In the past few years we’ve been bombarded by sensational news reports about the possible danger of taking higher doses of Vitamin E. These reports have been based on a review article that was published in the Annuals of Internal Medicine [4 January 2005; Vol. 142 No. 1] written by Dr. Edgar Miller, of the John Hopkins School of Medicine. Miller concluded that a “high” dosage of vitamin E supplements (over 400 IU per day) may increase death rates and should be avoided. Obviously, careful evaluation of this study is warranted, since most of us are consuming these optimal or advanced levels of vitamin E.
The Rest of the Wonderful Story
Here are important facts that the media reports didn’t mention:
• This is not a new study. It is simply a review of 36 controlled trials, with follow-up of longer than 1 year, done from 1966 to 2004. There is no new research here, just an interpretation of old data.
• Only 19 trials were considered for statistical interpretation. Out of the original 36, they eliminated 17 trials that did not have more than ten deaths.
• None of the individual trials noted any statistically significant differences in the mortality between the control group and the Vitamin E group.
• The studies involved patients that were already very ill. For example, the CHAOS study (Cambridge Heart Antioxidant Study) involved over 2,000 patients who had already suffered a heart attack. The ADCS study (the Alzheimer’s Disease Cooperative Study) involved patients who already had moderate to severe Alzheimer’s dementia.
• Many of the patients in both the Vitamin E group and the control group died.
• 8 of the 19 studies actually showed fewer deaths in the Vitamin E group than the control group. The authors were even very careful to point out that their marginal findings of increased deaths from all-causes could not be carried over to healthy individuals. But you didn’t hear that on the evening news.
Twisting the Numbers
First and foremost, realize that you can prove anything you desire by simply setting up the criteria of the study to meet the conclusion that you desire to achieve. Out of the original 36 trials, the reviewers eliminated 12 trials because there were less than 10 deaths, 3 trials were eliminated because there was no mortality data available, and 2 trials were eliminated because the mortality data was confusing. This left the reviewers with 19 trials that lasted for greater than one year and involved more than 10 deaths. They pre-selected trials that supported their conclusions. That’s just bad science.
But then the numbers get twisted even more. In order to have results that mean anything, you have to have “statistical significance.” In order to do this, you plug your data into simple formulas that tell you whether your results have a cause or whether they were the result of chance. When all the trials are considered together, or when each study was considered individually, there was no statistically significant connection that could be made between Vitamin E and death. The differences could only be attributed to chance.
However, by focusing their analysis on only one or two of the larger studies, they were able to show a very slight statistically significant difference in deaths between the two groups of very ill patients. These studies used higher dose vitamin E primarily and the researchers came up with a marginally significant difference in deaths between these two groups. But remember, the higher doses were only given to patients who where the most ill, so we would expect a higher death rate anyway.
When they compared the deaths between the control group and the Vitamin E group for all 19 studies, there was not a statistically difference in the death rate of either group. Had they analyzed all of the trials and let all the data speak for itself, they would have not found statistical significance. So the conclusion that higher doses of vitamin E causes more deaths from all-causes is absolutely bogus. This is truly a manipulation in the highest sense of the word. They were literally grabbing at straws for anything they could show statistically. First they had to eliminate 17 of the trials. Then they eliminated the low dose vitamin E studies and focused on those who were most ill. Even by their own admission they state, “High dose vitamin E trials were often preformed in patients with various chronic disease, and we could not evaluate or project these findings to healthy adult populations.” But you didn’t hear that on the news either.
A Question of Motives?
Why would such a marginal review of the medical literature be reported in the media as such a sensational finding? The media has jumped all over this study and created a tremendous scare. Maybe there is a common thread. The pharmaceutical industry sponsored this study, at least in part, and they have a tremendous influence on the media. When you look at the maneuvering that was done to try to show a negative result, you have to wonder.
Realize that this is a study that hasn’t even been released yet. The last time that I recall the media jumping on a pre-released study was with the Fen/Phen crises. Mayo Clinic had concluded in a study in the New England Journal of Medicine that over one-third of the patients who used the Fen/Phen combination for weight loss for over 3 months had heart valve damage. For obvious reasons, this study needed to be reported as soon as possible.
When you compare the present review study to this situation, you can see why I am suspicious. I don’t know what the motives were behind this study. However, I personally believe that this is going to be only one of several negative studies that we will be dealing with over the next few years.
Different Perspective
This fat soluble vitamin continues to receive high acclaim as an exceptional antioxidant especially when paired with vitamins C, beta carotene, and selenium. There are actually two natural plant sources of vitamin E. The first is a group called tocopherols and include d-alpha (or RRR-alpha), beta, gamma, and delta. The second group are called the tocotrienols, of which alpha tocotrienol is the most biologically active. Of the two groups of vitamin E, the d-alpha tocopherol is the most biologically active and all other forms are compared to it in terms of their respective activity levels (alpha = 100, beta = 25-50, gamma = 10-35 and alpha tocotrienol = 30). There is also a synthetic vitamin E known as dl-alpha or all-rac-a-tocopherol, but it only has an activity level of 74% of natural or d-alpha tocopherol. Many people won’t think that this information is important on the surface, but if you are looking for natural vitamin E or trying to perform a calculation on equivalents, it becomes critical.
