Foods and Supplements for a Ketogenic Diet

Ketosis occurs when the body is largely starved of carbohydrates but has an alternate energy source. Ketogenic products encourage the burning of fat in place of sugar/carbohydrates as a caloric source. The key is to avoid rises in blood sugar and insulin, while providing alternate fuels.

There are numerous keto-friendly products; these are considered to be those that contain fewer than 10 calories per serving of net carbohydrates (minus fiber). Fiber doesn’t raise blood sugar and insulin response, so is neutral and not counted when looking at labels. Most dietary supplements fall into the category of being ketogenic neutral; that is, they neither contain significant carbohydrate sources nor directly contribute ketogenic stimulating substances like fat. The main ketogenic products are fats: MCT and coconut oils (both contain MCTs) are the most important ones. Some take beta-hydroxybutyric acid, a ketone, directly.

Ketogenic diets tend to decrease electrolytes and increase the need for water. This increases the need for magnesium, potassium, and even sodium. If blood sugar drops too low, the kidneys can create blood sugar by converting the proteins (i.e. the amino acid glutamine) into glucose (gluconeogenesis), so high protein diets are also discouraged. This leaves non-starchy vegetables and fats as the most desirable parts of the diet, along with some protein and fiber. Nuts and seeds are often okay, but some are more starchy; check the labels. Dairy is largely out due to its lactose content, but non-dairy foods and beverages may be okay if also low carb. Fish oil supplements are desirable. Green foods are important; supplements like chlorella or spirulina can be very useful, as can wheatgrass or barley grass.

Other supplements used on a ketogenic regime include green tea and EGCg capsules, L-glutamine if exercising (it can convert to sugar, so use sparingly), 7-keto DHEA, collagen or gelatin or bone broth. Anti-inflammatory substances may also be helpful: turmeric and curcumin, ginger, etc.

Unless eating natural or fortified sources of vitamin D, or getting adequate sun exposure, supplementation of this vitamin is recommended. A multiple vitamin is the best source, assuming it has enough for your needs,  as it also supplies other nutrients needed for metabolism of fats and energy production. Calcium supplementation may be needed unless consuming lots of green vegetables. Look for digestive enzymes that supply lipase if consuming lots of fat (not needed for MCT oil). Supplements containing ox bile (also in some digestive enzyme formulas) may be needed if inadequate gall bladder function is suspected or known. Don’t forget the electrolytes!

Excerpts from my interview about nutrition and diabetes

Fasting blood sugar tests are how doctors have long checked patients for blood sugar issues. A person’s options are greatest when they first discover that their blood sugar has gone out of balance. If they wait until after they’re on insulin or other medications, any natural means for improvement in blood sugar control could cause a dose of medicine to become an overdose. It is very important that your physician knows if you are going to try to control your blood sugar naturally, and that you test your blood sugar levels every time before taking medication in order to avoid dangerous interactions.

It normally takes several years to progress to full diabetes, and many people make diet and lifestyle changes that can control their blood sugar and prevent the development of diabetes without the use of drugs. But prolonged pre-diabetes weakens the system, being inflammatory and unsustainable over the long term. Of course, progression to full-blown diabetes is the biggest risk; meaning medications for the rest of your life, circulatory problems that can lead to blindness, neuropathy and amputations, more risks from infections, inflammatory problems, and even premature death. Adjustments to medications are needed and there is the possibility of insulin shock or diabetic comas. Frequent urination, high blood pressure, even the elevated risk of heart attack and stroke are other serious issues that diabetics face.

It’s a positive development that more people address health conditions when they first have indications of a growing problem. This may be partly because of high health care costs, but many people are motivated to improve their health for its own sake.

Metabolic Syndrome is a pre-diabetes condition defined as a combination of three or more of these symptoms: waist circumference over 40” for men and over 38” for women, high blood sugar (defined as a fasting blood glucose level over 100 mg/dL), high triglycerides (over 150 mg/dL), low high-density lipoprotein (HDL, the "good" cholesterol, levels below 40 mm Hg for men and under 50 for women), and hypertension (high blood pressure; the top number (systolic) over 130 and/or the bottom number (diastolic) over 85). Medical treatment for one or more of these symptoms is also considered a risk factor. Metabolic Syndrome increases belly fat and is a step on the path towards developing adult-onset diabetes. Low blood sugar (hypoglycemia) may be a symptom of yo-yo blood sugar regulation, a loss of control that could develop into pre-diabetes and diabetes.

There are a number of factors, but lifestyle choices are controllable, whereas a genetic predisposition is not. Most gene expression, the way that genetics actually plays out in real life, responds to environmental factors. For the gene itself, nutrients are part of its environment that trigger or suppress specific genetic responses.

