Vitamin E: The Real Low-down On Vitamin E

Could vitamin E be bad for you? Don't you believe it.

It would certainly seem unlikely that a well-known antioxidant source like vitamin E could actually do any harm. And yet I came across an article from Reuters Health recently with this headline: 'Vitamin E May Worsen Elders' Respiratory Infections.'

My first reaction: I wasn't buying it.

And after reading the article I was no less sceptical. But before I had a chance to do some digging to locate the report of the study, I received an e-mail from US HSI panellist Dr Allan Spreen, who had already read the report.

And to say Dr. Spreen had a bone to pick would be an understatement. So I asked him if he would write a commentary about the inaccuracies hidden in the report, and he quite generously responded with a rare insider's view of a clinical study - in this case, a study that went way off track somewhere.

State of the Art in Medical Evaluation of Vitamins
So. here are Dr Spreen's comments:

The Journal of the American Medical Association (JAMA) published in August a serious paper (at least I really tried not to laugh) concerning the 'Effect of Daily Vitamin E and Multivitamin-Mineral Supplementation on Acute Respiratory Tract Infections in Elderly Persons.'

This would certainly appear to be significant information since the elderly are not particularly immune to respiratory infections, and some cheap insurance against them would be great news. Alas, such does not appear to be the case.

Cutting to the chase (meaning reading the 'conclusions' paragraph, which is all most doctors have time for), we are enlightened with the following: 'Neither daily multivitamin-mineral supplementation at physiological dose nor 200 mg of vitamin E showed a favourable effect on incidence and severity of acute respiratory tract infections in well-nourished non-institutionalised elderly individuals. Instead we observed adverse effects of vitamin E on illness severity.'

Guess that about settles it. No need now to waste any money taking vitamins for this problem anyway.

Mama mia, where do I begin?

Star treatment?
Permit me an opinion here (alas, the first of many): the authors were either, 1) desperate to publish something...anything (this is possible), 2) hell-bent on demonstrating that vitamins are worthless (my first choice), or 3) total idiots (not ruling this out).

The list of vagaries in such a useless piece of rubbish is so long that we could take two sessions to handle it all. I take it back - the article is not useless. It's an excellent example of how conventional medicine tries to trample on the effects of simple, inexpensive, and amazingly safe alternatives to pharmaceuticals (which are not so simple, inexpensive, or safe). In that light it's worth a good look.

So let's play with the only named nutrient in the entire work, vitamin E. Other than a generalised (and deliberately weak) multivitamin-mineral preparation, vitamin E is the spotlighted nutrient, so we'd certainly expect it to be handled appropriately as the star of the show.

First, the nutrient selection. I can't really explain why vitamin E would be someone's first choice for respiratory infections. It's like giving an antibiotic for insomnia...it may be a great agent, but not necessarily for everything. In this case, the idea is that vitamin E was shown in a previous study to demonstrate a positive effect on the immune system in general (they admit to that), but not specifically respiratory infections.

A bit of a leap there, but not necessarily altogether a bad idea. I mean, I'd have studied some of the really well known nutrients for acute illness (such as vitamin C, n-acetyl cysteine (NAC), alpha lipoic acid, or others), but still the idea may have some worth.

Measure for measure
So let's get to the really bad ideas. The first would be the obvious responsibility to describe your main topic correctly. Vitamin E is fat-soluble, and therefore is measured in international units (IU) of activity, as opposed to milligrams. Not once is 'IU' ever mentioned.

Okay, milligram and IU use may be close, in general, but it's not really proper to interchange them - especially since we're reading this in one of the most respected medical journals!

Another downfall is that the vitamin E is also measured in units that make absolutely no sense, specifically 'mg/dL' when they say that the vitamin E supplement 'contained 200 mg/dL of alpha-tocopheryl acetate.

This normally means 'milligrams per decilitre,' meaning the number of milligrams contained in 100 cubic centimetres of whatever solution is being measured... gibberish in this context. Other than just sloppy work this also could be forgiven, except that the mistake comes at THE ONLY TIME IN THE ENTIRE PAPER WHERE THE ACTUAL FORM OF VITAMIN E IS DESCRIBED (and you guessed it: there are several forms of the stuff).

Something's not right here
Now things become a bit more serious. One would guess that the most likely conclusion (you're not supposed to have to GUESS in a published, peer-reviewed scientific paper) is that the researchers used '200 mg of dl alpha-tocopheryl acetate', and if so that's very important.

Here's why: 'dl' alpha-tocopheryl is SYNTHETIC vitamin E, and that distinction is most significant for this particular nutrient because only half of the molecules in dl alpha-vitamin E are utilised by the body. (The other half are molecules unrecognised by the body, and must also be handled by it, though nobody knows how!)

So assuming the researchers did use '200 mg of dl alpha-tocopheryl acetate' (hard to prove since they messed up the description), the mistake is a big one. They not only used a smaller active dose, but also one that has to be handled abnormally by the body.

Fear not, it gets worse. Say, for sake of argument, that these paragons of nutritional wisdom used natural vitamin E (this would be signified by the term 'd alpha-vitamin E' instead of 'dl alpha...').

Any nutritional doctor who knows anything at all, knows not to use alpha tocopherol, natural or otherwise, because using the alpha fraction without the other fractions - beta, delta, and gamma - causes the other fractions to decrease in value. This is why good supplements are always of the 'mixed tocopherol' variety, containing all the fractions.

And guess what. In the body of the report (not on the first page, like the abstract's conclusions), they made an amazing discovery: 'In the vitamin E group, alpha-tocopherol and cholesterol-adjusted alpha-tocopherol levels increase significantly, while gamma-tocopherol levels decreased significantly.'

Really.

Conclusion: not worthy
Oh, and don't go thinking that the knowledge of alpha-tocopherol adversely affecting gamma tocopherol might be previously unknown. It's not only known, but known to JAMA! Just two months earlier, JAMA reported on 2 studies showing antioxidants (including vitamin E) helped reduce risk of Alzheimer's disease (up to 70%, by the way).

And 2 weeks earlier than that, IN THE SAME JOURNAL, vitamins were shown to reduce the risk of cancer, cardiovascular disease and osteoporosis [JAMA, June 19, 2002]).

The Alzheimer's researchers used dietary vitamin E in their study, and the September 2002 edition of Life Extension explains exactly why: 'Dietary vitamin E is rich in the gamma tocopherol fraction of vitamin E, whereas vitamin E supplements consist primarily of alpha tocopherol [depending on which you buy/ed. note]. IT IS THE GAMMA TOCOPHEROL FRACTION OF VITAMIN E THAT HAS BEEN SHOWN TO BE THE CRITICAL FACTOR IN SUPPRESSING FREE RADICALS.' (emphasis mine)

And our erstwhile researchers were using a synthetic supplement that ITSELF lowered that very fraction.

Hopefully, the problems above will not be seen as insignificant, as I've gone to considerable length to demonstrate that they are anything but. Bear in mind, however, that your doctor sees the one-liner in the conclusions on page one 'showing' him how useless vitamin E is, when what's useless is the report itself.

We could go on to examine the incredibly tiny dosages used of all the other nutrients in the study (the puny RDA of the vitamins, and only one half to one quarter the RDA of the minerals!)...

But I figured these rats had already led us through enough of a maze.