Gettysburg Medical Center
 The Clinical View
 by P.E. Hoffsten, M.D.
 26 January 2005

VITAMIN E:  A WONDERFUL IDEA THAT DIDN’T WORK

            Most people know that for something to burn, oxygen is needed.  Thus, we get the term oxidation which means that whatever was burned was combined with oxygen and energy was released.  This energy generally takes the form of fire if paper, or gasoline, or wood is being oxidized rapidly.  Oxidation can take a slower form than fire.  When wine sits exposed to air, the alcohol turns to acetic acid because of oxygen; then the wine tastes like vinegar.  So oxidation doesn’t necessarily mean rapid energy release causing fire.

            Long ago, it was realized that the aging process involved oxidation of our proteins and other structural parts of our bodies.  Aging can be thought of as slowly “burning up your proteins”.  Thus was born the idea of finding something that would slow down or stop the oxidation of our proteins and thereby stop the aging process.  Such an anti-aging agent took on the broad name of an “anti-oxidant”.

            The first and most promising antioxidant was Vitamin E.  It was discovered more than 50 years ago that chickens provided with a synthetic diet aged unusually rapidly.  Through various research efforts, Vitamin E was discovered to be the agent missing in a synthetic chicken diet.  When Vitamin E was added to the synthetic diet, the chickens aged in a normal manner and it was noted that it took only a tiny amount of Vitamin E to make the chickens normal again.

            Most vitamin deficiencies in humans were discovered because of the characteristic clinical illness that developed when the vitamin wasn’t provided.  The classical example is scurvy that resulted from Vitamin C deficiency. The British navy learned in the 1700’s that if their sailors were provided with limes during the long voyages at sea, scurvy didn’t develop in their sailors who then became known as “lime-es”.  Eventually, we found Vitamin C to very rich in citrus fruit.  A disease called beriberi develops in people who lack Thiamine.  A disease called pellagra develops in people that lack niacin.  Rickets develops in people who are Vitamin D deficient.  But look as I will, there has never been a reported case of what happens to a human being if they lack Vitamin E.  Thus, the minimal daily requirement for humans is really not known.  Instead it is projected on a weight basis from what chickens need in order to grow normally.  Thus, we think that normal adult minimum daily requirement for Vitamin E in humans is 22 units.  But we don’t have a clue what would happen if somebody gets less than that.

            Now comes thinking in the great American way.  Since aging involved oxidation and  Vitamin E was an antioxidant, it was just logical that Vitamin E must be an anti-aging Vitamin.  Of course, if a little is good, a lot must be better.  So the counters at nutrition stores and your local pharmacy blossomed with Vitamin E tablets at 400 units per capsule.  Some capsules are 1,000 units per capsule and with the idea that a whole lot of Vitamin E must be wonderful.

            Surveys done in 2003 indicated that one of every five adults was using Vitamin E supplements at more than 400 units per day.  The high dose Vitamin E idea really took hold.  But where is the information or data that says that Vitamin E prevents aging or anything else for that matter?

            In the past two months, there have been several publications looking at the effects of Vitamin E.  All studies thus far indicate a higher mortality rate in those people taking Vitamin E than in those not taking Vitamin E.   Controlled studies have been done to see if Vitamin E prevents cancer or heart attacks or strokes or high blood pressure.  To this time, there have been no studies demonstrating prevention of these problems.  There have been studies that suggested a decreased rate of Alzheimer’s disease and possibly prostate cancer but subsequent studies trying to confirm the original observations have not been successful.

            The message of this column is, “Vitamin E has no demonstrated benefits.  The weight of evidence at this time indicates a higher mortality rate among those taking Vitamin E than in those not taking Vitamin E.”   For a comparison, the death rate for those on Vitamin E was higher than the death rate that got Vioxx taken off the market.

            This medicine and pharmacy business is very confusing.  Ideas that seem so right sometimes seem to fade like the Vitamin E story.  At this point, the wonderful antioxidant idea has no demonstrated merit.  As with Vitamin E, a group of antioxidants called carotinoids have been shown to have an increased mortality rate in people that use them in high doses.  The other antioxidant popularly used is Vitamin C and it also has no demonstrated merit.

            So what can you believe?  To this time, the weight of evidence in multiple studies favors taking one aspirin per day.  It also favors taking 1200 mg of calcium per day.  It favors the use of Glucosamine/Chondroitin Sulfate at 4 grams per day.  It favors taking Folic Acid at 1 mg per day and maybe 5 mg per day.  Lastly, it favors taking Vitamin D at 800 units per day instead of the usual adult minimum daily requirement of 400 units per day.  All of these recommendations are based on the premise that we all want to live more comfortably longer without the effects of aging.  The latter, over-the-counter medications mentioned may well help in this regard but antioxidants do not, no matter how good the idea was to begin with.