Dr. Thomas A. Barringer of Carolinas Medical Center in Charlotte, North Carolina reports that his studies show that multiple vitamins benefit our diabetic population. He states that “any population at risk of having marginally inadequate nutrition, such as the elderly in general, might also benefit." Dr Barringer adds: “all obese people might benefit." He pointed out that supplements are safe and relatively inexpensive, so taking a daily multivitamin is "a reasonable option" for people who are overweight, who have any type of diabetes, who may not receive adequate nutrition or whose immune system is weak. (March 4th 2003 Annals of Internal Medicine)

Take a good multiple vitamin with a fat-containing meal in order to absorb the fat soluble nutrients. If you take green foods or other nutritionally dense dietary supplements, take them with a meal to help increase the total nutritional value of that meal.

Alpha Lipoic Acid (ALA) is a potent antioxidant that reduces insulin resistance. Insulin resistance occurs from swings in blood sugar from poor diets high in refined carbohydrates (white flour, white sugar, high fructose corn syrup) that eventually lead to the hormone Insulin becoming ineffective at moving carbohydrates out of the bloodstream into the cells. ALA has the additional benefit of protecting cells from oxidative damage, including liver cells.

Chromium is available in several forms. While much of the current evidence is on the form called chromium picolinate, other forms may be gentler and more active in controlling cholesterol, such as chromium nicotinate that’s bonded to niacin (Vitamin B-3). This mineral helps us to properly manage blood sugar and is a component of Glucose Tolerance Factor. Chromium may also help maintain lean body mass (muscle) during calorie-restricted dieting.

Citrin® helps to limit the liver's production of fat from carbohydrate.

GlucoFit® is a source of corosolic acid for proper insulin sensitivity to allow sugars to be moved from the bloodstream into cells.

Gymnema sylvestre improves uptake of glucose into cells, may block ability to taste “sweet” and may be useful for maintaining healthy cholesterol and triglyceride levels

HCA (-Hydroxycitric acid) is an extract from the fruit rind of Garcinia cambogia may reduce the body’s ability to convert carbohydrates into stored fats.

Stevia extract is a natural herbal product that is non-caloric, may support pancreatic function and promote insulin sensitivity.

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.

