Vitamin E Meta-Analysis – A Fresh Perspective.

There are three types of lies - lies, damn lies, and statistics
--- Benjamin Disraeli

So here are the headlines. Vitamin E may cause premature death as initially published in the Annals of Internal Medicine. One more headline banner designed to sell news. What are the facts? What is behind the story?

In a sentence: don't worry. This is another flawed paper from a variety of viewpoints. In fact this is an thinly veiled advocacy, not a dispassionate or even scientific analysis of "the facts."

First and foremost, as we have mentioned quite frequently in the last few years, with respect to other studies, the real differences are exceptionally small. Less than 1/2 percent or 0.4%. Refer again to Gerd Gigerenzer's fine book, Calculated Risks, on the misuse of statistics in science and medicine.

This is not really a study. It is a meta-analysis. A meta-analysis is an attempt to review the scientific or medical literature and by combining the power of multiple studies. These pooled statistics give a broader view over time, geography and study populations. But these attempts suffer some serious methodological flaws. Poor design study control.

What is particularly misleading is this series of events. A study is constructed and reviewed upon publication. A summary of the findings are presented and discussed. There may be room for discussion interpretation or even disagreement with the summary. A conclusion then ends the paper. You, the reader, then suffer from having to read a news account or worse, an internet “flash bulletin” that is a quick, usually poorly informed, view of the conclusion. So you rarely get well-informed news reports. This is much like the old game -- pass the word:

Ten people are in a circle. One person starts by whispering in the ear of the person to his or her right. The next person does the same. By the time the “whisper” returns full circle to the beginning, there is little resemblance between the start and final utterance.

So it is with the report you read. You are reading a snippet of a conclusion of a summary of a study that was most likely flawed in the first place. Your yield is not too accurate.

We must also caution you that statistics are used in not entirely honest fashion in medicine and in science. This paper uses some very sophisticated mathematical analysis of quadratic equations. The plain fact is this. The overall decrease in death in those taking Vitamin E from low dose to 2000 units daily was 0.05% Yes, I said decrease in death, although you can see that the change here is … negligible. So the authors segmented out a portion that took over 400 units daily and capriciously and arbitrarily assigned them to high dose. Of the high dose group there was a 0.48% increase in death. Again .. Virtually negligible

Now what else can we say about the methodology of these studies?

What is Vitamin E? Alpha tocopheryl acetate (synthetic Vitamin E), natural alpha tocopherol, or as we always recommend: mixed tocopherols. That is a blend of the natural alpha, beta and gamma tocopherols. All vitamins should be taken as a mixture and not as an isolated fraction.
There is never going to be a good, definitive vitamin study because, as the authors point out, it is too expensive to construct the ideal study. Dose response curves with various formulations. Vitamin E should be taken along with Vitamin C and some form of nutrient such as NAC (n-acetyl cysteine) to promote glutathione formation. They all work in concert as a redox reaction. One is oxidized and then next then reduces and neutralizes the reaction. A study of this sort is not going to de done, because too many variables are involved. So you are waiting for Godot as the ultimate comment is offered yet once again: this requires further study.
The study only measured death as an end point. In real life, I think were are also concerned with vitality, quality of life and a host of other attributes of energy production. So death is an unassailable end point, but has only limited value. And, the authors admit that they excluded a number of studies in their Meta analysis where the death rate was too low. We do not know how many subjects would have been included otherwise, .but it may have been sufficient to dilute the “death rate.”

“we could not evaluate the generalizeability of our findings to healthy adult populations."

They don’t know. Yet, their final recommendation is a flat and unequivocal conclusion: high dose vitamin E supplements (over 400 international units) may increase all causes of mortality and should be avoided. This does not necessarily follow from the discussion or the meta-analysis. It shows an inherent bias.
And the most important point is association does not equal causation. With such weak statistical association any causation is barely inferred. This is the most common logical fallacy. So let us repeat: association does not equal causation.

In this paper we note that there are no major pharmaceutical interests that are apparent, but always look to the authors themselves to see their motivation. Was this a Meta analysis to prove a point? There is clearly a strain in medicine today that is ardently anti-nutrient and "anti-vitamins."

"Food, food, food," Senay exclaimed. "Great sources of Vitamin E include certain vegetable oils, nuts, and green leafy vegetables. If you're taking a multivitamin, that's probably OK. You're not going to overdose on that. But eat a great diet. That is kind of the solution to so many things."

All you need to do is eat a hearty set of 3 meals a day and you will get all the vitamins you need. Do you know how much Wheat Germ oil you need to consume to get these? Do you want to consume Wheat germ oil? Did you know there are no studies to prove this common assertion. None.

No there is a more pernicious movement out of Europe that we all need to be cognizant of as it gathers even more ominous steam. It is the Codex (which is shorthand for the Codex Alimentarius). A bureaucratically formulated series of “recommendations” that is sweeping European countries and is about to be imported into the US market. You will not be able to buy high dose Vitamins or nutrients.

Now why do you suppose that would be? Numerous interests on a macro scale are involved. A subject for another letter.

The reader is also referred to a number of supporting sites:

Jean Carper who has been reporting the development of AntiAging Medicine and the rise and effectiveness of Nutritional Medicine with great success.
Read what the LEF has written on this tempest.
The authors of Forty Something Forever have recently commented on their website HealthSavers, much as you have been reading here.
Council for Responsible Nutrition has also put out a special bulletin on the subject.
See also the accompanying spreadsheet that augments the study's statistics but in color and with greater clarity. The differences are seen to be tiny.
From the Linus Pauling Institute in Oregon a most thorough treatise on all the known and well-documented benefits from Vitamin E. A summary comment on this paper.
Journal of American Nutraceutical Association, Mark Houston, Editor
American Journal of Clinical Nutrition (Am J Clin Nutr Hathcock et al. 81 (4): 736) on Vitamin C and Vitamin E