Flu Shot Realities

Nutrition and Seasonal Flu

Antibiotics fight bacteria but won’t help against viral infections, and there are limited medical options. Flu drugs must be taken within 48 hours of the first symptoms of influenza and only claim to reduce symptoms by about 1.5 days. [1], [2]

Flu shots are only effective against 1-3 strains of influenza; depending on how lucky the researchers’ guess was several months earlier. But exposure to one or more flu strains, such as by getting a flu shot, actually make us more susceptible to infection from other virus strains by reducing our immune response.  Researchers know that, theoretically, when people are exposed to bacteria or a virus, it can stimulate the immune system to create antibodies that facilitate the entry of another strain of the virus or disease. For example, Canadian researchers in four separate studies found that people who had received the seasonal flu vaccine in the past were more likely to get sick with the H1N1 virus. [3]

There is evidence that the nutrient status of the host even affects the genetic expression of viruses. An unsuitable environment like a well-nourished body inhibits the ability of a virus to freely replicate and thrive. This not only makes viruses more virulent, but also more prone to mutate inside us to become more immune- and drug-resistant strains if we are nutrient deficient! ^{[4], [5], [6], [7]}

Research going back over a century has proven that nutrient deficiencies, for example of vitamins A or D, can lead to increased susceptibility to infectious diseases. A well-known and decades-old example is the strong association of vitamin A deficiency with the development of more severe measles infections, leading to a much higher rate of mortality. ⁵

Although the immune response has been demonstrated to be impaired in nutritionally deficient hosts, the actions and vigor of the virus itself may also be affected by the nutritional deficiency. Viruses have been shown to develop increased virulence due to changes in their genomes when replicating in a nutritionally deficient host. The exact mechanism for viral genetic changes is not well documented but seems related to increased oxidative stress in the host. For example, selenium-deficient mice were more susceptible to viral infections, and developed severe forms of illnesses even when infected with mild viral strains. Both the immune system and the viral systems were affected by the nutrient deficiency in ways that strengthened the virus and weakened the host. ⁵

Volunteers inoculated with live attenuated influenza virus are more likely to develop fever and evidence of an immune response in the winter when vitamin D levels are naturally low.  And an interventional study showed that vitamin D reduced the incidence of respiratory infections in children. [8]

Compelling epidemiological evidence indicates that vitamin D deficiency is a stimulus causing seasonal flu rates to be much higher in the winter months than the summer months. Evidence now confirms that lower respiratory tract infections are more frequent, sometimes dramatically so, in those with low serum vitamin D levels. In an intervention study, 800 IU of vitamin D daily reduced seasonal flu levels in winter months to the low levels commonly reported in summer months...virtually eliminating seasonal flu in that population. [9]

We can see that vaccines and flu drugs convey only limited protection and treatment against viral infections, and that the wisest course is to fortify our immunity with adequate nutrient intake.

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[1] http://www.tamiflu.com/treat.aspx 

[2] http://www.relenza.com/

[3] CBC News 9/23/09; Dr. Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion

[4] Cunningham-Rundles S, McNeeley DF, Moon A.  Mechanisms of nutrient modulation of the immune response.  J Allergy Clin Immunol. 2005 Jun;115(6):1119-28; quiz 1129. Review.

[5] Zaslaver M, Offer S, Kerem Z, Stark AH, Weller JI, Eliraz A, Madar Z. Natural compounds derived from foods modulate nitric oxide production and oxidative status in epithelial lung cells.  J Agric Food Chem. 2005 Dec 28;53(26):9934-9.

[6] Calder PC, Kew S.  The immune system: a target for functional foods? Br J Nutr. 2002 Nov;88 Suppl 2:S165-77.

Janeway, Charles A.; Travers, Paul; Walport, Mark; Shlomchik, Mark (2001) Immunobiology, 5th Ed., Garland Publishing, New York and London.

