E, Curse or Blessing?
Years ago, when the kids were little, my family went
on a rafting trip on the Snake River in Idaho.
Everyone enjoyed the river adventure, and we later took a side trip
through Coeur D'Alene where we found a dusty second hand book store called the
"Book Worm". Inside the store,
I found a 1964 copy of "Vitamin E, Your Key to a Healthy Heart" by
Herbert Bailey.(49) This was one of the
first books that stimulated interest in Vitamin E and sold a million copies.
Left Image: 1942 Photo by Ansel Adams of The Tetons and the
Snake River, Grand Teton National Park,
Wyoming. National Archives and Records Administration, US National Park
History of Vitamin E - Discovered in 1922
About 90 years ago, an obscure researcher named
Herbert Evans, was hot on the trail of an unknown dietary ingredient in wheat
germ required for fertility in his laboratory rats. This was Vitamin E. The
chemical structure was determined in 1938, and Evans named it "tocopherol",
a word meaning "to bear young" in ancient Greek. Early
work also found Vitamin E prevented muscular dystrophy in young rats fed a
vitamin E deficient diet. (46-48). In
the 1930's and 1940's, two Canadian cardiologists, Wilfred and Evan Shute
treated 30,000 patients with natural vitamin E and reported considerable
success in reversing heart disease.(45)
Medical Conference on Vitamin E
In 2008, I attended the ACAM Medical Meeting in
Orlando where Kenny Jialal, MD was awarded the Linus Pauling Medal in
recognition of his Vitamin E research.(3-4)
Dr. Jialal then took the podium and spoke on Vitamin E, summarizing
hundreds of research studies over decades.
Some studies were favorable, some were unfavorable, some used one type
of vitamin E, and some used another type of vitamin E, some he had no idea
which type was used. I think you get the
gist. At the end of the hour, Dr Jialal
had completely confused my remaining understanding of Vitamin E, transforming
the topic into a giant enigma wrapped in a mystery. I left the room with a headache. In this article, we will hopefully remedy the
headache, and clear up any confusion about Vitamin E with new insights. First, let's look at some recent doubts about
Doubts About Vitamin E, Vitamin E is Deadly !!
You may have seen news reports that Vitamin E is
dangerous, deadly and increases mortality.
These media stories were based on an article by Edgar Miller in the Jan
2005 Annals of Internal Medicine, a meta-analysis of 19 studies on Vitamin E, concluding
that Vitamin E increases mortality. (13-14)
Here are a few of the news reports:
on Vitamin E is Deadly (1-2):
High dose vitamin E death warning, November, 11, 2004 from BBC News:
High doses can be harmful. Elderly people could be risking their lives
if they take even moderately high doses of vitamin E, evidence suggests. (1)
Study: High dose of Vitamin E
increases death risk. By Steve Sternberg, USA TODAY November 10, 2004: High-dose
vitamin E supplements taken daily can increase a person's risk of premature
death, researchers said Wednesday. People who take daily doses of 400
international units or higher are about 10% more likely to die of a variety
of causes than people who take smaller doses or no vitamin E, according to an
analysis of 14 studies conducted between 1993 and 2004. Many of the studies
did not specify causes of death, but researchers believe patients died of all
the usual causes, including heart disease and cancer.(2)
The Solution: Use Natural Vitamin E and Avoid Synthetic E
The effect of Miller's Vitamin E article was that
many people stopped taking Vitamin E. An
excellent rebuttal to Dr Miller by Dr Mark Houston pointed out the type of
Vitamin E used in Miller's meta-Analysis was synthetic DL alpha tocopherol.
"None of the 19 studies in Miller's
review article included any of the other seven forms of vitamin E, and, in
fact, most of them used the synthetic DL alpha tocopherol form."(15) It is important to distinguish natural
vitamin E from the synthetic Vitamin E which is to be avoided. In addition, Houston recommends a mixture of
the 8 types of Vitamin E found in nature.
Fox Guarding the Henhouse?
