Life Extension Magazine

Life Extension Magazine April 2009

As We See It

Dietary Supplements Under Attack

By William Faloon

Dietary Supplements Under Attack

Near the end of 2008, the media ran headline news stories claiming that vitamins C, D, and E do not prevent heart attack, stroke, or breast cancer. Within five days, we posted a rebuttal on the home page of our website.

When these biased stories are launched, the media never gives us prior notice to prepare a response. That means the public only hears conventional medicine’s distorted side of the story.

What follows is a slightly modified version of how we responded to these unfounded attacks:

In the early 1990s, several large population studies showed significant reductions in cardiovascular disease in those who consumed vitamin C or vitamin E.1-6

The most widely reported study emanated from UCLA, where it was announced that men who took 800 mg a day of vitamin C lived six years longer than those who consumed the recommended daily allowance of 60 mg a day. The study, which evaluated 11,348 participants over a 10-year period of time, showed that higher vitamin C intake reduced cardiovascular disease mortality by 42%.7

These kinds of findings did not go unnoticed by the federal government, who subsequently invested hundreds of millions of dollars in an attempt to ascertain if relatively modest vitamin doses could prevent common age-related diseases.

In a recent study used by the media to attack dietary supplements, four groups of male doctors were given various combinations of vitamin C and/or vitamin E or placebo. After eight years, there was no reported difference in heart attack or stroke incidence among the groups.8 This led the media to state that consumers should not buy these supplements.

As you will read, there were so many flaws in this study that the findings are rendered meaningless. Regrettably, consumers who trust their lives to the mainstream media may fall victim to this latest charade to discredit validated methods to reduce cardiovascular disease risk.

Do You Take Your Vitamins Every Other Day?

In the study involving four groups of male doctors, subjects in the vitamin E groups were told to take one 400 IU capsule of synthetic alpha tocopherol every other day.8 This design flaw raises several issues that are rather obvious to serious supplement takers.

Do You Take Your Vitamins Every Other Day?

First of all, we don’t take our vitamins every other day. Free radicals are constantly being generated in our bodies, and supplement users today seek to take their antioxidants with most meals, as oxidative damage is generally the greatest after eating.9,10

It is ludicrous to think that these study subjects would reduce their vascular risk by taking a modest dose, every other day, of a form of vitamin E with inferior antioxidant capacity.

If one were to rely only on synthetic alpha tocopherol, the minimum daily dose needed has been shown to exceed 800 IU,11,12 far greater than the 400 IU ingested every other day by the subjects in this poorly designed study.

Serious supplement users normally take 400 IU every day of natural vitamin E along with a plethora of complementary nutrients. We would not expect 400 IU of synthetic vitamin E taken every other day to produce much of an effect. Yet that is the dose given to these study subjects with the expectation that this would produce a reduction in cardiovascular disease. This is not the only flaw of this study.

Natural Versus Synthetic Vitamin E

There was a longstanding debate as to whether natural or synthetic vitamin E is better. For most vitamins, there is no difference between natural and synthetic. In fact, for most vitamins, the only forms available are synthetic. With vitamin E, however, the natural form has proven to be far superior.4,13-16

Natural vitamin E is distributed through the body much better than the synthetic form.12,17-21 The reason is that specific carrier proteins in the liver selectively bind to natural vitamin E and transport it through the blood to our cells. These carrier proteins only recognize a portion of synthetic vitamin E and ignore the remainder.22-25

Japanese researchers gave natural or synthetic vitamin E to young women to measure how much vitamin E actually made it into their blood. It took only 100 mg (149 IU) of natural vitamin E to produce blood levels that required 300 mg (448 IU) of synthetic vitamin E to achieve.12

How to Check Vitamin E Labels

When checking vitamin labels, natural vitamin E is usually stated as the “d” form or RRR- [for example d-alpha tocopheryl acetate or RRR-alpha-tocopheryl acetate, d-alpha tocopherol, and d-alpha tocopheryl succinate]. Synthetic vitamin E will have an “l” after the “d” or all-rac- [for example, dl-alpha tocopheryl acetate or all-rac-alpha-tocopheryl acetate, dl-alpha tocopheryl succinate, and dl-alpha tocopherol]. Remember – “dl” or “all rac-” signifies synthetic vitamin E, whereas “d” or “RRR-” signifies natural vitamin E. If you are getting 400 IU of natural d-alpha tocopherol (d-alpha tocopheryl succinate or acetate), it is equal to about 800 IU of synthetic dl-tocopherol (dl-alpha tocopheryl succinate or acetate).

