In my last column I described one of my actual dreams. This time I am describing reality—but it is so unexpected that it feels like a dream. Yes I am awake. Yes I am dressed. Yes this is the New England Journal of Medicine I am reading. And yes, it says: "among middle-aged women the use of vitamin E supplements is associated with a reduced risk of coronary heart disease." That is the conclusion of Dr. Meir Stampfer and his colleagues at Harvard Medical School in their report of a questionnaire study involving 87,000 nurses with follow-up over an 8-year period. They found a 45 percent reduction in coronary heart disease amongst nurses taking vitamin E supplements over 100 units per day compared to those who relied on dietary sources alone. This is important because it has been the dogma of FDA (Food and Drug Administration) for the past 50 years that "the average American Diet is adequate in vitamins and minerals." I addressed this as the "nutrition death sentence" in my 1980 book, MegaNutrition.
In a second and parallel study in this same issue of the Journal, Dr. Eric Rimm and his colleagues, including Dr. Stampfer, report their observations on 40,000 men, all health professionals, observed over a 4 year period. The conclusion is similar: "evidence of an association between a high intake of vitamin E and a lower risk of coronary heart disease." A dose of 100 to 250 units per day was associated with 46 percent reduced risk of heart attack. There was no further benefit at doses over 250 units and the results held regardless of fat intake, iron intake or alcohol intake! Even such factors as age and family history of heart attack did not weaken the vitamin E effect. On the other hand there were no additional benefits from taking magnesium, carotene or vitamin C—except that in men still smoking, those with the highest carotene intake had a 70 percent reduced risk of heart attack compared to the low carotene smokers.
Taken together these two studies include over 127,000 men and women and the over-all impact of vitamin E turns out to be a 45 percent reduction in risk of heart attack for those taking vitamin E supplements at doses above 100 units a day for more than two years. The benefits were unaffected by intake of fat, whether saturated, monounsaturated or polyunsaturated. The benefits held up regardless of high cholesterol or diabetes. The benefits even held up in smokers!
Are you taking vitamin E? Will you? Or do you need more proof? If so you are not alone. Dr. Daniel Steinberg wrote the editorial comments on these two research papers and offered 3 reasons NOT to take vitamin E. First is that convincing proof requires further research, especially intervention trials, to pin down the magnitude of benefits. Second is the question of safety of large doses of vitamin E for long time periods. Third, "we should ask how many patients will slack off on their adherence to better-established but somewhat more onerous, preventive measures, such as cholesterol-lowering diet, regular exercise, and smoking cessation."
These are the words of the medical establishment, channeled through the mind of a brilliant researcher, but one who lives off research grants, not by the goodwill of patients. His creed is the rule of absolute proof: "we must play by the rules and insist on large, long term, double blind clinical trials. Until they are done, please, let's hold the vitamin E." To the mind of a nutrition physician a different rule must prevail, that of possible benefit: the rule of Hope. In the real world of the doctor and patient, when there is health, happiness and life itself at stake, common sense dictates the rules and a non-toxic, non-invasive treatment deserves a trial if it might help.
There you have it, the latest controversy in medical thinking. Of course, I leave it up to you to decide for yourself. As for me, I shall continue taking 1000 units of vitamin E more or less daily as I have since 1968. Among my colleagues in the Orthomolecular Medical Society, the new Association of Orthomolecular Physicians and the American College for Advancement in Medicine, all together numbering over 1000 physicians, I have heard of not a single case of harm from vitamin E in 25 years. One of my patients once took a teaspoonful of vitamin E oil, amounting to about 4000 units in a single dose. She had diarrhea for half a day. I also can recall two women who stopped vitamin E because it increased their sexual feelings at a time when there was no available partner.
These two research reports, coming as they do from the New England Journal, the most prestigious of our general medical journals, are a turning point in medical history, one of the first times that vitamin supplementation has won public respect from the medical establishment for other than gross deficiency disease. By respect, I refer to the inclusion of data comparing vitamin treatment with surgery, head to head. In those patients who took vitamin E over 100 units daily, risk of heart attack was 0.63 compared to those who had no treatment; by comparison those who had coronary by-pass surgery or angioplasty had a risk of 0.68, almost 10 percent higher. Though the statistical difference is not significant, the practical difference is in favor of vitamin E because of the huge reduction in cost.
The question of cost is important because once an influential medical journal endorses such a study, by publishing it, the expectation is that doctors will heed the message and prescribe vitamin E. Patients surely will ask about it and demand it. Will health insurance companies pay for it? Not yet they won't. Would the country go broke if vitamin E supplementation were covered by national health insurance? I say the country will go broke without it.
The actual cost of 100 units of vitamin E is as low as $6.20 a year per person at the wholesale price in small quantities, such as to individual doctor's offices. In large quantities the cost might be half as much. Thus, if 150 million Americans took vitamin E at that dose under government sponsorship, the total cost could be as low as $3.00 a year per person or less than 500 million dollars. That may sound like a lot but it would pay for itself. As an investment it would be a 200 to 1 payoff. The reduction in coronary heart disease thereby would cut our national medical and hospital bills, which now stand at $800 billion, by about $100 billion* annually. And that is based upon the benefits of just this one vitamin. How about the other 50 nutrients? There are many other benefits that remain unknown to our medical orthodoxy that still puts nutrition last. Putting nutrition first might save our nation from iatrogenic* bankruptcy. (*i.e. medically caused.)
. Stampfer MJ, Hennekens CH, Manson J E et al: Vitamin E consumption and the risk of coronary disease in women. NEJM 1993;328:1444-9.
. Rimm, EB, Stampfer MJ, Ascherio A et al: Vitamin E consum ption and the risk of coronary heart disease in men. NEJM 1993;328:1450-6.
. Steinberg, D: Antioxidant vitamins and coronary heart disease. NEJM 1993; 328:1487-8.
©2007 Richard A. Kunin, M.D.