Category: Cardiovascular

Vitamin B12 And Folic Acid Reduce The Risk Of Blood Clots In The Brain

Claus Hancke

October 31, 2005

After Americans enriched their diet with folic acid in 1996, the frequency of blood clots in the brain was reduced by 15%. Now research shows that added supplementation of Vitamin B12 will markedly lower this risk even further.

Immediately, it sounds simple: People with high levels of the amino acid homocysteine in the blood have an increased risk of blood clots in the brain and in the heart. You also know that you can lower homocysteine with folic acid and, to a lesser extent, with B6 and B12 vitamins. When the Americans began to enrich cereal products with folic acid from 1996, both the average American’s homocysteine and the rate of blood clot in the brain decreased by about 15% in three years.

“The money fits”, and then the result is almost obvious in advance, if you want to conduct a lottery experiment, where every other participant gets folic acid, B6 and B12 vitamins. Of course, they get fewer blood clots in the brain.

But the reality is more varied. In Norway, such an experiment (NORVIT) was conducted with 3,750 patients who had just survived a blood clot in the heart. For 3.5 years, they were supplemented with either folic acid (0.8 mg), vitamin B6 (40 mg), both or blind tablets (placebo). Among those who only received folic acid, mortality decreased approx. 10%, but not statistically certain. But in the other two groups the death tolls were increased, not statistically certain either.

Perhaps it is too late to start taking supplements when you are already severely calcified. Or, as will appear, perhaps it was more decisive that the Norwegians “forgot” to give the participants vitamin B12.

An experiment has also been carried out in the USA (VISP). It was with people who had recovered from a blood clot in the brain, but had an increased risk of a new one. Admittedly, the Americans did not initially find any effect either. Supplementation of folic acid (2.5 mg), vitamin B6 (25 mg) and vitamin B12 (0.4 mg) did not reduce or improve mortality or risk of blood clots in the brain. Therefore, the experiment was simply stopped after two years. It was useless, they thought.

B12 is useful if it is absorbed
A close explanation could be the aforementioned enrichment of cereal products with folic acid. After all, the average homocysteine had already fallen by approx. 15% in the Americans. During the trial, it only dropped a further 2%.

But the Americans have since studied the numbers more closely. In doing so, they discovered one important source of error in particular: Many of the 3,680 elderly participants had reduced absorption of vitamin B12 from the gut and therefore had relatively little B12 in their blood (less than 250 pmol/l). This is often seen in the elderly, and it is now known that these elderly need supplements of at least 1,000 micrograms of vitamin B12 per day. But the participants had only received 400.

What would it look like if you now disregarded these participants and concentrated on those with normal B12 uptake? It was decided to investigate. At the same time, participants with reduced kidney function were disregarded, as they also respond sluggishly to these supplements. Finally, participants who were previously receiving medical treatment with B12 were naturally disregarded.

There remained 2,155 people who had no problems absorbing B12. In this large group, the supplements both lowered homocysteine further and reduced the overall risk of death, blood clot in the heart or blood clot in the brain – by 21%! The treatment helped anyway; even a lot when the ability to absorb B12 was intact.

As stated, it appears that the fortification of cereal products with folic acid has reduced the Americans’ risk of blood clots in the brain by approx. 15%. Now it seems that a solid supplement of vitamin B12 on top of that can reduce it significantly more – but the many elderly people, who absorb vitamin B12 poorly, presumably need larger supplements.

This is the result at the moment. It must be verified before it is approved. But the indications are there.

