More evidence that antioxidant “dangers” are exaggerated (especially beta-carotene)

More evidence that antioxidant “dangers” are exaggerated (especially beta-carotene) By Neil E. Levin, CCN, DANLA In a study published in 2006, cancer researchers tested daily supplementation of 400 IU of vitamins E as alpha-tocopherol along with 50,000 IU (39 mg) of beta-carotene on 540 head and neck cancer patients for three years after treatment with radiation therapies. Due to safety concerns in previous trials (which I have repeatedly criticized in previous writings, for various reasons), the beta-carotene component was discontinued during the trial. During a median 6 ½ years of follow up, 179 of the patients died. The researchers concluded that high-dose vitamin E supplementation could be harmful to cancer patients, with a 38% increased risk for death. 1 This study has been associated with the hyperbolic warnings against antioxidant use for cancer patients. The same group of researchers published a 2007 study looking at the same group of 540 cancer patients treated by radiation to see if the antioxidant vitamins reduced the toxicity of the treatments. This report investigated the dietary intake, supplementation and plasma levels of beta carotene in the patients to look for correlations in outcomes, specifically acute adverse effects of the radiation therapy and cancer recurrence. A higher beta carotene dietary intake was associated with 39% fewer severe acute adverse effects, and higher plasma levels with 27% fewer severe adverse effects, from the radiation treatments. The researchers reported that, “This study suggests that a higher usual dietary beta carotene intake can reduce the occurrence of severe adverse effects of radiation therapy and decrease local cancer recurrence.” 2 This conclusion is at odds with fears of beta-carotene toxicity that have been massively publicized over the past 14 years. Now, in 2008, we have heard again from this same group of researchers continuing to review the data from the same group of patients. It turns out that the large increase in mortality in the patient group given antioxidants - reported in the 2006 study – was basically limited to those patients who smoked during their radiation treatments. In fact, there was no significant mortality increase in patients who only smoked before or after the course of radiation treatment, or for non-smokers. 3 This new information tells us that the general cautions about antioxidants should be limited to certain narrow conditions or situations, such as active smokers during therapy. This is good information, since we know that 40% of cancer patients actually die of malnutrition; that plasma levels of antioxidants are a far better measure of antioxidant status than supplement intake prescriptions or dietary recall surveys; and that antioxidants are synergistic with inter-related functions and should not be given separately. Now we also can point to numerous benefits of antioxidants in clinical studies that have been far overshadowed by the over-hyped negative conclusions of a relative few prominent-but-flawed studies reported by prestigious institutions, sometimes with NIH funding. I agree with those critics who insist that it should be considered scientifically inappropriate to use the drug model for nutrient research, because the nutrients already exist in the diet and in the body and are clearly impacted by other nutrients; as well as other variables, some of which are quite well known. By contrast, in a drug study a new, foreign chemical is being tested which should not already be present in the diet or the body, making toxicity a bigger issue while eliminating many of the variables that are inappropriately ignored in sensational-but-flawed nutrient studies that get so much media attention and so many undeserved citations in scientific journals. I have previously written about the use of antioxidants for cancer patients, as have others, with the common conclusion that most such warnings are overblown and that much of the published science has been favorable regarding those combinations of factors. REFERENCES

• Bairati I, Meyer F, Jobin E, Gélinas M, Fortin A, Nabid A, Brochet F, Têtu B. Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer. 2006 Nov 1;119(9):2221-4. PMID: 16841333
• Meyer F, Bairati I, Jobin E, Gélinas M, Fortin A, Nabid A, Têtu B. Acute adverse effects of radiation therapy and local recurrence in relation to dietary and plasma beta carotene and alpha tocopherol in head and neck cancer patients. Nutr Cancer. 2007;59(1):29-35. PMID: 17927499
• Meyer F, Bairati I, Fortin A, Gélinas M, Nabid A, Brochet F, Têtu B. Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long-term effects on recurrence and mortality: a randomized trial among head and neck cancer patients. Int J Cancer. 2008 Apr 1;122(7):1679-83. PMID: 18059031