My second letter to Reader's Digest about vitamins

Subject: Re: Vitamin Hoax Thank you for your reply. But your statement that "supplements are unregulated" is completely untrue, and is contradicted by the FDA itself on its own official Web page [“FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products (prescription and Over-the-Counter).”]. Are your experts completely unfamiliar with the Dietary Supplement Health and Education Act prohibiting new dietary ingredients without FDA pre-approval and regulating adulterated products and label claims, the Serious Adverse Event reporting act passed last year, the mandatory federal current Good Manufacturing Practices (cGMP) that are now being implemented requiring quality controls and identity testing of ingredients, and currently operational GMP-audited manufacturers? That inflammatory falsehood is exactly the kind of media myth that evidences bias or abject misunderstanding. You have represented a misguided opinion as fact, when it is clearly contradicted by official records of the FDA, FTC and the Congressional Record in both law and regulations. As a watchdog for clinical studies that are misrepresented or poorly done, it is obvious to me that your writers cherry-picked negative studies that were heavily criticized, some contradicted by more robust data or not able to be replicated, and some done with very sick people where the results were admittedly not applicable to healthy populations. Many scientists simply fail to understand the topic of nutrition, thinking that nutrients should be taken just like drugs: in isolation and in high potencies to treat disease in their studies. That is pharmaceutical medicine, not basic human nutrition, which is an all-too-common mistake that creates a lot of confusion when applied to the moderate dietary supplements used by ordinary people to enhance their vitamin-starved modern diets. Using examples of potential side effects from taking amounts far above commonly available supplement potencies as the main reason to avoid taking them entirely is intellectually dishonest, in my opinion, when no one was actually suggesting that everyone take those mega dose amounts in the first place. When you say that, “Food (especially locally farmed food) is the only way to get your vitamins that's absolutely proven to be safe and effective”, you are only partially right. I am a nominee to the Illinois Local and Organic Food Task Force, on a slate approved by the state Department of Agriculture, so I do understand your point and empathize. But you forget the tens of thousands of people affected annually by food poisoning. This makes vitamins orders of magnitude safer than food, especially fresh foods, and are thus more deserving of your praise for safety and efficacy. You also seem to forget that vitamins are regulated as a special, highly regulated food category by the federal government (by law), and not as drugs. If it is so 'easy' to "get what you need from food" then why does your own report admit that only 3% of us get the minimal nutrient levels from our diet? That really disproves this tired old mantra, doesn't it? It is pure institutional bias that prevents the NIH from recommending multiple vitamins, when even the mainstream medical journal JAMA has done so years ago. If you remember (I do), it took the federal government 20+ years to endorse the use of folic acid to fortify foods denatured of that essential vitamin, during which entire time the evidence was already strong that it could prevent birth defects; with a request in to the Nixon administration that it was time to take action. The March of Dimes recommended this fortification long before the government finally caved in (during the Clinton administration!), but meanwhile thousands of children were born each year with potentially preventable and predictable birth defects while waiting for the perpetually elusive 'more conclusive evidence'. But there never seems to be enough evidence when we're talking about dietary supplements. Even a multiple vitamin taken by the mothers should have been enough to spare these children, but the government still to this day won't fully act to protect people's health by recommending that the 97% of us not eating even minimally right take a simple and safe daily multivitamin, as many doctors already recommend. Are we so set on forcing people to eat right, when they clearly won't, that we should all just pretend that taking a multivitamin as nutritional 'insurance' is somehow fundamentally wrong? In good conscience, I can't do that. I know better. And so do most Americans, who have opted to take vitamins and do so without much risk. Perhaps you haven’t noticed the reports that our food supply has dramatically dropped in nutritional value over the past half century due to factors such as chemical farming, less nutritious plant varieties, changes in storage and handling, etc? The nutritional content of U.S. fruits and vegetables has declined over the past 50 years, according to a researcher at the University of Texas. Cited in an article by Scripps Howard News Service, biochemist Donald Davis said that of 13 major nutrients in fruits and vegetables tracked by the Agriculture Department from 1950 to 1999, six (protein, calcium, phosphorus, iron, riboflavin and vitamin C) all showed noticeable declines. Declines ranged from 6% for protein, 20% for vitamin C, and 38% for riboflavin. [February 2006, official meeting of the American Association for the Advancement of Science in St. Louis, MO] Data from the Department for the Environment, Food and Rural Affairs (DEFRA) showed that, between 1940 and 1991, trace minerals in UK fruits and vegetables fell by up to 76 per cent, and United States Department of Agriculture (USDA) figures showed similar declines. [McCance and Widdowson 1940–1991, The Composition of Foods, 1st to 5th editions, published by MAFF/RSC] [Mayer AM, 1997, ‘Historical changes in the mineral content of fruits and vegetables’, in Lockeretz W (ed.), Agricultural Production and Nutrition, Tufts University School of Nutrition Science and Policy, Boston, MA, p 69–77. See also British Food Journal 99(6), p207–211] [Bergner P, 1997, The Healing Power of Minerals, Special Nutrients and Trace Elements, Prima Publishing, Rocklin, CA, p 312] Neil E. Levin, CCN, DANLA www.honestnutrition.com

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. N Engl J Med. 1994 Apr 14;330(15):1029-35. http://content.nejm.org/cgi/content/full/330/15/1029?ijkey=bd47b716724d0dad4cad0fb19337308753658337 8. Wright ME, et al. Development of a Comprehensive Dietary Antioxidant Index and Application to Lung Cancer Risk in a Cohort of Male Smokers. July 2004 American Journal of Epidemiology http://aje.oupjournals.org/cgi/content/abstract/160/1/68?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=beta+carotene&andorexactfulltext=and&searchid=1100534768534_1530&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=7/1/2004&tdate=7/31/2004&journalcode=amjepid 9. Buijsse B, et al. Plasma carotene and alpha-tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: The Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA). Am J Clin Nutr 2005;82:879–886. 10. Brighenti F. The total antioxidant capacity of the diet is an independent predictor of plasma beta-carotene. European Journal of Clinical Nutrition (2007) 61, 69–76. 11. Clark LC, Marshall JR. Randomized, controlled chemoprevention trials in populations at very high risk for prostate cancer: elevated prostate-specific antigen and high-grade prostatic intraepithelial neoplasia, Urology 57 (2001), pp. 185–187. 12. Duffield-Lillico, AJ, et al. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: a summary report of the Nutritional Prevention of Cancer Trial, Cancer Epidemiol. Biomarkers Prev. 11 (2002), pp. 630–639. 13. Stampfer MJ, et al. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993;328:1444-9 14. Bauernfeind, J. Tocopherols in Foods. In: Vitamin E: A Comprehensive Treatise. Marcel Dekker, Inc., New York and Basel, pp. 99-167, 1980. 15. Horwitt, M.K. The Promotion of Vitamin E. J. 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