What role do nutrients play in cardiovascular disease?
Germany is one of the countries where dietary supplements enjoy high sales.
For which supplements are there truly evidence-based studies with positive results for known cardiovascular risk factors?
In addition to optimized metabolic control and a healthier lifestyle, affected patients can also benefit from targeted supplementation with biofactors such as vitamins and minerals.
One example of this is “metabolic syndrome,” the precursor to diabetes mellitus, which combines several risk factors:
- Abdominal fat tissue (“abdominal obesity”)
- High blood pressure
- Disorders of fat metabolism (especially elevated triglyceride and low HDL cholesterol levels)
- Elevated fasting blood sugar levels or insulin resistance
Insulin resistance is the root cause of the problem here. It leads to impaired glucose utilization and excessive insulin production. This in turn impairs fat metabolism and blood pressure regulation.
How important are biofactors?
Magnesium
Magnesium plays a central role in insulin and glucose metabolism.
- Low magnesium levels are closely linked to poorer blood sugar control.
- It helps regulate blood pressure.
- It improves lipid profiles—including increasing HDL cholesterol and lowering triglycerides.
- It has anti-inflammatory properties, which can reduce the risk of cardiovascular disease.
- As a natural calcium antagonist, magnesium has a vasodilatory and hypotensive effect, can normalize the heart rate, and protect the heart muscle tissue.
- A good magnesium supply is also associated with lower CHD mortality.
- The risk of type 2 diabetes is reduced
The lower limit for serum magnesium is 0.85 mmol/L. Magnesium deficiency can be compensated for by oral supplementation in daily doses of around 300 mg of magnesium.
Medicinal products that are approved for use and characterized by high bioavailability (e.g., organically bound magnesium salts) should be selected. Magnesium orotate has an absorption rate of up to 90% and a rapid release of active ingredients within 10 minutes.
Zinc
Zinc plays a crucial role in regulating glucose metabolism.
- Zinc deficiency can contribute to insulin resistance
- The trace element also has an antioxidant effect and can suppress proinflammatory cytokines.
- It can improve blood sugar control and lipid metabolism parameters.
- It can support wound healing and thus the prevention of diabetic foot syndrome.
- It has a preventive effect on diabetic neuropathy and retinopathy.
The highest and safest dosage for long-term use without negative health effects is 25 mg of zinc per day.
If 50 mg or more of zinc is taken daily over a longer period of time, anemia, disturbances in iron or copper metabolism, the immune system, or fat metabolism are possible.
The acute form of zinc poisoning, with symptoms including nausea and vomiting, cramps, diarrhea, loss of appetite, and headaches, occurs (only) after daily doses of more than 200 to 400 mg of zinc.
Vitamin B1
One consequence of diabetes is what is known as “diabetic neuropathy.” Vitamin B1 plays a special role here.
- Among other things, it is produced directly in the peripheral nerve cells and serves as a coenzyme in carbohydrate metabolism.
- Hyperglycemia leads to an increased need for vitamin B1.
- Patients with diabetes mellitus may experience a three- to fourfold increase in renal vitamin B1 losses due to their condition.
- Targeted supplementation with the provitamin benfotiamine can compensate for a thiamine deficiency that damages the nerves.
- It can alleviate symptoms of neuropathy
- Studies have shown that the biofactor can improve nerve conduction velocity compared to placebo.
Thiamine is often replaced by benfotiamine, a lipid-soluble precursor with five times higher bioavailability, which enters the bloodstream directly without a transporter and from there reaches the cells of the dependent organs.
If a deficiency is suspected, it is therefore advisable to try treatment with orally administered vitamin B1 in the form of benfotiamine.
Various randomized studies examined different daily doses, and the optimal dose was found to be 300 mg of benfotiamine twice daily.
Vitamin B12
Vitamin B12 is stored in the liver and muscles. As a result, deficiency symptoms only develop over weeks and months, initially with non-specific complaints such as fatigue, exhaustion, concentration problems, and unsteadiness.
However, if vitamin B12 deficiency is left untreated, more serious disorders can develop:
- Blood formation disorder in the bone marrow (megaloblastic and hyperchromic macrocytic anemia)
- Central and peripheral nervous system damage (polyneuropathies)
- Cerebral and cognitive dysfunctions
Possible causes of vitamin B12 deficiency:
- reduced food intake
– vegan and vegetarian diets or low meat consumption
– general malnutrition due to dieting or malignant diseases - Absorption disorders
– Gastrointestinal disorders: such as celiac disease, Crohn's disease, irritable bowel syndrome, or Helicobacter pylori infections
– Gastrectomy, bariatric surgery (stomach reduction)
– Alcohol abuse
– Pancreatic insufficiency (weakness of the pancreas) - Disorders of vitamin B12 utilization
– Liver disease, renal insufficiency - Pharmacotherapy
- Proton pump inhibitors, H2 receptor antagonists, and antacids: reduction in stomach acid production, which hinders the release of vitamin B12 from food
– Antibiotics
– Metformin (antidiabetic medication)
Compensating for vitamin B12 deficiency with daily doses of 1,000 μg has been made easier thanks to the availability of a high-dose, oral, and well-tolerated dosage form.
The registered doctor 02/2025