By: Vitality Council

References:
1. Toole JF, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA. 2004 Feb 4;291(5):565-75.
2. Bonaa KH. NORVIT: Randomized trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. Program and Abstracts from the European Society of Cardiology Congress 2005; September 3-7, 2005; Stockholm, Sweden. Hot Line II. Iflg. Linda Brooks. NORVIT: The norwegian vitamin trial. Medscape sept. 2005. (Ikke publiceret i trykt medie)
3. Spence DJ et al. Vitamin intervention for stroke prevention trial. An efficacy analysis. Stroke 2005;36:2404-2409.

jama.ama-assn.org
www.medscape.com
stroke.ahajournals.org
www.iom.dk

You Must Plug The Hole Before The Boat Sinks

Claus Hancke

October 11, 2005

A Norwegian study has shown that if you have already experienced an acute myocardial infarction, the risk of another such infarction will not be reduced by taking folic acid, Vitamin B6, and Vitamin B12, even if homocysteine levels are lowered thereby.
If you get a great deal of folic acid, the blood content of the amino acid homocysteine will be relatively low. So much is certain. When the content is low, the risk of blood clots in the heart or brain hemorrrhage – other things being equal – is also low. It is also safe, but both are statistics only.

With these facts in the bag, one is tempted to think that supplementation with folic acid must be a good idea. As you know, folic acid is the B vitamin that young women should take to avoid having children with spina bifida. One can agree with the American Heart Association, which advises everyone to get 0.4 mg of folic acid a day, the same dose that women should take as a supplement.

In Tromsø in Norway, the so-called NORVIT trial (Norwegian Vitamin Trial) was the first to test whether supplements also help heart patients who have already had a blood clot in the heart. If the media is to be believed, it ended with a scare.

The results, which were presented in September at this year’s congress of the European Society of Cardiology (ESC), led directly to warnings against folic acid in the press: B vitamins could be dangerous for heart patients, it said, and our own Danish heart association was quick to announce, that folic acid is “still” not recommended for heart patients – even though the month before was said something close to the opposite.

But, as is so often the case, the reports were misleading. Strictly speaking, the Norwegian trial did not show that folic acid is dangerous. If you want to argue that it showed anything at all, it was that the risk of heart attack, stroke, or death decreased—albeit by only a few percent—in those who took 0.8 milligrams of folic acid a day for 3.5 years . However, this was not statistically certain.

The fact is that there were in fact not one, but three trials, with a total of 3,750 people, all of whom had had blood clots in the heart. One showed that a combination of folic acid, vitamin B6 and B12 led to approx. 20% more cases of blood clots in the heart than placebo (cheat pills). The second – the only one where only folic acid was used – showed no difference in reality. There was also no difference in the third trial, where the participants only received vitamin B6.

In one area, the experiments turned out to be successful: those who received folic acid achieved a drop in the blood homocysteine content of approx. 30%. Enough so that one could hope for a nice drop in the number of new blood clots. Which did not appear.

But the questions arise: Is it appropriate for heart patients to be careful about taking folic acid, vitamin B6 and vitamin B12 at the same time?
Or are we talking about completely different anatomical conditions with secondary prophylaxis than there are with primary prophylaxis? After all, you have had a blood clot.

Also at the congress, the ESC’s designated commentator, Ian Graham, doubted the result. He believed that the experiment might have been too small and too complicated to be credible.

One can go a step further and think that the result is purely due to chance. In any case, it is not supported by any theory.
It is more likely that folic acid is simply not suitable for preventing blood clots in severely arteriosclerotic patients. – In other words secondary prophylaxis.

There is a lot of evidence that folic acid – and low homocysteine – slows the development of atherosclerosis in healthy people – i.e. primary prophylaxis. But the usefulness of this function diminishes when the calcification is already very advanced. The bottom plug must be inserted before the boat is sunk.

If folic acid is to prevent blood clots, you probably have to start in good time. On the other hand, the vitamin has other benefits. Among other things. experiments convincingly indicate that it helps to keep the brain young, even in the elderly.