Most studies show that synthetic vitamin E is only half as active in the body as the natural form.17 As it relates to the flawed study claiming that vitamin E does not prevent heart attack, the 400 IU of synthetic alpha tocopherol given every other day equates to only 100 IU a day of the natural form.

We would not expect 100 IU of natural vitamin E a day by itself to reduce vascular disease risk. As you will continue to read, however, there are many other flaws in this study that render its conclusions useless.

Vitamin C Potencies Too Low

If all you are going to take to protect against free radical damage is vitamin E and/or vitamin C, then you will need far greater potencies than were given to the study subjects in this flawed study.

Vitamin C Potencies Too Low

Published studies that document vascular benefits in response to vitamin C typically use doses of 1,000-6,000 mg each day.26-31 The authors of the flawed study alluded8 to this when they stated:

“In a pooled analysis of nine cohorts, vitamin C supplement use exceeding 700 mg/day was significantly associated with a 25% reduction in coronary heart disease risk.”8,32

Since the doctors who designed this flawed study knew that vitamin C intakes exceeding 700 mg a day significantly reduce heart attack rates,32 we cannot figure out why they limited their subject’s daily dose to only 500 mg.8

Two-time Nobel Prize laureate Linus Pauling and his associates advocated daily doses of vitamin C ranging from 10,000 to 20,000 mg to protect against heart attack. Linus Pauling’s theory was that atherosclerosis is primarily caused by insufficient vitamin C intake.33 Dr. Pauling compared the high amount of vitamin C naturally synthesized in the bodies of animals that don’t typically die of heart attacks.34 A 150-pound goat, for example will maintain an ascorbate blood concentration equivalent to ingesting 13,000 mg of vitamin C.34

Unlike most animals, humans lack an internal enzyme needed to manufacture vitamin C in their body. If humans don’t obtain enough vitamin C from external sources, they die acutely from scurvy, or according to Linus Pauling…slowly suffer atherosclerotic occlusion. Dr. Pauling crusaded to educate humans about the need to take mega-doses of vitamin C.

Dr. Pauling and his associates published papers stating that when vitamin C levels are insufficient, the body uses cholesterol to repair the inner lining of arteries. Dr. Pauling believed that cholesterol’s involvement in atherosclerosis was a direct result of insufficient vitamin C.34-36

Life Extension has long recommended that its members take at least 2,000 mg a day of vitamin C, along with potent plant extracts to enhance the biological benefits of ascorbate inside the body. The 500 mg daily dose of vitamin C given to the subjects of this flawed study8 was clearly inadequate. This did not stop the headline-hungry media and many conventional doctors from recommending that aging humans avoid these supplements altogether.

Alpha Tocopherol Users Need CoQ10

A number of studies document the ability of ubiquinol CoQ10 to protect against LDL oxidation better than alpha tocopherol (and other lipid-soluble antioxidants).79-83

Some of these studies show that alpha tocopherol vitamin E can turn into an LDL pro-oxidant unless ubiquinol is also present.84,85 These studies help explain the inability of the alpha form of vitamin E by itself to significantly reduce heart attack rates in certain populations.

The good news is that most members have been taking CoQ10 supplements since around 1983 (when Life Extension introduced it to the American public) and have thus protected their alpha tocopherol from converting into a pro-oxidant.

The subjects given synthetic alpha tocopherol in this flawed study were not given CoQ10 supplements, which further explains why there were no reductions in heart attack and stroke risk.