Science Sins and Media Mistakes

Science Sins and Media Mistakes What You Should Know About Dietary Supplement News Reporting By Neil E. Levin, CCN, DANLA Are male smokers taking beta-carotene really at increased risk of cancer? Are high dosages of Vitamin E really hazardous to your health? Is ephedra, an herb with demonstrated weight loss benefits, really a “killer” that merits its banned status by the U.S. Food and Drug Administration? Natural health remedies have a long history of promoting health and wellness, dating back thousands of years. But sloppy science and sensationalist health reporting by the news media make this increasingly hard to believe. And misleading and contradictory information about the safety of nutritional supplements may cause consumers to make poor health choices – or to avoid making any choices at all. The result: Many miss out on the myriad health benefits supplementation can bring about. Understanding the common sins of commission and omission on the part of science and the press arms the public with the ability to make better decisions – if not to apply a liberal grain of sea salt to what they’re reading and seeing. Beta Carotene: Myth vs. Fact There have been several instances where the reputation of a dietary supplement or herb has been tarnished due to poor science combined with the media’s inertia. The association of cancer risk with the use of the anti-oxidant beta-carotene is a prime example. In 1994, an antioxidant study being conducted in Finland was halted as a result of a report noting an increase in cancer rates among male smokers taking beta-carotene. Headlines roared: Beta-carotene connected with cancer risk. Doctors told patients to avoid this nutrient and sales dropped. Yet ten years later, the data was re-analyzed, this time taking into the account the smoker’s total antioxidant intake – not just beta-carotene. The results were clear: a combination of antioxidants – including beta-carotene – actually lowered lung cancer risk in male smokers. Supplementing beta-carotene to people with low antioxidant status was simply a matter of too little, too late. The antioxidant itself was not to blame; the lack of other antioxidants was. Science Sin: Poor science did not originally eliminate additional dietary antioxidants as variables or look at how antioxidants interact and support each other. Adding one antioxidant does not make up for the lack of others. Nutrients are not drugs, and supplementing a single nutrient is actually a model of a drug study, not a nutrient study. Media Mistake: Failing to fact check. In the original report, the researchers stated that the slightly increased risk was possibly due to chance and that there was no known mechanism as to how this could happen. Yet the news media and others, including a National Institute of Health (NIH) scientific panel, stubbornly continue to refer to beta-carotene as potentially harmful even though credible scientists actually revised those findings years ago and high blood levels of beta-carotene are shown to be consistently protective to populations at risk for cancer. Sloppy Science and Vitamin E One of the strongest examples of sloppy science is the controversy over Vitamin E. In 2004, warnings were issued by authors of a study published in Annals of Internal Medicine about taking 400 IU or more of Vitamin E per day. This warning was based on a “meta-analysis” report that was generated by statisticians who mathematically integrated the results collected from 19 individual studies, selected partly on the basis of at least ten deaths occurring - from any cause - in the course of each study. Sales of this essential vitamin dropped dramatically. This was a major national news event. But when leading antioxidant researchers re-reviewed the same individual datasets more carefully for the American Journal of Clinical Nutrition, they found that daily doses of Vitamin E up to 2,000 IU were actually safe in the same study populations. It seems that the Annals report did not properly segregate doses and forms, such as taking into account other supplements taken. Nor did it find a dose-dependent relationship between vitamin E and death risk, which is a normal toxicological rationale for determining risk. Apparently, it was simply sloppy work that was not able to be replicated using more accurate statistical models that properly accounted for more variables. Similarly, the Institute of Medicine sets the safe upper level of Vitamin E at 1,500 IU per day. And a recent SENECA study of 90,000 nurses showed a 30% to 40% lower incidence of heart disease among those who take in the highest amounts of Vitamin E from diet and supplements, indicating that the Annals report may have scared a lot of people from taking a life-saving essential vitamin. Science Sin: Mistaking unverified statistics for proven science. The straight mathematical integration of data from different selected scientific studies – and the interpretation of the results – were left largely to statisticians whose methods were heavily criticized in comments by other researchers published by the same journal. Consequently, apples were compared to oranges and the reputation of Vitamin E among consumers continues to feel the squeeze. The researchers have never adequately addressed the criticism or the reanalysis that produced vastly different results. Media Mistake: Making a mountain out of a molehill. The outcome of the original study was interpreted by the press to be more meaningful than it really was, as if one study negated all others, and no follow-up was done to report the reanalysis or to mention the myriad of studies showing the proven protective effects of vitamin E. To this day, journalists continue to cite the flawed report – even though Vitamin E has been proven safe and beneficial. Ephedra’s Bad Rap But it’s Ephedra – an herb most commonly used to assist with gentle weight loss and easing breathing difficulties – that will go down in history as the most pilloried dietary supplement ever. The FDA banned Ephedra in 2004 based on a series of unproven Adverse Event Reports (AERs.) AERs are by definition preliminary, unscreened and unverified reports of possible associations of a substance with a side effect. In banning Ephedra, the FDA said that evidence proving that the product has caused actual harm to someone is not required; all that is required is scientific evidence that supports the existence of some theoretical risk. Ironically, after closer examination of the claims, the FDA eliminated virtually all of the Ephedra AERs from consideration. It also admitted that a total ban on the herb would possibly prevent only one estimated death per year out of 3 billion doses taken by 20 million consumers. In comparison, about 100 out of 11 million people with true food allergies die each year. Yet tree nuts, fish and dairy (the most common food allergens) are still legal. Science Sin: Considering AERs to behard evidence. AERs are unverified and thus cannot be considered scientific evidence as proof of toxicity. Government and medical authorities falsely and cynically assumed that most dietary supplement AERs are true, while drugs that have received far more numerous AERs outlining severe side effects (including death) continue to be widely prescribed. More than 100 years of scientific studies were arbitrarily ignored by the FDA in ruling that ephedra had no benefits and no safe level of use; and the agency likewise ignored its own scientific panels that found no smoking gun. Supplements containing large doses of caffeine and other stimulants were lumped in as “ephedra-related” AERs because they also happened to contain ephedra; or more likely, synthetic ephedra alkaloids. Ironically, ephedrine alkaloids are still universally available as OTC drugs for allergies in doses considered too dangerous to sell in a dietary supplement label. However, they are usually sold behind the counter at pharmacies because of the risk of people making crystal meth from these drugs. Ironically, the ephedra herb is too dilute to economically make meth from. I assume that ephedra was axed as an innocent bystander in the drug war to avoid it competing with products which had to be locked up behind the counter. The coincidental timing of the supplement ban and access to the competing drug is very suspicious. Media Mistake: Not getting the whole story; scaring people unnecessarily. Journalists did not bother to research the whole story when it when it came to reporting on this controversial herb. The media made the all-too common assumption that press releases issued by researchers or governmental offices are true. With a little digging, the “real” story might have been reported. But the media was largely content to focus on the sensational “killer herb” rather than to investigate the facts and find out the truth. When controversy arises around dietary supplement or herb, an unproven AER is often at its root. AERs are intended to be an early warning system to allow experts to try to look for and hopefully isolate a dose-related cause and effect. But most, if not all, AERs involving dietary supplements actually involve a combination of substances and issues that include the supplement as well as prescription drugs or other substances along with pre-existing conditions. And many “adverse effects” attributed to supplements are known side effects of prescription drugs. It’s dubious that either science or the media will admit fault or repent. But with a little effort, consumers can get the most accurate and up-to-date information to ensure they can make informed and beneficial decisions when it comes to their most important asset: our families’ health.

