Heard a lot about vitamin E in the news lately? This is an attempt to provide a fair and balanced evaluation of what we know about the safety and the benefits of vitamin E.

The last year has produced several articles that have brought into question the value of vitamin E as a key nutrient in good health. The latest incident occurred at the scientific session of the annual meeting of the American Heart Association in November of this year. Researchers from Johns Hopkins University presented a meta-analysis of 19 studies done between 1993 and 2004. After reviewing these studies they concluded that use of high-dose vitamin E may increase the risk of mortality. They defined high-dose vitamin E as any dose of 400 IU or greater per day. The news that researchers found a 10% increase in the risk of death in people taking “high-dose” vitamin E became instant news.

What made this presentation even more newsworthy is that the Institute of Medicine set an Upper Tolerable Intake level of vitamin E at 1500 IU per day. This upper limit was established to represent the maximum intake for a nutrient that is likely to pose no risk of adverse health effects in most healthy persons in the general population. The question became, who is right about how much vitamin E is safe? Secondly, is vitamin E helpful or harmful if more people died who took it than those who did not? Finally, and as importantly, does this change the belief that antioxidants, like vitamin E, protect the body from disease at all?

The answer to those questions comes from a careful analysis of both the science supporting vitamin E and the findings of those who criticize vitamin E. The flaw, in the conclusions about vitamin E presented by the researchers, is that these 19 studies of 136,000 mostly elderly patients were done on individuals that already suffered from serious chronic diseases, including cancer, heart disease, Alzheimer’s, Parkinson’s, and kidney failure. The fact is that in 18 of the studies there was no evidence of increased mortality among the vitamin E users. The one study that did find an increased mortality, accounts for the basis of the overall increase mortality conclusion made in the presentation. The combination of studies on chronically ill patients with a single study providing the majority of events is hardly conclusive.

There have been similar studies on vitamin E concerning heart disease and cancer that have questioned the value of taking vitamin E. The Nurses Health Study found that nurses with the highest intake of vitamin E from diet and supplements had a 30-40% lower rate of heart disease. Studies on patients with known heart disease however, revealed that vitamin E did not prevent second heart attacks or reduce repeat adverse cardiovascular events. The conclusion of many researchers was to dismiss the primary prevention aspects of vitamin E because they were not reproducible in patients with known disease. This attitude has been found in many of the cancer studies of vitamin E. Lower rates of cancer among vitamin E users was not emphasized unless, the studies among the patients who had cancer also improved. The case of stomach cancer is a good example. A study reported that stomach cancer patients given vitamin E showed no improvement or decrease progression of their disease. This study questioned the role of vitamin E in preventing cancer of the digestive system. What was not mentioned is the fact that a bacteria, H. pylori, is associated in 90% of stomach cancer. When patients received the appropriate antibiotics to kill the bacteria causing the cancer, the patients who took vitamin E recovered more quickly and were less likely to have the cancer return.

Vitamin E is not a cure in most cases. The scientific evidence is abundant that vitamin E protects the phospholipid membranes of cells. It represents a key lipid soluble antioxidant that inhibits cellular damage by free radicals that have a cumulative injurious effect on the body. A study published in the Annuals of Neurology showed that 400 IU of vitamin E, taken in concert with 500 mg of vitamin C reduced the risk of Alzheimer’s by 60%. The Age-Related Eye Disease Study recommends 400 IU of vitamin E daily along with lutein, zinc, vitamin C, beta-carotene, and copper to stop the progression of macular degeneration. A March 1998 Journal of the National Cancer Institute contains a Finnish study of 29,000 men who after six years had a 32% lower risk of prostate cancer and a 41% lower morality rate if they did develop cancer when they took vitamin E.

A large study was begun this year at the National Institutes of Health to determine if vitamin E and selenium have a significant role in other types of cancer protection. The bottom line is that a recommendation of 400 IU of vitamin E per day for good health is both safe and smart. The vast body of evidence that a good diet and proper nutritional supplements are protective against disease remains solid.

John Mamana, M.D.
Clinical Associate Professor of Medicine, Georgetown University
CEO, American Health Sciences

Ref:
1. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willet WC, vitamin E Consumption and the risk of coronary disease in women. N Engl J med 1993; 328:144-9.
2. Zandi, P. Archives of Neurology, January 2004; vol 61: pp 82-88.
3. Knetkt p, Reunanen A, Jarvinen R, Heliovara M, Aromaa A. Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol. 1994; 139: 1180-9.

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