Multivitamins in the prevention of cardiovascular disease

Multivitamins are used to prevent vitamin and mineral deficiency; however there is a common belief that taking multivitamins may prevent cardiovascular disease (CVD).  This study published in the November 7, 2012 of the Journal of the American Medical Association demonstrated among this population of US male physicians that taking a daily multivitamin for more than a decade of treatment and follow-up did not reduce major cardiovascular events, including nonfatal myocardial infarction (MI), non-fatal stroke and CVD mortality.


The Physicians’ Health Study II (PHS II) is a randomized, double-blind, placebo-controlled trial investigating several different vitamins including beta-carotene, vitamin E, vitamin C and a daily multivitamin. PHS II launched in 1997 with continued treatment and follow-up through 2011. The other three arms of the study looking at beta-carotene, vitamin E and vitamin C have been previously published. This study on the use of multivitamins, was just released November 7, 2012 and is entitled “Multivitamins in the Prevention of Cardiovascular Disease in Men – The Physicians’ Health Study II Randomized Controlled Trial”


A total of 14,641 male US physicians initially aged 50 years or older, including 754 men with a history of CVD at randomization, were enrolled and randomly assigned to either receive a daily multivitamin or a placebo. Of men enrolled in PHS II, 5% had a history of MI or stroke.


Over an average follow-up of ~11 years, 1732 CV events occurred, but this rate of CV events was no higher among men taking placebo than those taking a daily multivitamin.

There was no statistically significant difference in rates of MI, all stroke, hemorrhagic stroke, ischemic stroke, congestive heart failure, angina, coronary revascularization, CVD mortality, or overall mortality.

No major differences in negative effects were seen between the group receiving the multivitamin or the placebo


There is a concern that people who think they are benefiting from taking a daily multivitamin may be less likely to participate in preventive health behaviors, such as diet and exercise that are both known to reduce the risk of cardiovascular disease. Furthermore, people with heart disease or risk factors may continue to lead unhealthy lives yet take daily vitamins supplements in the hope of reducing their risk of future problems while avoiding making the needed lifestyle changes. This distraction from effective CVD prevention is viewed as the main ‘hazard’ of daily multivitamin supplementation.

The PHS II participants as a whole, exercised regularly, ate reasonably well, and didn’t smoke so the group probably represented, on average, a well-nourished population who already have adequate or optimum intake levels of nutrients, for which supplementation may offer no benefits. Multivitamin supplementation may play a role in nutritionally at-risk populations or those with nutritional deficiencies.


The best way to determine if you are getting all the nutrients in the amounts you need for your age and gender is to have your diet assessed by a Registered Dietitian.  BetterByDesign Nutrition has several different packages to meet your needs.  Remember, that visits to a Registered Dietitian are covered by most extended benefit plans.  As well, many companies have Employment Assistance Programs (EAPs) that will cover short term visits to a Registered Dietitian.  Click on the “Assessment Options” to see the various services we offer.

New Statistics Canada report finds almost a third of Canadian children are overweight or obese

A new Statistics Canada report released on September 20, 2012 finds that almost a third (31.5%) of 5- to 17-year olds were overweight (19.8%) or obese (11.7%) in 2009 to 2011. While the percentage who were overweight was similar across age groups, the prevalence of obesity was almost double in boys overall than girls (15% versus 8%). In children aged 5 to 11 years, boys are more than three times likely to be obese (19.5%) compared to girls of the same ages (6.3 %). Experts say that the new obesity cutoffs of the World Health Organization standards used to measure obesity were not enough to explain these findings.


The study (Obesity in Children and Adolescents: Results from the 2009 to 2011 Canadian Health Measures Study) was based on actual measured heights and weights of 2,123 children and adolescents in Canada aged 5 to 17, between the years 2009 and 2011.


The data involved only one measure of overweight, BMI (Body Mass Index) which is the defined as a person’s body mass divided by the square of their height.  Another recent Canadian study referred to in this report demonstrated that over time, waist circumference among Canadians of all ages has increased more than BMI, indicating the need to monitor waist circumference.


Evidence for adults indicates that changes in the distribution of body fat such as increased waist circumference, are associated with elevated health risk. Weight carried around the abdomen (in so-called “apple” shaped people) is a greater risk than weight distributed overall or in the hips and thighs (as in so-called “pear-shaped” people). Even when the prevalence of BMI doesn’t change, distribution of body fat centered around the waist is associated with increased health risk.