Unbalanced Fox news report misleads about vitamin-mineral safety

Unbalanced Fox news report misleads about vitamin-mineral safety By Neil E. Levin, CCN, DANLA I watched the special health report on vitamins and minerals on FOX-32 (How Do Vitamins and Minerals Really Affect Your Body? on 2/12/08, see link below), but was disappointed that the report exaggerated the risks of vitamins and minerals and minimized their benefits without any mention of the common deficiencies that exist in the American population. For example, the report cautioned about vitamin E causing blood thinning, but the Food and Nutrition Board of the Institute of Medicine has set an upper tolerable intake level (UL) for vitamin E (alpha-tocopherol) at 1,500 IU per day, which “is the highest dose unlikely to result in bleeding problems;” though the Institute has also said that the danger of the vitamin inhibiting clotting was not convincing. In other words, taking about four times the most common strength of even a hi-potency vitamin E capsule might be a problem in terms of affecting clotting, but this potency is higher than is available as a dietary supplement and one that people are unlikely to try without specific medical advice. Yet, somehow, the far more common danger of a vitamin E deficiency was completely ignored. This, despite the fact that, according to dietary data from the National Health and Nutrition Examination Surveys, ninety percent or more of the adults studied had usual intakes below the current Estimated Average Requirement. Why is a theoretical overdose problem even mentioned in the report, especially with no balancing mention of known deficiencies and benefits? What happened to fair and balanced reporting? And what are the benefits of vitamin E supplementation? An NIH-supported USDA -Tufts University study published in the medical journal JAMA reported, “…we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold,” for nursing home patients taking 200 IU of vitamin E daily. And Annals of the New York Academy of Sciences reported that, “The results of this clinical trial show that vitamin E supplementation significantly reduces the incidence rate of common colds and the number of subjects who acquire a cold among elderly nursing home residents.” Zinc was also mentioned in the FOX report as a possible overdose candidate, but levels required to reach the negative side effects mentioned are between 150-450 mg per day, again requiring a consumer to take several capsules to achieve this. The highest potency I have ever seen (in 35 years) was 75 mg, though 15-50 mg products are relatively common. Yet the median intake among American adults is just over 2/3 of the Daily Value, making deficiencies far more common than overdoses. Again, the FOX report ignored the common, greater danger in favor of sensationalizing a remote possibility of overdosing. Zinc is essential for many biochemical reactions in the body, and is most notably associated with immune function and wound healing. Yet isn’t FOX essentially warning people against taking zinc, hinting that they may be in danger but without any hint of the true risks and benefits? A dietician in the report stated that there is no proof that taking extra vitamin C shortens or prevents colds. That should come as news to the researchers at the University of Pittsburgh Medical Center. Publishing results of a Review Study in the medical journal American Family Physician in February 2007, these physicians reported that, “Thirty trials involving 9,676 cold episodes showed a statistically significant decrease in illness duration with vitamin C taken before onset of symptoms…. Likewise, 15 trials involving 7,045 cold episodes demonstrated a decrease in severity scores and in days confined to the home.” While there is some little evidence (not none) that vitamin C can prevent the incidence of colds, there is significant evidence that it can shorten the duration and severity of colds. Don’t you think that the FOX report is irresponsible by highlighting rare nutrient overdoses while ignoring common deficiencies? Also, why would one person’s opinion that vitamin C is worthless against colds trump the collective evidence of 30 clinical studies that met the strict criteria of a review study? Given these gross errors, I suggest that FOX assigns fact-checkers to review all medical and health reports. Let’s put an end to the flawed practice of naively taking the word of health professionals who appear not be up-to-date on what’s published in the medical literature. This is most important when demonstrably false blanket statements are made that inappropriately dismiss the safety and efficacy of essential nutrients that are known to be deficient in most Americans’ diets. REFERENCES: http://www.myfoxchicago.com/myfox/pages/Home/Detail;jsessionid=BF06BF0BCA71AE327C05A6BA65DEB517?contentId=5757535&version=2&locale=EN-US&layoutCode=VSTY&pageId=1.1.1&sflg=1 Vitamin E Fact Sheet NIH Office of Dietary Supplements Zinc Fact Sheet NIH Office of Dietary Supplements “Thirty trials involving 9,676 cold episodes showed a statistically significant decrease in illness duration with vitamin C taken before onset of symptoms: an 8 percent decrease (95% confidence interval [CI], 3 to 13 percent) in adults and a 13.5 percent decrease (95% CI, 5 to 21 percent) in children. Likewise, 15 trials involving 7,045 cold episodes demonstrated a decrease in severity scores and in days confined to the home. Vitamin C did not decrease the incidence of cold in the general population. However, a subgroup of six trials involving runners, skiers, and soldiers participating in subarctic exercises demonstrated a 50 percent relative reduction in the risk of developing a cold (95% CI, 32 to 62 percent).” Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007 Feb 15;75(4):515-20. Review. PMID: 17323712 [PubMed - indexed for MEDLINE]. 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 [PubMed - indexed for MEDLINE] 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 JASPREET K.C. AHUJA, JOSEPH D. GOLDMAN, and ALANNA J. MOSHFEGH. Current Status of Vitamin E Nutriture. Ann NY Acad Sci 2004 1031: 387-390. Erwin RB, et al. Dietary intake of selected minerals for the United States population: 1999-2000. Adv Data. 2004 Apr 27;(341):1-5. PMID: 15114720 [PubMed - indexed for MEDLINE] 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. JAMA. 2007 May 2;297(17):1882. PMID: 15315997 [PubMed - indexed for MEDLINE] Meydani SN, Han SN, Hamer DH. Vitamin E and respiratory infection in the elderly. Ann N Y Acad Sci. 2004 Dec;1031:214-22. Review. PMID: 15753147 [PubMed - indexed for MEDLINE]

Selective facts produce poor journalism (or science).

Selective facts produce poor journalism (or science). For example, the Women's Health Study had a 7% reduction in major cardiovascular events with vitamin E, a number that was not significant. But there was a significant 24% reduction in cardiovascular death in the vitamin E group. Would you characterize that as a failure for vitamin E? The media did. Yet, the authors of the study admitted that, "This was largely attributable to fewer sudden deaths in the vitamin E group (38 vs 51 among women assigned to placebo) and fewer deaths from other cardiovascular disease (ie, deaths due to cardiovascular diseases other than ischemic heart disease and cerebrovascular disease, 20 vs 34, respectively)." The Williams College ginkgo study in JAMA allowed participants to miss up to 6 daily doses over a 2-week period (nearly 50%!) before they were eliminated for non-compliance. It also tested only one brand of ginkgo (Ginkoba) on healthy volunteers for only six weeks, with results (by convention) not applicable to other brands. This was an obvious attempt to see whether a quick, drug-like effect could be obtained from a short course of supplementation. Longer term studies are more authoritative, especially if compliance is better. The CoQ10 statement is laughably wrong: "Coenzyme Q10 has not been carefully tested to see if it is safe and effective. Because coenzyme Q10 is sold as a dietary supplement rather than a drug, it is not regulated by the US Food and Drug Administration." This is a complaint that the FDA does not test individual dietary supplement products for potency or approve individual label claims. The agency does have the longstanding right to veto dietary supplement label claims and to remove any mislabeled or adulterated product from the national market. This contrasts with the FDA's explicit approval of drugs and drug claims, though the agency doesn't test individual pharmaceuticals for potency or safety, either. Of course, the FDA would take issue with their supposed inability to regulate dietary supplements. They even claim the opposite on their web page. Note the first 4 words: "FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products (prescription and Over-the-Counter). Under the Dietary Supplement Health and Education Act of 1994 (DSHEA), the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.* Manufacturers must make sure that product label information is truthful and not misleading. FDA's post-marketing responsibilities include monitoring safety, e.g. voluntary dietary supplement adverse event reporting, and product information, such as labeling, claims, package inserts, and accompanying literature. The Federal Trade Commission regulates dietary supplement advertising." regarding the CNN report: http://www.cnn.com/2007/HEALTH/04/09/chasing.supplements/index.html

The critical condition of patients admitted to the ICU is associated with worsening oxidative stress.