[7] Beck MA, Handy J, Levander OA. Host nutritional status: the neglected virulence factor. Trends Microbiol. 2004 Sep;12(9):417-23. Review. PMID: 15337163

[8] Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40. Epub 2006 Sep 7. Review. PMID: 16959053

[9] Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review. PMID: 18298852

Memory and Age

Memory and Age By Neil E. Levin, CCN, DANLA The most important things for an older person to consider in protecting against minor memory loss – often attributed to “aging” – include: · Maintain at least a nominal physical activity level to keep circulation and body functions at optimal levels. · Take a good multivitamin to assure minimal levels of essential nutrients. Too many elders fail to eat properly or to get adequate levels of B vitamins and other key nutrients associated with proper cognitive function. Also, the elderly don’t absorb nutrients from food as efficiently, making supplementation even more important. · Don’t forget to eat meals. Often, single, divorced or widowed seniors fail to eat regular meals on schedule. This creates nutrient deficiencies that complicate their ability to maintain physical and mental health. · Don’t overeat on processed, high fat, high sodium foods such as fast foods to “compensate” for poor eating habits. · Take foods and supplements that are rich in antioxidants. Oxidative damage is clearly associated with many of the conditions that affect mental, as well as physical, capabilities in older people. This includes negative changes to the brain itself; and also the nervous system, the eyes and joints. · Use vitamin D, which may be in your multivitamin or calcium supplement, to compensate for the lack of direct sunlight on skin. This essential vitamin also helps with immunity, cardiovascular health and bone health. · If your dietary habits are reasonably good and you still want some more natural aids for brain and memory function, consider a brain nutrient formula. Of course, college age is a time when many students want to use brain nutrients to maximize their learning and recall, especially for tests. Many adults then coast through adulthood until they reach their 40’s or 50’s and start to get a little forgetful. By then, they should already be examining their diet, lifestyle and stress levels to consider whether they may need additional nutritional support for their mental functions. If they wait until things get bad - in their 60’s, 70’s or later - it may be too late to preserve their memories and mental acuity. Basic brain nutrients are multivitamins, lecithin and fish oil. Antioxidants will protect the brain’s structures and functions throughout adulthood. Magnesium, an essential mineral that is deficient in 90% of Americans, helps to reduce toxic effects of chemicals on neurons; as do antioxidants such as vitamin E, tocotrienols, and vitamin C. People will usually hint at the need, or ask about Ginkgo or look at the section. We’re not the family, friends or work colleagues that people try to hide symptoms from…after all; we are the ones that perfect strangers often disclose their bowel habits and other normally hidden quirks to. Speaking in user-friendly but technical structure-function language will often make the discussion less personal and more scientific, removing much of the emotional content of the health issue. Phosphatidyl Serine is a phospolipid compound derived from soy lecithin that plays an essential role in cell membrane composition and intercellular communication. Phosphatidyl Serine is a major structural component of neural membranes where it assists in the conduction of electrical impulses and facilitates the activity of neurotransmitters involved in learning, memory and mood. These properties make Phosphatidyl Serine formulas ideal basic supplements for the support of cognitive function. There is enough evidence of the safety and efficacy of PS for the FDA to have issued a qualified health claim for it. DMAE is known primarily as a precursor to choline and acetylcholine (chemicals in the brain responsible for nerve transmissions and cognitive function), and has been used most predominantly to improve memory and focus while stimulating neural activity. Many researchers believe that it may serve an anti-aging function by increasing the body’s capacity to produce acetylcholine – a deficiency commonly associated with memory loss. Scientific research has demonstrated that Ginkgo Biloba Extract has antioxidant activity in in vitro studies and thus may aid in maintaining healthy brain and memory function. The insulating myelin sheaths that protect the brain, spine and thousands of miles of nerves in the human body are almost two-thirds Lecithin. Lecithin is composed of many different components, including Choline, Inositol, Linoleic Acid, Phosphatidyl serine, fatty acids and triglycerides. These valuable constituents of Lecithin are vital for the proper functioning of many metabolic processes. And let’s not forget the benefit of DHA and fish oil. Fish oils are typically molecularly distilled and tested to be free of screened for the absence of potentially harmful levels of contaminants (i.e. mercury, heavy metals, PCB's, dioxins, and other contaminants). DHA is utilized in forming the brain and nerves. And last but not least, antioxidants and magnesium are very helpful in protecting brain structures and may be useful in preventing some of the feared declines associated with aging brains. For example, vitamin C actually pumps glutamates out of neurons.

