Bonnie's Comments on Vitamin E

I am sure many of you are puzzled over the news that Vitamin E may increase mortality rates.
In this case, the "you cannot always believe what you read or hear" mantra could not be more appropriate.

First, it was not a study. It was a meta-analysis. What appeared in yesterday’s on-line issue of Annals of Internal Medicine is a review of nineteen clinical trials performed with vitamin E over the last few decades.

The authors conclusions are as follows: 

"High dosage vitamin E supplements may increase all-cause mortality and should be avoided."

Although, the researchers noted limitations in their meta-analysis and is riddled with contradictions:

1) The authors say "Overall, vitamin E supplementation DID NOT affect all-cause mortality."

2) The authors also state, "High dosage trials (>400IU) trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is UNCERTAIN. Precise threshold at which risk increases (from vitamin E) is difficult."

Based on their own comments, the authors inappropriately try to draw conclusions for the whole population based on a combination of studies of people who were already at grave risk with existing diseases including cancer, heart disease, Alzheimer’s, Parkinson’s and kidney failure.

3) It is crucial to note that the analysis does not suggest that Vitamin E was the cause of death among these middle-aged to elderly persons already afflicted with a life-threatening illness. The placebo groups (not taking vitamin E) had an all-cause mortality rate of 1022 per 10,000 and the high-dose (defined by the researchers as 400 IU and up) vitamin E subjects had an ACM increase of 39/10,000.

4) This is not a clinical study but a skewed statistical review. The researchers ignored all studies where there was no indication of increased mortality and focused solely on people who died, from any cause, during the study evaluation timeline. The key is to remember that a meta-analysis is only as good as the data used. If the data is selective, or only looks at a limited aspect of a nutrient, as is the case with the present study, the analysis will be limited in terms of its validity.

5) Although the John Hopkins study has not been publicly released, we assume that the studies included in the meta-analysis are very likely to have involved only one particular form of Vitamin E, namely alpha-tocopherol, which is often produced synthetically. A convincing body of evidence now points to the fact that alpha-tocopherol in supplements, particularly at high doses, might reduce the body's uptake of vital components of Vitamin E which are much more effective antioxidants than alpha-tocopherol, such as, gamma- and beta-tocopherols, and tocotrienols (e.g. Handelman GJ et al,J Nutr 115; 807-13,1985; Burton GH et al,Am J Clin Nutr67; 669-84, 1998; Huang HY, Appel LJ.J Nutr 133; 3137-40, 2003.). This is why we always recommend a mixed tocopherol when taking supplemental vitamin E.

Years of clinical research shows that Vitamin E supplementation is safe. This has been clearly documented in recent clinical trials including:

-Morris CD, Carson S. Routine vitamin supplementation to prevent
cardiovascular disease: a summary of the evidence for the U.S.
Preventive Services Task Force. Ann Intern Med. 2003;139:56-70.

-Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topel EJ. Use of
antioxidant vitamins for the prevention of cardiovascular disease:
meta-analysis of randomized trials. Lancet. 2003;361:2017-23.

-Shekelle PG, Morton SC, Jungvig LK, Udani J, Spar M, Tu W, et al.
Effect of supplemental vitamin E for the prevention and treatment of 
cardiovascular disease. J Gen Intern Med. 2004;19:380-9.

The highly respected, independent organization Institute of Medicine finds, "Vitamin E supplements safe at levels of at least up to 1,000 mg (1,600 IU) for normal, healthy adults. This meta-analysis provides no convincing evidence to the contrary."

I hope this makes things a bit more clear for you.

Have a happy, healthy day.

Bonnie Minsky, MA, MPH, LDN, CNS
Nutritional Concepts

© Copyright 2004