The critical condition of patients admitted to the ICU is associated with worsening oxidative stress, according to a medical journal article. "A major finding of the study was that administration of antioxidant vitamins at between 66% and 100% of RDA can reduce the risk for oxidative stress by 94%..." "...dietary enteral supplementation with vitamins C and E for 10 days prevented lipid peroxidation and oxidative stress in critical care patients and significantly influenced their clinical outcome at 28 days." "Greater depletion of antioxidants has been related to a greater severity of trauma, systemic inflammatory response syndrome, or sepsis." full article is available at: http://ccforum.com/content/10/5/R146

Natural Health: Ten Predictions for the Year 2008

Natural Health: Ten Predictions for the Year 2008 By Neil E. Levin, CCN, DANLA 12/10/2007 The New Year will bring more proof of antioxidant benefits for human health. Recent research shows that antioxidants help to maintain healthy brain functions during aging, protect brain and nerve cells, and prevent hormones and cholesterol fractions from oxidizing to become more harmful forms. Look for an expanded understanding of the benefits of these synergistic nutrients in 2008. 2008 will provide more proof of omega-3 fatty acids’ benefits. For example, DHA helps to maintain healthy balances of cholesterol fractions and protects the brain and nerves. EPA helps normalize cell membranes and cellular health. These essential fats are typically very low in the American diet, so dramatic results could occur in clinical trials providing these nutrients to participants. There will be more safety scares regarding popular prescription and Over-The-Counter drugs, creating new safety warnings and label cautions. Since the most popular medications are typically blocking or inhibiting natural body functions (calcium channel blockers, cholesterol production inhibitors, serotonin re-uptake inhibitors, stomach acid production inhibitors, etc.) rather than dealing holistically with the causes of problems that create body imbalances (lack of optimal levels of nutrients, environmental chemicals and metals, chronic stress - lack of deep sleep, low fiber - high carbohydrate diets, etc.), major side effects from such drugs are inevitable. Side effects from pain medications will become more evident, increasing the number of people looking for safer alternatives. Herbs and spices are the major natural alternatives with some scientific evidence of efficacy. The market for organic and local foods will continue to grow at amazing levels. This will put pressure on the regulatory, farm and grocery industries to manage these products and segregate them to maintain their integrity. That contrasts with the increased reliance on genetically engineered corn to produce ethanol that raises food costs and increases the use of farm chemicals. And there is much evidence that non-genetically engineered foods are both environmentally and nutritionally superior to their modified cousins, while natural farming techniques are proving superior to chemical and genetically engineered farming in terms of managing fuel and seed costs, water use, improving both crop yields and selling prices, etc. Millions of farmers around the world have already weaned themselves from the chemical-genetic “green revolution” to use appropriate local farming techniques and have actually been more successful as a direct result of truly “green” practices. America has begun to awaken to the benefits of local and organic foods in terms of freshness, reducing the use of fossil fuels for transportation and demonstrable benefits to local economies. Watch for these trends to accelerate in 2008. Blood pressure and blood sugar concerns will continue to grow, along with a medical backlash attacking natural strategies to manage these concerns. However, science will also continue to amass evidencing the positive health benefits of natural products to help people maintain already healthy blood levels, in contrast with the poor symptom management that is a characteristic of pharmaceutical or surgical interventions used to “correct” chronic biological imbalances. These issues dovetail with current obesity and cardiovascular concerns and are part of the same syndrome related to chronic stress and poor diets. Positive reports of the benefits of higher levels of vitamin D will continue to proliferate, though with some bias against the synthesized vegetarian/vegan form of vitamin D2 versus D3 from fish oil or sheep lanolin. Health authorities will be pressured to raise both the recommended Daily Value and the Upper Limit of vitamin D to five times the current levels. Research will continue to accumulate regarding the health benefits of whole grains and whole foods, as will reports of people allergic or sensitive to gluten, corn, and other grains. More mainstream processed groceries will have whole food options in 2008. This is a good trend, though with cautions for the sensitive minority. There will be continuing claims that “dietary supplements” are illegally contaminated with steroids or other pharmaceutical drugs. These claims will typically be self-serving and defensive, made primarily by athletes accused of cheating by using banned substances. Beyond the obvious fact that legitimate supplement manufacturers do not have illegal substances on hand and that GMP (Good Manufacturing Practices certification) quality manufacturing protocols would avoid inadvertent contamination, these accusations are a barometer of how “unregulated” the mainstream media and the public thinks dietary supplements are. While there are plenty of regulations written specifically to regulate supplements, and even the FDA claims that it has adequate regulatory authority, somehow certain medical authorities and journalists like to pretend otherwise; perhaps to have a handy punching bag to deflect attention from the well-documented hundreds of thousands of deaths caused annually from pharmaceuticals and medical errors. In any case, expect more of this blame game in 2008. With a presidential election campaign under full swing, no meaningful legislation regarding health care or Medicare will be passed in 2008. There will be a narrow window of opportunity for such measures in 2009 with a new Congress and Administration. Natural health advocates will continue to press for meaningful use of nutrition to combat the major causes of disease and illness in America, with probably little impact against the lobbying might of the medical and pharmaceutical interests. The wild card is if, by some miracle, the insurance industry finally notices that their costs could be contained by the use of targeted nutrition such as the use of calcium and vitamin D to prevent osteoporosis, antioxidants to prevent age-related macular degeneration and oxidative-related glaucoma that affect vision and impact seniors’ independence, omega-3 fats to prevent coronary heart disease, the use of fiber to manage healthy cholesterol levels, etc. That could swing the pendulum towards the use of natural products to control healthcare costs. But I’m not betting on it happening in 2008, though I hope that they wise up soon enough to manage the recently overactive increases in medical costs. There will be additional, unjustified health scares about essential nutrients in 2008. Especially beware of “meta-analyses” that mix unrelated studies and magnify the number of variables using often-flawed statistical models. Some probable targets: · Kava (a few unrelated, anecdotal reports of liver problems) · Folic acid (a few reports of higher cancer levels despite a lot of cellular data indicating the opposite, creating a backlash against re-fortification of refined foods) · Vitamin E (continued championing/publicity of questionable meta-analyses over more rigorous blood-level studies will continue the inexplicable controversy over the safety of this essential nutrient that most Americans are reportedly deficient in.) · Beta-Carotene (again, blood level studies and total antioxidant studies repeatedly show its safety, but studies measuring only administration of certain doses to sick populations that may be deficient in antioxidants create a conflicting picture.) · DHEA (this adrenal hormone has been vilified as a “steroid”, but is no more so than vitamin D. No less an authority than physician and US Senator Tom Coburn has sent a letter to his colleagues informing them that he has reviewed the issues and urging them to avoid a ban of this natural product, which is useful in anti-aging strategies but not for bodybuilders. Efforts by leading senators (including presidential candidates Clinton and McCain) to ban DHEA are ongoing.