By: Vitality Council

Reference:
Bonaa KH. NORVIT: Randomized trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. Program and Abstracts from the European Society of Cardiology Congress 2005; September 3-7, 2005; Stockholm, Sweden. Hot Line II. Iflg. Linda Brooks. NORVIT: The Norwegian vitamin trial. Medscape Sept. 2005. (Not published in a printed media).

www.medscape.com/viewprogram/4494_pnt
www.iom.dk

Antioxidants Halve The Damage Of Brain Hemorrhage

Claus Hancke

October 6, 2005

Countless animal studies have shown that the brain injury following a brain hemorrhage can be reduced dramatically with antioxidants. Several clinical human studies are now being conducted.
Next to heart disease and cancer, brain hemorrhage is the most common cause of death in Western countries. Among those who survive, many will face severe difficulties in the years ahead with chronic brain injuries and paralysis. But more and more people will experience a brain hemorrhage because of an increasing number of old people.

Can this gloomy perspective be mitigated? Numerous trials have shown that antioxidants can both prevent brain hemorrhage and reduce subsequent brain injury if the accident nevertheless occurs. This fascinating topic has just been elucidated in a robust overview of researchers from the pharmacological laboratory at the Rene Descartes University in Paris.

Contrary to popular belief, a brain hemorrhage is rarely a hemorrhage. It is far more often a blood clot, which either forms on the inside of one of the brain’s large arteries – in the same way as a blood clot in the heart – or is supplied with the blood. Regardless of the language confusion, the result is the same: parts of the brain on the blocked side get no oxygen and perish, while the victim becomes more or less paralyzed on the opposite side.

This is where the antioxidants come in. They fight free oxygen radicals, which are responsible for the majority of brain damage. The free radicals are formed during a lack of oxygen, but paradoxically, it is not an absolute advantage when the organism breaks down the blood clot itself – or when it is broken down medically, which can more or less be done up to three hours after the first symptoms. The renewed blood supply – this is called reperfusion – unfortunately leads to a massive production of free radicals – and thus further brain damage.
Regardless of whether the blood supply resumes or not, things can go wrong.

Why do these free radicals occur in tissues that do not receive blood or that have only temporarily been lacking blood? The article reviews the possibilities. Certain enzymes e.g, which normally inactivate free radicals, stop functioning. In addition, the weakening of the mitochondria – the energy factories of the cells i.a. – play a role. It is the mitochondria that process the oxygen, and when they weaken, the free (oxygen) radicals leak. It has been proven that the more free radicals are formed, the worse the brain damage.

It is therefore logical to believe that antioxidants can limit the damage. This is also true of a large number of experiments on animals. Here, damage has been reduced by more than 50% by pre-treating the animals with antioxidants such as NAC (n-acetyl-cysteine), resveratrol (the colorant in red wine), lipoic acid (a beneficial and harmless food supplement that is banned in Denmark) or melatonin ( also beneficial, harmless and forbidden for Danes).

With vitamin E, it has also been possible to halve the damage – or more. Of course, it worked best when the treatment was started quickly. Quick help is double help.

There are now several clinical trials on humans, but the difficulty is that you cannot predict when or if a person will have a brain haemorrhage. In the trials, the treatment is only started when the brain haemorrhage has occurred. There are no reliable results yet, and the antioxidants that are tested are unfortunately synthetic substances, which can be patented (and later sold as expensive drugs): Tirilazad, Ebselen, Edavaron and NXY-059. Edavaron is recognized as a treatment in Japan.

What can ordinary people do? The review concludes that antioxidants are “certainly some of the most promising agents against cerebral hemorrhage” and that they are of “great interest” in combination with the medical breakdown of blood clots used today.
You have to choose yourself. But it is worth noting that a solid intake of antioxidants seems to be able to prevent – perhaps tragic – consequences of a brain haemorrhage.

By: Vitality Council

Reference:
Isabelle Margaill et al. Antioxidant strategies in the treatment of stroke. Free Radical Biology and Medicine 2005;39:429-43.

Vitamin K against osteoarthritis and atherosclerosis

Admin

August 22, 2005

Researchers recommend Vitamin K supplementation. The need for this vitamin may be even greater than was previously supposed. Vitamin K deficiency leads to weaker bones and calcification of the arteries and vitamin K supplementation will both treat and prevent these problems.

Vitamin K “should be strongly considered as a dietary supplement” for women after menopause and for diabetics, groups which have high risks of developing both osteoarthritis and atherosclerosis. The vitamin is very non toxic and seems to be able to combat these ailments.

