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Medicine 101 – Dr. Tara Macart


Not long ago, the media was frenzied with the thought that vitamin E could be hazardous for your health. Coming on the heels of the Vioxx scandal, it seemed that both pharmaceuticals and vitamins had a dark side. Later, a meta-analytical review of the scientific data revealed that synthetic vitamin E was guilty of the disappointing out comes. Thankfully, the natural form of vitamin E, d-alpha-tocopherol, was spared this disgrace.

Why all the concern about vitamin E and cardiovascular disease?  Well, vitamin E prevents lipid oxidation. If oxidized LDL, oxidized bad cholesterol, is integral in the development of arteriosclerotic plaques, as hypothesized, then vitamin E may interfere with the progression of cardiovascular disease. Now, to the science!

The Cambridge Heart Antioxidant Study (CHAOS) looked at 2000 patients with atherosclerosis. They found that 400 iu or 800 iu of vitamin E daily, as d-alpha-tocopheryl acetate, lowered the risk of heart attack by 77% over one and a half years. Unfortunately, there was very little difference in the risk of fatal heart attacks between the treatment groups and the control.

The Heart Outcomes Prevention Evaluation study (HOPE) evaluated 400 iu of d-alpha-tocopheryl acetate against an ACE inhibitor called Ramipril (a blood pressure drug). Ramipril was significantly useful in reducing deaths from heart disease and stroke, but 400 IU of d-alpha-tocopheryl acetate apparently was not.

Another study done in Italy, called the GISS, tested over eleven thousand people who had already had a heart attack. They tested 1 gram of omega-3 fish oil against 300 mg of dl-alpha-tocopheryl acetate, or both. The results showed that the group who took the fish oil had fewer subsequent heart attacks but the synthetic vitamin E group did not have any significant effect.

Considering these studies, scientists should follow up with investigation of different doses, different forms of vitamins, and eventually different combination protocols. For example, rather than pairing off one drug against one supplement, has anyone tested the effects of ACE inhibitors with a specific array of nutritional supplements? Such investigation may provide the very best results yet.

While attention has been brought to alpha-tocopherol, some study has been aimed at the less famous components in vitamin E, like tocotrienols. A clinical study by the Kenneth Jordan Heart Research Foundation in New Jersey is doing just that. This 5 year study followed 50 patients with narrowing of the carotid artery. The treatment group took 650 mg of tocotreinols with tocopherols. This group had three patients get worse (compared to fifteen in the placebo group), twelve patients remained stable (compared to eight in the control group) and ten patients showed improvement (compared with two with the placebo). Furthermore, the treatment group had better measures of oxidation and their cholesterol profile improved.

The bottom line—- vitamin E shows some evidence of benefit in cardiovascular disease, but be selective and stick to a natural source. The usual dose is 400 IU per day, but more study should go into identifying a therapeutic dose of vitamin E with all the tocotrienols and tocopherols.