The real facts about the vitamin E death warning...

Do you ever feel fed up with all the conflicting health information in newspapers and magazines?

This week, you'll see a story about the benefits of taking a certain supplement. A week later, you'll read or hear a report about the dangers of the very same substance, with warnings by an expert to stay away from it.

A good example comes from the latest "death warning" about vitamin E. According to recent headlines, people could be "risking their lives" if they take even moderately high doses of vitamin E [1].

To add to the confusion, researchers from Israel now tell us that some patients with diabetes can reduce their risk of dying from heart disease by taking — you guessed it — high doses of vitamin E [2].

This kind of conflicting evidence prompts many frustrated people to throw up their arms in frustration at the fact that "even the experts can't agree." It's easy to become so frustrated and confused that you simply ignore it all.

Don't throw your vitamin E supplements in the bin just yet. There are several important aspects of the Johns Hopkins study that didn't get much coverage in the news.

Here's a closer look at what they actually did.

The researchers looked at a number of studies carried out between 1993 and 2004. All compared vitamin use against a dummy supplement (placebo).

They found that the risk of death did not differ significantly between people given vitamin E and those assigned to placebo.

However, the effect of vitamin E differed according to how much was used. In the low-dose studies, vitamin E was linked with a small reduction in the death rate.

In the high-dose studies, those who took vitamin E had a 4% increase in the risk of death. Though this increase was small, it was statistically significant.

It was this discovery that generated the headlines.

One problem is that the review included studies where vitamin E was taken with other vitamins and minerals. The increased risk of death found in some of the studies could have been linked with these other nutrients. It may have had nothing to do with vitamin E.

What's more, many of the study groups were people with pre-existing chronic diseases such as cancer, heart disease, Alzheimer's, Parkinson's and kidney failure.

Even the editors of the Annals of Internal Medicine (the journal where the study was published) write that the findings may not apply to healthy adults.

Dr. Alan Gaby, an expert in nutritional therapies, also points out that some of the results were complicated by the fact that the vitamin E and placebo groups were not comparable.

"In one high-dose vitamin E study (Cambridge Heart Antioxidant Study), the vitamin E group had higher cholesterol levels and significantly greater percentages of participants with high blood pressure, diabetes, cigarette smoking, and severe coronary artery disease, compared with the placebo group," says Dr. Gaby.

"Thus, the people taking vitamin E were sicker than those taking the placebo, a fact that could account for the slight increase in mortality seen in the vitamin E group."

Facts about vitamin E

There are also several different forms of vitamin E. Read the label on a vitamin E supplement, and it will probably say alpha-tocopherol (pronounced al-fa tocko-ferol).

Most of the studies reviewed in the Johns Hopkins research were done using the synthetic (dl-alpha-tocopherol) rather than the natural (d-alpha-tocopherol) form of alpha-tocopherol.

Natural vitamin E has roughly twice the availability of synthetic vitamin E. Because of this, you have to take about twice as much of it to get the same effect [4].

If there is a small negative effect of high-dose vitamin E, it might be due in part to the use of dl-alpha-tocopherol.

Vitamin E is actually a collective term for eight naturally occurring compounds, four tocopherols (alpha-, beta-, gamma- and delta-) and four tocotrienols (alpha-, beta-, gamma- and delta-).

Concentrations of alpha-tocopherol are higher in wheat germ oil, almond and sunflower oil; gamma-tocopherol is the major form of vitamin E in corn oil and soybean oil; levels of tocotrienols are high in rice bran, barley, oats and palm oil.

Although most research has focused on the potential health effects of alpha-tocopherol, the three other tocopherols and four tocotrienols are also important.

In fact, supplementing with alpha-tocopherol has been shown to reduce blood levels of gamma- and delta-tocopherol [3].

Although they're usually more expensive than alpha-tocopherol, mixed tocopherols are the preferable form of vitamin E, in terms of both safety and effectiveness.

If you do use a high-dose vitamin E supplement, look for one that contains mixed tocopherols. Some manufacturers use this term to mean the synthetic dl-alpha-tocopherol, so you need to read the label closely.

Of course, the fact that some forms of vitamin E are natural doesn't mean it can be consumed safely in unlimited amounts. Many supplements, including vitamin C, iron, CLA and CoQ10 — under certain conditions — can have negative side effects.

Even plain water has the potential to be harmful [6]!

Based on its blood-thinning effects, there are concerns that vitamin E could cause problems if combined with medications that also thin the blood, such as aspirin. In theory, the blood could thin too much, causing bleeding problems.

Vitamin E may also enhance the body's sensitivity to its own insulin in people with type II diabetes [5]. This could lead to a risk of blood sugar levels falling too low.

If you're taking medication, it would be a good idea to talk with your physician before using a high-dose vitamin E supplement.

The bottom line

One of the main goals of a newspaper or magazine is to sell more copies. They'll achieve this with a sensational headline that reads something like "vitamin E death warning" rather than one that accurately reflects the findings of a study.

Personally, I use a multi-vitamin and mineral supplement that contains 150 IU of vitamin E (d-alpha-tocopherol succinate). Most days, I also use a meal replacement supplement containing 30 IU of vitamin E. That gives me at least 180 IU of vitamin E each day, plus what I get from my diet.

This new research has not convinced me to use less vitamin E.

One study is not really news. Think of it as a single piece of a jigsaw puzzle. It's only when you put the pieces together by comparing many studies in a given field that you get an accurate picture of what's really going on.

References
1. Miller, E.R. 3rd, Pastor-Barriuso, R., Dalal, D., Riemersma, R.A., Appel, L.J., & Guallar, E. (2004). Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality. Annals of Internal Medicine, 142
2. Levy, A.P., Gerstein, H.C., Miller-Lotan, R., Ratner, R., McQueen, M., Lonn, E., & Pogue, J. (2004). The effect of vitamin E supplementation on cardiovascular risk in diabetic individuals with different haptoglobin phenotypes. Diabetes Care, 27, 2767
3. Huang, H.Y., & Appel, LJ. (2003). Supplementation of diets with alpha-tocopherol reduces serum concentrations of gamma- and delta-tocopherol in humans. Journal of Nutrition, 133, 3137-3140
4. Burton, G.W., Traber, M.G., Acuff, R.V., Walters, D.N., Kayden, H., Hughes, L.,& Ingold, K.U. (1998). Human plasma and tissue alpha-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E. American Journal of Clinical Nutrition, 67, 669-684
5. Manning, P.J., Sutherland, W.H., Walker, R.J., Williams, S.M., De Jong, S.A., Ryalls, A.R., & Berry, E.A. (2004). Effect of high-dose vitamin E on insulin resistance and associated parameters in overweight subjects. Diabetes Care, 27, 2166-2171
6. Noakes, T.D. (2003). Overconsumption of fluids by athletes. British Medical Journal, 327, 113-114