and Gaming Behaviors of Portuguese and Brazilian Esports Players. Nutrients 2023, 15, 4200. https://doi.org/10.3390/nu15194200

Complementary Medicine

A mixed bag of supplement studies

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Ian Lloyd

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