A Tale of Two Studies: Vitamin E - Food vs Supplements

Vitamin E: Food vs Supplements Here is an illustration of the apparent contradiction between whether food sources of vitamin E are better to prevent prostate cancer than supplemental vitamin E sources: Two large studies, both published in the same technical journal at the same time, seem to reach contradictory results as to whether supplemental vitamin E is valuable in relation to prostate cancer. But are they both equal and contradictory? Actually, one is far more rigorous, and thus presumably more valid, than the other. In the first one (Serum and Dietary Vitamin E in Relation to Prostate Cancer Risk <1>), definite and large benefits were shown for supplemental alpha-tocopherol vitamin E, but not for food sources (containing mostly gamma-tocopherol). In the second one (Supplemental and Dietary Vitamin E Intakes and Risk of Prostate Cancer in a Large Prospective Study <2>), only food sources containing gamma-tocopherol were effective, but not supplemental vitamin E as alpha-tocopherol. A closer look reveals that the first study responsibly looked at serum levels and food plus supplemental vitamin E intake, then related that data to prostate cancer rates over up to 19 years afterward. This study's conclusion was that, "In summary, higher prediagnostic serum concentrations of alpha-tocopherol, but not dietary vitamin E, was associated with lower risk of developing prostate cancer, particularly advanced prostate cancer." The second study looked only at questionnaires related to subjects' intake of vitamin E from food and supplements at the start of the 5-year study, then compared the number of cancers over a 5-year period to data obtained from that questionnaire. The incubation period for cancers is estimated to be in the decades, rarely a period of 5 years or less. That, along with the lack of any data on serum antioxidant status and the use of a questionably reliable survey to determine intake of vitamin E from food or supplements, makes the second report far less meaningful than the first one. Don’t get me wrong, I am not against food sources of nutrients and routinely recommend vitamin E sources containing gamma-tocopherol, along with the full range of tocopherols and tocotrienols. But when preliminary or sketchy science is all-too-often reported as if it’s definitive when it’s really not, and when it is contradicted by better science, I am compelled to put things into a more realistic perspective. The measurement of serum levels in the body, along with careful reporting of a nutrient’s intake from various sources, is much more compelling than relying on a questionnaire that may be done by memory. It is well-known among nutritionists that daily food diaries are notoriously different than weekly food surveys done by memory recall, which almost always seem to conveniently forget the junk food, snacks and extra calories. A cancer study lasting nearly 4 times as long is also far more compelling than a shorter one because it will be more likely to encompass the cancer’s incubation period and allow for the development of symptoms that will allow detection. As the National Cancer Institute reports: “Prostate cancer often does not cause symptoms for many years.” <3> The use of supplemental alpha-tocopherol is supported by other reputable studies. For example, The Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study demonstrated a 32% reduction in prostate cancer incidence in response to daily alpha-tocopherol supplementation. <4> 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 (100 I.U. and above) are considerably above levels obtainable from diet alone. <5-7> In the case of supplemental vitamin E, the results for prostate cancer in the more rigorous, better designed and better implemented study shows that it is more beneficial for prostate health than only food sources of vitamin E, which also tend to be much weaker amounts (often far below 100 IU daily, with Americans’ typical intake being only around 9.5 IU (6.4 mg) of alpha-tocopherol, below the RDA of 22.5 IU (15 mg). <8-9> This indicates our general need for supplemental vitamin E, unless by some miracle we all suddenly decide to eat wholesome natural foods containing a lot more vitamin E. But in the meantime, it would be nice if these studies were put into perspective so we could accurately assess their value to our health habits. Unfortunately, media coverage of negative reports, especially regarding vitamins, tends to drown out the positive ones, even when the good news is backed by studies with better design and implementation. In this case, supplemental vitamin E was the clear winner over the abysmal amounts in our diet, which ideally should be increased to healthy levels. REFERENCES: 1. Weinstein, SJ, et al. Serum and Dietary Vitamin E in Relation to Prostate Cancer Risk. Cancer Epidemiol Biomarkers Prev 2007 16: p. 1253-1259 http://cebp.aacrjournals.org/cgi/content/abstract/16/6/1253?ct 2. Wright, ME, et al. Supplemental and Dietary Vitamin E Intakes and Risk of Prostate Cancer in a Large Prospective Study. Cancer Epidemiol Biomarkers Prev 2007 16: p. 1128-1135 http://cebp.aacrjournals.org/cgi/content/abstract/16/6/1128?ct 3. National Cancer Institute’s Web site http://www.cancer.gov/cancertopics/factsheet/Detection/early-prostate 4. Weinstein SJ, et al. Serum alpha-tocopherol and gamma-tocopherol in relation to prostate cancer risk in a prospective study. J Natl Cancer Inst. 2005 Mar 2;97(5):396-9. PMID: 15741576 5. Bauernfeind, J. Tocopherols in Foods. In: Vitamin E: A Comprehensive Treatise. Marcel Dekker, Inc., New York and Basel, pp. 99-167, 1980 6. Horwitt, M.K. The Promotion of Vitamin E. J. Nutr. 116:1371-1377, 1986 7. Weber, P., Bendich, A. and Machlin, L.J. Vitamin E and Human Health: Rationale for Determining Recommended Intake Levels. Nutrition 13:450-460, 1997 8. Ervin RB, Wright JD, Wang CY, Kennedy-Stephenson J. Dietary intake of selected vitamins for the United States Population: 1999–2000. Advance data from vital and health statistics; no 339. Hyattsville, Maryland: National Center for Health Statistics. 2004 9. Vitamin E, Office of Dietary Supplements • NIH Clinical Center • National Institutes of Health http://ods.od.nih.gov/factsheets/vitamine.asp

Are antioxidants worthless against heart disease?

