A "Question of Faith": Do Multivitamins, Antioxidants and Mineralsupplements Improve Your Quality of Life?

Image 1: Do you believe that you could solve this profound imbalance by randomly adding more people to both sides of the seesaw? No? Well, why are you taking a high-dose multivitamin then?

As the name of this website already implies, I am an outspoken believer in the usefulness of "supplements" (as in "to supplement" = to add to something, where it makes sense). There is however a particular group of "supplements", which is a real thorn in my side... Yes, I am talking about those one-size-fits-it-all-multivitamin-multimineral-multi-whatever products with "high quality ingredients" the ratios of which are based on either the "recommended dietary allowances" of the omniscient USDA (actually a way better name would be "random dietary allowances") or the even more idiotic maxime that "if some is good, then more is probably even better". These days every major supplement company has at least one of these formulas in their line-up and obvoiusly they all will claim that only their product will provide you "with all the vital nutrients you need".

Wtf!? How do those guys know which nutrients I need? 

Even if those formulas were perfectly balanced - which they certainly are not, because we simply don't know what the "perfect balance" is, yet - the chances that anyone of you, my educated, well-nourished whole-food eating readers, has a full-blown, all across the board nutrient deficiency that would be fixed by any of those products are probably one in a million. What is much more likely, though is that you have a small or (oftentimes due to "healthy supplements") profound nutrient imbalance.

Let's say you are an aspiring male fitness athlete and have been taking your ZMA religiously for years. At the same time you have heard that copper is not only bad for you, but that "we all" would get way too much copper in our diet, anyways. So you have been avoiding copper like a plague and ingesting 30mg of zinc from your ZMA everyday... now chances are that you have already set off the natural (and optimal) ratio of copper to zinc in your body. Let's say the optimal ratio was 1:12 (copper to zinc, and again - we do not even know what the optimal ratio would be). With your high zinc and low copper intake you are now at 1:20, i.e. 60% off! Now the nice guy from your local GNC convinces you that it would be prudent to add the brand new "Male Super-Power Vitamin" to you supplement regimen if you wanted to live a long and healthy life. Chances are that the guy who designed that product will also have heard that zinc is good for men and that we all get way too much copper (and even if he knew better, he will be aware that his formula won't sell if it does not follow conventional stupidity... ah, I mean wisdom). So, the product will have 200mcg of copper and 30mg of highly bioavailable zinc - I mean it's a "high quality product"! What is going to happen now? What? Right! The well-formulated product will exasperate you existing imbalance... Your multi does not do that? How come you think so?

"Ever since I take my multi, I have not become sick and feel way better!"

Right, you feel better... and you are not alone! In fact many of the 8112 participants in a well-controlled randomized, double-blind, placebo-controlled, primary human intervention trial which was conducted by a group of scientists from Paris (Briancon. 2011), also felt that the capsule with 120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 µg selenium and 20mg zinc, they had been taking for 76 months(!) improved their overall well-being.

Warning! I suggest you don't continue reading the following paragraphs if you do feel that your vitamin product works and do not want to take the risk that it will stop working as soon as you have finished reading this blogpost ;-)

What is pretty strange, though, is that this effect did not depend on whether the subjects actually received the anti-oxidant + mineral combination, or not. Rather, the main determinant of the the results of the health-related quality of life (HRQoL) questionnaire in this sample of healthy French adults was whether the subjects, who, as it is right and proper for a "placebo-controlled" trial, obviously did not know whether they were ingesting a capsule with the active ingredients or the placebo (it had been established in a previous study that the two capsules were indistinguishable; cf. Hercberg. 1998), believed that they were in the active arm of the study (cf. figure 1, believers vs. non-believers):

Figure 1: Perceived effect on global health (VAS) in subjects who had "no idea" whether they received the active or the placebo treatment and subjects who thought they received the active ("believers") or placebo ("non-believers") treatment (data adapted from Briancon. 2011)

What is also interesting, is that women were slightly more susceptible to placebo effect than men (not to the nocebo effect though), although this difference did not reach statistical significance.

