Hello, this is Dr. Wentz.
Today I want to talk to you about the controversy surrounding reports on Vitamin E that were published in the Annals of Internal Medicine last fall and the Journal of the American Medical Association this Spring. Both of these studies included conclusions that Vitamin E, the premier antioxidant, does not provide protection against disease such as heart attacks and cancer and might actually raise the risk of heart disease.
Well, you can imagine my response. I had dismissed the earlier report as simply another example of the on-going prejudice in the medical establishment against supplementation and any other type of health practice not officially sanctioned by the medical powers that be. Reviewing the study myself, I felt once again that it was hardly worth responding to publically. It was so full of bias and misinterpretations.
Controversy and confusion
But then a few months later, when JAMA published the second report, that indicated that vitamin E was not only not supportive of good health but possibly even a threat, I could no longer be silent. And it appears I’m not the only one. Over recent months there has been an outpouring of critical reaction about both of these reports. The controversy has grown with the public once again left confused and wondering who they should believe. That’s why I feel its important to reveal the scientific truth on this subject.
To begin with, based on value of scientific discovery, neither of these reports should have received the amount of attention in the media as they did. Neither of them provided any real information or insights on the mechanisms or effectiveness of vitamin E supplementation. I can only surmise that the sensational nature of the conclusions made by the authors of these studies which contradict accepted knowledge about a proven nutrient attracted the attention of the media because of shock value. The studies themselves in my opinion have serious problems and the media have misinterpreted the implications.
Not good science
The primary problem with the study published in the Annals was that it simply was not good science. It was what is called a meta-analysis – a statistical manipulation of old data with no new research. The numbers from a total of 19 clinical trials performed between 1993 and 2004 involving 136,000 people were combined and analysed to come up with a conclusion that “vitamin E supplements may increase deaths and should be avoided”. Now when performed correctly a meta-analysis can sometimes provide new insight what multiple studies may be telling us, but in this case the original studies that were combined into a large data set varied widely in size, quality and in patient characteristics. Some of the study subjects suffered from a wide range of diseases including cardiovascular disease, cancer, Alzheimer’s, kidney disease or cataracts while others were in groups of healthy adults.
In addition, only nine of the 19 studies focussed solely on vitamin E while ten looked at vitamin E combined with other vitamins and minerals. In plain English, the authors were not comparing apples to apples. For example, not all of the studies in this report even used the same form of vitamin E. Some of them used the synthetic form which we know does not perform in the same way as the natural vitamin E found in foods and may even compete for binding sites with natural vitamin E. Its interesting to note that virtually all the vitamin E sold in quality health food stores is now natural vitamin E. Only in some large clinical trails do we see synthetic vitamin E used today. Possibly because its less expensive. Possibly because they don’t know any better. In one of the more perplexing aspects of this review, studies in which there was little difference in mortality between study groups were excluded from the meta-analysis even though they met all the criteria for inclusion. This is not science and a quest for truth. This is selecting only the data that support your view.
Patient selection a problem
Patient selection was also a serious problem in the JAMA study. The participants were all at least 55 years old and suffered from a range of degenerative diseases. All of the over 7,000 study subjects had vascular disease or diabetes and at least one other significant cardiovascular risk factor. In addition, subjects in the study were typically taking five different pharmaceutical medications including beta blockers, platelet anti-sticking agents, statins, diuretics, calcium channel blockers and ACE inhibitors. And yet, the 1.5 % increase of heart failure over the placebo group was attributed to, you guessed it, vitamin E with no adjustment or consideration for the pharmaceutical therapy.
Pharmaceutical mind-set
Information derived from this population gives us no guidance of the proper vitamin E intake for healthy individuals in different age groups which points out another problem with both of these reports – the mind-set of pharmaceutical thinking. These industry-supported so-called medical researchers are testing the effects of vitamin E as if it were a drug. They want to know if it can cure heart disease after it has already progressed in elderly people. I believe optimal nutrition is powerful enough to help people to recover from degenerative disease but nutrients are very different from drugs. They behave very differently in your body. Second, these kinds of studies treat nutrients as if they were drugs by trying to measure the effect of just one or sometimes two nutrients. The food you eat doesn’t contain a single or a couple of nutrients. That’s why I insist on people consuming wide spectrum antioxidants and why I consider supplementation to be of far greater value when combined with healthy diets.
