This week, the Journal of the American Medical Association (JAMA) reports that long-term supplementation with either vitamins C (500 mg) or E (400 IU) is ineffective at reducing major cardiovascular events, including heart attack and stroke.

The study was a ten year randomized, double-blind, placebo-controlled trial in low risk, healthy men over 50-years old.

Unfortunately, results do not get any more conclusive than this. Sorry boys, you are going to have to stick with diet and exercise for now.

It was thought that antioxidants such as vitamins C and E may reduce risk of cardiovascular disease by decreasing oxidative damage and reducing inflammation. But it appears that consuming these vitamins in supplement form is ineffective.

It is still a good idea to get enough of these antioxidants from dietary sources, however. Fruit is a good source of vitamin C. Almonds are good for vitamin E. A bonus is that a diet rich in fruits and nuts actually is associated with a lower risk of heart disease.

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Also in JAMA, low-dose aspirin was shown to be ineffective at reducing the risk of cardiac events in patients with type 2 diabetes. This finding is somewhat surprising because aspirin is effective at reducing cardiac events in non-diabetic individuals, and patients with diabetes are considered to be at particularly high risk for heart disease. It was thus reasoned that aspirin should be recommended for people with diabetes. However, in this group of diabetic patients in Japan, aspirin did not the reduce risk of a cardiovascular event.

One thing to note is that this study was relatively small, only 2,539 participants. So it may have lacked statistical power to find a real benefit. If you have type 2 diabetes and are currently taking daily aspirin, I wouldn’t stop just yet.

The good news for everyone is that basic dietary and lifestyle factors are by far the largest contributors to heart disease, diabetes and cancer. You can avoid most of these problems by eating a varied diet of whole foods, maintaining a healthy weight and staying moderately active. I’d choose that over aspirin any day!

Do you take many dietary supplements?

UPDATE: The problems with vitamin C and E supplements were expanded on this week by Tara Parker-Pope at the New York Times Well Blog. It is a great read if you are interested in this topic.

The case for eating breakfast everyday is mounting. We already know that people who eat breakfast are generally thinner than those who do not. They also tend to eat a healthier diet overall. Now new data suggest that the nutritional quality of your breakfast is also important for your health. Surprise!

A study published in the latest issue of the American Journal of Clinical Nutrition is the first to address how your choice of breakfast is correlated with the quality of food chosen during the rest of the day. The scientists combined dietary data from three continuous National Health and Nutrition Examination Surveys (1999-2004) to determine energy density, nutritional quality and variety of foods eaten. They also examined the relationship between breakfast choices and body mass index (BMI). A total of 12,316 people were analyzed.

Eighty percent of people in the study reported eating breakfast. Although breakfast eaters ate more total daily calories during the study, the foods they chose tended to be of lower energy density. Lower energy density foods have fewer calories per gram and are usually associated with more nutritious fare such as fruits, vegetables and grains. Examples of higher energy density foods are meats, cheeses and processed carbohydrates.

Interestingly, breakfasts of lower energy density, such as cereal with milk and fruit, were an indication of a more diverse diet throughout the rest of the day. In other words, participants who ate cereal for breakfast were more likely to report eating a lot of fruits, vegetables, grains, legumes and other healthful foods overall. This was true whether or not breakfast itself was included in the calculation.

People who chose breakfasts of higher energy density ate fewer different kinds of foods, but more pastries and junk foods. Countless studies have shown that dietary diversity is one of the best predictors of good health. This was confirmed in this study, as higher energy density breakfasts predicted fewer beneficial micronutrients consumed overall.

The researchers also found that seventeen percent of people who ate breakfast reported items that could not be “grouped into the major food groups,” things such as pastries, confections and meal replacement drinks and bars. With this the authors of the study point out that a significant percentage of Americans do not eat “real food” for breakfast (somewhere Michael Pollan is smiling and nodding). Not surprisingly, this group comprised the highest average energy density of any type of breakfast.

Women (but not men) that did not eat breakfast had a higher average BMI. This was true regardless of body image or attempted weight loss. In both men and women, breakfast energy density showed a linear positive association with BMI. This means that even for people who do eat breakfast, if you eat foods with higher energy density you will probably weigh more.

In English, what this all means is that although eating breakfast alone does a body good, it is much better if your breakfast is cereal and fruit rather than eggs and meat.

There is no clear cause and effect in an analysis of this kind, however there seems to be a correlation between eating less healthy foods at breakfast and making poor food choices throughout the day. While it is possible that some people simply make unhealthy selections all the time, there is also a possibility that your breakfast choices affect metabolic and hormonal systems that alter your cravings for different foods over the course of the day. Indeed, there are studies showing that people who eat whole grains in the morning have altered insulin responses for nine to twelve hours after eating.

Even if your breakfast choice does not have a direct impact on the rest of your food selections, choosing cereals and fruit will certainly bring you a step closer to better health. Pouring a bowl of whole grain cereal and adding some fruit is pretty simple, and I guarantee you it is easier than making eggs and sausage. Do yourself a favor and save the cakes and donuts for dessert.

This article can also be found at Synapse.

A recent New York Times article questions the conventional wisdom of the value of stretching before a workout. Instead, the best way to prepare for physical exertion is a brief, easy cardio workout followed by a series of sport-specific movements designed to loosen joints and increase blood flow to the muscles you will be using.

Multiple research studies over the last several decades have shown that stretching does not help prevent injury during a workout. Even more surprising is that stretching appears to actually weaken the muscle for a period of up to 30 minutes following the stretch, thereby hurting overall performance.

But this does not mean you should skip your workout warm up. Scientists now recommend that you begin your workout with a light, 5-10 minute aerobic exercise, such as a jog. This movement will increase blood flow to your muscles and make them more pliable and ready for additional exertion.

To improve performance in a specific sport, dynamic stretching is recommended. Dyamic stretching is a way to stretch muscles while moving, a practice that actually does appear to increase muscle power, flexibility and range of motion. Data is also emerging that it reduces risk of injury.

The goal of dynamic stretching is to perform “range-of-motion exercises that activate all of the joints and connective tissue that will be needed for the task ahead,” says Team Running USA coach, Terrence Mahon. For example, runners should do movements that activate hip and knee joints (such as squats and lunges), while golfers should perform shoulder and back movements.

That’s right, even golfers can improve performance with dynamic stretching.

A few of the best dynamic stretches are described in the article.

In sum, the new recommendation for beginning a workout is an easy, 5-10 minute aerobic exercise followed by a five minute recovery, and then a series of dynamic stretches appropriate for your sport. It is important that you complete this warm up immediately before you begin your training. Waiting too long (30 minutes) before beginning your workout can be detrimental, increasing muscle stiffness.

Although I read and believe the accuracy of this story, I think it will be hard for me to stop touching my toes and hanging my heels off a stair before going on a run. It is such a regular part of my routine and feels so natural. But according to this article that may actually be hurting my run.

What do you guys think?