Multivitamins are like religion: Believe in it and it works!

A pros pos statistical significance, as far as the "real" markers of health and disease are concerned, the "key message" (I use the words of the scientists ;-) of the SU.VI.MAX was that "long-term supplementation with antioxidant vitamins and minerals has no effect on quality of life" - in other words, although there were not measurable improvements, the study did not provide further evidence for the hypothesis that long term supplementation with anti-oxidant supplements, selenium and vitamin E in particular, had any negative effect on objectively measurable health markers (if you want to read more about the flawed analysis of and biased media reports on the data from the SELECT trial, read my previous blogpost on this issue).

Image 2: Add a body made of animal products to this guy and you have all the nutrients you need ;-)

It should be mentioned here that in a previous analysis of other data from the same cohort, the scientists had found a small, but statistically significant decrease in cancer and all-cause mortality among the male study participants of the active arm of the SU.VI.MAX trial (Hercberg. 2004). So, while the quality of life did not improve, the miserable life of some of the male subjects was at least extended by a few years ;-) All sarcastic jokes aside, even the scientists realize that in the presence of conflicting evidence, the "major implication for public health of the present findings is that a lifelong diet rich enough in vitamins and min-erals may be preferable to supplementation that is likely not to be efficacious and has the potential to be harmful." - sound advice!

Those of you for whom this is not the first visit, here at the SuppVersity, will be aware, that, as a trained scientist, I don't content myself with the conclusions my "colleagues" (from another branch of science) draw. Therefore, I dug a little deeper into the actual data that comes with the study and - alas! - I was able to find a statistically significant (p<0.014) increase in the reported "vitality" among the women who actually received the vitamin + mineral supplement (cf. figure 2):

Figure 2: Real (difference between treatment and placebo) and perceived (difference between "believers" and "non-believers") of antioxidant + mineral supplement (data calculated based on  Briancon. 2011)

What is strange though, is that of all statistically significant differences between women who believed they received the supplement and those who did not, just this one is the least distinct. Moreover, in all the other variables, where there was a statistically significant difference between believers and non-believers, the "real" data (meaning the comparison of subjects who actually received the treatment vs. the placebo group) could not confirm the positive self-assessment of the believers. Among the male subjects, there was even a trend toward reduced quality of life measures in the real data, where the "believers" thought that it was the "supplement" they were taking that soothed their bodily pain, improved their general health or overall physical performance (physical summary scale).

So what? Am I wasting my money?

These additional observations do yet not falsify any of the three main conclusions, Serge Briacon and his five colleagues from Nancy University, the Metz University, the University Paris Descartes, the University hospital of Nancy and the French Department of Public Health draw based on their interpretation of the data:

1. [t]here is no proof that supplementation with these vitamins and minerals is beneficial in participants whose dietary intakes are already sufficient
    
2. [t]he perception that supplementation improves general well-being is not supported by this trial.
    
3. [a] reverse causal pathway may even be advocated (healthier participants may have been more likely to believe they were in the supplement group).

What this means for you is that if your multivitamin "works", chances are that you are doing something right as far as your general lifestyle, your diet and your exercise regimen are concerned. If despite taking your multi religiously, you still feel miserable, you better take a closer look at what your real problems are instead of switching from one band-aid-fits-it-all "solution" to the next one.

Kitchen Sink "Multi" W/ 55+ Ingredients Doubles Red Blood Cell Accumulation of Fish Oil: Taken With MV 3g of Fish Oil Increase Red Blood Cell DHA + EPA Just as Much as 6g!

If is debatable how beneficial high tissue levels of omega-3s are, but if you are between 50-70 years old and insist on loading your red blood cells and tissue with DHA + EPA, a certain kitchen sink multi may help.

Supplement interactions are either great or dangerous. If they are the former you often call them synergisms. If they are the latter, you will usually call them interference. Whether the latest paper from the Swinburne University of Technology in Australia is about the former, or the latter form of interaction probably depends on your stance with respect to the beneficial effects of high red blood cell and tissue omega-3 levels.

