Vitamin E: The Framing of a Vitamin.
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A recent study published online in the Annals of Internal Medicine has created quite a stir. Unfortunately, the study was immediately picked up by the media with frightening headlines such as;

Vitamin E may do more harm than good. CNN

High dose vitamin E death warning. BBC NEWS

High Doses Of Vitamin E Found to Raise Risk of Dieing. Washington Post

This misuse of information can be very frustrating and confusing. It is important to have a more complete picture of this study in order to make informed choices about your health and supplementation. Not all the information that was seen in the papers was 100% accurate and largely taken out of context.

The Study

Researchers from Johns Hopkins University recently published a report in the online edition Annals of Internal Medicine (Nov. 10) alleging that high-dose vitamin E may increase the risk for mortality. This study considered doses in excess of 400 IU per day to be high and doses less than 400 IU per day to be low.
The validity of their conclusion that high doses of vitamin E are dangerous is potentially flawed.

The researchers drew conclusions about vitamin E use and mortality by combining results from 19 different studies of people that were already at grave risk with existing diseases, including cancer, heart disease, Alzheimer’s, Parkinson’s and kidney failure. 18 of those studies showed no statistically significant difference in mortality between people who consumed high doses of Vitamin E and those who didn’t. Only one report found a negative correlation and the researchers chose to focus on that instead of the 18 reports that didn’t.

In fact, a number of studies in the analysis showed positive results. The researchers even acknowledge this in their analysis: "High-dosage….trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult."

Potential Problems with the study

This was an analysis of several studies involving the use of vitamin E for various diseases. It did not include some observational studies, which have shown a correlation between vitamin E used and a reduced risk of coronary disease.

    * Vitamin E was often used in combination with other vitamins or pharmaceutical drugs being studied; the effects of these combinations were not discussed in the research.

    * The populations being studied mostly consisted of elderly people with chronic diseases. The paper recognizes this as a possible confounder, because elderly, sick people are more likely to be taking high doses of vitamin E. It would not be possible to generalize the findings to a young and healthy population.

    * The study looked at different types of research studies that used different protocols and procedures such as different doses of vitamin E taken for different lengths of time.

    * The original studies didn't necessarily differentiate between natural and synthetic vitamin E.

    * Some of the results of the original studies have been questioned.

The other side of the story.

It has been recognized in scientific literature that vitamin E does not substantially decrease mortality from heart disease in patients with known coronary artery disease, or for those who are at high risk for the disease. There is, however, a significant body of evidence showing the protective effect of vitamin E among lower-risk populations. Vitamin E may still safely be considered an effective tool in the primary prevention of disease, especially when taken as a preventative over longer periods of time. In addition, a recent study from Tufts University found that vitamin E was beneficial for reducing incidence of upper respiratory infections in elderly persons. Even the FDA has recognized the potential benefits of vitamin E reducing the risk of cancer in allowing the qualified health claim, "Some scientific evidence suggests that consumption of antioxidant vitamins (including vitamin E) may reduce the risk of certain forms of cancer. However, FDA has determined that this evidence is limited and not conclusive."

Research has also produced enough positive results to give the American Dietetic Association confidence to post the following information regarding vitamin E.

Vitamin E: A disease fighter; ADAF 2001

Vitamin E in your diet can help you stay healthy and fight some of the most common and deadly diseases. Research has shown that vitamin E helps prevent heart disease, cancer, Alzheimer’s disease, and diabetes.

Heart Disease disease is the leading cause of death in the United States. Research has shown that vitamin E may help prevent or delay heart disease by targeting the free radicals that mix with the “bad” (LDL) cholesterol in your body. LDL cholesterol clogs your arteries and can lead to a heart attack. In studies, people who had more vitamin E in their diet had lower rates of heart disease. Some doctors who treat heart disease (cardiologists) report that they recommend higher amounts of vitamin E to their patients and consume it themselves as well. One report found that vitamin E is the most common antioxidant vitamin taken by cardiologists, most often at 400 IU (268 milligrams) daily. Another study found that 75% of cardiologists recommend that their patients take vitamin E supplements (generally 400 IU) to protect their heart and keep it healthy.

Cancer, according to the American Cancer Society, causes one out of four deaths in the United States. Some research shows that vitamin E may protect against certain cancers by boosting the immune system. Researchers report that there may be a link between consumption of vitamin E and lower rates of prostate, breast, colon and cervical cancer.

Alzheimer’s disease studies have found that vitamin E intake may slow the progression of Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia. Dementia is a collective name for brain conditions that affect memory, thinking, behavior, and emotion. There are an estimated 18 million people in the world with dementia, for which there is no cure.
* Link to Alzheimer’s Association outlining benefit of vitamin E in regard to Alzheimer’s.

Diabetes research suggests that large amounts of vitamin E may help reduce health problems related to diabetes. About 16 million Americans have diabetes. Vitamin E is believed to help people with diabetes fight the unusually large amount of free radicals in their blood.
* This study explains tremendous beneficial effects for 40% of those with Diabetes.

More about Vitamin E:

Vitamin E is Safe and Beneficial                 

Shortcomings of the vitamin E meta-analysis

National Institutes of Health, Office of Dietary Supplements - Vitamin E Safety : Fact Sheet

Dr. Julian Whitaker, M.D. Comments on the Vitamin E meta-analysis

Vitamin E Supplements: Good in Theory, but Is the Theory Good?

Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality