Vitamin E: a good vitamin is badmouthed

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Date: 02/05/05 

Date: 4 Feb 2005 22:15:22 -0800

http://www.dragonflymedia.com/sv/2005/sv1801/wh_lead1801.html

January 2005 | Whole Health
Vitamin E: A Good Vitamin is Bad Mouthed
And practitioners swiftly defend its use
by Rebecca Ephraim, RD, CCN

The solid support for nutritional supplementation among the medical
profession was apparent in November when practitioners and authorities,
from both the integrative-medicine and mainstream-medicine communities,
swiftly came to the defence of high doses of vitamin E-a staple among
the millions who take nutritional supplements on a daily basis. The
uproar came as a response to a widely publicized study by Johns Hopkins
University concluding that 400 International Units (IU) or more of
vitamin E a day can increase the risk of death and should be avoided.

"We're horrified. We're looking at each other, going, where did
this come from? Why is it getting so much publicity?" says Maret
Traber, a professor of health and human sciences at Oregon State
University, who is considered one of the leading experts on vitamin E.
"This isn't a particularly good study. It's not new
findings-it's a mish-mash of old stuff."

In fact, despite the prestige of Johns Hopkins and the Annals of
Internal Medicine in which the research was published, the study is
characterized as severely flawed. Says Dr. Ronald Hoffman, director of
his own clinic in New York City, "While numerous drugs continue to be
aggressively marketed with unacceptable safety profiles, resulting in
thousands of otherwise avoidable deaths and injuries each year, a safe
and effective vitamin is being subject to unfair attack based on a
single, poorly designed study which has arrived at erroneous
conclusions."

The Johns Hopkins study (entitled "Meta-analysis: High-Dosage Vitamin
E Supplementation May Increase All-Cause Mortality") was a
compilation of previously conducted studies. The data from those
studies was put through a statistical analysis in order to arrive at a
conclusion. Defenders of vitamin E accuse the Johns Hopkins researchers
of combining results from 19 different studies that included many
people who were gravely ill with heart disease, cancer, kidney failure,
Parkinson's disease, and Alzheimer's disease and at risk of dying
to begin with. Additionally, there is concern that the use of the
synthetic form of vitamin E, which is less effective than natural
vitamin E and can even be detrimental, adversely skewed the results.
Despite these flaws, the study's conclusion stated: "High-dosage
(equal or greater than 400 IU per day) vitamin E supplements may
increase all-cause mortality and should be avoided."

Jeffrey Blumberg, professor of nutrition science at Boston's Tufts
University, criticized the study for what was overlooked. "It's
important to appreciate that these [Johns Hopkins] researchers...did
not investigate at all dozens of observational studies involving
millions of people that show vitamin E supplementation can be
beneficial and completely safe."

Interestingly, the researchers themselves noted in their published
paper that the studies they used were "performed in patients with
chronic diseases" and that "the generalizability of the findings to
healthy adults is uncertain."

PERHAPS THE MOST impressive aspect about the backlash to the Johns
Hopkins study was how quickly vitamin E advocates mobilized to convey
their outrage over research they believed to be flawed. Numerous
organizations-citizen advocacy groups, such as Citizens for Health,
trade associations including the National Nutritional Foods Association
and the Dietary Supplement Education Alliance, and professional
organizations such as the American College for Advancement of
Medicine-came together to make the case against the offending Johns
Hopkins study.

Although the study was lambasted with forthright analyses of its
shortcomings, the mainstream media also were walloped for the way it
covered the issue. With few exceptions, news organizations took a
shallow and sensational approach to reporting the study. A barrage of
lurid headlines such as "Vitamin E's Fatal Flaw" (New York's
Newsday), "Study: High Dose of Vitamin E Increases Death Risk" (USA
Today), and "High Dose Vitamin E Death Warning" (BBC News)
trumpeted a false impression.

"If you look at what the researchers said, they actually said there
was insufficient evidence to tar vitamin E. What I took from this
[biased coverage in the media] was, again, the lap-dog journalism in
America," lamented Frank Wiewel, who scours the scientific literature
as founder and president of People Against Cancer, an organization that
researches alternatives to conventional cancer care. He, and numerous
others in the integrative-medicine community who came forward to
comment, believe the news media is generally inept at covering complex
science issues.