Detoxification

Detoxification By Neil E. Levin, CCN, DANLA The EPA tracks about 650 toxic chemicals used in 23,600 facilities in the US. The agency reports that about half of the 4.24 billion pounds of these toxic chemicals are annually released into the air, ground or water. These include chemicals from the mining, smelting and power generation industries, paper production, electronic equipment manufacturing, plastics, pesticides, etc. While the highest release of chemicals is associated with mining and power production, other industries release problematic chemicals into the environment on a daily basis, all over our country. Certain groups are most at risk (e.g., children, pregnant and nursing women, the elderly). I would also add that people with multiple chemical exposures or even a single toxic level of exposure can develop a hyper-sensitivity to chemicals that can be debilitating. This condition is often called multiple chemical sensitivity. Of course, there is an increase in exposures as our exposure to so many chemicals uses up key nutrients and can overload the body’s ability to detoxify these toxic “insults” to the liver and other body systems. As our need for key nutrients and optimal detoxification processes grows during repeated, chronic exposures, our bodies may fail to keep pace and the levels of toxins can accumulate in our body. The results can be subtle (acne, headaches, persistent “colds”) or extreme (hair or tooth loss, chronic fatigue, pain). We see inflammatory-related conditions increasing, such as liver problems, cardiovascular issues, joint degradation and brain degeneration. While it is true that these conditions are associated with aging, it is also true that aging relates to the body’s inability to properly remove toxins and distribute nutrients to all of its tissues. Inflammatory chemicals can be either the original chemical or a biochemical metabolite that is produced in the body as a temporary step in neutralizing and removing the chemical. If inadequate nutrient stores do not allow the detoxification to complete - and often heroic levels of nutrients far above the RDI’s are required in these situations – then the body still will have a burden of toxic, inflammatory chemicals to contend with. The old adage is to reduce the exposure and increase the nutrients in order to allow the body to clear these toxins in its usual manner. Everything that lowers exposure, even removing shoes when entering a house or using appropriate filters for air ducts, may be helpful in reducing airborne toxins. But it is also important to reduce exposures through varied sources such as medications, non-organic food and the environment as best we can. Antioxidants, including sulfur-containing substances, are the key to detoxification. Methylation, sulfation and antioxidant reduction are some detoxification techniques used by the liver, especially. The liver utilizes these methods to render toxins inert enough to allow removal through the bile or the urine. Methylation can be enhanced by methyl donor nutrients, such as choline, TMG, DMG and SAMe. Sulfation is done with MSM, sulfur from plants (garlic, onions, broccoli, kale) or sulfur-containing proteins (methionine, cysteine, glutathione). Antioxidants include Vitamin C, alpha lipoic acid, etc. Any sources of these nutrients would be beneficial to aiding the body’s natural detoxification systems. One problem is that people often fear to use adequate, high levels of these nutrients, such as taking Vitamin C up to bowel tolerance levels. Some natural substances that enhance/support detoxification include Zinc, Selenium, Copper, Manganese, Sodium Alginate, Chlorella, Bladderwrack, MSM, Beet Root, Red Clover, Dandelion Root, Oregon Grape Root, and Milk Thistle Extract. Another new product is a broccoli seed concentrate called “sgs™”, which is backed by numerous clinical studies at Johns Hopkins regarding its ability to enhance natural detoxification. Adequate fiber is also important in moving the waste quickly through the colon to help remove toxins while avoiding exposure to toxins from the waste or from inappropriate microbes that fester in an unhealthy colon. Probiotics are important, especially bifidobacteria (Bifidus). Drinking adequate amounts of clean, filtered water is another must. Eating organic whenever possible is important, avoiding non-organic fruits and vegetables prone to heavy chemical exposure. Detoxification is a normal bodily function, so claiming that a dietary supplement can support this function would be a legitimate “structure-function statement” authorized by federal law if the clinical documentation is available. Neil E. Levin, CCN, DANLA is a nationally certified clinical nutritionist with a Diplomate in Advanced Nutritional Laboratory Assessment. He is a professional member of the International & American Associations of Clinical Nutritionists. Neil is the nutrition education manager and a product formulator for NOW Foods, a natural food and dietary supplement manufacturer in Bloomingdale, Illinois. Neil is a member of the Scientific Council of the national Clinical Nutrition Certification Board and serves on the board of directors of the Mid-American Health Organization (MAHO), the Midwest regional affiliate of the National Products Association (formerly NNFA). Neil is routinely interviewed for articles in trade magazines serving the natural products industry and has published articles in magazines and newspapers, contributed to scientific journals and has been a guest on numerous radio shows. He has been interviewed for television news reports many times over a 33-year career. You can read some of Neil’s recent articles at his non-commercial website: http://www.honestnutrition.com/

