• UPDATE ON VITAMIN E
  • by Herbert Webb, MD Pulmonologist
  • There has been a great deal of interest expressed in the series on herbal medicine by Dr. Herb Webb. To say that we've also had interest about the information on Vitamin E in last month's installment would be an understatement! Dr. Webb was kind enough to draft a written answer to the many questions he received after his article on vitamin E and after a talk he gave to his patient group.
  • Dr. Herbert Webb is a pulmonologist in private practice in San Pedro, CA, and an illustrious graduate of the program at Harbor-UCLA. He is Medical Director of the San Pedro Peninsula Hospital Pulmonary Medicine Department and their Pulmonary Rehabilitation program. He wrote this article for their Better Breathers' Club newsletter. With the gracious permission of Editor Kris Brust, RN, and Dr. Webb, we share it with you.
  • RESEARCH TERMINOLOGY
  • Epidemiologic study: what causes the disease?
  • Preventative study: what prevents the disease?
  • Prospective study: epidemiologic study with respect to medical, social and environmental factors.
  • Retrospective study: records are investigated and patents are interviewed AFTER they get the disease.
  • Randomized study: subjects are assigned to groups by a toss of the coin, avoiding inadvertent selection bias.
  • Placebo: inert substance used by researchers to substitute for the medication being studied; a "sugar pill".
  • Double blind: neither the researcher or the subject know whether the subject is getting the placebo or real medicine; this prevents the researcher from telegraphing hoped-for results to the patient.
  • Many studies have now documented the dramatic difference between epidemiologic evidence and interventional or primary prevention studies. Epidemiologic evidence indicates that diets high in carotenoid and flavenoids found in food such as fruits and vegetables, as well as high serum levels of vitamin E (alpha tocopherol) and beta carotene, are associated with the reduced risk of cancer, heart disease and death. However, the result of interventional or primary prevention studies indicate that there is no benefit to antioxidant agents given as preventative agents in prospective, randomized and double-blinded placebo prospective trial basis.
  • The most dramatic such evidence comes from the famous Finnish study of vitamin E and Beta carotene on the incidence of lung cancer and heart disease in Finnish male smokers. This study evaluated 29,133 male Finnish smokers age 50-69 years. They were given one of four combinations: either vitamin E at 50 mg per day alone, or a placebo. These individuals were followed up for 5 to 8 years. Vitamin E had no effect on the incidence of lung cancer, although it did seem to decrease incidence of prostate cancer. Beta carotene resulted in a dramatic increase of lung cancer. Numerous other studies have shown no benefit of beta carotene or vitamin E on the incidence of ischemic heart disease. Beta carotene is definitely no longer recommended as a supplement. There were more deaths in those taking the beta carotene, but no change in the mortality rate in those taking vitamin E. There was a slight increase in incidence of hemorrhagic strokes (bleeding into the brain) in those taking vitamin E. Numerous other studies have documented that there is no benefit on the incidence of cardiovascular events such as cardiovascular death, myocardial infarction (heart attack) and cerebrovascular infarction (stroke) by taking vitamin E. Large studies such as the Hope Trial with 9,541 patients, the Heart Protection study with 20,534 patients, and the GISSI Prevention Trial with 11,324 patients all showed no benefit from taking supplemental vitamin E on most cardiovascular events.
  • Vitamin E might be beneficial to chronic renal (kidney) failure, hemodialysis patients in terms of preventing fatal or nonfatal myocardial infarction (heart attack), or in patients with a rare form of angina pectoris called variant angina pectoris or vasospastic angina.
  • There were some studies comparing antioxidants (vitamin E plus vitamin C plus selenium) to a conventional statin type medicine (Zocor) on preventing heart disease. Statins were studied with and without niacin and then in combination with the antioxidant vitamins. The findings were that the Zocor or statins plus niacin had a dramatic benefit on preventing coronary artery disease. So, the statin drugs and niacin work. But the antioxidant vitamins actually negated that value and produced a negative result! What happened? Vitamin E converts good cholesterol into bad cholesterol! It appears that vitamin E converts a good fraction of the HDL cholesterol (happy cholesterol) into the nonbeneficial unhappy form of HDL2. So, in summary, there's no reason to take vitamin E for the prevention of heart disease unless you have a very rare form of angina called variant or vasospastic angina.
  • Vitamin E has been studied in numerous settings to see if it will prevent other cancers. It doesn't have any effect on prevention of colon cancers or breast cancer in women. So far, it has shown questionable benefit in preventing aggressive metastatic (spreading) prostate cancer. And, frustratingly, the data is not clear as yet as to whether vitamin E may protect against the development or progression of Alzheimer's disease.
  • The influence of vitamin E supplementation on the occurrence of respiratory tract infections is very important information for our COPD patients. Two large randomized placebo controlled studies found no reduction in the incidence of respiratory tract infections in hospitalized elderly patients receiving daily vitamin E supplements. Furthermore, in one of these studies, in those experiencing respiratory infections, those who received vitamin E supplementation at 200 international units per day had a significantly longer total illness duration (19 versus 14 days). To add insult to injury, they were even sicker than the other patients with more symptoms, higher fever, and more restriction of activities. In summary, when COPD patients came down with respiratory infections, the folks who took vitamin E got sicker and stayed that way a full five days longer.
  • A major interaction of vitamin E with therapeutic medications includes the dangerous interaction of vitamin E in high doses with Coumadin anticoagulants, which leads to an increased incidence of hemorrhage in the brain. To summarize, it appears that there is little evidence, except in certain niche situations, for taking vitamin E for any benefit. Perhaps vitamin E in small doses has little negative side effects or complications. I do not recommend vitamin E supplementation at this time. Numerous experts in the field concur with me.
  • We would all like to thank Dr. Webb for this valuable information and for answering so many of the questions that we received. We would also like to share with you the following information provided by Kris Brust, RN.
  • Those of our readers who wish to review the research themselves will find the reference listings are about an inch thick! For reviewing the raw data, here is a good start:
  • New England Journal of Medicine 1994; 220-1029: "The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers"
  • Journal of the American Medical Association 2003; 290: 476 "The ATBC Study Group. Incidence of cancer and mortality following alpha tocopherol and beta carotene supplementation: a post intervention follow up"
  • Lancet 1992; 340: 1124 "Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects"
  • New England Journal of Medicine 1997; 337: 408 "Antioxidants and atherosclerotic heart disease"
  • Annals of Internal Medicine 1995; 123: 860 "The antioxidant vitamins and cardiovascular disease; a critical review of epidemiologic and clinical trial data"
  • Thanks, Dr. Webb! This series was great and we hope we can get you to contribute other articles to the Second Wind the near future.

  • Do you have a question about respiratory disease that has been bothering you? If so, feel free to write and ask us, either through our web site or by mail. We answer all of your letters.