Fifty years ago, two Canadian physicians discovered that natural vitamin E supplements could
reverse heart disease in their patients. Evan Shute, M.D., and his brother Wilfrid, were briefly
praised in newspapers and magazines - and then quickly damned by their medical peers.
At the time, no one understood how or why vitamin E might protect the heart, and relatively few physicians were willing to believe that a simple vitamin could protect against the leading cause of death in North America. Meanwhile, the Shute brothers continued recommending vitamin E supplements to their patients. And today, two decades after they passed away, vitamin E is widely regarded as one of the best natural ways to prevent coronary heart disease.
Many of vitamin E's beneficial protective effects - in Alzheimer's disease and cancer, as well as heart disease - are commonly attributed to its antioxidant activity. As the body's principal fat soluble antioxidant, vitamin E neutralizes hazardous molecules called free radicals, which are found in pollutants and byproducts of metabolism. But recent research has shed new light on how vitamin E works.
In the past several years, physicians and researchers have begun redefining heart disease as an inflammatory disorder of the blood vessels. At the same time, vitamin E has emerged as a potent anti-inflammatory nutrient, protecting against heart disease and other inflammatory disorders, such as rheumatoid arthritis.
Inflammation in Blood Vessels
Much of the inflammatory process in heart disease centers around the low-density lipoprotein (LDL) form of cholesterol, generally regarded as the "bad" cholesterol. High levels of LDL better than total cholesterol as a predictor of heart disease risk. However, during the 1990s, Kenny Jialal, M.D., a cardiologist and antioxidant researcher at the University of Texas Southwestern Medical Center, Dallas, and other researchers found that LDL was not problematic until it was oxidized, or damaged by free radicals.
Widely misunderstood, LDL is actually necessary for health. It is the medium through which fat-soluble nutrients, such as vitamin E and beta-carotene, are transported through the blood. However, when a person does not consume enough antioxidants, free radicals build up in LDL and oxidize it.
Normal LDL is ignored by the body's immune system. But when LDL is oxidized, the body's immune system responds by activating white blood cells, much the way it would to quell an infection. These white blood cells engulf the oxidized LDL as if it were bacteria. As immune activity heats up, "adhesion molecules" are released, enabling the white blood cells, now gorged on oxidized LDL, to stick to artery walls.
During the immune response, the body also secretes other inflammatory substances, such as interleukin-6 (IL-6) and C-reactive protein (CRP), which intensify and help sustain the immune response. Studies by Paul M. Ridker, M.D., of the Harvard Medical School, have found that high blood levels of CRP - now recognized as a sign of serious inflammation - increase the likelihood of a heart attack by four and one-half times. In fact, elevated CRP levels are a better indicator of heart disease risk than cholesterol, triglyceride, or homocysteine.
In response to Ridker's breakthrough studies, physicians are increasingly measuring their patients' CRP levels. However, relatively few physicians know that two clinical trials showed natural vitamin E supplements to significantly reduce CRP levels. In one of these studies, published in the journal Diabetes Care, Jane E. Upritchard, Ph.D., of the University of Otago, New Zealand, reported that supplements of 800 IU of natural vitamin E supplements, but not vitamin C or lycopene, lowered CRP levels by half in four weeks. In the other study, Jialal asked 72 subjects, some with heart disease or diabetes and others healthy, to take 1,200 of natural vitamin E daily for three months. People in all three groups had an average decrease of 30 percent in CRP and 50 percent in interleukin-6, the pro-inflammatory parent molecule of CRP.
Other intriguing research indicates that vitamin E has other types of anti-inflammatory activities as well. For example, it is a mild inhibitor of Cox-2, an enzyme the body uses to make inflammatory compounds. Vitamin E inhibits different types of adhesion molecules, which promote inflammation, and it also turns off some of the genetic activity leading to inflammation.
Such anti-inflammatory activity provide an explanation for why vitamin E supplements have reduced the risk of heart disease in most clinical trials. In perhaps the most dramatic of these studies, Nigel G. Stephens, M.D., of Cambridge University, England, gave 400 or 800 IU of natural vitamin E to 2,000 patients with previously diagnosed heart disease. After supplementation for an average of 18 months, vitamin E reduced the incidence of heart attacks by 77 percent.
Vitamin E Beneficial in Rheumatoid Arthritis
Several studies show that the anti-inflammatory properties of vitamin E carry over to the treatment of other more traditional inflammatory diseases. Several years ago, in Annals of the Rheumatic Diseases, a team of British and German researchers described their use of vitamin E in treating 42 patients with rheumatoid arthritis. The patients were given either 900 IU of vitamin E twice daily or placebos for 12 weeks. Overall, patients taking vitamin E had about a 50 percent decrease in their arthritic pain. In addition, 60 percent of the patients taking vitamin E felt better, compared with half that number in the placebo group.
