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.

Obesity is quickly becoming America’s number one public health concern, and there is little doubt our changing food landscape is largely responsible. To combat negative press and present an image of public responsibility, food industry giants like McDonalds’s and Coca-Cola have announced policies that seem aimed to help consumers make healthier, informed lifestyle choices. However, leading nutrition and public health experts charge that these policies are disingenuous and are closer to advertising than sincere social responsibility.

In the October 15 issue of the Journal of the American Medical Association (JAMA), David Ludwig, MD, PhD, and Marion Nestle, PhD, MPH, published a commentary on the role of the food industry in public health. The question they seek to answer is, “Should the food industry be welcomed as a constructive partner in the campaign against obesity?”

The answer, they argue, can be found in the analysis of scientific data on food industry practices. One such study published in 2006 investigated United States food corporation practices in school nutrition and concluded that food companies “make public promises of corporate responsibility that sound good, but in reality amount to no more than [public relations].” Another study found that McDonald’s continued to use trans fats in their cooking oil until at least 2005, even though they claimed otherwise. (They were required to pay a settlement for deceptive advertising).

Trans fat! There is no amount of trans fat in the diet that is considered safe.

The food industry also heavily funds an independent firm, the Center for Consumer Freedom (CCF), that aggressively lobbies against “obesity-related public health campaigns, legislation to regulate marketing of junk food to children and scientists who advocate for healthier diets.” It is difficult to understand how these practices meet the proclaimed agenda of these companies to increase the health of society.

These issues then raise an interesting question. Why would a food company care about the health of society? Isn’t a food company’s primary goal to make profits for their shareholders? Of course it is, and that is fine. The problem is that the most healthful foods—unprocessed vegetables, fruits and grains—are not nearly as profitable as highly refined and processed foods. This fact makes the industry’s claims to promote health somewhat dubious.

The obvious answer to why a food company might claim to have concern for public health even if health is at odds with its product is that companies must work to maintain a positive image. Advertisers know very well that image and branding have a tremendous impact on sales. Generally our society does care about health and is willing to pay a premium for products they consider to be healthful. Thus these public health campaigns are indeed a form of advertising because they help shape the public image of a company and its products.

How then do these campaigns manifest in society? One example is the voluntary efforts of beverage companies (in conjunction with the American Heart Association and the William J. Clinton Foundation) in 2006 to curb the sale of sugary drinks in schools, one of the largest sources of excess calories for children. Though at first glance this seems like a noble effort by the companies, after much negotiation the agreement ultimately permitted several caloric drinks to remain on campuses, including sweetened vitamin waters and sports drinks. So much for getting those sugary drinks out of schools.

Also, the food industry invests enormous amounts of money to fund nutrition research. However a study published last year in the Public Library of Science (PLoS) journal found that studies fully funded by industry are 4 to 8-fold more likely to have conclusions favorable to industry compared to those with no industry funding. This raises the possibility of a “systematic bias” in scientific research when industry is involved.

Thus the authors conclude that the interests of the food industry are at odds with public health and should be separated from policy decisions. They go on to argue that while market-driven supply and demand works splendidly for many industries, it must be more carefully regulated when public health and safety are involved. This, they say, is the primary reason there are so many safety requirements on cars, and our food supply should be held to similar rigorous standards.

“Modifiable dietary factors cause substantially more illness and death than automobile crashes. Left unchecked, the economic costs associated with obesity alone will affect the competitiveness of the US economy.”

The authors recommend several courses of action. First, the government must “ensure that nutritional policies are based on solid science, rather than special interests.” Second, congress should provide more funding to nutrition research to “help counter the influence of the industry money.” Third, allow an independent body such as the Institute of Medicine to draft dietary guidelines (this task is currently under the control of the United States Department of Agriculture, which is primarily concerned with the well-being of the food industry and not public health). Fourth, restructure agriculture subsidies to “support public health, not commodity producers.” And finally, “reform campaign finance laws to prevent corporate political donations from leveraging the legislative process.”

These recommendations would be a good start to combating obesity in America, but it is important to remember that ultimately the responsibility for your health is in your own hands. If we as consumers decide we would rather buy healthier, less processed foods and purchase them in larger percentages than processed foods, the food industry will certainly notice.

This article can also be found at Synapse.

What role do you think the food industry should play in public health policy?