In view of the fact that few people share my skepticism with respect to the possibility that all the "good" fish oil supplements could tip the scale which is currently unbalanced in favor of omega-6 fatty acids into the other direction, I simply assume that calling what Andrew Pipingas et al. observed in a recently conducted human trial a "synergism" has a better chance of majority appeal.

You can learn more about omega-3 & co at the SuppVersity

Fish Oil Makes You Rancid?

Are All Fats Bad For You?

N3/N6 Ratio Doesn't Matter on SAD Diet

MUFA & Fish Oil Don't Match

Fish Oil Doesn't Help Lose Weight

Rancid Fish Bad 4 Health

Now that I have made sure that you remember articles like "Too Much of a Good Thing: When Fish Oil Starts to Clog Your Arteries (re-read it) or "High Omega-3 Diet Sucks: Intra-Muscular Lipid Ratios Determine Exercise Performance" (re-read this one), it's about time to take a closer look at the actual "news". News that have been published in the peer-reviewed open source journal nutrients; and news that would confirm what most "health" fanatics do already: believe in the power of multivitamin tablets.

In the said study, Pipingas et al. fed their 160 subjects who had been randomized to one of the following four treatment arms (see Figure 1), either 3g (240 mg EPA and 240 mg DHA) or 6g of fish oil (480 mg EPA and 480 mg DHA) and a regular multivitamin supplement, 6g of fish oil alone or placebo supplement.

Figure 1: Graphical overview of the randomization process (Pipingas. 2014)

In accordance with the subjects age, i.e. 50-70 years, the multivitamin products that were selected were the Men's & Women's editions of Swisse Ultivite 50+ a kitchen-sink "multi" with 55+ ingredients (see Figure 4 for the complete ingredient profiles)!

"The sample consisted of 160 healthy male and female volunteers aged 50 to 70 years. Participants were recruited from the general community and were non-smoking volunteers, not currently taking any medication or vitamin/herbal supplements. Exclusion criteria were; diagnosis of dementia, diabetes, neurologic (i.e., Epilepsy, Parkinson’s disease, head trauma) or psychiatric disorders (i.e., depression, schizophrenia), cardiovascular disease (including stroke) or past or present drug or alcohol abuse. Individuals taking anti-coagulant, anti-cholinergic, anti-depressants or acetyl-cholinesterase inhibitors were also excluded. Further exclusion criteria included those currently taking cognitive enhancing supplements regularly and current or long-term multivitamin or fis hoil supplementation." (Pipingas. 2014)

The placebo "fish oil" contained 1000 mg of Sunola Oil and 50 IU of vitamin E administered in a soft gelatin capsule. Sunola oil is a mono-unsaturated, high oleic (n-9) sunflower oil and was chosen as a control given that it is virtually trans-fat free and has a similar profile to olive oil. Small sachets with a few drops of fish oil were included in containers to assist with blinding by providing a fish odour when opened. The placebo multivitamin contained carrot powder with a small amount of riboflavin to produce colouration of the urine similar to the active multivitamin. The placebos were identical to the active tablets in shape, size and colour.

Figure 2:Change for red blood cell fatty acid status over the course of supplementation (Pipinga. 2014). Please mind that the values are shown as percentages of the fatty acid indices, which in turn are percentages - absolute changes are small!

And the results? Well, as you can see in Figure 2 it's hard to ascribe the different effects placebo and active treatment hat on the red blood cell omega-3 levels, above all the levels of EPA and DHA, where the addition of the "cheap" multi made the 3g dosage as potent as the 6g dosage of fish oil, to the "placebo effects".

Aside from the "Kitchen Sink"-sring, I am about to discuss in the bottom line, there is yet another string attached to theses impressive results - a gender-catch, if you will (see Figure 3):

Figure 3: Variability in red blood cell incorporation stratified by treatment allocation for measures of DHA (A), EPA (B), AA/EPA ratio (C) and total n-3 fatty acid (D). EP: eicosapentaenoic acid, DHA: docosahexaenoic acid, AA: Arachidonic acid, FO: fish oil, MV: multivitamin. Circles and stars represent outliers less than 2 and greater than 2 standard deviations from the mean respectively (Pipinga. 2014).