Are antioxidants worthless against heart disease? By Neil E. Levin, CCN, DANLA 8/15/07 In a published report, A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women (Results From the Women’s Antioxidant Cardiovascular Study), researchers concluded that, “There were no overall effects of ascorbic acid (vitamin C), vitamin E, or beta carotene on cardiovascular events among women at high risk for CVD.” (1) This is simply untrue. In order to reach that conclusion, the researchers had to count non-compliant subjects as taking vitamin E, even when it was obvious that they weren’t following the study protocol. Is that intellectually honest? I would have given the opposite conclusion. When subjects assigned to take vitamin E actually took their vitamin E, the results were significant and proved that the vitamin had benefits: “Censoring participants on noncompliance led to a significant 13% reduction in the primary end point…Reductions in secondary study end points were also stronger, with a 22% reduction in MI … a 27% reduction in stroke … and a 9% reduction in CVD mortality … There was a 23% reduction in the combination of MI, stroke, or CVD death…Among those with prior CVD, the active vitamin E group experienced fewer major CVD events …” [-11%] "A marginally significant reduction in the primary outcome with active vitamin E was observed among the prespecified subgroup of women with prior cardiovascular disease (RR, 0.89; 95% CI, 0.79 - 1.00 [P = .04]; P value for interaction = .07). There were no significant interactions between agents for the primary end point, but those randomized to both active vitamins C and E experienced fewer strokes (P value for interaction = .03)." Why did the researchers gloss over these admitted benefits (that those assigned to take vitamin E who actually did take it had "significant" benefitsand those with prior CVD who took the relatively low levels of C plus E experience fewer strokes)? This was wholly ignored in the study's conclusion, as well as the subsequent press release and extensive news coverage. I have found and published (2) criticisms of this particular failing (reaching improper conclusions not truly supported by the data) before: (3-10) REFERENCES: 1. Cook N, et al. A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women. ARCH INTERN MED. VOL 167 (NO. 15), AUG 13/27, 2007 2. 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 3. Edgar R. Miller, III, MD, PhD; et al. High-dose vitamin E supplementation may increase all-cause mortality, a dose response meta-analysis of randomized trials. Annals of Internal Medicine: Online: Nov. 10, 2004: Print: 4 January 2005 | Volume 142 Issue 1 4. A study conducted by USA Today found that more than half of the experts hired to advise the government on the safety and effectiveness of medicine had a direct financial interest in the drug or topic they were asked to evaluate. An analysis of financial conflicts of interest at 159 FDA advisory committee meetings from January 1, 1998, through June 30, 2000, found that at 92% of the meetings, at least one member had a financial conflict of interest, while at 55% of meetings, half or more of the FDA advisers had conflicts of interest. These conflicts included helping a pharmaceutical company develop a medicine, then serving on an FDA advisory committee that judges the drug. 5. Lonn E, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16;293(11):1338–47. PMID: 15769967 6. Blumenthal M, Farnsworth NR. Echinacea angustifolia rhinovirus infections [letter]. N Engl J Med. Nov.3, 2005;353(18):1971–1972. 7. 21 C.F.R. Pt. 119, Final Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated Because They Present an Unreasonable Risk (Published February 11, 2004) (Effective April 12, 2004) available at http://www.fda.gov/ohrms/dockets/98fr/1995n-0304-nfr0001.pdf 8. Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. Efficacy and safety of Echinacea in treating upper respiratory tract infections in children: A randomized controlled trial. J Amer Med Assn Dec 3, 2003;290(21):2824–30. 9. Fugh-Berman A, Myers A. Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: current status of clinical and basic research. Exp Biol Med (Maywood). 2004 Sep;229(8):698–704. Review. PMID: 15337824 10. Effects of Long-term Vitamin E Supplementation on Cardiovascular Events and Cancer. JAMA. Vol. 293 No. 11, Vol. 293 No. 11, March 16, 2005

Selenium and Antioxidant Safety

My letter criticizing their editorial in Annals of Internal Medicine was accepted and published online by that journal: http://www.annals.org/cgi/eletters/0000605-200708210-00177v1#21702 It is unfortunate that synergistic nutrients are tested individually, like drugs. This is a pharmaceutical practice, not human nutrition, and shouldn’t imply that comprehensive mixtures of nutrients (like a multivitamin) would have the same effects. I dispute that “randomized, controlled clinical trials have shown that ß-carotene and vitamin E supplements, which were widely believed to be safe, increase mortality and morbidity”. The choices, increasing variables, and manipulation by statistical models in meta-analyses are often questionable. In this report, prediabetic symptoms were not even considered as a variable. Buijsse noted that high carotenoid intake, confirmed by measures of blood levels, was associated with lower mortality rates among the elderly over a ten-year period, countering the claim that ß-carotene dangers are proven. The Miller meta-analysis, cited as proof of vitamin E’s dangers, was heavily criticized in published responses, and its conclusions were NOT replicated when the same data was re-analyzed (Hathcock). It should therefore not be cited as proof of the vitamin’s danger. Another meta-analysis cited (Bjelakovic) reported that antioxidant vitamins may increase death rates. But the authors did not determine a dose-dependent or cause-and-effect relationship between antioxidants and deaths (from all causes) of study participants. The researchers pooled 68 published trials, excluding 405 published studies with no deaths reported. Too wide a range of potencies (Vitamin A 1333 IU - 200,000 IU, vitamin E 10 IU to 1000 IU), and durations (28 days to 12 years) were lumped together. The statement, “No dietary supplement, including selenium, has proven useful so far for the prevention of cardiovascular disease or cancer in the general U.S. population,” is questionable. The Alpha-Tocopherol, Beta- Carotene Cancer Prevention (ATBC) Study published by the National Cancer Institute demonstrated a 32% reduction in prostate cancer incidence in response to daily alpha-tocopherol supplementation. The Women’s Health Study (JAMA) reported a significant 24% reduction in cardiovascular death with supplemental vitamin E. The NIH reports, “Taking a daily supplement containing 200 μg of selenium … significantly reduced the occurrence and death from total cancers. The incidence of prostate cancer, colorectal cancer, and lung cancer was notably lower in the group given selenium supplements.” Yet you suggest lowering consumption below the Daily Value (70 μg) used in multivitamins and far below the current upper limit. On the contrary, the Lewin Group reports that the use of antioxidants could save the vision and independence of many senior citizens, saving billions of dollars in healthcare costs. REFERENCES: 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 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. 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 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 Weinstein SJ, et al. Serum α -Tocopherol and γ-Tocopherol in Relation to Prostate Cancer Risk in a Prospective Study. J. Natl. Cancer Inst. 2005 97: 396-399; doi:10.1093/jnci/dji045

What is the difference between L-Taurine and Taurine, or between L-Glycine and Glycine?

