Vitamin E Safe and
Effective
Real Benefits of
Vitamin E
Vitamin E and Health
Vitamin D Update
Ask Dr. J: Bypass
Recovery
References
In the Health News
Diet and Disease
Recipe of the Month:
Healthy Holiday Nog
Dear Friends,
It is always troubling to me
when media reports of scientific
research amplify the actual information
to make a hyperbolic point that
agrees with the writer, or promotes
the view of the magazine or newspaper.
It is even worse when the scientific
authors draw conclusions that
are not completely warranted by
their data, displaying a bias
of their own which is bound to
be magnified by the media.
One such example is the recent
hype about a meta-analysis (a
study of studies) concerning vitamin
E and the supposed potential for
it to increase mortality when
taken in high doses. No new research
was reported in this review, but
the authors conglomerated earlier
studies, combined the results,
and made overreaching conclusions
that vitamin E supplementation
was associated with a higher risk
of mortality from all causes.
Many hundreds of studies on vitamin
E have reported a variety of benefits,
a reduction of serious diseases,
and no safety risks.
The conclusion in this current
paper is not justified by the
studies. All but one of the reports
on doses lower than 400 IU showed
either no effect or reduced mortality.
Some reports on doses between
400 and 800 IU per day showed
a slightly increased mortality,
but this may not have been due
to vitamin E. Even leaving aside
the issue of which studies used
natural and which synthetic vitamin
E, among all the studies on doses
above 400 IU per day, only one
reported with statistical confidence
that their results were real,
rather than due to chance, and
this study showed significant
benefit from vitamin E at 440
IU per day (the Polyp Prevention
Study of 1994, showing 1/3 as
many deaths in the vitamin E group
compared to the control group).
On the contrary, we already have
evidence that vitamin E in high
doses from supplements is beneficial.
The Nurses’ Health Study
of 87,245 subjects reported a
34 percent lower mortality in
the group with highest vitamin
E intake. For those subjects who
took vitamin E supplements for
more than two years, the mortality
risk was reduced by 41 percent.
These results are in accord with
a large body of evidence in animals
and humans, and theoretical evidence
based on the physiological effects
of vitamin E. To suggest that
vitamin E is more dangerous than
smoking is downright ludicrous.
The meta-analysis authors neglect
to emphasize that a daily dose
of 2000 IU of vitamin E is of
benefit to patients with Alzheimer’s
disease. They further display
their bias by failing to emphasize
the clear benefits from vitamin
E supplements below 400 IU. Combining
studies with insignificant data,
different time periods, designs,
and subjects, and equivocal results
does not show that vitamin E is
unsafe. The real danger is in
pooling data to draw erroneous
conclusions that scare people
away from taking vitamin E, thus
depriving them of the real benefits
of this valuable nutrient.
Lost in the hyperbolic media
reaction to the negative conclusions
of the meta-analysis of vitamin
E are the many real benefits from
taking this supplement, revealed
in numerous studies of many kinds
over many years. It is important
to put all research into perspective,
and carefully review every publication
for both bias and honest misunderstandings.
In some of the studies, the small
increase in mortality could easily
have been due to other causes,
and in at least one, the vitamin
E group had greater severity of
their underlying illness than
the control group.
The meta-analysis included some
research that used synthetic d,l-alpha
tocopherol, as opposed to d-alpha
tocopherol, the natural form.
While many studies have found
benefits from both synthetic and
natural alpha-tocopherol, a more
valuable supplement is a mixture
of tocopherols, including beta-,
delta-, and, perhaps most importantly,
gamma-tocopherol. Each of these
has benefits, including protection
from cancer and heart disease.
The long history of safety and
benefits from vitamin E is not
to be passed off too lightly,
and these benefits have been shown
in studies using either synthetic
vitamin E or natural d-alpha tocopherol,
not the preferred mixed tocopherols.
We would be wise not to disregard
these studies based on one review
and no new research.
As early as the 1940s, vitamin
E in large doses was reported
to have clinical benefit in heart
disease, and since then numerous
other benefits have been reported.
A new population study of 957,740
subjects over 30 years old, followed
since 1982 showed that those who
were regular consumers of vitamin
E for under 10 years had a 40
percent lower risk of dying of
amyotrophic lateral sclerosis
(ALS, or Lou Gehrig’s disease)
compared to non-users or occasional
users. Those who were regular
users for more than 10 years had
a 62 percent lower risk.
A finding from the Cancer Prevention
Study of 991,522 US adults showed
that regular consumption of vitamin
E for more than 10 years was associated
with a 40 percent reduction of
the risk of bladder cancer. In
this study, vitamin E use for
less than 10 years was not associated
with a reduction of risk.
So far, many indications suggest
that it is wise to start supplements
of vitamin E early in order to
achieve the most benefits. While
we do not want to take unnecessary
risks, the evidence for vitamin
E benefits far outweighs the supposed
risks.