Multiple Vitamins - Waste or Wise?

Multiple Vitamins - Waste or Wise? The information in this presentation is for educational purposes only. It is not intended to serve as a replacement for the advice of a medical professional. Amid the current confusion about whether or not to take multivitamins, here are some facts you should consider: There are widespread nutrient deficiencies in America: According to dietary data from the National Health and Nutrition Examination Survey 1999-2000, ninety percent or more of the adults studied had their usual intakes below the current Estimated Average Requirement. 9-11 A report published in the medical journal JAMA made this strong statement: “Most people do not consume an optimal amount of all vitamins by diet alone. Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements.” 2 There is strong evidence that multivitamins may improve immune functions in adults: A so-called “gold standard” randomized, double-blind, placebo-controlled trial looked at adults age 45+ during a one-year study, with results of diabetic and non-diabetic subjects reported separately. 1 73% of those receiving the placebo reported getting infections over the year versus 43% of those taking multivitamins, a 30% difference. Infection-related absenteeism was also found to be much higher in the placebo group (57%) than in the treatment group (21%). But the most striking results were found among the diabetic subjects. A whopping 93% of diabetics receiving the placebo reported getting infections versus only 17% of those taking vitamins, an amazing 76% difference! In other words, the diabetics that did not take multivitamins were over five times as likely to report infections as those in the group that did take the vitamins. Multivitamins reduce birth defects: A meta-analysis of published studies reviewing women’s use of prenatal multivitamins was published by the Journal of Obstetrics and Gynaecology of Canada (JOGC). Researchers found that taking prenatal multivitamins may reduce the risk of a wide range of serious birth defects, including: cardiovascular and limb defects, cleft palate and oral cleft, congenital hydrocephalus, and urinary tract anomalies. Their conclusion was that, “Maternal consumption of folic acid-containing prenatal multivitamins is associated with decreased risk for several congenital anomalies, not only neural tube defects. These data have major public health implications, because until now fortification of only folic acid has been encouraged. This approach should be reconsidered.” 3 The data indicated that the possible benefits to infants of their mothers taking prenatal multivitamins went far beyond the well-known prevention of neural tube defects in the children. That known benefit has already led to widespread fortification of folic acid in processed foods, especially refined flour. Multivitamins protect pregnant women and their fetuses: Another possible benefit of multivitamin use is to prevent potentially fatal complications in pregnant women. This finding was reported by researchers at the University of Pittsburgh: “Women who are considering becoming pregnant may significantly reduce their risk of developing a common life-threatening complication called pre-eclampsia by taking a multivitamin supplement regularly three months before conception and during the first trimester of pregnancy.” 8 Multivitamins reduce infertility: Harvard scientists found that women who took multivitamins at least six times a week were over 40% less likely to have fertility problems linked to ovulation than other women. Dr Jorge Chavarro, from the Harvard School of Public Health, presented his findings to delegates at the American Society for Reproductive Medicine conference in New Orleans in October, 2006. 