The inter-individual variability you easily see if you take a look at the confidence intervals (boxes) and standard deviations (lines) in Figure 3, is enormous and gender-dependent - a variability that does not remain without consequences:

• the increase in DHA failed to reach statistical significance,
• at study endpoint, the total LC n-3 PUFA index was statistically significantly elevated only for those receiving this multivitamin in addition to 6 g of daily fish oil
• the general observation that women seem to incorporate DHA + EPA more efficiently is thwarted by the extreme inter-individual differences among the female participants

Even if it was not questionable what it is that increases the accumulation of DHA + EPA (see bottom line for more detailed elaborations on this question), it's eventually even questionable to which extent you're going to benefit.

Figure 4: Ingredient profile of the "multivitamin products" that were used in the study at hand (ingredients according to manufacturer website)

Bottom line - Let's take a parting look at these "multivitamins": Based on the experimental evidence from the study at hand, it's quite obvious that this multivitamin will double the effects the use of a regular fish oil supplement will have on the DHA + EPA enrichment of red blood cells, but the use of the word "this" is of paramount importance, here. It's the "on the other hand" that tells you that it's well possible that your multivitamin will not have the same effects, because it does not contain extra 20 mg Actaea racemosa, 1.25 mg Bacopa monnieri, 50 mg Crataegus monogyna, 50mg Curcuma longa, 25 mg Cynara scolymus, 500mg of Gingko biloba, 5 mg phosphatidylserine-enriched soy, as well as vitamin C as ascorbate dihydrate with added citrus bioflavenoids, calcium as orotate, vitamin E as succinate, iron as ferrous fumarate, magnesium as aspartate dihydrate and amino acid chelate mixture and so on and so forth (see Figure 4 for the complete ingredient profiles).

As I have hinted at in the headline of today's SuppVersity article this was thus no ordinary multivitamin suppplement and the effect could be due to any of the 55 herbals, polyphenols, vitamins, minerals and what not. Unfortunately, it's not very likely that Swisse Wellness Pty Ltd., who sponsored the study at hand, will be inclined to sponsor the necessary follow up studies as well.

I mean, it would not be good for business, if it was only one of the common ingredients to elicit this effect... And let's be honest, the statement that the results were "suggesting that some vitamins/minerals aid the incorporation of LC n-3 PUFA into red blood cells" (Pipinga. 2014) is, if anything, testimony to the fact that the scientists did not read the labels of the "multivitamin" supplements they were administering.

Common Nutrient Deficiencies, Their Health Consequences and How You Can Fix Them - Part 1: Potassium Deficiency, Bone & Protein Loss, Stroke, Heart Disease & High Mortality

The fact that many Americans don't get enough of the "non-salt" electrolytes (calcium, magnesium, potassium) is also due to the fact that mineral water is still an exotic beverage in the US.

A recent paper by scientists from the Council for Responsible Nutrition in Washington (Wallace. 2014) says: Large portions of the population had total usual intakes below the estimated average requirement for vitamin A (35%), vitamin C (31%), vitamin D (74%), vitamin E (67%), choline (92%) and vitamin K (67%), as well as potassium (100%), calcium (39%) and, of course, magnesium (46%) - and that despite the fact that more than 50% of the US citizens consume a multivitamin and -mineral supplement of which probably 90% believe that it would balance their dietary shortcomings.

Reason enough to take another look at the possible health consequences and ways to fix these deficiencies by increasing the intake of certain foods or supplements.

There are more articles to come in this series, but you can use these to sugar the wait:

Pasta "Al Dente" = Anti-Diabetic

Vinegar & Gums for Weight Loss

Teflon Pans Will Kill You!

Yohimbine Burns Stubborn Fat

You Can Wash Pesticides Away

Milk = Poisonous Hormone Cocktail

Instead of tackling them in an alphabetical order, I would like to start with the two in my humble opinion most critical deficiencies - "critical", not necessarily because they entail the worst health consequences, but "critical", because no one appears to care about them:

You will probably think I am exaggerating (and in fact, I am), but if we are talking about America's Heart Disease Burden (CDC), i.e.

