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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
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.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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