It’s been a rough week for nutritional supplement users. A couple of days ago it was reported that older women who took nutritional supplements, particularly iron, had a slightly increased risk of death. Yesterday, everyone was talking about a clinical trial published in JAMA that linked vitamin E and prostate cancer.
As a physician who uses nutritional supplements as primary therapies in my medical practice, a writer and formulator who vigorously promotes them—and a man who takes a wide variety of supplements himself—I make a point to take a hard and critical look at studies such as these. My No. 1 responsibility is to be certain that the therapies I recommend are safe and efficacious. If careful evaluation of the research reveals risks or dangers, I would be the first to let you know.
All too often, however, reporters pick up on the juiciest, most sensational minutia and run with it, and this most recent study is no exception. After reviewing it in detail, I have several comments.
The Truth About Vitamin E and Prostate Cancer
The absolute increase in risk of prostate cancer in the men taking vitamin E alone was 1.6 per 1,000 man-years. This means that for every 1,000 men taking the form of vitamin E used in this study (see No. 3 below) for one year, 1.6 more cases of prostate cancer were diagnosed than in men in the placebo group.
There were no statistically significant differences in aggressiveness of prostate cancer or in death rates among the various groups. Keep in mind that most prostate cancers never cause problems. In fact, they usually go undetected—unless men are regularly screened, as those in the study were. Just last week, the U.S. Preventive Services Task Force recommended against routine PSA screening for prostate cancer, stating that it led to unnecessary interventions and did more harm than good. As I’ve said time and again, the vast majority of older men have prostate cancer, but most of them die with it, not from it.
Unlike drugs, vitamins and minerals are not magic bullets targeting one single symptom or physiological process. They are meant to be used as they are found naturally in food—in combination. Most vitamin E supplements contain only alpha-tocopherol (the form used in this study). For years, alpha was thought to be the most essential tocopherol, but research has shown that other forms also help fend off free radicals. Alpha-tocopherol does not occur alone in nature: it is accompanied by three other tocopherols and four tocotrienols. One of them, gamma-tocopherol, is actually more abundant in the diet than alpha-tocopherol. It is a potent antioxidant that also boosts the power of its more prominent cousin. Furthermore, in this and other studies, the combination of vitamin E plus selenium did not increase risk, which reinforces the importance of taking vitamin E along with other vitamins and minerals.
This is one negative study among many positive studies that show the health benefits of vitamin E for the prevention and/or treatment of heart disease, Alzheimer's and other neurodegenerative disorders, macular degeneration and other common diseases.
Finally, it is nonsense to jump to the conclusion, based on this study, that vitamin E and prostate cancer are linked, and that all men should stop taking it.
Bottom line: This has in no way changed my recommendations. I continue to prescribe vitamin E as part of a comprehensive nutritional supplement program. The multivitamin I use at my clinic and have been recommending for years includes 300 IU of vitamin E (alpha-tocopherol) along with gamma and other tocopherols and tocotrienols, 200 mcg of selenium, and a broad range of other vitamins and minerals.
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