4 Multivitamins and chronic conditions: Another scientific review published in JAMA noted that, “Although the clinical syndromes of vitamin deficiencies are unusual in Western societies, suboptimal vitamin status is not. Because suboptimal vitamin status is associated with many chronic diseases, including cardiovascular disease, cancer, and osteoporosis, it is important for physicians to identify patients with poor nutrition or other reasons for increased vitamin needs. The science of vitamin supplementation for chronic disease prevention is not well developed, and much of the evidence comes from observational studies.” 5 The report concluded, “Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis.” Multivitamins may reduce childhood tumors: In a case-control study of brain tumors and the mothers’ use of vitamin and mineral supplements early in pregnancy, the researchers confirmed earlier research indicating that mothers taking multivitamins had a reduced risk of their child developing brain tumors. “The results of the study add to the evidence of a protective role for multivitamins, suggest a possible role for micronutrients early in pregnancy...” 6 Vitamin-Mineral Deficiencies are Theoretically Linked to Increased Cancer Risks: Researchers writing in the scientific journal Nature Reviews Cancer have stated, “Diet is estimated to contribute to about one-third of preventable cancers -- about the same amount as smoking. Inadequate intake of essential vitamins and minerals might explain the epidemiological findings that people who eat only small amounts of fruits and vegetables have an increased risk of developing cancer. Recent experimental evidence indicates that vitamin and mineral deficiencies can lead to DNA damage. Optimizing vitamin and mineral intake by encouraging dietary change, multivitamin and mineral supplements, and fortifying foods might therefore prevent cancer and other chronic diseases.” 7 There is a wide range of published research on multivitamins and I have presented only a sampling to you today. I hope that this information intrigues you as to the potential benefits of the vitamins and minerals found in multivitamins, and the fact that some respected health authorities advocate that most Americans take a good multivitamin. Copyright 2007 Neil E. Levin REFERENCES: Barringer TA, et al. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003 Mar 4;138(5):365-71. PMID: 12614088 Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002 Jun 19;287(23):3116-26. Review. Erratum in: JAMA 2002 Oct 9;288(14):1720. PMID: 12069675 Goh YI, et al. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can. 2006 Aug;28(8):680-9. PMID: 17022907 Chavarro, J. (Harvard School of Public Health) American Society for Reproductive Medicine conference. New Orleans, LA. October 2006. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002 Jun 19;287(23):3116-26. Review. Erratum in: JAMA 2002 Oct 9;288(14):1720. PMID: 12069675 Bunin GR, et al. Maternal supplement, micronutrient, and cured meat intake during pregnancy and risk of medulloblastoma during childhood: a children's oncology group study. Cancer Epidemiol Biomarkers Prev. 2006 Sep;15(9):1660-7. PMID: 16985028 Ames BN, Wakimoto P. Are vitamin and mineral deficiencies a major cancer risk? Nat Rev Cancer. 2002 Sep;2(9):694-704. Bodnar LM, et al. Periconceptional multivitamin use reduces the risk of preeclampsia. Am J Epidemiol. 2006 Sep 1;164(5):470-7. Epub 2006 Jun 13. PMID: 16772374 Dial S, Eitenmiller RR. 1995. Tocopherols and tocotrienols in key foods in the U.S. diet. In: Ong ASH, Niki E, Packer L, eds. Nutrition, Lipids, Health, and Disease. Champaign, IL: AOCS Press. Pp. 327–342. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000). Institute of Medicine, NIH Ahuja JK, et al. Current status of vitamin E nutriture. Ann N Y Acad Sci. 2004 Dec;1031:387-90. PMID: 15753177

