“You can’t just take a vitamin and call it a day. If only health were that easy!”
There used to be a compelling movement to encourage people to take B-vitamin supplements to manage homocysteine levels. When I first got diagnosed with diabetes in 2003, I was a fan of the book The Heart Revolution: The Extraordinary Discovery That Finally Laid the Cholesterol Myth to Rest, which asserted that high homocysteine levels, not cholesterol, were much more strongly associated with cardiovascular incidents. The solution? Vitamin B supplementation (vitamins B6, B12, and folic acid). However, there is more to this story.
Patients like me with diabetes and chronic kidney disease should monitor cardiovascular health. It is a major risk factor.
“Patients with diabetic kidney disease have exceptionally high rates of cardiovascular morbidity and mortality. In fact, the excess mortality among patients with diabetes appears to be largely limited to the subgroup with kidney disease and explained by their high burden of cardiovascular disease.”
— Pálsson & Patel, Cardiovascular Complications of Diabetic Kidney Disease
While I am currently on a statin (Rosuvastatin Calcium), I continue to believe the evidence about homocysteine versus cholesterol as a bigger risk factor for heart disease. I have written about some of the issues with our current standard of care regarding cholesterol monitoring, including the need to test for LDL pattern A versus pattern B and the growing belief that there is no evidence of high cholesterol levels causing heart disease, as referenced in my article about cheese.
However, despite these beliefs, it’s not clear that vitamin B supplementation is the answer in my case. A study published in JAMA back in 2010 complicated the story.
Among patients with diabetic nephropathy, high doses of B vitamins compared with placebo resulted in a greater decrease in GFR and an increase in vascular events.
What? So the evidence suggests that Vitamin B supplementation hurts, not helps, the situation!
In the past, most of my reading suggested that vitamin supplementation in general may not help that much and that what we’re probably buying is just expensive urine. I was sort of OK with that tradeoff on the chance that the vitamins didn’t hurt but could help. However, with evidence that vitamin B supplementation actually hurts people in my situation, I have stopped taking vitamin B supplements altogether!
