January 2005 | Whole Health
Vitamin E ... A Good Vitamin is Bad Mouthed
... and the backlash is stunning
by Rebecca Ephraim, RD, CCN
The rock-solid support for nutritional supplementation among pockets of the medical profession was raucously apparent last November when a raft of practitioners and authorities, from both the “integrative medicine” community and mainstream medicine, swiftly and very visibly came to the defense of high doses of vitamin E — a staple among the millions who take nutritional supplements on a daily basis. The uproar came as a response to a widely publicized study by Johns Hopkins University concluding that 400 International Units (IU) or more of vitamin E a day can increase the risk of death and should be avoided.
“We’re horrified; we’re looking at each other, going where did this come from? Why is it getting so much publicity?” said Maret Traber, Ph.D., a professor of Health and Human Sciences at Oregon State University and considered one of the leading experts on vitamin E. “This isn’t a particularly good study ... it’s not new findings — it’s a mishmash of old stuff.”
In fact, despite the prestige of Johns Hopkins and the Annals of Internal Medicine, in which the research was published last November, the study is characterized as severely flawed. Ronald Hoffman, M.D., medical director of his own clinic in New York City and a high-profile spokesman and activist of complementary and integrative medicine, said, “While numerous drugs continue to be aggressively marketed with unacceptable safety profiles, resulting in thousands of otherwise avoidable deaths and injuries each year, a safe and effective vitamin is being subject to unfair attack based on a single poorly designed study which has arrived at erroneous conclusions.”
The John Hopkins study (entitled “Meta-analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality”) was a meta-analysis, which is a compilation of previously conducted studies. The data from those studies are put through a statistical analysis in order to arrive at a conclusion. Defenders of vitamin E accuse the Johns Hopkins researchers of combining results from 19 different studies of people, many of whom were gravely ill with heart disease, cancer, kidney failure, Parkinson’s and Alzheimer’s and at risk of dying to begin with. Additionally there is concern that the use of the inferior synthetic form of vitamin E, which is less effective and can even be detrimental, adversely skewed the results. Yet, despite these flaws, the study’s conclusion stated, “High-dosage (equal or greater than 400 IU per day) vitamin E supplements may increase all-cause mortality and should be avoided.”
Jeffrey Blumberg, Ph.D. (in pharmacology) and professor of nutrition science at Boston’s Tufts University, criticized the study for what was overlooked. “It’s important to appreciate that these [Johns Hopkins] researchers ... did not investigate at all dozens of observational studies involving millions of people that show vitamin E supplementation can be beneficial and completely safe.”
Interestingly, the researchers themselves noted in their published paper that the studies they used were “performed in patients with chronic diseases” and that “the generalizability of the findings to healthy adults is uncertain.”
Fighting False Impressions
Perhaps the most impressive aspect about the backlash to the Johns Hopkins study was how quickly vitamin E advocates mobilized to convey their outrage over research they believed to be flawed. Numerous organizations from citizen advocacy groups, such as Citizens for Health, to trade associations including National Nutritional Foods Association and Dietary Supplement Education Alliance, and professional organizations for physicians like the American College for Advancement of Medicine, marshaled the brightest academic and professional stars (such as those quoted earlier) to make the case against the offending Johns Hopkins study.
Although the study was thoroughly lambasted with solid, forthright analyses of its shortcomings, the mainstream media also were walloped for the way they covered the issue. With few exceptions, news organizations took a shallow and sensational approach to reporting the study. A barrage of lurid headlines such as “Vitamin E’s Fatal Flaw” (New York’s Newsday), “Study: High Dose of Vitamin E increases Death Risk” (USA Today) and “High Dose Vitamin E Death Warning” (BBC News) trumpeted a false impression.
“If you look at what the researchers said [in their notes published with the study], they actually said there was insufficient evidence to tar vitamin E. What I took from this [biased coverage in the media] was, again, the lap dog journalism in America,” lamented Frank Wiewel, who scours the scientific literature as founder and president of People Against Cancer, an organization that researches alternatives to conventional cancer care. He, and numerous others in the integrative medicine community who came forward to comment, believe the news media are generally inept at covering complex science issues.
There are also allegations that the mainstream media have a bias against nutritional supplements and perpetuate negative impressions of them — fostered by anti-supplementation interests. In a prepared statement released shortly after the study was announced, Dr. Hoffman conveyed his suspicions, “[Even though] hundreds of studies attest to the safety and benefits of high-dose vitamin E ... expect the new data to form the cutting edge of a new initiative by government regulators and conservative members of the medical establishment to further regulate the supplement industry. Already, several proposals are being advanced, here and in Europe, to place significant caps on available doses of nutritional supplements in a misguided effort to ‘protect’ the public.”
However, those who supplement with vitamin E can take solace in the position of the U.S. government’s own Institute of Medicine (IOM) on vitamin E — which flies in the face of the Hopkins study warning against high doses of vitamin E. IOM states on its Web site (ods.od.nih.gov/factsheets/vitamine.asp), “The general health risk of too much vitamin E is low.” The IOM has set an Upper Tolerable level for vitamin E at 1,000 mg or 1,500 IU per day. This upper limit represents the maximum intake for a nutrient that’s likely to pose no risk of adverse health effects in most healthy people in the general population.
The current recommended daily allowance for vitamin E is a paltry 22 IU. Yet, nearly all of the studies that illustrate that vitamin E reduces disease call for the use of 400 IU or more of vitamin E per day. This includes studies that show that vitamin E may help prevent heart attacks, decrease incidence of prostate and breast cancers, slow the progression of Alzheimer’s disease, reduce the risk of heart attacks in certain diabetics, reduce the deleterious effects of air pollution, and aid in the treatment of intermittent claudication, premenstrual syndrome, childhood epilepsy, certain forms of chronic hepatitis, osteoarthritis and infertility. Ironically, a year-old study from Johns Hopkins University (published in Annals of Neurology, Jan. 2004) showed that 400 IU of vitamin E (in conjunction with 500 mg of vitamin C) a day reduced the risk of Alzheimer’s by 60 percent.
Rebecca Ephraim is a registered dietitian and certified clinical nutritionist.
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