Antioxidant Confusion

Antioxidant Confusion By Neil E. Levin, CCN, DANLA Board certified clinical nutritionist with diplomate in advanced nutritional laboratory assessment March 2, 2007 A meta-analysis published in the medical journal JAMA this week reported that antioxidant vitamins do not extend life and may even increase death rates slightly. 1 These conclusions make no sense, based on the scientific record. A meta-analysis relies on a statistical model of existing science, and this model has severe limitations. Even the authors admit some of the basic problems inherent in this type of analysis. More importantly, the authors could not find a dose-dependent or cause-and-effect relationship between antioxidants and deaths (from all causes) of study participants. In other words, they couldn’t show that antioxidants actually caused any deaths or that there was risk at a particular dosage. Yet this questionable speculation received widespread publicity from the sensation-hungry media during “Sweeps Month”, dutifully spreading the lie that antioxidants are now worthless and dangerous. The researchers pooled 68 previously published trials but arbitrarily excluded all published studies that had no deaths reported from any cause. Indeed, 405 otherwise eligible studies were excluded solely for this reason, which if included would likely have dramatically changed the results and conclusion. The researchers did not disclose why they decided to exclude these. This is equivalent to playing a card game after removing all but 7 cards from the deck. (That wouldn’t be a fair game, would it?) They largely ignored the original outcome measures of the studies, many of which had shown positive results for antioxidants, to look only for deaths from any cause in a tiny segment of all published research. This arbitrary decision echoes a frequently cited complaint by scientists commenting to the journal Annals of Internal Medicine when the infamous Miller meta-analysis of vitamin E was released a few years ago, which led to a dramatic slowdown of vitamin E sales. 2 It is interesting that the Miller study’s negative conclusions about vitamin E safety have since been thoroughly debunked by a more rigorous analysis published in the American Journal of Clinical Nutrition by leading antioxidant experts. 3 It is even more interesting that the flawed Miller review was cited as a reference by the JAMA authors but the second, more thorough analysis of the same data by real nutrition experts was not. The lesson learned is that a flawed meta-analysis of nutrients by statisticians and physicians may not hold up to a more competent review done by actual experts in the field of nutrient interactions, though the initial report may have scared people and changed their behavior. Critical comments and corrections typically go ignored, uncited and unreported, in contrast with the sensational initial report. 4 I question both the selection of studies reviewed and the references cited in this meta-analysis. Obviously, excluding six times as many potentially eligible studies as were actually chosen solely because of a requirement that someone in the study population had to die unfairly magnifies negative results by dramatically reducing the pool of studies with potentially positive results and healthier populations. This negative shift is a result of limiting the combined patient population to those studies with at least one dying patient. This population shifts to those individuals who are more likely to be deficient in a variety of antioxidant substances and who are unlikely to respond to limited amounts of one or few supplemental antioxidants. The lack of additional supporting antioxidants may even sometimes increase the oxidative stress on the body. A review of antioxidant science noted, “These negative results…should not be taken as evidence that the free radical theory of aging is flawed. In fact, they prove merely that a complex organism like a human or rodent is unlikely to respond predictably to crude manipulations such as supplementation with one or a small number of compounds.” 1, 5, 6 This mirrors the JAMA authors’ admissions that “antioxidant supplements may show interdependency and may have effects only if given in combination,” and that their findings “should not be translated to potential effects of fruits or vegetables,” which are sources of numerous and varied antioxidant substances. 1 Previous studies have shown the folly of such a protocol. Some years ago an antioxidant study in Finland was halted early because of a widely reported increase in cancer rates among male smokers taking beta-carotene. 7 Headlines associated this supplement with cancer risk. Despite objections that the study was flawed, beta-carotene use dropped. A later analysis published in July 2004 took another look at that same Finnish smokers' study data, but now taking into account total antioxidant intake, which (should have) cleared away the scientific controversy. 