One reason that synthetic and
d-alpha tocopherols are used in
studies is that they are less
expensive than natural, mixed
tocopherols, especially those
that are high in gamma-tocoopherol.
Although even the less expensive
forms are often beneficial, nutritionally
oriented physicians most often
recommend the mixed tocopherols
for patients. Gamma-tocopherol
is more abundant in food than
alpha-tocopherol, and taking alpha
alone might deplete gamma.
Age-related macular degeneration,
a leading cause of blindness in
the elderly, is markedly reduced
in subjects who take antioxidants
(including 400 IU of vitamin E)
and zinc. Macular degeneration
is associated with increased mortality
from heart disease and other causes
of death, and therefore it is
a reflection of systemic disease
and other risk factors.
The Cambridge Heart Antioxidant
Study showed that subjects taking
400 to 800 IU of vitamin E had
a significantly reduced risk of
recurrent heart attacks, even
though the vitamin E group turned
out by chance to have more severe
disease at the start of the study
(and a slight but not significant
higher mortality). In the HOPE
trial, mortality was unaffected
by 400 IU of natural vitamin E
for 4.5 years, but as we can see
from the studies above, much longer
times may be necessary to show
results.
Vitamin E has a number of physiological
benefits, including reducing platelet
aggregation, preventing oxidation
of LDL, inhibiting overegrowth
of smooth muscle cells (involved
in the initiation of vascular
disease), and preserving endothelial
cells. It reduces inflammation
and CRP levels, associated with
increased cardiac risk. In addition,
400 IU daily reduces claudication
and relieves PMS symptoms.
As noted earlier, a dose of 2000
IU per day is helpful in slowing
Alzheimer’s disease progression.
This flawed analysis does not
alter the importance of vitamin
E as part of a comprehensive dietary
supplement program.
After last month’s article
on vitamin D, it came up again
at the recent meeting of the American
College for Advancement in Medicine
(www.acam.org). It appears that
vitamin D is also protective against
autoimmune diseases, including
multiple sclerosis (MS), and possibly
type 1 diabetes and inflammatory
bowel disease, but most people
do not get enough.
MS incidence is highest in geographical
areas where sunlight exposure
is lowest, and sunlight is the
single best source of vitamin
D (the action of ultraviolet light
on cholesterol in skin cells produces
vitamin D), although oily fish
or fish oil supplements are good
dietary sources, and small amounts
are found in eggs and mushrooms.
In an animal model of MS (experimental
autoimmune encephalitis, or EAE),
treatment with a hormonal derivative
of vitamin D stops the initiation
and progression of the disease.
It stimulates the production of
neurological tissue anti-inflammatory
substances. It also stimulates
the death of inflammatory cells
and blocks their entry into nerve
tissue.
With high exposure to sunlight,
production of vitamin D can reach
10,000 IU per day. An intake of
1000 to 2000 IU daily is needed
to maintain healthy serum levels,
and some estimates go up to 4000
IU, all levels that appear quite
safe. The form that is added to
milk, synthetic vitamin D2, is
only one fourth as effective as
the natural D3 form. Supplements
are important for the elderly,
whose production is inefficient,
or for those avoiding sun or using
sunblock.
Other benefits of vitamin D include
protection from osteoarthritis,
osteoporosis, some cancers, fibromyalgia-like
symptoms, and hypertension.
Q. My husband
has had coronary bypass surgery
and is having trouble building
up his exercise program of distance
running. Any suggestions?
—TB, via email
This may be related in part to
the medications he is taking,
as some of them reduce stamina
and lead to fatigue, such as beta-blockers.
Cholesterol-lowering drugs inhibit
the production of coenzyme Q10,
an essential cofactor for cardiac
and muscular energy production.
Bypass surgery is very traumatic,
and recovery can be slow, but
coronary patients have recovered
sufficiently to run marathons
after surgery. It is important
for your husband to have optimal
nutrition as part of the process,
as well as his healthy diet and
exercise program.
One of the most important supplements
for the heart is the coenzyme
Q10 (200-400 mg), as high doses
have been found effective for
a number of conditions. Complementing
this with L-carnitine (2000-4000
mg) is helpful for heart muscle
health, as it transports fatty
acids into the mitochondria where
energy is produced. In addition,
magnesium (500-1000 mg) is helpful
for the heart rhythm and blood
flow.
I still recommend high doses
of vitamin E (800-1200 IU), and
vitamin C (4000-6000 mg or more).
Other helpful supplements that
I have written about before include
L-arginine, niacin, fish oils,
ginkgo biloba, garlic, policosanol
(for cholesterol levels and arterial
health), and D-ribose, a five-carbon
sugar that helps heart muscle
energy.
Stampfer MJ,
et al., Vitamin E consumption
and the risk of coronary disease
in women. N Engl J Med. 1993 May
20;328(20):1444-9.
Ascherio A,
et al., Vitamin E intake and risk
of amyotrophic lateral sclerosis.
Ann Neurol. 2004 Nov 4; [Epub
ahead of print]
Age-Related
Eye Disease Study Research Group.