A second study of patients with rheumatoid arthritis was published last year by Egyptian physicians in the journal Arzneimittel-Forschung/Drug Research. The doctors tested three regimens: one with conventional anti-arthritic drugs, another with the drugs plus a modest antioxidant supplement, and the third with the drugs plus 600 IU of vitamin E three times daily. Patients taking either the vitamin E of multi-antioxidant supplement reported a significant decrease in pain during the first month of treatment. Those taking only the drugs did not feel any improvement until the end of the second month of treatment.
The anti-inflammatory benefits of vitamin E might extend to respiratory allergies as well. Andrew Fogarty, M.D., of the University of Nottingham, England, studied dietary data and blood levels of immunoglobulin E (IgE), a marker of allergic reactions, in 2,500 people. According to Fogarty's article in Lancet, higher vitamin E intake was associated with lower levels of IgE. Along the same line, animal research has shown that vitamin E can lower IgE levels and pro inflammatory proteins called cytokines.
Natural Vitamin E
Studies by Robert V. Acuff, Ph.D., of East Tennessee State University, Johnson City, have determined that the body prefers the natural form of vitamin E over synthetic. Natural and synthetic vitamin E have different chemical structures, and both are sold as supplements. In a battery of human tests, Acuff found that natural vitamin E was absorbed into blood and tissues twice as well as the synthetic form.
To distinguish between natural and synthetic vitamin E, read the fine print on a label. Natural vitamin E will be listed as "d-alpha" tocopherol (or d-alpha tocopheryl acetate or d-alpha tocopheryl succinate), whereas synthetic vitamin E should be identified as "dl-alpha" tocopherol.
Although the human body prefers the natural d-alpha tocopherol form of vitamin E, other forms of vitamin E are also absorbed, though to a lesser degree. For this reason, it may be worthwhile to take a "nature like" vitamin E supplement with the other natural forms of vitamin E. There are eight variations of natural vitamin E, four tocopherols - alpha, beta, gamma, and delta - and four similarly named tocotrienols. All are antioxidants, and it is likely that all also have anti inflammatory effects. Their slightly different molecular structures may enable some of these vitamin E variations to work where others cannot.
Based on the research, at least 200 IU of d-alpha tocopherol daily is needed to achieve any significant health benefits, and 400 IU appears to be a more ideal dosage. Dosages above 800 IU daily are best taken with a physician's guidance. Consider adding some of the other tocopherols and tocotrienols to ensure you get all of the natural forms of vitamin E.
REFERENCES
Ridker PM, Hennekens CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. New England Journal of Medicine, 2000;342:836-843.
Upritchard JE, Sutherland WHF, Mann JI. Effect of supplementation with tomato juice, vitamin E, and vitamin C on LDL oxidation and products of inflammatory activity in type 2 diabetes. Diabetes Care, 2000, 23:733-738.
Devaraj S, Jialal I. Alpha tocopherol supplementation decreases serum C-reactive protein and monocyte interleukin-6 levels in normal volunteers and type 2 diabetic patients. Free Radical Biology & Medicine, 2000; 29:790-792.
Wu D, Hayek MG, Meydani SN. Vitamin E and macrophage cyclooxygenase regulation in the aged. Journal of Nutrition, 2001;131:382S-388S.
Islam KN, Devaraj S, Jialal I. Alpha-tocopherol enrichment of monocytes decreases agonist induced adhesion to human endothelial cells. Circulation, 1998;98:2255-2261.
Devaraj S. Jialal I. Low-density lipoprotein postsecretory modification, monocyte function, and circulating adhesion molecules in type 2 diabetes patients with and without macovascular complications. The effect of a-tocopherol supplementation. Circulation, 2000;102:191-196.
Stephens NG, Parsons A, Schofield PM, et al. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge heart antioxidant study (CHAOS). Lancet, 1996;347:781-786.
Edmonds SE, Yinyard PG, Guo R, et al. Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial. Annals of the Rheumatic Diseases, 1997;56:649-655.
Helmy M, Shohayeb M, Helmy MH, et al. Antioxidants as adjuvant therapy in rheumatoid disease - a preliminary study. Arzneimittel-Forschung/Drug Research, 2001;51:293-298.
Fogarty A, eLewis S, Weiss S, et al. Dietary vitamin E, IgE concentrations, and atopy. Lancet, 2000;356:1573-1574.
Zheng KC, Adjei AA, Shinjo M, et al. Effect of dietary vitamin E supplementation on murine nasal allergy. American Journal of the Medical Sciencies, 1999;318:49-54.
Burton GW, Traber MG, Acuff RV, et al. Human plasma and tissue a-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E. American Journal of Clinical Nutrition, 1998;67:669-684.
The information provided by Jack Challem is strictly educational and not intended as medical
advice. For diagnosis and treatment, consult your physician.