Amazingly, another negative Vitamin E study
published by Sesso in JAMA Nov 9, 2008 again used the synthetic form of Vitamin
E.(9) You would think that doctors are
highly intelligent, and would know to use the natural form of vitamin E, when
designing such a study. A skeptic might
suggest that perhaps the synthetic form was intentionally used to insure failure
and discredit vitamin E. Another
disturbing fact is that Sesso's negative Vitamin study was sponsored by Wyeth,
a drug company with a long history of animosity to natural treatments. The
paper also disclosed that the authors were in bed with the drug companies. They
received funding from Wyeth, Merck, Bristol Meyer Squibb, Astra Zeneca, Pfizer
and Bayer. Dr. Gaziano, the chair of the project, even served as expert witness
for Merck, defending the drug company in court. (9) I would say this is another example of “the Fox
Guarding the Henhouse”.(10)
Different Types of Vitamin E, Synthetic vs. Natural
Natural vitamin E is in the "D" form (D is
for Dextro which is Latin for Right-Handed). Synthetic Vitamin E is a
combination of D and L form (i.e. DL).
The synthetic form is cheaper, but is not recommended. There are the 8 types of Vitamin E -
tocopherols in natures including, alpha, delta, gamma forms. Dr. Jialal says the gamma form is more
beneficial than the alpha form.
that the Natural Form of Vitamin E is Beneficial
Two landmark Vitamin E studies were published in
1993 in the New England Journal of Medicine. Eric Rimm's study showed a 36% reduction in
heart disease in men taking the relatively modest 60 IU vitamin E daily in the
diet.(41) Meir Stamfer's study showed a
33% reduction in heart attacks in women with the highest dietary vitamin E
Studies Showing Benefits of Natural Vitamin E
In 1992, Verlangieri published a study in which
natural vitamin E reversed atherosclerosis in a primate model.(27) A 1995 study published in JAMA by Hodis
showed Vitamin E caused regression of atherosclerosis on serial coronary
angiography. (28) Dr. Hodis concluded
with this statement: "These results
indicate an association between supplementary vitamin E intake and
angiographically demonstrated reduction in coronary artery lesion progression." In 1996, Stephens published his study in
Lancet which showed that tocopherol (vitamin E ) given to patients with
advanced coronary artery disease reduced the risk of non-fatal Myocardial
Infarction (MI) by 77%, (but did not decrease total mortality in this study).(37) In 2000, Boaz published a study in Lancet
showing that 800 IU/daily of natural Vitamin E reduced heart attacks by 70%
over 1.4 years in Hemodialysis patients. (44)
Carotid Stenosis with Natural Vitamin E
In 1997 Bierenbaum presented data on reversal of
atherosclerosis in carotid stenosis with mixed tocopherols and tocotrienols at
a meeting in Montreal.(2) The Bierenbaum
study was done at the Kenneth Jordan Heart Research Foundation in New Jersey.
The five-year study evaluated 50 patients who had stenosis of the carotid
artery. One group of 25 patients received 650 mgs of tocotrienols plus
tocopherols. The other group of 25 received a placebo. All patients had serial
carotid sonography every six months. In the Placebo group, fifteen patients
showed worsening of the stenosis, eight remained stable and two showed some
improvement. In the Vitamin E Group
using Tocotrienol plus tocopherol, three patients showed minor worsening, and
12 remained stable. Ten patients showed
regression of stenosis with improvement.(29-32)
Not only is there a difference between synthetic and
natural vitamin E, there is also a new form of vitamin E called Tocotrienol
which new research suggests is the more biologically useful form. (22) Let's take a look at the Tocotrienol form of
21st Century Form of Vitamin E - Tocotrienol
The Difference Between the Tocopherol and
Tocotrienol is IDENTICAL
to Tocopherol except for the three double bonds in the tail. These three
double bonds create a kinked configuration of the "tail" which allows
the molecule more mobility through lipid membranes. The double bond also indicates a state of
electron desaturation, meaning it can accept electrons readily as an
antioxidant. The three double bonds represent an "unsaturated" side
chain which allows the molecule to penetrate into saturated lipid membrane
layers in various target organs. Thus,
the tocotrienol form is superior to tocopherol as an antioxidant, serving to
reverse lipid peroxidation. About 99% of
medical research since the discovery of Vitamin E has been devoted to the
tocopherol form, and 1% on the tocotrienol form. This seems to be changing. There are no
synthetic forms of tocotrienols available, only natural ones.(5-8)(16-19)(22-25)
Trans-Fats vs. Natural Oils
Remember the difference between Processed Trans-Fats
and Natural Oils such as cold pressed olive oil? The unhealthy Trans-Fats have a straight
carbon tail because they have been processed, so the Carbons are located on the
opposite sides of the double bonds (trans).