New preliminary reports are indicating that exercisers and those exposed to UV light and ozone may have a greater need for vitamin E. In a small test (5 men) conducted by German researchers at the University of Ulm, Germany, it was noted that the subjects experienced very little DNA damage to white blood cells when 800 IU’s of vitamin E was taken twice on the day before exercise and one dose a day afterward. This same group experienced significant DNA damage when the same test was repeated without the vitamin E supplementation (Mutation Research, 1995). Lester Packer, Ph.D., University of Berkeley, recently presented some of his recent findings regarding UV light and ozone. In a recent animal study, Packer observed that when skin was exposed to a single dose of UV light (suberythemal), vitamin E levels dropped by 40-48%. Exposure to ozone caused a similar decrease in vitamin E levels.
Putting these Studies in Proper Perspective
The overwhelming majority of the individual studies showed major health benefits for those who took Vitamin E, yet the Miller report ignored them. Consider these findings:
The CHAOS study showed a 77% decrease in the number of non-fatal heart attacks in the vitamin E group when compared to the control group. This is a major statistical improvement.
In the ADCS study, the patients with moderately, severe Alzheimer’s dementia who took high dose vitamin E (2,000 IU) were able to stay home 2 to 3 years longer than the control group. In other words, the Alzheimer’s dementia in the control group advanced much faster than the patients in the Vitamin E group.
The patients in the Vitamin E study not only showed a decrease in the progression of their Alzheimer’s dementia, but also saved a considerable amount of money that would have otherwise been spent on skilled nursing home care.
These findings are collaborated by many, many studies that show that a full and balanced nutritional supplementation program is highly effective in preventing chronic degenerative diseases and helping those who already suffer from them.
Applying the Facts about Vitamin E There are some valid concerns about the use of high-dose vitamin E supplementation:
Never use vitamin E alone. Vitamin E is not a drug but simply a nutrient that we get from our food; however, because of supplementation we are able to get it at levels you cannot obtain from your foods.
There is always the possibility that when you use vitamin E alone, it can become a pro-oxidant and actually cause increased free radical production.
Use optimal levels of all the important nutrients on a regular basis. Vitamin E is the most important antioxidant within the cell membrane; however, it is regenerated (may be used over and over) by vitamin C and alpha lipoic acid. All the studies that look at total antioxidant status, always shows a health benefit. Beta-carotene was once ostracized when a study looked at the use of beta-carotene alone in heavy smokers, and found an increased risk of lung cancer. Follow-up analysis of that same study has now shown that when you looked at total antioxidant (beta-carotene with other antioxidants) there was a significantly decreased risk of cancer.
Always use natural vitamin E (d alphatocopherol). Synthetic vitamin E (dl alphatocopherol) may be harmful. The body does not recognize this mirror image of natural vitamin E and tries to get rid of it. Many of the studies in our medical literature, including several that were reviewed in this meta-analysis, used synthetic vitamin E.
The only difference on your bottle is an “l” following the “d”. Go for the “d” only! (dalpha- tocopherol)
Use 400 to 450 IU of alpha-tocopherol in combination with a complete supplement program for full cellular nutrition. Using just alpha-tocopherol can actually displace other very important vitamin E’s like gamma, delta, and beta-tocopherols. It’s even better to add some additional gamma-tocopherol and tocotrienols to your nutritional supplementation. Several companies are now offering this mixture of vitamin E’s in an additional supplement.
Summing Up
Remember, don’t believe everything you hear in the media! This latest study has been blown way out of proportion and is strictly a statistical manipulation. Unfortunately, it will have an effect on physicians and the market place. Doctors will not take the time to do an in-depth objective evaluation of this study, but it will strengthen their bias against supplements. I know, because I know several physicians that have practiced this way for over 24 years. It truly makes me sad. Their conclusions and claims are bogus and they completely ignore the wealth of studies that show a tremendous health benefit of using high-dose levels of natural vitamin E as part of a full program for cellular nutrition. The overwhelming majority of studies show tremendous health benefits for using supplements for very serious illnesses. These studies show a much greater health benefit than almost all of the drugs studied in these same diseases. When individuals add these optimal, advanced levels of antioxidants to a proactive lifestyle, they decrease their risk of developing the chronic degenerative diseases that were being studied. The other serious fallacy of this meta-analysis is the fact that there is no way you can translate this study of serious ill patients to the general, healthy population. Even the reviewers themselves came to that conclusion. And finally, the number of deaths between the two groups was insignificant. They only found a statistically significant finding when they looked at just a few studies in the more serious ill patients who were receiving higher dose vitamin E.
No doubt, we are going to see more and more studies trying to demonstrate the danger of taking nutritional supplements. It is ironic when you consider that medications are the third leading cause of death in this country. If you don’t believe me, get a copy of my book Death by Prescription and look at the evidence.