This is the very uncompromising conclusion put forth in a new scientific summary of vitamin K which has been published in the American Journal of Health-System Pharmacy, which is a serious but lesser known professional journal.

In spite of this journals lack of prominence, it’s very direct message regarding vitamin K will spread throughout the world. It was quickly published in its entirety by www.medscape.com the worlds largest website for doctors. Medscape has millions of readers worldwide.

Vitamin K is found almost exclusively in green vegetables. It is practically nonexistent in other foodstuffs. It was previously believed that the bacteria in our intestines hold us well supplied with the vitamin. This is not the case!

It is officially recommended (in the USA) that one has an intake of no less than 100 micrograms vitamin K daily, corresponding to about 75 grams green salad, spinach, etc. This is supposedly enough for the blood to coagulate properly.

But according to the article ensuring proper coagulation is far from enough. The vitamin is just as important for bones and arteries, and its optimal effect requires much more than officially recommended. In studies with vitamin K1, 10 times the official recommendation (10,000 micrograms) is typically used. This can be done worry free, there are no side effects. No effects have been reported, even when 45,000 micrograms K2 was used per day, 400-500 times recommended, for up to many years.

Vitamin K is responsible for making certain proteins able to bind to calcium. This occurs by the vitamin attaching mild acids (carboxyl groups) to the protein enabling it, like a type of crane, to pick up and move calcium to where it is needed. The protein which has this effect in bones is called osteocalcin and is produced with the aid of vitamin D. With the help of a weak acid osterocalcin can pick up calcium from the blood and place it in the bones. Vitamin K has long been used in Japan to counteract osteoarthritis.

In clogged arteries, for example the coronary arteries, the opposite occurs. It is believed that vitamin K counteracts the depositing of calcium in these vessels by adding a certain protein to the same acids. If the protein is missing or damaged and inaccessible to the acid, the blood vessel clogs quickly. This has been shown in animal studies. Normally the “crane” removes calcium from the arteries so they do not become clogged.

That there is a protein which prevents atherosclerosis and that vitamin K is necessary for its production is a very revolutionary theory. The theory is supported by Dutch research. In a three year long randomised study on older women, half received a daily dose of 1,000 micrograms vitamin K while the rest unknowingly received placebo.

The stiffness of the women’s carotid arteries was measured before and after the three years as a measure for the degree of arthrosclerosis. After the three year period this was unchanged in the women who received the vitamin K whereas nature had marched on in the rest of the women. Their arteries became 8% stiffer.

The strange phenomenon where calcium disappears from the bones and is accumulated in the arteries with age is called the “calcification paradox.” Aging phenomena are without a doubt a part of the explanation, but vitamin K deficiency is probably also contributory. It is without a doubt important to consider this paradox.

Important
If you receive strong blood thinning medicine such as Marevan, you should unfortunately avoid vitamin K supplements. Any such supplement can counteract your treatment and be life threatening.

By: Vitality Council

References:
1. Adams J, Pepping J. Vitamin K in the treatment and prevention of osteoporosis and arterial calcification. Am J Health-Syst Pharm 2005;62:1574-81.
2. Braam LA et al. Beneficial effects of vitamin D and K on the elastic properties of the vessel wall in postmenopausal women: A follow up study. J Thromb Haemosta. 2004;91:373-80.

www.ajhp.org
www.blackwellpublishing.com/journal.asp
www.iom.dk

Vitamin E Protects Against Blood Clots And Brain Haemorrhages

Admin

August 9, 2005

Healthy women over 65 can lower their risk of serious consequences of arthrosclerosis by 25 %. This is confirmed by the world’s longest study of vitamin E, so far.

In 1997 44 % of all American cardiologists regularly used antioxidants, especially vitamin E, to prevent coronary thrombosis and strokes. The confidence in vitamin E was so strong that it surpassed the confidence in aspirin, which was only used by 42 %.