The healthy natural oils have a curved configuration of the carbon tail
because the Carbons are on the same side of the double bond (cis). This
difference is called cis-trans isomerism.
Trans Fats Have Straight Tails - Tocotrienols Have Curved Tails
to the beneficial natural oils, Tocotrienols have a curved carbon tail, giving
them more biological activity than the tocopherol counterpart. The Tocotrienol tail is not stationary, but
actually vibrates back and forth in space like a pendulum, absorbing energy
within the membrane bi-layer. (8)
Benefits of Tocotrienol Form of Vitamin E
1) Tocotrienols are protective in stroke-induced
injuries. Natural palm tocotrienol complex fed to hypertensive rats led to
increased tocotrienols level in the brain, and more protection against
stroke-induced injury compared to controls. (50)
2) Tocotrienol reversed atherosclerosis in carotid
artery stenosis in a human study by Bierenbaum. (51)
3) Tocotrienols and cholesterol reduction: Gamma
tocotrienol inhibit hepatic cholesterol synthesis without interfering with
CoQ10 production, thus reducing LDL cholesterol levels safely. (5-7)
Tocotrienol form of Vitamin E is useful in prevention and reversal of heart
disease, stroke and other forms of atherosclerotic vascular disease.
Apo-E Mouse Studies Show Tocotrienol Protects, Tocopherol Does NOT
The Apo-E Mouse Model is a genetically modified
mouse that develops atherosclerosis of the aorta. Two separate studies, by
Qureshi and another by Black showed that feeding Tocotrienols to the Apo-E mice
virtually eliminates atherosclerotic plaque. (38,39) Tocotrienols reduced the atherosclerosis plaque
by 98%, an amazing result. On the other hand, Tocopherols had no such
beneficial effect in Apo-E mice in the study by Shaish (1999) who found no
change in plaque size with Tocopherols.(40)
Coronary Artery Disease
My previous article discussed the use of high dose
Vitamin C, and the amino acid, Lysine, (the Linus Pauling Protocol) for
reversing heart disease. Steve Hickey
and Hilary Roberts come right out on page 167 of their book, and make the
statement, "Vitamin C and Tocotrienols can reverse coronary artery disease".
(52) They would improve the Linus
Pauling Protocol by adding the Tocotrienol form of Vitamin E. Regarding heart disease and atherosclerotic
vascular disease, the authors state that "on the available evidence, the combination
of Vitamin C and Tocotrienols could be curative with no known harmful effects."
Research for the NIH, the Guinea Pig Model:
Tocotrienols clearly prevent atherosclerosis in the
Apo-E mouse model. Further research in
the guinea pig model should be done. C.
G. Willis showed that Vitamin C deprived guinea pigs develop atherosclerotic
vascular disease. (see references in Chapter 37) Experiments should be done giving tocotrienols
to Vitamin C deprived guinea pigs, and I would predict Tocotrienols would be
beneficial, reducing or preventing atherosclerotic plaque formation. In addition, there is a GLO deficient mouse
model used to study atherosclerosis.
Experiments giving tocotrienols to GLO deficient mice should also be
E - Bleeding Precautions
E can have a blood thinning effect, so most surgeons and anesthesiologists
will ask about Vitamin E use prior to elective surgery, and request that the
Vitamin E be discontinued a week in advance of elective surgery to avoid
bleeding complications. Increased mortality from high dose vitamin E could be
related to bleeding complications.