The term vitamin E refers to a family of eight different compounds, each of which has different effects on the body. Consuming the complete spectrum of the forms in the correct balance enhances the positive effects of vitamin E. That’s why its important for a vitamin E supplement to include mixed tocopherols and mixed tocotrienols. Also, there is good evidence that vitamin E may prevent artherosclerosis by preventing the oxidation of LDL, a first step in plaque formation. However, once the plaque is formed, vitamin E may not be useful in preventing plaque rupture, the cause of many heart attacks. This would help to explain why clinical studies run on people who already have heart disease show little effect.
Expecting a single nutrient like vitamin E to effectively treat heart disease is like servicing your car by replacing the spark plugs without checking the oil. When you continue to run the car this way, you might end up doing serious damage if it turns out to be low on oil. A clinical study aimed at providing a true measure of the effectiveness of a nutrient would have to take into consideration the combined and inter-related effects of all the 40-odd essential nutrients consumed by the study subjects throughout the study. That is nearly impossible to do of course and would be extremely expensive, but that’s no excuse for taking the easy route of treating nutrients as though they were pharmaceuticals. We must understand how nutrients depend on each other and interact with each other in order to function.
News sensationalism
One of the main problems illustrated by this whole episode is that its another example of the sad way that people get their information on nutrition today. Unfortunately for the public, the mass media are less interested in providing information than they are in selling their form of medium via sensationalism. Oxidative stress and the diseases associated with it, is a complex biological process and rarely will journalists take the time to understand the implications of clinical studies on such a subject before they attempt to report on it. Not only does vitamin E work with other nutrients to protect the cells from free radical damage, it also plays multiple other positive roles in human physiology from modulating gene expression to influencing enzyme activity. Clearly a headline splashed across a newspaper or television report is not going to give you a clear and accurate report of medical findings on the subject as complex as this.
Common sense
The bottom line is that in all matters of good nutrition, just as in all matters of health, we need to use our common sense when making decisions. As a medical scientist, I respect the power of scientific enquiry but to me common sense is necessary to properly interpret science. Without being moderated by common sense, the devotion to numbers, data and other facts can result in a step away from the truth rather than discovery of truth. Common sense also allows us to understand the fact that vitamin E is an essential nutrient so we have to obtain it from our diet. With the knowledge that our diets rarely provide the optimum amount, we know that we have to supplement to acquire adequate amounts.
Finally, we need to place both of these studies into context and look at the bigger picture. That picture includes all the other clinical studies with much larger patient populations. Studies that showed significant preventive cardio-vascular benefits from vitamin E supplementation and demonstrated its role as an effective and safe part of a healthy lifestyle.
People now uncertain and at risk
About 40% of adults in the US take vitamin E supplements. When I read that about 20% of these people have now decided to reduce their intake due to these reports, I feel that it’s a real shame. The authors of the meta-analysis admitted that: “generalisation of the findings to healthy adults is uncertain.” But that isn’t going to prevent many people from hesitating the next time they consider supplementing with vitamin E. This could be truly detrimental to the health of these people, some of who may have a critical need for high levels of vitamin E.
It would be next to criminal to deny ourselves the benefits of vitamin E – the premier antioxidant – but that may already be happening. In fact a recent news item reported that a major clinical study on the protective effects of vitamin E and selenium on prostate cancer is in jeopardy of losing participants due to media counts of these two studies. There is no question that vitamin E supplements are one of the most powerful tools that we have in protecting ourselves from degenerative disease.
A recent report estimated that increased intakes of vitamin E and certain other supplements could potentially contribute to saving US$89 billion of care costs annually by delaying the onset of cardio-vascular disease, stroke and osteoporosis.
In the end, you have to make your own choice. I would hope that would you make that choice based on the best information and evidence available. I know what my choice is – to provide my body with the benefits of natures most important antioxidants in the right forms and optimal amounts.
Thank you.
Transcript of LifeMasters audio, August 2005