As we noted already, the dose of vitamin E used in this study was also too low to expect a reduction in vascular disease events. While alpha tocopherol vitamin E is a classic antioxidant, its free radical-quenching efficacy pales in comparison to polyphenol extracts37 from green tea, pomegranate, grape seed, and blueberry.

Based on the superior anti-oxidant properties of plant extracts such as pomegranate, health-conscious people today are able to obtain greater protection against free radicals and enhance the efficacy of the vitamin C without necessarily having to take the mega-doses recommended by Linus Pauling. On the flip side, to attack the value of vitamin C based on a group of doctors who took only 500 mg a day does not make sense, since this amount does not correspond to the doses that scientific studies show are needed to prevent heart attack.

Alpha Tocopherol Displaces Gamma Tocopherol

An increasing number of scientists are questioning the wisdom of administering alpha tocopherol vitamin E by itself.38-42 The reason is that alpha tocopherol displaces critically important gamma tocopherol in the body.43 The authors of the flawed study admitted that the failure to include gamma tocopherol may have been a reason that no effect was seen in the alpha tocopherol groups.8 Here is a quote directly from the flawed study:

“Moreover, PHS II and other prevention trials have used alpha-tocopherol, whereas the gamma-tocopherol isomer also may have a role in cardiovascular disease prevention because it has greater efficacy than alpha-tocopherol to inhibit lipid peroxidation and it may be suppressed in the presence of alpha-tocopherol.”8

The above admission understates the critical importance that gamma tocopherol plays in maintaining arterial health. While alpha tocopherol helps protect against lipid peroxidation, gamma tocopherol is required to neutralize the dangerous peroxynitrite free radical.44

Peroxynitrite damages arteries because:

1. Peroxynitrite promotes the degradation of alpha tocopherol, thereby depleting the body of the vitamin E needed to protect the lipid (fat) part of LDL against oxidation.45 LDL is composed of both lipid and protein parts (moieties), and oxidation associated with both moieties has been implicated in atherosclerosis.46,47 In a fascinating paradox, when alpha tocopherol is given without gamma tocopherol, the result is that alpha tocopherol itself can be neutralized in the body by the peroxynitrite free radical. This in turn promotes oxidation of the lipid moiety of LDL, a major step on the path towards atherosclerosis.

2. Peroxynitrite promotes LDL protein oxidation.48-51 While alpha tocopherol inhibits LDL lipid peroxidation, gamma tocopherol is needed to protect against oxidation of the protein moiety of LDL.42,52,53

In the absence of gamma tocopherol, which can occur when alpha tocopherol is given without gamma tocopherol, both LDL lipid and protein oxidation is increased, which reveals the egregious mistake of trying to prevent vascular disease by administering only alpha tocopherol. Health-conscious individuals should be assured that other nutrients such as lipoic acid and polyphenol plant extracts also block protein and lipid LDL oxidation.9,54-62

Some studies suggest that only gamma tocopherol prevents heart attacks.6 As it relates to atherosclerosis, gamma tocopherol blood concentrations have been reported to be significantly lower in coronary heart disease patients than in healthy control subjects. While alpha and gamma tocopherols each perform life-sustaining functions, only gamma tocopherol increases endothelial nitric oxide protein expression.52,53,63 As I will describe next, a deficit of nitric oxide in the endothelium is a primary cause of arterial disease.

Vitamin E Basics

Alpha tocopherol and gamma tocopherol are the two major forms of vitamin E in human plasma. The dietary intake of gamma toco-pherol is generally two- to four-fold higher than that of alpha tocopherol. Alpha tocopherol plasma levels, however, are about four-fold higher than those of gamma tocopherol.64 One reason is that there is a preferential cellular uptake of gamma tocopherol over alpha tocopherol, meaning that more gamma tocopherol is removed from the blood and assimilated into cells.65

Scientific studies consistently show that gamma tocopherol plays a significant role in modulating intracellular antioxidant defense mechanisms.39,42,66 Interestingly, the presence of gamma tocopherol dramatically increases the cellular accumulation of alpha tocopherol.67