US "Heart Disease Map" (CDC)

• about 600,000 deaths due to heart disease in the United States every year – that’s 1 in every 4 deaths,
• heart disease being the leading cause of death for both men and women in the US,
• 720,000 heart attacks with 515,000 "first timers" and 205,000 people who had at least one heart attack before, and 
• a financial burden of $108.9 billion each year for heart disease and its consequences, alone, 

we cannot do so without talking about the insufficient potassium and choline intakes of the average American. Why? Well, because these constantly overlooked nutrients are at least as important for your heart as any of the overrated vitamins and the publicly transfigured alleged "supermineral" magnesium.

Today's episode will be about potassium - potassium and nothing but potassium! But don't worry we will deal with choline in the next episode and tackle all the non-significant rest in later episodes. Obviously I am exaggerating, but as mentioned before: I truly believe that choline and potassium are the most overlooked, yet crucially important nutrient deficiencies the average Westerner will have.

Table 1: Paleolithic nutriton according to Eaton (2000) - /1/ based on 3000 kcal/d, 35 % animal: 65 % plant subsistence; /2/ average of US men and women according to the Food and Nutrition Board (1989)

If you look at the Mediterranean diet, the DASH diet and, of course, the Paleo diet, you will find that there is more to it than olive oil, higher protein intakes and no grains. Let's take the Paleo diet, I mean, the half-science based version and not the strange amalgam of all sorts of dietary trends you will find in the blogosphere, as an example (see Table 1).

It is of course higher in calcium, in magnesium folate, B1, B2, vitamin A and vitamin E than the current US diet, but those are nutrients everyone thinks about. Copper (10x higher!) and not even in the list Wallace et al. present in their recent paper in the Journal of the American College of Nutrition (Wallace. 2014), potassium (4.2x higher) and manganese (3.8x higher) are micronutrients no one ever talks about.

Urinary potassium excretion vs. food logs: In subjects who are not on diuretics or other medications that would influence the urinary potassium excretion, the urinary potassium excretion is not necessarily a more accurate, but certainly a more reliable and objective measure of an individual's total potassium intake.

The FDA in their infinite wisdom even limits the maximal amount of potassium in dietary supplements to 99mg - i.e. ~2% of their own recommended daily allowance and the prescribed potassium intake on the DASH diet (4,700mg/day for adults (18y+, breastfeeding women "may" consume an extra 500mg/day). If we take the potassium intake of the average Cretan iteration of the Mediterranean (according to Kafatos. 2000) diet or the Paleo diet (according to Eaton. 2000) as a reference it would be as a reference that's 1.8% and 0.8%, respectively. That's unquestionably much less than you would need to double the pathetic 2500mg/day of potassium the average American gobbles down with a 3,000kcal/day diet (Eaton. 2000) - bad news, in view of the fact that insufficient potassium intakes are associated with...

• 29% higher all-cause mortality risk in the 1,448 randomly selected healthy subjects in the Rotterdam Study (Geleijnse. 2007)
• 20% increased higher all-cause-mortality risk in the 12,267 participants of the Third National Health and Nutrition Examination Survey Linked Mortality File (1988-2006), a prospective cohort study of a nationally representative sample (Yang. 2011) 
• 36% increased CVD risk (stroke, myocardial infarction, coronary revascularization, or CVD mortality) for the subjects with the lowest (vs. highest) urinary potassium excretion in 2,275 adults with prehypertension aged 30 to 54 year (Cook. 2009)

Table 2:  Estimated Usual Intakes of Sodium, Potassium, and Calories and Sodium-Potassium Ratio at Baseline by Sex, NHANES IIII Linked Mortality Filea (Yang. 2011)

Even exercise won't save your ass, if you don't get enough potassium! That's at least what the results of Yang's analysis of the data from the shows. The increased mortality risk did after all not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity (Yang. 2011).

