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A study is coming out in next week's JAMA, with an editorial, that was begun when early clinical trial results didn't support epidemiologic and animal research. Because these earlier studies were typically short-term, perhaps the problem is that you need more time to see benefits develop. So the current study was prospective--meaning you take an equivalent group of people, start the treatment in half of them, and see what happens.

In this case, the median duration was 7 years of taking a daily dose of 400 IU of a natural vitamin E. WHAT IS VERY IMPORTANT TO NOTE IS THAT THE STUDY ENROLLED PEOPLE WHO WERE ALREADY SICK--patients had to be at least 55, and have vascular disease or diabetes mellitus plus an additional cardiac risk factor. The earlier trials indicated that in healthy people, at worst the effect of vitamin E supplementation was neutral. It was people already at high risk for lung cancer who were more likely to develop it with vitamin E--and it was thought the cancer had already begun, and that vitamin E advanced it more quickly.

The same as soy, which appears to have preventive benefit for breast cancer in healthy women, but accelerate cancer growth if it already exists.

In this group of people already suffering from a chronic disease, there was no preventive effect for cancer. Unfortunately, the risk specifically for heart failure increased--by about 13%, if I read the statistics correctly.

The conclusion: In patients with vascular disease or diabetes mellitus, long-term vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase the risk for heart failure.

Another point that I find potentially very important is that the vitamin E supplement typically consisted only of alpha-tocopherol. Vitamin E in foods (such as almonds and avocadoes) involves 8 compounds, not one. There's alpha, beta, gamma, delta versions of tocopherol, and ditto for the tocotrienols. There aren't many supplements that actually combine all 8 compounds in the vitamin E family--and even these are a recent item.

So....taking supplements has to be thought through, and I think that trying to incorporate them in diet as much as possible makes great sense. The next best is to find a supplement that provides the nutrient as you'd find it in food.

In terms of the cautions that do arise from this study, one point in the editorial is particularly compelling: This report "reemphasizes the importance of controlled clinical trials for testing important hypotheses deriving from basic biological findings or from epidemiological observations. The latter can mislead; well-designed clinical trials rarely do."

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