8 A composite antioxidant index was generated for each of the 27,000 men over 14 years. The calculated amounts of carotenoids, flavonoids, Vitamin E, selenium and Vitamin C were compared to actual lung cancer rates, with a clear result: an increased intake of a combination of antioxidants lowered lung cancer risk in male smokers. Another large study has noted that high carotenoid intake, as confirmed by measures of blood levels, was associated with lower mortality rates among the elderly over a ten year period. 9 The dietary level of antioxidants is an independent predictor of plasma beta-carotene, especially in moderate alcohol drinkers. A more recent study reports, “This may explain, at least in part, the inverse relationship observed between plasma beta-carotene and risk of chronic diseases associated to high levels of oxidative stress (i.e., diabetes and CVD), as well as the failure of beta-carotene supplements alone in reducing such risk.” 10 In other words, we shouldn’t expect one or two supplemented antioxidants to compensate for a deficiency of total antioxidants in the diet. In fact, many of the protocols for supplementation in the included studies may have actually been of too low potency to achieve noticeable health benefits by remedying latent nutrient deficiencies in fragile patient populations. In other words: many of the interventions were too little, too late. Don’t blame the vitamins. The JAMA report admits that the study populations, the variety of antioxidants used, their potencies and the protocols for taking them were extremely variable, complicating their data with many uncompensated variables. Yet the authors actually claim that, “This increases the trustworthiness of our findings.” I don’t think so! One trial included gave only a single serving of antioxidants and then monitored participants for 3 months. Others used doses of as little as 10 IU of vitamin E (a low amount that is below the Daily Value) and 20 mcg of selenium 1 (an amount far below the 70 mcg DV and not anywhere near the 200+ mcg/day associated with lower cancer rates). 11, 12 I am not alone in these criticisms. Alexander Schauss, PhD, FACN has written, “The range of doses in the different trials they selected for the meta-analysis is dramatic. For example, vitamin A ranged from 1333 IU to 200,000 IU, and vitamin E from 10 IU to 1000 IU. The duration of the studies range from 28 days to 12 years. Nevertheless they were all lumped together.” An Associated Press article quoted other experts criticizing this meta-analysis: ‘Meir Stampfer, professor of nutrition and epidemiology at the Harvard School of Public Health, said the new analysis hasn't discouraged him from taking his vitamins. Stampfer said the studies were too diverse to pool together because they looked at various combinations and doses of antioxidants tested in different groups of people. The trials ranged from a three-month study of 109 elderly nursing home residents to a 12-year study of 22,071 male doctors. "This study does not advance our understanding, and could easily lead to misinterpretation of the data," said Stampfer, who was not connected to the new report.’ The AP report also quoted Donald Berry, chairman of the department of biostatistics at the University of Texas’ M.D. Anderson Cancer Center, stating that this expert also disagreed with the researchers' finding of an increased risk of dying. "There are so many choices you can make when you're doing these analyses," he said. A study of approximately 90,000 nurses suggested that the incidence of heart disease was 30% to 40% lower among nurses with the highest intake of vitamin E from diet and supplements. Researchers found that the apparent benefit was mainly associated with intake of vitamin E from dietary supplements. High vitamin E intake from food was not associated with significant cardiac risk reduction. 13 Levels of Vitamin E above 100 IU daily are associated with decreased risk of coronary heart disease and certain types of cancer, as well as enhancement of immune function. These increased vitamin E intakes are considerably above levels obtainable from diet alone. 14, 15, 16 In a report on the Women’s Health Study published in JAMA, subjects supplementing with vitamin E were reported to have a significant 24% reduction in cardiovascular deaths. 17 Have these previously published benefits of antioxidants miraculously vanished simply because some doctors manipulated a statistical model to elicit unreliable data with no solid basis? Many of the studies included were of patients with specific, serious medical conditions, including one of elderly nursing home patients measuring incidences of bacterial infections (contrasting with a 2004 study published in JAMA noted that, “we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold, that merits further investigation.” 