Furthermore, the difference in all-cause mortality risk between participants with low (Q1) intakes and those who approached "paleo" or at least "Mediterranean" potassium intakes was even large: 39% even after full adjustment!

• 38% increased total stroke and ischemic stroke in among 43,738 US men, 40 to 75 years old, without diagnosed cardiovascular diseases or diabetes, who completed a semi-quantitative food frequency questionnaire in 1986 (Ascherio. 1998) 

• 

  Figure 1: Potassium intake and adjusted risk of stroke among 43,738 US men aged 40 to 75 years followed for eight years. Risk was adjusted for age, total energy intake, smoking, alcohol consumption, history of hypertension, history of hypercholesterolaemia, parental history of myocardial infarction before age 65 years, profession, and quintiles of body mass index and physical activity (He. 2001)

  28% increased ischemic stroke risk in the 85,764 women in the Nurses’ Health Study cohort, aged 34 to 59 years and free of diagnosed cardiovascular disease and cancer who completed the dietary questionnaires of scientists from the Brigham and Women’s Hospital and Harvard Medical School in 1980 (Iso. 1999)
• 50% increased total stroke risk in the 5,600 men and women older than 65 years and free of stroke at enrollment in The Cardiovascular Health Study (Green. 2002)
• 28% increased total stroke risk according to a 2001 (re-)analysis of data from 9805 US men and women who participated in the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-Up Study (Bazzano. 2001) 
• significantly lower bone mineral density (BMD) in elderly men and women with per unit differences that were significantly higher than for magnesium (~30%) and total fruit and vegetable intake alone (+400%; cf. Tucker. 1999)
• higher protein loss due to low-grade acidity; just like the bone loss (Dawson-Hughes. 2000) the loss of nitrogen can be countered by potassium bicarbonate supplements (~4-6g per day lead to a 86.4% reduction in urinary nitrogen excretion in postmenopausal women; cf. Frassetto. 1997 | learn more)

Sociodemographic and -economic studies show that older men and women and people from lower socioeconomic groups are at particularly  high risk of low potassium (and high sodium) intakes (Loftfield. 2013).

Figure 2: Graphs showing age-adjusted death rates in the US from cerebrovascular accidents, 1968 through 1988, by socioeconomic quintiles, i.e. median income and high school completeion (Modan. 1992)

No wonder that their risk of hypertension-related diseases is significantly higher than that of their better-off peers. Needless to say, as well, that a low potassium and high sodium intake are inevitable consequences of the standard American convenience diet with lot's of high salt, low potassium processed foods and few minimally / unprocessed low salt, high potassium foods.

Figure 3: Low carb, low fat, vegetarian, vegan, low glycemic, Mediterranean, balanced and palolithic diets, they may be based on different premises, but the food recommendations are the same (Katz. 2014).

A pattern of which the diet overview in Katz' and Meller's recent paper "Can We Say What Diet Is Best for Health?" indicates that it one of the few criteria all the en-vogue diets from low-carb to paleo have in common.

Being based on a limited amount of refined starches, added sugars, processed foods; limited intake of certain fats and emphasizing whole plant foods, with or without lean meats, fish, poultry, seafood. They are all well capable of providing the RDA 4,700mg/day of potassium so few of the modern convenient food buyers are consuming on a daily basis.

Potassium: Why and from where?

• Increasing potassium intake lowers blood pressure in both hypertensive and normotensive people. 
• Increasing potassium intake and reducing sodium intake are additive in lowering blood pressure High potassium intake reduces the risk of stroke and prevents renal vascular, glomerular, and tubular damage. 
• Increasing potassium intake reduces urinary calcium excretion, which reduces the risk of kidney stones and helps prevent bone demineralisation.
• Increasing serum potassium concentrations reduces the risk of ventricular arrhythmias in patients with ischaemic heart disease, heart failure, and left ventricular hypertrophy.

The best way to increase potassium intake is to eat more fresh fruit and vegetables and the list on the left gives you an idea which of them contain particularly high amounts of this essential electrolyte. On a whole foods diet supplements shouldn't be necessary.