The cardiologists relied on the universal theory that arthrosclerosis arises when cholesterol is oxidized and that vitamin E, amongst other things, prevents this oxidization. Unfortunately solid evidence that vitamin E truly protects against arthrosclerosis, and thereby prevents thromboses, has been lacking. Large randomized studies have been disappointing, but also encumbered by obvious faults. Everything is shrouded in doubt. But if the doctors have stopped using vitamin E in disappointment, maybe they will begin using it again now.

The occasion is the largest and longest randomized study up until now with vitamin E. It showed that when healthy women over 65 received vitamin E as a supplement, their risk of suffering a coronary thrombosis or a stroke decreased by 26 %. And not only was the incidence lowered, the diseases also became less dangerous. The total mortality rate was approximately halved (to 51 %).

Other studies of vitamin E have been relatively short, and have had participants who suffered from serious arthrosclerosis. However this study lasted ten years, and the participants were healthy. Exactly because they did not suffer seriously from arthrosclerosis from the beginning, it was hoped that it was not too late to prevent it. A total of 20,000 women received 600 units of natural vitamin E (alpha-tokoferol) every other day for ten years. Just as many other women were given a placebo (fake pills).

The women who were over 65 benefited. However, the large majority was younger than 65. They had no obvious benefits from the treatment. 18,000 women under 65 received vitamin E. 352 of these suffered a coronary thrombosis or a stroke, some with a fatal outcome. That number was eleven higher than amongst the 18,000 who received placebos. A small and random difference. Apparently vitamin E did not benefit the younger women.

For comparison only 2 times 2000 women over 65 participated. In the group receiving vitamin E, there were 130 cases of either cardiac thrombosis or stroke. In the placebo group there were 46 cases more. This difference is relatively large, and statistically quite certain.

But why does vitamin E not benefit the younger? The obvious answer is that maybe it does, but younger women more seldom suffer cardiac thrombosis, and the potential effect is difficult to measure. In the course of the ten years the study ran, less than two percent of those under 65 suffered a cardiac thrombosis or a stroke. Those older, of course had a bigger risk (about eight percent). One can speculate that despite the neutral numbers, the younger group did in fact become less atherosclerotic because of the vitamin E supplement. No one knows, since a direct measurement of the blood vessels was not conducted. The only measurement for the degree of arthrosclerosis was the rough numbers for cardiac thrombosis and stroke.

If seen under the same light, statistically there was only tendency towards benefit from vitamin E. It is a natural consequence of the fact that there were nine times as many young participants, as there were older. The researchers did however choose to conclude on the basis of this result. They believe that the study does not warrant a general recommendation of vitamin E for the prevention of cardio-vascular disease. With regards to those over 65, it is being said that the result deviates from “the total knowledge” and should be investigated further.

This is a somewhat weak comment. A more direct comment came from Maret Taber who is professor at the Linus Pauling Institute in California and one of the World’s leading vitamin E experts:

“Vitamin E has its clear value in the fight against cardiac disease and other degenerative sufferings. It is most important for smokers, persons suffering from hypertension and those who eat an unhealthy diet.”

By: Vitality Council

Reference:
Lee, I-Min. Vitamin E in the primary prevention of cardiovascular disease
and cancer. The Womens Health Study: A randomized controlled trial. JAMA
2005;294:56-65.

jama.ama-assn.org
www.iom.dk

Cholesterol reducing pills: Do they have a downside?

Admin

August 3, 2005

Medications taken against cholesterol may prolong life in the event of arteriosclerosis and perhaps even heart failure. However, new figures seem to indicate that many patients get serious side effects from taking such medications, which side effects could have been avoided had they also taken Co-enzyme Q10.

Millions of people worldwide use cholesterol reducing medicine in the form of statins. These people most often have clogged coronary arteries and the statins are used to protect them against further atherosclerosis, blood clots, and strokes. They work, but to a lesser degree than many people think.

If they are given to one hundred 40-80 year old people who are at high risk due to atherosclerosis or diabetes, they prevent about one coronary blood clot or one stroke per year. In the course of five years, about two deaths are avoided.