18), patients with tumors removed from their colon/rectum (antioxidants are associated with apoptosis, a desirable change that leads to death of cancer cells 19, 20), patients with age-related macular degeneration (a condition associated with a deficiency of various antioxidants 21-24), patients with coronary heart disease (a condition related to oxidative damage 14-16), dialysis patients with a history of cardiovascular disease (a condition related to oxidative damage that is reduced by supplemental vitamin E 17), cataract patients (another condition related to oxidative damage 25), male cigarette smokers/present and former cigarette smokers/asbestos workers (all related to low levels of total antioxidants and high toxic load), as well as patients with alcoholic hepatitis, cirrhosis, lupus, heart failure, ALS, etc. This meta-analysis will not stand the test of time because of its many variables, flaws and the arbitrary structuring of its statistical model. When better studies exist, often supported by blood assays, that show higher serum antioxidant levels reduce actual death rates in large populations, then no arbitrary statistical model should be able to negate that robust science with a merely theoretical danger based on such preliminary, questionable criteria. All studies cited here were published in peer-reviewed scientific journals, but that does not make them all of equal quality. Remember my story of the meta-analysis on vitamin E that was refuted by a better meta-analysis, yet both were peer-reviewed? A meta-analysis has more validity if fewer variables are included and if the selection of studies included is not biased by a presumed conclusion. Were hundreds of studies without dying participants ineligible for this particular meta-analysis review simply because of a selection bias, with an intent to demonstrate the dangers of supplementation? These scientists should know better. I see their report as an ill-disguised partisan attack by medical special interests on dietary supplements, a smokescreen for those that don’t look at the quality and quantity of well-designed studies that do show the benefits of vitamins to protect health and prevent deaths. The Lewin Group has presented evidence that the use of antioxidants could save the vision and independence of many senior citizens, while saving the public billions of dollars in healthcare costs. 26 The Institute of Medicine, part of the National Institutes of Health, after reviewing hundreds of well-designed studies, has set safe upper limits for several antioxidants at levels far above the Daily Values. 27 Antioxidants are safe, and proven so in better studies than this one. REFERENCES: 1. Bjelakovic G, et.al. Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention: Systematic Review and Meta-analysis. JAMA 2007. 297(8):842-857 2. Miller ER 3rd, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1):37-46. Epub 2004 Nov 10. Summary for patients in: Ann Intern Med. 2005 Jan 4;142(1):I40. PMID: 15537682 3. Hathcock JN, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr. 2005 Apr;81(4):736-45. Review. PMID: 15817846 4. Levin, N. Land of Confusion: How Poor Science and Misleading Media Coverage Create Public Confusion About How Dietary Supplements Affect Health. J App Nutr, Vol 55, No. 1, 2005 8-15 5. Beckman KB, Ames BN. The free radical theory of aging matures. Physiol Rev. 1998 Apr;78(2):547-81. Review. PMID: 9562038 6. BLOCK, G. Are clinical trials really the answer? Am. J. Clin. Nutr. 62, Suppl.: 15175-15205, 1995 7. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. 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Nutr. 116:1371-1377, 1986. 16. Weber, P., Bendich, A. and Machlin, L.J. Vitamin E and Human Health: Rationale for Determining Recommended Intake Levels. Nutrition 13:450-460, 1997. 17. I-Min Lee, MBBS, ScD; et al. Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer. The Women’s Health Study: A Randomized Controlled Trial. JAMA. 2005;294:56-65 18. Meydani SN, et al. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. PMID: 15315997 19. Narayanan BA. Chemopreventive agents alters global gene expression pattern: predicting their mode of action and targets. Curr Cancer Drug Targets. 2006 Dec;6(8):711-27. Review. PMID: 17168675 20. Valko M, et al. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007;39(1):44-84. Epub 2006 Aug 4. Review. PMID: 16978905 21. Chiu CJ, Taylor A. Nutritional antioxidants and age-related cataract and maculopathy. Exp Eye Res. 2007 Feb;84(2):229-45. Epub 2006 Jul 31. Review. PMID: 16879819 22. Moriarty-Craige SE, et al. Antioxidant supplements prevent oxidation of cysteine/cystine redox in patients with age-related macular degeneration. Am J Ophthalmol. 2005 Dec;140(6):1020-6. PMID: 16376645 23. Richer S, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry. 2004 Apr;75(4):216-30. PMID: 15117055 24. Koh HH, et al. Macular Pigment Optical Density in Early, Age-Related Maculopathy (ARM); Comparisons With Normals and Effects of a Lutein Supplement. Invest Ophthalmol Vis Sci 2002; 43:2562 25. Meyer CH, Sekundo W. Nutritional supplementation to prevent cataract formation. Dev Ophthalmol. 2005;38:103-19. Review. PMID: 15604620 26. DaVanzo JE, et al. An Evidence-Based Study of the Role of Dietary Supplements in Helping Seniors Maintain their Independence. The Lewin Group Inc. January 20, 2006 27. National Institutes of Health, Institute of Medicine, Office of Dietary Supplements. Vitamin E Fact Sheet