In the end, things could be so easy: Whether you are consuming high carb, low carb, no carb, high protein, low protein, or even vegetarian diet - there is no reason any of you would have to be taking potassium supplements.

So don't fret about the FDAs unquestionably inexplicable conclusion to prohibit the inclusion of more than 99mg of potassium in dietary supplements, but make sure that you get add at least one of the fruit and vegetable items from the following list of high potassium foods in each of your meals

Fruits ★★★ Apricots Avocados Bananas Dates Figs Kiwi Mangos Melons Nectarines Oranges Papayas Peaches, fresh Pears, fresh Prunes

Vegetables ★★★ Artichokes Beans: kidney, lima, pinto, red, white, etc. Greens: beet, chard, collard, kale, mustard, spinach, turnip Parsnips Potatoes: sweet, white French fries, chips, etc. Pumpkins Tomatoes: fresh, canned, paste, etc. Winter squash Yams Zucchini

Other ☆★★ Chocolate Cocoa Custard Lentils Milk Milk drinks Milkshakes Nut butters Nuts Peanut butter Peanuts Pudding Salt Substitutes Yogurt

And what about hyperkalemia? Potassium balance is normally maintained by precise physiological mechanisms that match potassium excretion to intake, mainly through the kidney but also through the gastrointestinal tract. Large loads of potassium are excreted rapidly with only a minimal increase in plasma potassium concentration (He. 2001). A high food and even oral suppplement intake is thus not an issue for people with healthy kidneys who don't have to take potassium sparing diuretics or similar meds.

References:

• Ascherio, A., et al. "Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men." Circulation 98.12 (1998): 1198-1204.
• Bazzano, Lydia A., et al. "Dietary potassium intake and risk of stroke in US men and women National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study." Stroke 32.7 (2001): 1473-1480.
• CDC. Heart Disease Fact Sheet. < www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm > visited on March 20, 2014.
• Cook, Nancy R., et al. "Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study." Archives of internal medicine 169.1 (2009): 32-40. 
• Dawson-Hughes, Bess, et al. "Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women." Journal of Clinical Endocrinology & Metabolism 94.1 (2009): 96-102.
• Geleijnse, Johanna M., et al. "Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study." European journal of epidemiology 22.11 (2007): 763-770.
• Green, D. M., et al. "Serum potassium level and dietary potassium intake as risk factors for stroke." Neurology 59.3 (2002): 314-320.
• He, Feng J., and Graham A. MacGregor. "Fortnightly review: beneficial effects of potassium." BMJ: British Medical Journal 323.7311 (2001): 497.
• Iso, Hiroyasu, et al. "Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women." Stroke 30.9 (1999): 1772-1779.
• Kafatos, Anthony, et al. "Mediterranean diet of Crete: foods and nutrient content." Journal of the American Dietetic Association 100.12 (2000): 1487-1493. 
• Katz, D. L., and S. Meller. "Can We Say What Diet Is Best for Health?." Annual Review of Public Health 35.1 (2014).
• Loftfield, Erikka, et al. "Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City." The American journal of clinical nutrition 98.5 (2013): 1282-1288. 
• Modan, Baruch, and Diane K. Wagener. "Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status." Stroke 23.9 (1992): 1230-1236. 
• Wallace, Taylor C., Michael McBurney, and Victor L. Fulgoni III. "Multivitamin/Mineral Supplement Contribution to Micronutrient Intakes in the United States, 2007–2010." Journal of the American College of Nutrition 33.2 (2014): 94-102.
• Yang, Quanhe, et al. "Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey." Archives of internal medicine 171.13 (2011): 1183-1191.

Hair Mineral Analysis: Significant Correlations Between Calcium, Magnesium, Potassium & Sodium and Met. Syn., Insulin Resistance, Waist, BP etc. - Implications?

Does her hair hold the secret to her fitness body? Actually that's unlikely, but it appears possible that a hair analysis could reveals what's keeping you back from a similarly amazing physique.

Hair mineral analyses have been discredited by certain snake oil vendors who use them to sell their "oils" in form of an endless list of "essential" supplements you'd have to take if you don't want to end up as dead as the hair they used to produce the analysis. Still, they share one big strength with the more expensive RBC or other cell tests: They give you an idea of your actual calcium, magnesium, sodium and potassium balance.