Many of the treated meanwhile develop heart failure, which is reduced pump function of the heart, because atherosclerosis damages the heart muscle permanently. They begin to complain of tiredness and increasing shortness of breath.

Is it risky to take cholesterol lowering pills in this situation? There can be debated. The debate is due to the way that the medicine works. It blocks the livers production of mevalonic acid, which is necessary for the production of cholesterol, but it also blocks the production of vital Q10! Not only does the blood’s cholesterol level fall, but also the bloods Q10 level.

Because Q10 is necessary for the tissues to create energy it is easy to imagine that a heart muscle which is weakened by heart failure, is further weakened when Q10 is removed.

Apparently statins work anyway. Statins are believed to lengthen life in heart failure. Not because they lower cholesterol, which may actually be damaging when suffering from heart failure, but because statins have other effects than reducing cholesterol. They are antioxidants and counteract inflammation. In addition they promote the creation of new blood vessels in the heart. None of these effects have anything to do with cholesterol.

Maybe the positive effects of statins outweigh the dramatic Q10 loss that they cause. Nonetheless, it is hard to believe that this loss is completely harmless, especially with heart failure.

The American cardiologist P.H. Langsjoen is one of those who warn that we find ourselves in an epidemic of heart failure with unclear reasons and who believe that statins could be one of the reasons.

At a congress in Los Angeles he put forth data which indicates previously unrecognised side effects. Two thirds of 51 newly referred statin treated patients complained of muscle pain, more than 80% were abnormally tired, and almost 60% had shortness of breath. When they stopped using statins and instead received Q10 (240 mg/day), most became symptom free.

At the same congress a randomised trial showed that muscle pain and tiredness was present in one out of every ten on those treated with statins, but disappeared when they took Q10 (100 mg/day). Just as important, more than half experienced an improved quality of life and many showed improved heart function.

Pills against cholesterol lengthen life, but it is necessary to take Q10 if quality of life also increases so that a longer life is a life worth living.

By: Vitality Council

References:
1. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: A randomised placebo-controlled trial. Lancet 2002;360:7-22.
2. Langsjoen PH et al. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors. 2003;18(1-4):101-11.
3. Liao JK. Statin therapy for cardiac hypertrophy and heart failure. J Investig Med. 2004 May;52(4):248-53.
4. Bandolier. Statins in heart faikure. http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/statHF.html
5. Fourth Conference of the International Coenzyme Q10 Association. Los Angeles April 14-17 2005.

www.thelancet.com
www.iospress.nl/html/09516433.php
journalseek.net/cgi-bin/journalseek/journalsearch.cgi
www.jr2.ox.ac.uk/bandolier/booth/cardiac/statHF.html
www.coenzymeq10.it/home.html
www.iom.dk

Carnitine, a Stimulant for Heart, Brain, and Muscles

Claus Hancke

May 9, 2005

Carnitine creates energy in aged cells. The message from a new scientific congress is that supplementation of carnitine seems to help against both heart disease, arteriosclerosis, and dementia.

Are your memory failing or are you loosing strength, then perhaps carnitine is the remedy for rescue

Carnitine is an – undeservedly – overlooked dietary supplement that is on its way into the ‘scientific warmth’. A clear signal is that the New York Academy of Sciences dedicate a whole volume of its famous scientific annals to carnitine alone.

Here you can read more than 197 pages from all 18 contributions given at a two-day conference on carnitine held by the academy in March 2004. The contributions are, among other things, about the importance of carnitine for the burning of fat, for the functioning of the muscles and the heart and about its promising role in the fight against a weakened memory.

………………………

By: Vitality Council

Reference:
Salvatore Alesci et al. (Eds.). Carnitine: The Science behind a Conditionally Essential Nutrient. Annals of The New York Academy of Sciences 2005, vol. 1033.

www.annalsnyas.org
www.iom.dk

Fish Oil Prevents Stroke

Claus Hancke

April 25, 2005

Many believe that fish oil protects against stroke, but French researchers have now discovered how this works. Fish oil helps the brain to better cope with a reduced blood supply.

