Top gynae debunks the ‘myth of supplements’

Photo: Prof Athol Kent

These blunt assertions, based on reputable studies in the USA and South Korea, were made by Professor Athol Kent a veteran obstetrician gynaecologist at the University of Cape Town and Groote Schuur Hospital, in an address to the South African Menopause Society’s recent annual conference.

Kent, the editor of the SAMS’s monthly “Menopause Matters” newsletter and a groundbreaker in medical student teaching methods at UCT, was addressing one of the country’s top gatherings of his peers in Stellenbosch on February 24th.

He said that while micronutrient supplements had a role to play in certain high-risk populations where targeted use was appropriate, (such as pregnant women)¹, – the US Preventative Services Dietary Task Force had concluded that there was insufficient evidence to assess the balance of benefits and harms of the use of single or paired nutrient supplements – other than beta carotene and Vitamin E.²

Citing a study in South Korea and published in the Journal of the American Medical Association, JAMA, earlier this year Kent also said that maintaining mild to moderate consumption of alcohol decreased the risk of dementia compared to sustained non-drinking.³ The large study found that sustained heavy drinking was associated with increased risk of dementia.

Kent’s conference topic was, “Dietary supplementation and lifestyle changes for the prevention of the diseases of ageing – what is the evidence?”

Physicians should model healthy lifestyles

He told delegates that his aim was to impart, “what you should tell your patients and what you should be doing yourself.”

He said ageing was both a chronological and biological construct. Chronologically and medically, a middle-aged adult was appropriately defined as being between 45 and 64 years old, while 65-plus years was appropriately medically defined as “old”.

Biological age on the other hand was defined by how a person’s body or cells functioned. This depended on age in years, genetics and epigenetics, the former a parental endowment and the latter defined as how an inherited DNA was affected by its environment. He stressed that DNA could be altered intra-uterinely by maternal factors, such as drugs, radiation, smoking, stress and metabolism.

All epigenetic factors ‘reprogrammed,” the cells’ DNA sequence by changing methyl groups attached to the DNA. Unless there were environmental changes by methylation, normal cell replication faithfully and precisely followed its DNA sequence, the only change of each replication being a shortening of the chromosomes.

A cell in a hostile environment would undergo faster and less precise replication than a cell in a favourable one.

In healthy people with a balanced diet, there was no evidence that supplements such as vitamins, minerals and multivitamins were worth recommending for the prevention of cardiovascular disease or cancer.2

A hostile, (or inadequate), environment would include various deficiency states, malnutrition, pollution, pathogens and sedentary or stressful states.

Returning to old age “and its ravages,” Kent said a web of factors modified the risks. These traditionally included appropriate supplements, screening, medical interventions, lifestyle factors, diets, exercise, mental and social health, cancers, MHT, (Menopausal Hormone Treatment), Aspirin, sleep and alcohol, food quality and quantity, burning calories, mind/body wellbeing and ubuntu.

Screening not preventative

He said screening for quality-of-life-benefit had ‘nothing to do with prevention’, especially for cancer where it was fraught with complexity. Liquid biopsies might change this, “but we are a long way from their prime-time acceptance,” he added.

Screening for early stages of non-malignant disorders was ‘highly questionable (e.g. Dementia)’.

With medical interventions, aspirin as a preventative measure was not recommended for healthy people over 60, while MHT improved the quality of life and longevity. Antihypertensives were protective against dementia.

With eight hours per night considered optimal sleep, the published literature suggested that insomnia may contribute to cognitive decline in older adults, Kent added.

An article published in Cell in 2013 summarised for the first time the molecular indicators of aging in mammals. A barometer of interest in the topic was that approximately 300 000 articles on aging have been published since 2013 – as many as were published during the previous century.
In addition, almost 80 experiments had been conducted with mammals, including humans, that confirmed that interventions in the aging process could prevent, delay, and even avoid age-related diseases such as cancer.

‘Positive’ foods when it came to ageing were mostly plant-based: all fresh fruits and vegetables (unsaturated fats), fibre-rich goods, Flavonoids (fruits vegetables, grains, tea and wine), unprocessed foods, fermented drinks, with three ‘surprising’ additions being potatoes, berries and nuts.

Kent said caloric restriction, (defined as lessening caloric intake without depriving essential nutrients), resulted in changes in molecular processes that had been associated with aging, including DNA methylation.”

‘Negative’ foods included red meats, animal fats, foods containing preservatives, all sugar-added foods and drinks and ultra-processed foods – all of which increased health risks associated with obesity, CVD, cognitive decline and a shortened health span/lifespan.

He described exercise as, “the greatest benefit you can give your body,” with all physiological systems benefiting. Research had found that just 54 minutes of vigorous exercise per week was “potentially optimal.”

“That works out at eight minutes a day, with a 36% lowered risk for early death and the risk of heart disease reduced by 35%, he added.⁴

Expanding on the role of Ubuntu (a person is a person through people), in slowing down ageing, Kent said it embodied all the virtues which maintained harmony and the spirit of sharing among members of a society.

When it came to the social aspects of ageing, Covid isolation had ‘a lot to answer for,” he said, advising clinicians to ask their older patients whether they were seeing friends and to encourage interaction with family and friends.⁵

“Tell them to join a group, club or team or anything to do with books/reading, sports, hiking/walking, bridge, science, yoga, music, religion, food or cooking, animals, hobbies or entertainment,” he urged.

References:

1.https://www.medscape.com/viewarticle/951722?src=WNL_mdplsfeat__mscpedit_obgy&uac=359822AK&spon=16&impID=3429638&faf=1

2. US Preventive Services Task Force  JAMA. 2022;327(23):2326-2333. https://jamanetwork.com/journals/jama/fullarticle/2793446

3. Open. 2023;6(2):e2254771: Changes in Alcohol Consumption and Risk of Dementia in a Nationwide Cohort in South Korea – Jeon et al JAMA Netw

4. doi.org/10.1093/eurheartj/ehac5725. Ref Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults A Systematic Review and Meta-analysis
Hoang et al  JAMA Netw Open. 2022;5(10):e2236676.
Association of Social Support With Brain Volume and Cognition
Salinas et al  JAMA Netw Open. 2021;4(8):e2121122.