A randomized, placebo-controlled,
clinical trial of high-dose supplementation
... AREDS report no. 8. Arch Ophthalmol.
2001 Oct;119(10):1417-36.
Borger PH,
et al., Is there a direct association
between age-related eye diseases
and mortality? The Rotterdam Study.
Ophthalmology. 2003 Jul;110(7):1292-6.
Delcourt C,
et al., Age-related macular degeneration
and antioxidant status…Arch
Ophthalmol. 1999 Oct;117(10):1384-90.
Yusuf S, et
al., Vitamin E supplementation
and cardiovascular events in high-risk
patients. .... N Engl J Med. 2000
Jan 20;342(3):154-60.
Stephens NG,
et al., Randomised controlled
trial of vitamin E in patients
with coronary disease: Cambridge
Heart Antioxidant Study (CHAOS)
Lancet. 1996 Mar 23;347(9004):781-6.
London RS,
et al., Efficacy of alpha-tocopherol
in the treatment of the premenstrual
syndrome. J Reprod Med. 1987 Jun;32(6):400-4.
Ziaei S, et
al., A randomised placebo-controlled
trial to determine the effect
of vitamin E in treatment of primary
dysmenorrhoea. BJOG 2001 Nov;108(11):1181-3.
Sano M, A et
al., A controlled trial of selegiline,
alpha-tocopherol, or both as treatment
for Alzheimer’s disease.
The Alzheimer’s Disease
Cooperative Study. N Engl J Med.
1997 Apr 24;336(17):1216-22.
Hayes CE, Vitamin
D: a natural inhibitor of multiple
sclerosis. Proc Nutr Soc. 2000
Nov;59(4):531-5.
Spach KM, et
al., ... 1,25-dihydroxyvitamin
D3 reverses experimental autoimmune
encephalomyelitis by stimulating
inflammatory cell apoptosis. Physiol
Genomics. 2004 Jul 08;18(2):141-51.
Vieth R, Vitamin
D supplementation, 25-hydroxyvitamin
D concentrations, and safety.
Am J Clin Nutr. 1999 May;69(5):842-56.
VanAmerongen
BM, et al., Multiple sclerosis
and vitamin D: an update. Eur
J Clin Nutr. 2004 Aug;58(8):1095-109.
Coenzyme Q10 improves the functioning
of patients with congestive heart
failure, confirmed by a new study
of severely diseased patients
awaiting heart transplants. (Berman
M, et al., Coenzyme Q10 in patients
with end-stage heart failure awaiting
cardiac transplantation: a randomized,
placebo-controlled study. Clin
Cardiol. 2004 May;27(5):295-9).
Of the 27 patients who completed
the study, those on coQ10 had
improvements in a walk test, breathing,
nighttime urination, fatigue,
and their class of disease severity.
They used 60 mg of coenzyme Q10,
while much larger doses (200-600
mg) are likely to be better.
a. The antioxidant flavonoid
quercetin has beneficial actions
in managing allergies and preserving
vision. A new study shows that
its antioxidant properties are
particularly valuable in protecting
brain cells. In culture, quercetin
was even better than vitamin C
in reducing damage to cells exposed
to hydrogen peroxide (Study: an
Apple a Day Really Does Keep Doctor
Away, Reuters, Nov 16, 2004).
Oxidative free radical damage
is associated with brain aging
as well as degeneration of other
tissues. Other sources of free
radicals are ultraviolet light,
normal biochemical reactions,
and stress. Red apples have the
most of quercetin, particularly
in the skins. Quercetin is also
found in cranberries, blueberries,
yellow or red onions, and cabbages.
b. A combination of indole-3
carbinol (from cabbage and broccoli)
and soy isoflavones (genistein)
was more effective at reducing
cancer cell growth than either
alone (Auborn KJ, et al., Indole-3-carbinol
is a negative regulator of estrogen.
J Nutr. 2003 Jul;133(7 Suppl):2470S-2475S).
Both nutrients induced cell death
and reduced proliferation in estrogen
sensitive tumor cells, but the
combination was even better. Soy
is not harmful as some suggest.
Holiday season recalls the parties
with overflowing egg nog full
of cream and sugar, but a rich
nog drink can be made with a healthy
vegetarian recipe that is delicious.
In advance, freeze 4 bananas without
the skin. Put the bananas in a
blender with 4-8 (depending on
size) frozen strawberries, 2 cups
of soy milk, rice milk, or coconut
milk, and 1 cup of water. Add
3 Tbsp of either honey or maple
syrup (this is optional, depending
on how sweet you like it) and
1-2 tsp of nutmeg. You can also
add 1/2 tsp of cinnamon. (If you
like, you can add one or two organic
eggs, but it will be rich and
smooth without them.) Blend this
all together until it is liquefied
and creamy, and serve with a sprinkle
of fresh grated nutmeg on top.
If you want to be festive for
the special occasion, you can
add a tiny bit of rum in each
glass at the time of serving;
I leave the amount up to you.