What is the difference between L-Taurine and Taurine, or between L-Glycine and Glycine? The natural forms of amino acids are typically the “L form”, as in L-arginine, L-cysteine, etc. Synthetic forms are denoted as “D forms”, such as D-Methionine and D-Carnitine. But there are 2 aminos that have only one form without these variations: Glycine and Taurine. These two aminos are sometimes called L-Taurine or L-Glycine, but are more properly called just “Taurine” and “Glycine”. Regardless of the name used, they are always natural amino acids. Technical explanation: Most aminos have a property that, when the molecule is put into a solution, it will polarize and rotate light either to the left or right. The Greek words denoting left and right are Levo for left and Dextro for right, so the letters L and D are used to distinguish these forms. This polarization and rotation of light is called “optical rotation”. The differing L and D forms are called stereoisomers. For amino acids that polarize light, the L form is the natural form. However, Taurine is an amino acid that does not polarize light. It thus is properly called just “Taurine”, without L or D configurations. While some label Taurine as “L-Taurine”, that name is not technically correct. “Taurine” is the same exact molecule and form as what is commonly mislabeled as “L-Taurine”. There is another amino acid that lacks a potential optical rotation. Glycine is a very simple molecule that comes only as “Glycine”, also lacking different L or D stereoisomer forms. The D forms of amino acids sold commercially are considered to be synthetic. However, D forms of amino acids are not always synthetic. There are several D forms that exist in nature. In addition, amino acids can be racemized by the body and go back and forth between the D form and the L form quite easily. However, only L forms can be incorporated into proteins. For the purposes of dietary supplements, the L forms are natural and the D forms are synthetic. DLPA and DL-methionine are actually racemic mixtures of both L and D forms. But there is no such thing as D-Taurine or D-Glycine; in other words, no synthetic forms exist of these two aminos since each only comes as one isomer that doesn’t polarize and rotate light to the right. Nor are there really L forms of these, since they do not polarize and rotate light to the left, either. There are simply single, natural isomers of just plain Glycine and Taurine. Don’t assume that all D or L forms of molecules are good or bad, since it really depends on the individual substance concerned. For example, the D isomers of vitamin E are the natural forms and the L isomers are synthetic; just the opposite of amino acids. Thus the terminology and forms of what is natural or synthetic will vary by substance. Some natural molecules exist as L form, some as D form and some have only one form, whether in food or if synthesized. Look for companies that only sell natural form amino acids and Vitamin E and use the correct scientific names for substances and compounds on their labels. Provided by Neil E. Levin, CCN, DANLA Board certified clinical nutritionist with diplomate in advanced nutritional laboratory assessment 6/8/2007

The Women’s Health Study and Vitamin E: Probable Benefits Lost in Study’s Conclusion

The Women’s Health Study and Vitamin E: Probable Benefits Lost in Study’s Conclusion In a new publication(1), researchers concluded that, “Long-term use of vitamin E supplements did not provide cognitive benefits among generally healthy older women.” Reading the details of the study, I find this conclusion to be a very inaccurate summation of the data. Vitamin E did show benefits in the women who were actually taking the vitamin, which many in the group who were supposed to be taking it failed to do. Including non-compliant study subjects in the data resulted in a misleading conclusion. The Women's Health Study is a randomized, double-blind, placebo-controlled trial of vitamin E supplementation (600 IU [ -tocopherol acetate], on alternate days) begun between 1992 and 1995 among 39,876 healthy US women. This study included about 5,000 women from the original Women's Health Study. Ignoring the complexity of the data and even the researchers’ own cautions about the robustness of their conclusions in order to produce a brief written or broadcast “sound bite” for a news report frequently results in over-simplistic and inaccurate reporting. It is also all too common that a careful analysis of the research data may even contradict a study’s main conclusions, making the ensuing media reports all the more misleading. This appears to be the case with this particular study. The researchers’ own data has elements that contradict the conclusion stated above. My concern about how the conclusion in this study may be sending the wrong message can be summed up in these contradictions to that conclusion (all quotations are from this study): · When results were adjusted to exclude non-compliant women (23-25% of the study population), there were benefits noted for those taking vitamin E: “…our secondary analyses including only compliant subjects suggested some potential cognitive benefits of vitamin E supplementation.” · Cognitive testing only was done for the last 4 years of a 9.6 year-long study, ignoring any possible improvements in the vitamin E group over the initial 5.6 year period: “Cognitive testing began a mean of 5.6 years after randomization; thus, we were unable to evaluate change in cognitive performance from randomization.” · Previous successful models were for mice given vitamin E from a young age, but not for mice given the vitamin only when elderly. Most women were in their 60’s when this trial began: “…in a transgenic mouse model of AD, a significant reduction in amyloid deposition in the brain was observed only when vitamin E supplementation was provided at young ages (5-13 months) but not at older ages (14-20 months).” · Previous successful human trials lasted over 10 years, but this study admittedly did not: “…2 observational studies of cognitive function both found that less than 10 years of vitamin E use was not strongly associated with better cognitive performance.” · There was a significantly lower risk of substantial decline in at least one cognitive measure for the people taking vitamin E: “For the verbal memory score, the vitamin E group had a borderline significant 15% lower risk of substantial decline compared with the placebo group (RR, 0.85; 95% CI, 0.71 to 1.02).” · Women who eat less dietary vitamin E did have less cognitive decline if they were in the group taking it as a supplement: “We observed that the vitamin E group experienced less adverse cognitive change compared with the placebo group among women with dietary intake below the median of 6.1 mg/d.” · There was also a benefit shown for vitamin E among the women who did not exercise: “Also among women who exercised less than once per week, the vitamin E group experienced a more favorable cognitive change than did the placebo group: the difference in mean change in global score over time was 0.06 (95% CI, 0.03 to 0.10).” · Another group that benefited from taking vitamin E was non-diabetic women: “We also observed that vitamin E treatment appeared beneficial among women without diabetes (mean difference, 0.03; 95% CI, 0.00 to 0.06) but not among women with diabetes (mean difference, –0.15; 95% CI, –0.31 to 0.01).” · The researchers admit that the dose used in this study is lower than was used in previous trials, making positive results more unlikely: “It is possible that the dose used in this study was not high enough.” · The authors also admit that other forms of vitamin E were not measured in this study, nor levels of other supporting antioxidants other than dietary vitamin E: “It has been suggested that tocopherols such as gamma-tocopherol that is found in foods rather than in supplements may be more important for delaying brain aging. Although alpha-tocopherol has stronger antioxidant properties, gamma-tocopherol has important additional anti-inflammatory effects that may enhance neuroprotection.” The researchers even caution against putting too much reliance on their own analysis: “However, these analyses themselves may be inherently biased and thus should be interpreted with caution.” It appears that the researchers were correct in cautioning that their conclusions may be questionable. It is dangerous to base health decisions on a one-line conclusion from a study without looking at the details of the study which may find benefits for specific populations, or without considering the admitted limitations of the study. In this particular case, the populations that benefited from taking vitamin E include non-diabetic women and women who eat diets low in the vitamin. Another section of the population also showed a benefit: those women who actually took the vitamin. That’s right, the data actually showed significant benefits for that portion of the study population that complied with the study protocol and properly took the vitamin, which about a quarter of the women failed to do. When non-compliant subjects were included in the total, vitamin E’s benefits as a whole were mostly insignificant; but if these subjects are excluded, the benefits become significant. If I were the researcher, my conclusion for this study would have reflected that taking vitamin E was shown to be protective to those women who took it; a far different conclusion than was written. People deserve more careful discussions and analysis of research data in order to be able to make informed health choices. Sadly, this study - and the subsequent reporting on the study - have failed to convey some useful and accurate information, and may even lead women away from taking an essential vitamin that showed evidence of being protective of mental function when taken as directed. REFERENCE: 1. Kang JH, et al. A Randomized Trial of Vitamin E Supplementation and Cognitive Function in Women. Arch Intern Med. 2006;166:2462-2468.

