I hope you’re all doing well.
Me? Oh, I’m fine. Thanks for asking.
Busy writing, reading, whistling, trying to remember to walk out the door with both my shoes tied, packing away gram doses of Valerian root before bedtime, getting my next product out, trying to avoid walking into the middle of a Cleveland ghetto at weird hours of the night, and of course not going broke doing it……..among other things!
It’s really a grand time.
If you’re like me you really enjoy quantifying the effect different supplements have on health issues. If you read this blog with any regularity I can only assume you’ve got large doses of nerd, supplement junkie, and goofball within you, so fear not, I made this post with YOU in mind.
We previously summarized the research on 10 popular health supplements and their effects on mood support. It turns out that kava, saffron petal, and EPA fish oil regularly have effects that are at least modest and fairly reliable.
Stuff like inositol and ginseng were not worth the trouble.
Well today, we turn our attention to heart health.
What happens when you compile 540 clinical studies on the 10 most popular supplements used to treat blood pressure, cholesterol and triglycerides for their effectiveness and reliability?
The results are in the chart below:
For a detailed version of how this chart’s compiled read the original article.
Here’s a short version of how it works:
- The higher up, the better. This is a measure of a supplement’s effect. (Ie, it had no effect, it had a small effect, it had a large effect, etc).
- The farther to the right, the better. This measures how many studies have been conducted on the supplement in the area of cardiovascular disease.
- The bigger the bubble, the better. This measures the number of studies in its primary area of interest.
You can scroll over the bubbles to see more detailed info about each supplement.
Okay, so what can we glean from this chart?
The Big Winners
Fish Oil (With Caveats)
Impact Factor: 1.4, Number of Studies: 129, Area of Strongest Effect: Blood triglycerides
Alright, so fish oil is well researched and consistently shows a modest effect on cardiovascular health. It’s the most scientifically verified health supplement in the world. So taking it’s a good idea.
However, its use does come with caveats.
Because the body of evidence surrounding fish oil has some curious downsides to it.
When I look over the results these are the points that seem most relevant:
- The majority of studies that showed large improvements (10%+) also used large doses. They start with 1g EPA + DHA or more and go up to 14g(!) per day. Like this one. If that’s true, then to get even a modest improvement in blood triglycerides you’d need to spend over $300/month and take 10 pills a day. It’s probably a better idea just to suck it up and go with that gym pass instead. Fatty, meet treadmill.
- Is it better to use unopposed EPA? The lion’s share of fish oil studies use an EPA/DHA blend, usually in a 1:1 or 3:2 ratio. However, there’s a good rationale for only using EPA since it circulates through your body quickly and is the fatty acid responsible for reducing inflammation, which also affects arterial stiffness. Vin Cutty has a very nice article articulating this line of thought.
- Does form matter? If you buy a purified fish oil you can choose between one that comes as an ethyl ester or a re-esterified fatty acid. Archaic detail? Yes. Un-important? No. This study compared the two forms on the same group of people and found no benefit from ethyl esters but did see see an improvement with re-esterified fatty acids.
- Best served with a side of statins. It’s hard to find clinically significant changes in normal people at low ( < 1g) doses of fish oil. However, if you’re already medicated the news gets better. People who take statins enhance the effectiveness of their meds and see additional benefits from the fish oil itself, even at smaller doses.
Impact Factor: 2.6, Number of Studies: 72, Area of Strongest Effect: Total Cholesterol
More than any other supplement, garlic consistently displays the largest affect across all measures of cardiovascular health.
This is likely due to the fact that it donates sulfur, which is an important building block for antioxidants and various signaling pathways in the body.
And if you shy away from the bad-breath-forming effects of the real stuff the news is even better: clinically effective doses are between 600-1,200 mg, which is what’s found in most supplements. If you buy one make sure to get it in an enteric coated tablet, which resists the acid in the stomach before dissolving.
Olive Leaf Extract
Impact Factor: 1.45, Number of Studies: 33, Area of Strongest Effect: LDL Cholesterol
Olive leaf extract gives you the benefits of olive oil (not to be confused with the hordes of fake stuff being sold in grocery stores) without all the greasy residue.
It’s like the mediterranean diet…..only in a pill!
But seriously…..it might do a body good.
The benefits of olive leaf extract comes from its phenolic compounds which are particularly effective at protecting your body’s LDL particles from getting ransacked by inflammatory compounds. Effective doses are in the 5-25 mg range, which is squarely in the “low-enough-that-you-might-be-able-to-buy-less-than-6-bottles-per-month-and-still-notice-a-difference” range.
Impact Factor: 0.8, Number of Studies: 43, Area of Strongest Effect: LDL Cholesterol
Policosanol is plant wax made from sugar cane and bee hives. Apparently it’s all the rage in Cuba.
It consistently has a modest effect on cholesterol levels, particularly LDL cholesterol because it increases its degradation in the bloodstream.
Its fairly well researched, but the weird part is that its hard to find a decent study that comes from an institution that isn’t controlled by the invisible hand of Fidel Castro.
That’s not necessarily bad, but health bubbles froth up when little echo chambers form around self-contained research networks that scratch each others backs on their way to tenure. That’s what happened with St. John’s Wort in the 1990’s. All the promising research came out of Germany, everyone proclaimed it to be a wonder drug, and then the study results couldn’t be replicated elsewhere and everyone stopped caring and moved on to the next miracle food.
Impact Factor: 0.6, Number of Studies: 19, Area of Strongest Effect: Blood Triglycerides
Curcumin is wonderful at reducing inflammation inside the body. It’s not so hot at changing your cholesterol count or blood pressure, where it just doesn’t seem to move the needle very much.
What little effect it does have is probably a side-effect of its ability to act as an antioxidant which helps LDL and HDL particles avoid degradation while taxiing through your blood vessels.
Impact Factor: 0.4, Number of Studies: 82, Area of Strongest Effect: Blood Pressure
For a while there was this big idea that eating cocoa would reduce your blood pressure. It was Dr. Oz’es big thing for a while.
Does it really? It depends who you ask. It’s about a 50/50 split whenever cocoa is tested for its ability to reduce blood pressure. However, regardless of changes in blood pressure the test subjects often gain weight when they take it in high doses.
Cocoa supplementation does improve circulating catechin levels, which is a very important pseudo-vitamin with widespread health benefits.
Impact Factor: 1.5, Number of Studies: 6, Area of Strongest Effect: Total Cholesterol
Berberine’s an interesting supplement. It’s great for diabetics. Possibly as good as metformin.
It’s had an effect on cholesterol and blood pressure but nothing that’s been replicated in non-diabetic people, making it an interesting-but-unproven-for-now botanical that’s best used for people that need to improve their insulin resistance.
Just Say No: Conjugated Linoleic Acid, Red Clover Leaf Extract, and Chromium
The verdict is in. After 156 clinical trials, 3,000+ human volunteers, and 174 bottles of Maalox later we can very safely say these three supplements do……..nothing.
Between them they have a 0.006% success rate at improving blood pressure or cholesterol levels. That’s not good.
So long. Smell ya’ later!