Heard a lot about vitamin E in the news lately? This is an attempt to provide a fair and balanced evaluation of what we know about the safety and about the benefits of vitamin E.
The last year has produced several articles that have brought into question the value of vitamin E as a key nutrient in good health. The latest incident occurred at the scientific session of the annual meeting of the American Heart Association in November of last year. Researchers from Johns Hopkins University presented a meta-analysis of 19 studies done between 1993 and 2004. They concluded that from a review of these studies, use of high-dose vitamin E may increase the risk of mortality. They defined high-dose vitamin E as any dose of 400 IU or greater per day. The news that researchers found a 10% increase risk of death in people taking “high-dose” vitamin E became instant print and broadcast media headlines.
What made this presentation even more interesting is that the Institute of Medicine set an Upper Tolerable Intake level of vitamin E at 1500 IU per day. This upper limit was established to represent the maximum intake for a nutrient that is likely to pose no risk of adverse health effects in most healthy persons in the general population. The question became, who is right about how much vitamin E is safe? Secondly, is vitamin E helpful or harmful if more people in the studies died who took it than those who did not? Finally, does this change the belief that antioxidants, like vitamin E, protect the body from disease at all?
The answer to those questions comes from a careful analysis of both the studies supporting vitamin E and the findings of those who criticize vitamin E. The flaw in the conclusions about vitamin E presented by the Johns Hopkins researchers is that these 19 studies of 136,000 mostly elderly patients were done on individuals that already suffered from serious chronic diseases including cancer, heart disease, Alzheimer’s, Parkinson’s and kidney failure. The fact is that in 18 of the studies, there was no evidence of increased mortality among the vitamin E users. The one study that did find an increased mortality accounts for the basis of the overall increase mortality conclusion made in the presentation. The combination of studies on chronically ill patients, with only a single study providing the majority of events, is hardly conclusive. The headlines generated by this presentation appear to be more to create news than to inform the public of a newly discovered risk. There continues to be a subtle but persisting bias against the belief that supplements like vitamin E help prevent disease by the medical establishment. The reliance on better early detection of disease and new treatment of disease remains the methodology of choice.
There have been similar studies concerning both heart disease and cancer that have questioned the value of taking vitamin E rather unfairly. The Nurses Health Study found that nurses with the highest intake of vitamin E from diet and supplements had a 30-40% lower rate of heart disease. Studies on patients with known heart disease, however, revealed that vitamin E did not prevent second heart attacks or reduce repeat adverse cardiovascular events. The conclusion of many researchers was to dismiss the primary prevention aspects of vitamin E because they were not reproducible in patients with known disease. This attitude that data on lower rates of disease is not valid unless it also occurs in patients with established disease ignores the value of disease prevention. The same attitude is present in the cancer prevention studies. Lower rates of cancer among vitamin E users was not emphasized unless the studies among the patients who had cancer also improved. The case of stomach cancer is a good example. A study reported that stomach cancer patients given vitamin E showed no improvement or no decrease in the progression of their disease. This study questioned the role of vitamin in preventing cancer of the digestive system. What was not mentioned is the fact that a bacteria H. pylori is associated in 90% of stomach cancer. When patients received the appropriate antibiotics to kill the bacteria likely causing the cancer, the patients who took vitamin E recovered more quickly and experienced lower rates of the cancer returning. This appears to be a study designed to produce results unfavorable to vitamin E.
Vitamin E is not a cure in most cases. The scientific evidence is abundant that vitamin E protects the phospholipid membranes of cells. It represents a key lipid soluble antioxidant that inhibits cellular damage by free radicals that have a cumulative injurious effect on the body. There is data that vitamin E taken at doses over 800 IU per day causes a decrease in blood clotting. There is no evidence that vitamin E presents a direct threat to healthy individuals. A study published in the Annuals of Neurology showed that 400 IU of vitamin E, taken in concert with 500 mg of vitamin C reduced the risk of Alzheimer’s by 60%. The Age-Related Eye Disease Study recommends 400 IU of vitamin E daily along with lutein, zinc, vitamin C, beta-carotene and copper to stop the progression of macular degeneration. A March 1998 Journal of the National Cancer Institute contains a Finnish study of 29,000 men who, after six years, had a 32% lower risk of prostate cancer and a 41% lower mortality rate if they did develop cancer when they took vitamin E. All these studies used doses of vitamin E of 400 IU and did not reveal any harmful effects to study participants. There are many more examples.
A large study was begun this year at the National Institutes of Health to determine if vitamin E and selenium have a significant role in other types of cancer protection. The results of this study should provide the evidence needed to draw purely scientific conclusions. The timing of this large prestigious study could not be better. The most commonly used antioxidants (vitamin C, beta-carotene, vitamin A, and vitamin E) have become targets of those researchers who doubt the role of antioxidants in disease prevention.
The existence of free radicals in the body is not in doubt. The fact that they cause muscle soreness after exercise, photo-oxidative damage to our eyes and skin and degenerative changes to our central nervous system, cardiovascular system and immune system is also unchallenged. The very process of aging has origins from cumulative free radical damage and hormonal changes. The fact that proper nutrition and appropriate nutritional supplements contributes to better health and less disease just does not appeal to some parts of the research community no matter what the data shows. Americans take more prescription medication today then ever before. A great deal of the research funding comes from large drug companies that want to keep it that way.
If you are currently taking vitamin E in daily doses of 400 IU or less, there is no reason to be alarmed. Most people will find vitamin E in their multivitamin or another type of disease prevention supplement because it is an essential nutrient to good health. These products generally do not use high doses of vitamin E but rather use the vitamin with other nutrients that maximize the benefits of vitamin E. Those individuals who feel they need to take higher doses of vitamin E should discuss their reasons with their doctor.
The good news for the fitness professionals and the nutritional scientists is that the general public wants to prevent disease. They believe that regular exercise and good nutrition are keys to a healthy life. The public has heard the message that obesity is about to pass cigarette smoking as the leading cause of death in the United States, and they want to do something about it. This means they want to be more active and make better meal choices. They will not be told that regular exercise is risky or causes injuries, and they will not be scared away from quality nutritional supplements. They want from us the information they need to make the lifestyle changes necessary to look younger, feel younger and live longer. There is going to be an enormous increase in information about disease reduction over the next few years. It is important to stay current to what is being published, so you can help your clients get the whole story.
- Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willet WC, vitamin E Consumption and the risk of coronary disease in women. N Engl J med 1993; 328:144-9.
- Zandi, P. Archives of Neurology, January 2004; vol 61: pp 82-88.
- Knetkt p, Reunanen A, Jarvinen R, Heliovara M, Aromaa A. Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol. 1994; 139: 1180-9.