More evidence of vitamin E safety!

More evidence of vitamin E safety! According to a new study published in the American Journal of Clinical Nutrition1, male smokers in a study population who had the highest blood levels of vitamin E suffered significantly fewer deaths than comparable male smokers who had lower blood levels of this essential vitamin. Researchers from the National Cancer Institute at the National Institutes of Health teamed up with their counterparts in Finland to review the relationship of blood levels of vitamin E (alpha tocopherol) and all-cause mortality in male smokers age 50-69 in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. The study included 29,092 men, with follow-ups continuing over a period of up to 19 years. For those in the groups with the highest blood levels of alpha-tocopherol, there was an 18% lower risk of deaths from all causes. Included in this figure are results relating to specific causes of death, including a 21% reduction in deaths from cancer, a 19% reduction in deaths from cardiovascular disease and a whopping 30% reduction in deaths from all other causes. The report reached this conclusion: “Higher circulating concentrations of alpha-tocopherol within the normal range are associated with significantly lower total and cause-specific mortality in older male smokers.” A non-reproduced meta-analysis6 warning of the largely theoretical dangers of taking vitamin E supplements has generated a lot of concern and a large decline in vitamin E usage, though this flies in the face of other, more rigorous studies showing that higher levels of serum vitamin E are associated with lower mortality numbers.1, 3-4, 7 These largely unsubstantiated warnings may be doing a disservice to figures showing that “93% of men and 96% of women in the United States do not consume the recommended daily amount of dietary vitamin E”.2, 5 In another study, ALS (amyotrophic lateral sclerosis) mortality was 62% lower among long-term users of vitamin E than among nonusers.8 Also, in a study of cancer patients done for the US Dept. of Health and Human Services, “Subgroup analysis did identify a statistically significant 9% reduction in all cause mortality” and “13% reduction in all-cancer mortality associated with supplemental vitamin E in combination with other micro-nutrients.”9 REFERENCES: Margaret E Wright, Karla A Lawson, Stephanie J Weinstein, Pirjo Pietinen, Philip R Taylor, Jarmo Virtamo and Demetrius Albanes. Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. American Journal of Clinical Nutrition, Vol. 84, No. 5, 1200-1207, November 2006. (Researchers were from the Nutritional Epidemiology and the Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, and the Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, and the Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland) Maras JE, Bermudez OI, Qiao N, Bakun PJ, Boody-Alter EL, Tucker KL. Intake of alpha-tocopherol is limited among US adults. J Am Diet Assoc2004; 104 :567 –75. Traber MG. How much vitamin E? ... Just enough! Am J Clin Nutr. 2006 Nov;84(5):959-960. PMID: 17093143 Wright ME, Lawson KA, Weinstein SJ, et al. Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Clin Nutr2006; 84 :1200–7. Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington, DC: National Academy Press, 2000. Edgar R. Miller, III, MD, PhD; et al. High-dose vitamin E supplementation may increase all-cause mortality, a dose response meta-analysis of randomized trials. Annals of Internal Medicine: Online: Nov. 10, 2004: Print: 4 January 2005 Volume 142 Issue 1 John N Hathcock, et al. REVIEW ARTICLE: Vitamins E and C are safe across a broad range of intakes. American Journal of Clinical Nutrition, Vol. 81, No. 4, 736-745, April 2005. Vitamin E intake and risk of amyotrophic lateral sclerosis. Ann Neurol. 2005 Jan;57(1):104-10. PMID: 15529299 Shekelle P, et al. Effect of the supplemental use of antioxidants vitamin C, vitamin E, and coenzyme Q10 for the prevention and treatment of cancer. Evid Rep Technol Assess (Summ). 2003 Oct;(75):1-3. Review. PMID: 15523748

Cleveland Clinic makes untrue statement regarding natural vs synthetic vitamins

On August 17, 2006 I submitted this request to the Cleveland Clinic for a correction to its web site, specifically regarding their claim that "There is no difference between natural vitamins and synthetic vitamins". My reference relates to a known difference between natural and synthetic vitamin E (to date, no correction has been made): On your web page (http://www.clevelandclinic.org/health/health-info/docs/0900/0955.asp?index=5429 regarding Diet, Exercise, Stress, and the Immune System) you make a false statement that "There is no difference between natural vitamins and synthetic vitamins." On the NIH Office of Dietary Supplements website (http://ods.od.nih.gov/factsheets/vitamine.asp) they clearly state that "The synthetic form is only half as active as the natural form [4]. [4} U.S. Department of Agriculture, Agricultural Research Service. 2004. USDA National Nutrient Database for Standard Reference, Release 16-1. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp Please correct this error.

LAND OF CONFUSION: How Poor Science and Misleading Media Coverage Create Public Confusion About How Dietary Supplements Affect Health

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