For references and links, see my web site: www.bioidenticalhormones101.com
References for Chapter 43.
Vitamin E, Curse or Blessing?
High dose vitamin E death warning , November 11, 2004, BBC News.
Study: High dose of Vitamin E increases death risk. By Steve Sternberg, USA
American College for Advancement in Medicine presented Ishwarlal Jialal with
the Linus Pauling Award.
Ishwarlal Jialal, M.D., Ph.D. UC Davis Professor Robert E. Stowell
Endowed Chair in Experimental Pathology Director of Laboratory for
Atherosclerosis and Metabolic Research Specialty: Pathology and
Laboratory Medicine, Biological Chemistry
(5) http://www.drpasswater.com/nutrition_library/tan_1.html Doctor Tocotrienol Barrie Tan Part One
(6) http://www.drpasswater.com/nutrition_library/tan_2.html Doctor Tocotrienol Barrie Tan Part Two
Health Benefits Beyond Vitamin E Activity, Solving the Tocotrienol Riddle. Dr. Barrie Tan
Mol Aspects Med. 2007; 28(5-6): 692–728. Tocotrienols in health and disease: the other
half of the natural vitamin E family. Chandan K. Sen, Savita Khanna, and
(9) http://jama.ama-assn.org/cgi/content/full/300/18/2123 Vitamins E and C in the
Prevention of Cardiovascular Disease in Men. The Physicians' Health Study II
Randomized Controlled Trial. Howard D. Sesso et al JAMA.
2008;300(18):2123-2133. November 9, 2008
Unfair Attacks on Supplements. The following is an analysis of a recent
study on vitamins C and E by the scientific team of the Alliance for Natural
Health, our international affiliate. Designed To Fail: A Trial Without Meaning.
Contributed by Steve Hickey, Ph.D.; Damien Downing, M.B.B.S.; and Robert
Verkerk, Ph.D., Alliance for Natural Health.
Nutr Rev. 2005 Aug;63(8):290-3. Failure of
vitamin E in clinical trials: is
gamma-tocopherol the answer? Devaraj S, Jialal I.
Vitamin E Supplements: Good in Theory,
but Is the Theory Good? E. Robert Greenberg, MD Annals of Internal
Medicine 4 January 2005, Vol 142, Issue 1, Pages 75-76
High-Dosage Vitamin E Supplementation
May Increase All-Cause Mortality Edgar
R. Miller et al. Annals of Internal Medicine 4 January 2005 |
Volume 142 Issue 1 | Pages 37-46
SUMMARIES FOR PATIENTS Vitamin E Supplements May Be Harmful. Annals of Internal
Medicine 4 January 2005 | Volume 142 Issue 1 | Page I-40
JANA Vol. 8 No. 1, 2005, “Meta-Analysis, Metaphysics and Mythology”Scientific
and Clinical Perspective on the Controversies Regarding Vitamin E for the
Prevention and Treatment of Disease in Humans by Mark Houston, MD
K, Ambra R, Selvaduray KR, et al. (2004). Tocotrienol-rich fraction from palm
oil and gene expression in human breast cancer cells. ANNALS OF THE NEW YORK
ACADEMY OF SCIENCES 1031: 143-157.
(17) Conte C, Floridi A, Aisa C, et al. (2004). Gamma-Tocotrienol metabolism
and antiproliferative effect in prostate cancer cells. ANNALS OF THE NEW YORK
ACADEMY OF SCIENCES 1031: 391-394.
(18) Hasselwander O, Kramer K, Hoppe PP, et al. (2002). Effects of feeding
various tocotrienol sources on plasma lipids and aortic atherosclerotic lesions
in cholesterol-fed rabbits. FOOD RESEARCH INTERNATIONAL 35 (2-3): 245-251
UNIQUE E® Tocotrienols - 60 Softgels $39.50 , AC Grace Co.
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palm tocotrienol: antioxidant activity of tocotrienol is linked with its
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from Douglas Laboratories January/February
2008 . Andreas M. Papas, Ph.D.
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Author: Jeffrey Dach MD