Fish oil must be close to being the world’s best medicine. If you get fatty fish two to three times a week, you protect yourself against suddenly suffering cardiac arrest. The risk is halved. But also the risk of a blood clot in the brain – by far the most frequent cause of so-called cerebral hemorrhage – and thus suffering a stroke, decreases. According to the largest, but not final study, so far, it is reduced by 40%.

It is consistent with animal research. Mice that are artificially exposed to a blood clot in the brain get less extensive brain damage if they in advance are fed with fish oil. Now French scientists have proven a mechanism that might explain this phenomenon.

Scientists from France’s National Science Research Center, CNRS, are behind the discovery. They have shown that the protection of the brain cells is due to the effect of fish oil on the cell’s potassium channels.

…………………………

By: Vitality Council

References:
1. Heurteaux, C et al. TREK-1, a K(+) channel involved inneuroprotection and generaql anesthesia. EMBO J. 2004, E-pub 2004, June 03.
2. Lauritzen, I et al. Polyunsaturated fatty acids are potent neuroprotectors. EMBO J 2000;19:1784-93.
3. Ka He et al. Fish consumption and risk of stroke in men. JAMA 2002;288:3130-6.
4. Salachas, A., et al. Effects of low-dose fish oil concentrate on angina, exercise tolerance time, serum triglycerides, and platelet function. Angiology, Vol. 45, December 1994, pp. 1023-31.

embojournal.npgjournals.com
jama.ama-assn.org
www.springerlink.com
www.iom.dk

Folic Acid Lowers Blood Pressure and Prevents Blood Clots

Claus Hancke

April 19, 2005

While folic acid lowers blood pressure, the dose must be large enough to have this effect. Diet alone will not provide a significantly large enough dose, so it is essential to take folic acid as a supplement. The vitamin also simultaneously protects the heart and brain against blood clots.

It has long been documented that the B vitamin, folic acid, prevents the birth defect Spina bifida. For eight years, Canada has fortified all flour with folic acid and has thus prevented 80% of these sad cases. Enrichment is also required in the United States, but in Denmark, expectant mothers must manage on their own. It’s their own problem to find out to take a supplement – before they get pregnant!

By: Vitality Council

References:
1. Forman JP, Rimm EB, Stampfer MJ, Curhan GC. Folate intake and the risk of incident hypertension among US women. JAMA. 2005 Jan 19;293(3):320-9.
2. American Heart Association’s 44th annual Conference on Cardiovascular Disease Epidemiology and Prevention. carole.bullock@heart.org
3. Endres M, Ahmadi M, Kruman I, Biniszkiewicz D, Meisel A, Gertz K. Folate deficiency increases postischemic brain injury. Stroke. 2005 Feb;36(2):321-5. Epub 2004 Dec 29.
4. Taivani A et al. Folate and vitamin B6 intake and risk of acute myocardial infarct in Italy. Eur J Clin Nutr 2004;58:1266-72.
5. Al-Delaimy WK, Rexrode KM, Hu FB, Albert CM, Stampfer MJ, Willett WC, Manson JE. Folate intake and risk of stroke among women. Stroke. 2004 Jun;35(6):1259-63.
6. Casas JP et al. Homocysteine and stroke: Evidence on a causal link from mendelian randomisation. The Lancet 2005;365: 224-32.
7. Klerk M, Verhoef P, Clarke R, Blom HJ, Kok FJ, Schouten EG; MTHFR Studies Collaboration Group. MTHFR 677C– T polymorphism and risk of coronary heart disease: a meta-analysis. JAMA. 2002 Oct 23-30;288(16):2023-31.
8. S Schwammenthal et al. Homocysteine, B-vitamin supplementation, and stroke prevention. From observational to interventional trials. Lancet Neurol. 2004;3(8):493.

jama.ama-assn.org
www.nature.com
www.stroke.org
www.thelancet.com
www.iom.dk

Fried Herrings – Are They Really Good For The Heart?