Excess weight in childhood is increasingly being linked to what were once thought to be adult-onset illnesses including Type 2 diabetes, high blood pressure (hypertension), abnormal blood fats / high cholesterol, hardening of the arteries and non-alcoholic fatty liver disease. Studies have shown that adolescents who are overweight have a 14 times increased risk of having a heart attack before they turn 50. Children that are obese also have higher levels of depression and low self-esteem and are more likely to be teased or bullied at school.


The amount of time spent in front of a TV, computer, video game or texting or surfing on smart-phones (so-called “screen-time”) has been found to be strongly correlated with childhood obesity. Children and adolescents that spend two hours or more of screen time per day are twice as likely to be overweight or obese than those who spend an hour or less of screen time.  Studies have also shown that screen time is higher amongst boys than girls, which may be related to higher rates of overweight and obesity found in boys compared with girls.


It would be helpful to encourage children of all ages to participate in regular daily physical activity and decrease their “screen time” to less than 1 hour a day (half the current amount associated with childhood overweight and obesity).

As well, to make sure that children (as well as adults) are within a healthy body weight, its recommended that they have their waist circumference monitored regularly as well as having their Body Mass Index (BMI) calculated and body fat percentage determined.

Our Dietitian is very experienced working with children and can assess your child”s current weight and nutritional status and make recommendations to reduce their risk of acquiring diseases including Type 2 diabetes, high blood pressure (hypertension), abnormal blood fats / high cholesterol and non-alcoholic fatty liver disease.

If you are concerned about weight management in you or your children,  please click on the “Contact Us” tab to find out how to contact us.


Vitamin D status of Canadians – from the Canadian Health Measures Survey

A Statistics Canada Report released in 2010 indicated that while 90% of Canadians 6- to 79-years old have enough Vitamin D in their blood for bone health, 10% (or roughly 3 million people) have concentrations considered to be inadequate and 1.1 million Canadians (or 4% of the population) is actually Vitamin D deficient; levels low enough to cause rickets in children and osteoporosis in adults.  The highest prevalence of deficiency is in men aged 20 to 39, with about 7% considered Vitamin D deficient.


Vitamin D is a fat-soluble vitamin that is naturally present in very few foods and is added to others (especially dairy products). Vitamin D is also produced in the body when ultraviolet rays from the sun makes contact with exposed skin and triggers vitamin D synthesis.


Vitamin D is essential for bone growth and bone remodeling but without sufficient vitamin D, bones can become thin, brittle, or misshaped. Together with calcium, vitamin D helps protect older adults from osteoporosis and children against rickets. Vitamin D is also known to be associated with a lower risk of breast and colon cancer, some cardiovascular disease and other diseases like multiple sclerosis.


Vitamin D is measured in nanomoles per litre (nmol/L).

  • Levels below 27.5 nmol/L is are considered to indicate deficiency.
  • Levels below 37.5 nmol/L are considered inadequate for bone health
  • It is suggested that 75 nmol/L is optimal for overall health.

“Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey” was based on data from the Canadian Health Measures Survey (CHMS) which collected physical measures of health and wellness from a nationally representative sample of Canadians aged 6 to 79 years, including blood and urine samples.


Data are from 5,306 individuals aged 6 to 79 years from all regions of Canada, representing all ages, both genders and all racial backgrounds. Measurement of Vitamin D as 25-hydroxyvitamin D [25(OH)D] concentrations were determined from blood tests, and factors known to affect vitamin D status were also assessed.


Ten percent of Canadians (or roughly 3 million people) have concentrations considered to be inadequate and 1.1 million Canadians (or 4% of the population) is actually vitamin D deficient; levels low enough to cause rickets in children and osteoporosis in adults.  The highest prevalence of deficiency is in men aged 20 to 39; with about 7% considered vitamin D deficient.

An estimated 4% of the population (5% of men and 3% of women) had levels indicating vitamin D deficiency.  The highest prevalence of deficiency (7%) was among men aged 20 to 39 years of age.

The report states that much higher concentrations (> 75 nmol/L) are needed for overall health and disease prevention and according to this report only 1/3 of people in Canada are above this level. 

