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MORE ON THE VITAMIN E SAGA - VITAMIN E BENEFITS UNDER ATTACK

(April 2002)

Vitamin E should help prevent heart attacks. In the test tube, it interferes with the oxidation of low-density lipoprotein cholesterol (LDL - bad cholesterol). That should help because LDL has to be oxidized to get into arterial vessels and cause arteriosclerosis and subsequent heart attacks. In experimental animals, vitamin E is clearly beneficial in preventing arteriosclerosis.

It is hard to get more than 30 milligrams of vitamin E in the diet, so many experts (Healthful Life included) have recommended a daily vitamin E supplement of 200 to 400 milligrams.

Why should there then be an attack on the usefulness of vitamin E?

1. A careful study using sophisticated measurements of antioxidant activity found that, in thirty healthy men and women, vitamin E in dosages of 200 to 2000 milligrams a day for eight weeks did not show any of the antioxidant activity that would interfere with the oxidation of LDL and protect against the development of coronary heart disease. This impressive study makes it dubious that, for healthy people, taking supplemental vitamin E would play any significant role in reducing the occurrence of coronary heart disease or heart attacks.

2. Although one study of high-risk people showed that vitamin E reduced non-fatal heart attacks (but not heart attack deaths), three other large studies found no benefit.

3. Two studies measuring progression of arteriosclerosis by ultrasound examination of the carotid arteries in the neck reported divergent results. One found no slowing in high risk persons with a history of coronary heart disease or the presence of major risk factors; the other, in healthy persons, found a slowing of the arteriosclerosis in those who took supplemental vitamin E in large doses. A problem with the latter study in healthy people is that the participants were studied by ultrasound and also asked about vitamin E usage. That is not as good as randomly selecting individuals either to receive or not receive vitamin E and, subsequently, doing the ultrasound studies.

Although most of the recent studies do not support the use of supplemental vitamin E, it is still possible that vitamin E could help prevent coronary heart disease in healthy people not at high risk or at risk only because of high cholesterol levels. In various studies, high risk has been defined as either having had evidence of coronary heart disease (including heart attacks) or as having high blood pressure, elevated cholesterol levels, diabetes, or obesity. In the latter studies, no attempt was made to study just high risk due to elevated cholesterol levels.

Where does that leave us?

  • There is inadequate evidence to state that vitamin E in the diet protects against coronary heart disease or heart attacks.

  • There is inadequate evidence to recommend vitamin E taken as a supplement in dosages of 200 to 600 milligrams to prevent coronary heart disease or heart attacks in people who have evidence of coronary heart disease or who have had a heart attack.

  • It is still possible that vitamin E in dosages of 200 milligrams to 600 milligrams will have some protective effect against coronary heart disease and heart attacks in persons at average risk or with somewhat increased risk due to a high cholesterol level. No study has been done that examines only an elevated cholesterol as the single factor increasing risk. That needs to be done because any effect of vitamin E would relate to cholesterol, not the other risk factors (diabetes, high blood pressure, obesity).

Healthful Life has recommended two dietary supplements for adults - folic acid and vitamin E. The evidence favoring folic acid supplements for anyone not getting 400 micrograms in the diet, and for all women who are or might get pregnant, is persuasive. The evidence for vitamin E is not. Taking 200 to 600 milligrams a day of vitamin E will almost certainly not hurt you, but it also may not do you any good.

(The editor of this newsletter has taken 400 milligrams of vitamin E for years; he is no longer going to do so and will not resume taking a vitamin E supplement until there are studies that provide impressive evidence of its benefit for the heart).
 
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