There are also allegations that the mainstream media has a bias against
nutritional supplements and perpetuates negative impressions of
them-fostered by anti-supplementation interests. In a prepared
statement released shortly after the study was announced, Hoffman
conveyed his suspicions. "[Even though] hundreds of studies attest to
the safety and benefits of high-dose vitamin E...expect the new data to
form the cutting edge of a new initiative by government regulators and
conservative members of the medical establishment to further regulate
the supplement industry," he said.

However, those who supplement with vitamin E can take solace in the
position of the U.S. government's own Institute of Medicine on
vitamin E, which flies in the face of the Hopkins study warning against
high doses of it. IOM states on its website
(ods.od.nih.gov/factsheets/vitamine.asp), "The general health risk of
too much vitamin E is low." The IOM has set an "upper tolerable
level" for vitamin E at 1,000 mg (1,500 IU) per day. This upper limit
represents the maximum intake for a nutrient that's likely to pose no
risk of adverse effects in most healthy people in the general
population.

Health Canada's recommended daily allowance for vitamin E is a paltry
25 IU maximum. Yet, nearly all of the studies that illustrate that
vitamin E reduces disease call for the use of 400 IU or more of vitamin
E per day. This includes studies that show that vitamin E may help
prevent heart attacks, decrease incidence of prostate and breast
cancers, slow the progression of Alzheimer's disease, reduce the risk
of heart attacks in certain diabetics, reduce the deleterious effects
of air pollution, and aid in the treatment of intermittent
claudication, premenstrual syndrome, childhood epilepsy, certain forms
of chronic hepatitis, osteoarthritis, and infertility. Ironically, a
year-old study from Johns Hopkins University (published in Annals of
Neurology, Jan. 2004) showed that 400 IU of vitamin E a day (in
conjunction with 500 mg of vitamin C) reduced the risk of Alzheimer's
by 60 per cent.

Health editor Rebecca Ephraim is a Registered Dietitian and Certified
Clinical Nutritionist. Contact her at health@dragonflymedia.com.

Sidebar: HOW TO TAKE VITAMIN E

The science of nutrition is young and rapidly evolving. Hence, it's
common to find varying opinions among integrative medicine physicians
who recommend vitamin E based on the research they've read and their
own clinical experiences with patients. Here are the insights of three
well-known physicians who are intimately familiar with supplementation.
They all agree that the natural form of vitamin E (designated as d, as
in d-alpha-tocopherol) has greater benefit than the synthetic
(designated as dl, as in dl-alpha-tocopherol). And they caution that
each person should seek an individualized program, preferably tailored
by a practitioner well-versed in nutritional medicine, since what works
for some may not be as good-and even harmful-to others.

ABRAM HOFFER, MD, PhD (in biochemistry), is a pioneer in nutritional
medicine and megavitamin research. At age 87, Hoffer continues his
full-time practice in Victoria and is editor of the Journal of
Orthomolecular Medicine: "I take 1,200 IU of d-alpha tocopherol
succinate. For my patients I have gone as high as 4,000 IU as a
treatment for Huntington Disease (a degeneration of cells in the
nervous system, including brain cells) and it has been very helpful. I
cannot recall any adverse reactions, even though thousands of my
patients are taking vitamin E. A combination [of antioxidants] is
better than any one antioxidant alone, so I also take several other
antioxidants, including vitamin C, lipoic acid, selenium,
N-acetylcysteine (NAC) and CoQ10."

STEPHEN T. SINATRA, MD, cardiologist, nutritionist, and anti-aging
specialist, is in private practice in Manchester, Conn. Sinatra, 58, is
also assistant clinical professor of medicine at the University of
Connecticut School of Medicine and author of eight books, the latest,
The Sinatra Solution, debuts this month. "The best way to take
vitamin E is to take the eight family compounds of vitamin E together
as opposed to just one. So the way I take vitamin E (300 IU/day) is to
take mixed tocopherols and tocotrienols together. If the balance is not
there you can get a pro-oxidant effect and literally get a reverse
effect that can possibly be deleterious."

ANDREW WEIL, MD, is a leader in the field of integrated medicine.
Director and founder of the Program of Integrative Medicine at the
University of Arizona, he conducts a private practice in Tucson and is
a bestselling author. Weil, 63, takes 400 IU of vitamin E as mixed
tocopherols and tocotrienols. "Based on what we know now, my advice
is still to take supplemental vitamin E in doses up to 400 IU a day,
but not exceeding that. Avoid dl-alpha-tocopherol and look for products
that include all four tocopherols, not just the d-alpha form. Better
yet, try to get the whole vitamin E complex: four tocopherols plus four
tocotrienols." - RE

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