Frequent milk consumption was related to better vitamin D levels in people of all ages; with those that drank milk more than once a day averaging 75 nmol/L.  Even with drinking milk more than once a day, vitamin D levels were still considered inadequate for overall health and disease prevention.   Those  that drank milk less than once a day had Vitamin D levels of 63 nmol/L

The average difference between people whose racial background was white (Caucasian) and people of other racial backgrounds was approximately 19 nmol/L, with whites having higher levels of Vitamin D.


Vitamin D comes from foods and supplements, and from sun exposure.

Food Sources

There are only small amounts of vitamin D naturally occurring in foods such as oily cold-water fish (85 gm of light canned tuna contains 200 IU) and only a small amount of vitamin D is found in fortified foods such as milk (1 cup of milk contains 100 IU of vitamin D).

Sun Exposure

Vitamin D can be made by the body when the skin is exposed to sunlight. During the spring and summer months in Canada, daily sun exposure (if not wearing sunscreen or clothes that cover much of the body) may produce sufficient amounts of vitamin D, however many people avoid this due to the increased risk of skin cancer.

Even in sunny parts of Canada, Vitamin D production from the sun from late October to early March is insufficient and Vitamin D supplements are recommended.

As well, the skin’s ability to produce vitamin D drops with age, putting people older than 50 years of age, at risk.

Additional factors such as the time of day, amount of cloud cover, smog and the natural colour of one’s skin (melanin content) all affect the amount of vitamin D synthesis available.


In northern climates, such as Canada which is above the 49th parallel, there are insufficient UV rays for 6 months of the year or more for adequate vitamin D synthesis.

The Canadian Cancer Society recommends that adults living in Canada should consider taking Vitamin D supplementation of 1,000 international units (IU) a day during the fall and winter months or year round if they are older (>50 years of age), have dark skin, don’t go outside often or if they do, wear sunscreen or clothing that covers most of their skin.


If you are an adult under the age of 50 years of age living in Canada, it is recommended that you supplement your diet with 1000 IU Vitamin D / day, more so if you are living in the Lower Mainland where there is often inadequate sunshine, even in the summer months.

Our Registered Dietitian can assess your diet and make recommendations to ensure you are getting sufficient micro-nutrients (vitamins and minerals), including Vitamin D.

Canadian study reports that cardiovascular risk is higher among certain ethnic groups

A study published in May 2010 in the Canadian Medical Association Journal and based on data conducted over an 11 year period was the first to compare cardiovascular risk factors and associated heart disease and stroke prevalence across the four major racial-ethnic groups living in the same geographic area, with a similar living environment and similar access to health care.  The report found that Whites (Caucasian), South Asians, Blacks and Chinese had striking differences in cardiovascular risk profiles.


The study entitled “Comparison of Cardiovascular Risk Profiles Among Ethnic Groups” was based on population health surveys between 1996 and 2007 and was conducted by the Toronto-based Institute for Clinical Evaluative Sciences.  It compared data from 154,653 Caucasians (Whites), 3,038 Chinese, 3,364 South Asians and 2,742 blacks who participated in Statistics Canada’s cross-sectional national population health survey between 1996 and 2007.


Risk factors for cardiovascular disease include smoking, diabetes, obesity, hypertension (high blood pressure) as well as psychological or social stress.


The study reported that Chinese had the most favorable cardiovascular risk factor profile with only 4.3% of the population reporting two or more major cardiovascular risk factors, such as smoking, diabetes, obesity and hypertension (high blood pressure).

South Asians had the next most favorable cardiovascular risk profile (7.9%), followed by Whites (10.1%) and Blacks (11.1%).


The study also found that smoking, obesity and stress were significantly more common in Whites, while diabetes and hypertension were much more prevalent among Blacks and South Asians.


Risk factors such as smoking, diabetes, obesity and hypertension (high blood pressure) are considered to be related to 90% of risk factors for cardiovascular diseases, so being aware of these ethnic differences can help you, your doctor and your dietitian make lifestyle changes specific to your ethnicity, including;

  • diabetes and hypertension lifestyle intervention targeted to high-risk South Asians and Blacks
  • obesity-prevention programs for Black women and White men and women
  • encouraging physical activity among South Asian and Chinese populations


If you have any of the risk factors known to be prevalent for your ethnic background, consider consulting with our Registered Dietitian.  She is a food and nutrition expert and is knowledgeable and experienced to help you make the lifestyle changes needed to lower your risk of cardiovascular disease.