Claus Hancke

March 15, 2005

An American study says that you can avoid heart flutter (atrial fibrillation) by eating fatty fish. Danish researchers have come to the exact opposite conclusion. Is that because the Danes like fried fish?

An American study concludes that you can avoid atrial fibrillation by eating fatty fish. Danish researchers have come to the exact opposite conclusion.

In the summer of 2004, researchers at Harvard University in Boston published an article stating that if you eat lots of fatty fish, your risk of atrial fibrillation will be reduced.

Atrial fibrillation is the most common cause of irregular heartbeat that will occur in a large number of elderly people and will require lifelong anticoagulant treatment.

To be precise, the American researchers had found that the risk of atrial fibrillation was reduced by 35% in people who consumed fatty fish at least five times a week and by 24% in the ones who consumed fatty fish 1 – 3 times a month – compared to people who only ate fish very rarely.

However, the matter is more complex than that: In January 2005, two Danish doctors published an article stating that a large consumption of fatty fish increases the risk of atrial fibrillation. They found the risk to be increased by 44% in the 20% who consumed the most fatty fish compared to the 20% who consumed the least.

Were do we go from that, then? If we take a rough average of the two studies, it will indicate that it does not matter whether or not you eat fatty fish.

But why are the results so conflicting? If we move below the surface, it turns out that the two studies are very different.

The American study included 5000 trial subjects with an average age of 73 years. The Danish study included 50,000 trial subjects with an average age that was 18 years less than the American study, i.e. 55 years.

Almost every fifth of the old Americans suffered atrial fibrillation during the 12-year duration of the American study. In comparison, the same was true for less than 2% of the Danes during the 6-year duration of the Danish study.

In total, the Americans observed more than twice as many trial subjects with atrial fibrillation compared to the Danes (980 and 456, respectively).

Frying distorts the fish oil
How were the person with atrial fibrillation indentified? The American trial subjects went through a cardiac examination every year in which all cases of atrial fibrillation were discovered. Contrary to this, information about the health state of the Danes was solely obtained from the hospitals – it was obviously assumed that all the trial subjects who had suffered atrial fibrillation had been hospitalized.

This discrepancy involves some uncertainty: Even though most trial subjects with atrial fibrillation were hospitalized, it is far from certain that this applied to everyone. Atrial fibrillation can very well be treated by a GP.

It was particularly important that the Americans observed that there is difference in the effect of fried fish and other kinds of fish. Fried fatty fish slightly increased the risk while non-fried (fatty) fish decreased the risk. Fried fatty fish neither increased the blood levels of fish oil (N-3 fatty acids) as non-fried fish does.

The Danish study does not explain how the fish were prepared. There was no distinguishing.

None of the studies explained how many and who took fish oil supplements: In the Danish study the trial subjects had not been given this question and in the American study, the information apparently did not alter the overall result.

To conclude: A detailed and precise American study has established that fatty fish reduces the risk of atrial fibrillation by approximately 33%.
A less detailed Danish study has established the opposite.

However, the size of the study is hardly decisive. It is probably more essential to pay some attention to how the fish was prepared. Fish oil is destroyed by high temperatures which, more or less, transforms the N-3 fatty acids into N-6 fatty acids, transfatty acids, and harmful oxidation products.

The American group has recently published some more news: Fatty fish – that has not been fried – reduces the risk of cerebral haemorrhage to approximately the same degree as is the case with atrial fibrillation. Fatty fish, on the other hand, increases this risk!

By: Vitality Council

References:
1. Dariush Mozaffarian et al. Fish intake and risk of incident atrial fibrillation. Circulation 2004;116:368-73.
2. n-3 Fatty acids consumed from fish and risk of atrial fibrillation or flutter : The Danish Diet, Cancer and Health Study. Am J Clin Nutr 2005;81:50-4
3. Mozaffarian D et al. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study. Arch Intern Med 2005 Jan 24;165(2):200-6.

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