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Doctors agree on vitamin E study being flawed

Dr. Gerald Chodak, a urologist, is a frequent video speaker on prostate cancer on medscape.com. The information he typically presents is balanced and based on the latest research on prostate cancer. However, his latest video is misleading and simply wrong.

 

 

If you can access this video go to: http://www.medscape.com/viewarticle/752293

After a brief introduction on the design and methodology of the SELECT trial (which you can see here), here are some of the things he said and I quote:

 

“The message is this: Not only did vitamin E not help to reduce the risk for prostate cancer, it actually increased the risk. This message is an important one to convey to our patients. With no prospective, randomized studies evaluating higher doses of supplements, there is really no way to tell whether there is any impact on disease prevention or treatment. Even more important, patients should realize that unless studied properly, we really do not even know the overall impact in terms of side effects.”

“Here we have yet another example of something that is over-the-counter that can actually cause harm. Patients should be alerted to that. Studies had previously suggested that vitamin E might be a heart-protective agent or may prevent other cancers.”

“However, well-done studies have failed to demonstrate that.”

“I think it is important to find out from our patients whether they are taking vitamin E supplements and caution them about the increased risk for developing prostate cancer. We should discourage our patients from taking supplements that have not been studied properly. Most people do it thinking, “Even if it doesn’t work, there’s no harm.”

“Here is yet another example that harm can occur when tested properly. I look forward to your comments. Thank you.”

I generally do not have time to comment on other sites and I have been writing about this extensively, including for the Natural Medicine Journal (by the way, this is a great e-journal and it’s free.) But I felt compelled to educate Dr. Chodak and other physician’s that come to this site.

Here’s my comment:

 

#1 of 20, Added By: Espinosand, MD, Urology, 8:06PM Nov 03, 2011

Synthetic alpha tocopherol is the type of vitamin E that was studied in the SELECT trial. This type of vitamin E which only one of 8 types and one not has not been in the supplement market for about 15 years. Research studies show that gamma-tocopherol maybe more protective for multiple conditions and its the one found most commonly in nature. Why was did the investigators use synthetic vitamin E? Because it was the type used in the ATBC lung cancer prevention trial among smokers that showed a 32% decrease in prostate cancer among men that smoke. However, in the ATBC trial, they used only 50 units of alpha tocopherol vitamin E. In the SELECT trial they used 400 units of the same – 8 times as much. The ATBC study began in 1985. So essentially, we are still studying a type of vitamin E that does not exist and its based on a study done almost 30 years ago. Mixed tocopherol vitamin E with gamma tocopherol its what is in the market and what many studies inconclusively show to be helpful.

I originally thought I was going to be challenged and ridiculed, but the opposite was true. Here are some responses from other physcian’s:

#2 of 20, Added By: suzannemack, MD, General Practice, 5:46PM Nov 08, 2011
I was just pleased to write virtually the same thing. Clearly this is misrepresentation of data. The problem is that most people will walk away with this soundbite of vitamin E. is bad. So a disservice has been done.
As patients start to wake up to the fact that most healthcare is not about creating health and look towards “alternative medicine” there is a panic struck in the hearts of pharmaceutical companies. One has to wonder who is “funding” all of these studies that report negative outcomes from “vitamins”.

#3 of 20, Added By: gplot, MD, Internal Medicine, 5:53PM Nov 08, 2011
Dr. Epinosand is correct. Vitamin E is not a single compound but a family of compounds of tocopherols and tocotrienols. High dose alpha-tocopherol was used in this study without beta, delta or gamma tocopherol. No tocotrienols were used in this study. The dose (400 IUs of d,l-alpha-tocopherol) was not selected based upon animal or human dosing studies. Additionally, only the d-racemic form (dextro-rotation) of tocopherols and tocotrienols are found in nature. We have no idea how the body metabolizes the l-racemic forms. Why should anyone be dosed with all-racemic high dose alpha tocopherol?The take home points for patients is not necessaril to avoid vitamin E but to avoid high dose all-racemic (d,l) alpha tocopherol.Please note that high dose all-racemic alpha tocopherol is what is found in most multivitamins.

#4 of 20, Added By: sheilageorgemd, MD, Family Medicine, 5:57PM Nov 08, 2011
Vitamin E has still not been studied properly. Synthetic alpha tocopherol was used and this will deplete the body of gamma tocopherol. What about a study with natural mixed tocopherols and natural mixed tocotrienols? We know that mixed tocopherols have some fantastic health benefits.

#5 of 20, Added By: An_27857841, MD, Ob/Gyn & Women’s Health, 5:59PM Nov 08, 2011
Poor study because “synthetic” Vitamin E was used. Synthetic Vitamin E is not what consumers are consuming. This study was a waste of money and misleading to the public.
Judith In

#6 of 20, Added By: GVKENT, MD, Internal Medicine, 6:32PM Nov 08, 2011
The comments so far have been very thorough and scholarly, but very technical. So what is the take home answer as far as “once a day” type multivitamin supplement danger?

#7 of 20, Added By: An_6681356, Other, 6:38PM Nov 08, 2011
This article I found on Pubmed describes the problem with alpha-tocopherols quite nicely:Crit Rev Food Sci Nutr. 2010 May;50(5):414-9.
Vitamin E forms in Alzheimer’s disease: a review of controversial and clinical experiences.
Usoro OB, Mousa SA.
SourceCollege of Pharmacy and Health Sciences, The Pharmaceutical Research Institute at the Albany, Rensselaer, NY, USA.Abstract
Vitamin E is a collective term for eight naturally occurring compounds, four tocopherols (alpha-, beta-, gamma-, and delta-) and four tocotrienols (alpha-, beta-, gamma-, and delta-). Although it is the major form of vitamin E in US diets, gamma-tocopherol receives little attention when compared to alpha-tocopherol, which is generally found in supplements and most studied for its effects on progression of cognitive impairment. Many clinical trials had been conducted with vitamin E and neurodegenerative disorders, with controversial results, including a recent study which disproves the benefit of vitamin E for Mild Cognitive Impairment and Alzheimer’s Disease. This study examined the alpha-tocopherol supplement instead of gamma-tocopherol. Gamma-tocopherol has been found to be more effective in scavenging free radicals and nitrogen oxygen species that cause inflammation; both of these are components of neurodegenerative disorders. Secondly, the use of alpha-tocopherol supplements significantly reduces serum gamma-tocopherol, and this may have important biological effects. Therefore, any potential health benefits of alpha-tocopherol supplements may be offset by deleterious changes in the bioavailability of other forms of tocopherols and tocotrienols. This might account for the null effects of alpha tocopherol supplementation in Mild Cognitive Impairment and Alzheimer’s Disease.

There were 12 others commenting along the same lines.

It’s simple, there’s good science and then there’s bad science. The SELECT trial is an example of bad science.

 

In Optimal Health,

Dr. Geo

 

 

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