Much in contrast to serum levels, by the way. If those are off, it's either due to an acute event (like diarrhea, for example ;-) or you have a real reason to be concerned. There is after all a really good reason these minerals are also called "electrolytes": They are heavily involved in the ion and thus charge-exchange that keeps your heart beating!

Serum analyses tell you if your heart will keep beating, but what do hair analysis tell you? That's a very valid question and the answer is NOTHING! You can use them to estimate your mineral balance, but a high calcium level in the hair, does not necessarily imply a high level in other body parts. Moreover, correlations as I am about to report them in today's SuppVersity article allow for hypotheses about causative effects, what they don't do, though is to prove cause and effect! Please keep that in mind while reading this article and before your next visit at your favorite quack.

Before we get to the actual hair mineral analysis data, let's briefly have a look at another set of striking and not so striking differences between the "normal" subjects and those with established metabolic syndrome:

Figure 1: Serum mineral concentrations, visceral (VAT) and subcutaneous body fat and smoking status in subjects w/ and w/out metabolic syndrome (Choi. 2014)

If you take a closer look at the data in Figure 1 you will see that - aside from marginal, but statistically non-significant differences in serum phosphor - the often-checked total Ca, Mg, K, Na & Ph concentrations did not differ between the two groups.

Potassium, insulin resistance & obesity: Later in this article you will learn that there was a negative association between the amount of potassium in the hair of the subjects and their HDL and insulin sensitivity. It's important not to confuse this with the message "potassium is bad for your insulin sensitivity" - in fact, in 1980, Rowe et al. observed significant decreases in plasma insulin response  to sustained hyperglycemia and a ~30% reduction in glucose metabolism (Rowe. 1980).

Moverover, visceral fat was a much more reliable parameter to distinguish the healthy and unhealthy subjects than subcutaneous fat and... a bit to my surprise: Smoking appears to be associated with a lower metabolic risk than non-smoking.

Let's take a look at the hair analysis, now

Much in contrast to the serum levels, the hair mineral analysis did reveal significant inter-group differences and corresponding correlations:

Of all potentially toxic molecules the researchers measured only the levels of arsenic and lead differed significantly between the two groups. The concentrations of cadmium, mercury, and aluminum were not different between the two groups, on the other hand, did not.

And what does that mean? If we take a parting look at the data in Table 1, you will see that, the one parameter that makes all the difference is none of the minerals. It's rather an old acquaintance: The total amount of visceral fat. With a p-value of p = 0.000 it's the best parameter we have to identify someone with metabolic syndrome. The hair minerals, on the other hand, may present with associations with individual features of the metabolic syndrome, namely...

Table 1: Multiple logistic regression analysis for hair mineral concentrations with metabolic syndrome (Choi. 2014)

• low calcium, low magnesium ➮ high blood pressure, high blood sugar, triglycerides, weight and waist,
• high sodium, high potassium ➮ low HDL,
• high copper ➮ low blood pressure, low weight, low waist, high insulin sensitivity,
• high chromium ➮ high weight, high waist, and
• high cobalt ➮ low blood pressure

Now, since, we don't know how exactly the hair mineral content ant the nutritional intake are connected, it is very difficult to make any recommendations based on these observations.

What appears to be relatively certain, though, is that these new findings don't change anything about my previous recommendation to make sure that you get enough calcium and magnesium - the thing about potassium, on the other hand, strikes me as odd. As an antagonist to calcium, the negative effects of K may yet simply be a result of a Ca deficiency in the average mid-40s subjects in the study at hand.

References:

• Choi, Whan-Seok, Se-Hong Kim, and Ju-Hye Chung. "Relationships of Hair Mineral Concentrations with Insulin Resistance in Metabolic Syndrome." Biological Trace Element Research (2014): 1-7.
• Rowe, John W., et al. "Effect of experimental potassium deficiency on glucose and insulin metabolism." Metabolism 29.6 (1980): 498-502.