Perhaps you have heard about the acclaimed American HOPE study from 2002. It was supposed to show that natural vitamin E has no effect - beneficial or otherwise - on atherosclerosis. Well, what a disappointment that was! And then, the topic could very well have been exhausted.
It just did not work out that way. The HOPE study which lasted for 4½ years and included 9000 trial subjects was prolonged for 2½ years. They wanted to be absolutely certain, they said. In the follow-up called HOPE-TOO only 4000 trial subjects were included. Some of the original HOPE trial subjects did not want to participate, others were dead, and yet others would only have the examination but not the pills.
Half of them were each given 400 I.U. of natural vitamin E (alpha-tocopherol) while the rest were given placebo. That these patients were severely atherosclerotic was certain: 50% had suffered coronary thrombosis, just as many had angina pectoris, and more than 1/3 had diabetes.
The preliminary HOPE study showed that vitamin E did not cause either more or less cancer, more or less cases of heart attack, stroke, deaths, or anything else. The same result was obtained in HOPE-TOO, only with this single addition: The ones who were given vitamin E had a slightly increased tendency to heart failure; i.e. a weakened cardiac pump function.
The difference was so small, however, that it could have been a matter of coincidence even though it was statistically significant. Anyhow, the authors used the opportunity to strongly warn against dietary supplements. They could, however, just as well have used the opportunity to recommend them since they also found that vitamin E has a protective effect against lung cancer!
This finding which was also statistically significant was rejected as an "error" by the authors in a consideration in which they referred to beta-carotene studies, which, of course, is something completely different.
No clothes on
A far more serious surprise, however, overshadows this biased conception: During the whole study, the trial subjects had no more vitamin E in their blood (serum) than the average man who does not take any supplements. The average level of serum vitamin E was 17.6 mmol/l. The normal range is 12 - 42 mmol/l. So, despite taking vitamin E supplements, they only just got their minimum need covered.
Granted, before the study, their serum levels of vitamin E were even lower, on average 10 mmol/l. This consists very well with them being seriously ill, overweight heart patients who were predominantly eating a lean diet - a lean diet typically does not contain much vitamin E.
Here, we will probably also find the explanation for the low serum blood levels of vitamin E as vitamin E can only be absorbed from the intestines in combination with fat. If vitamin E supplements are taken in relation to a lean meal, you almost might as well not take it; this also applies when taking 20 - 40 times the recommended dose as was the case in this study.
The story of The Emperor's new clothes comes to mind. HOPE-TOO has no clothes on. It was claimed that what was meant to be studied was the effect of megadoses of vitamin E, but the trial subjects only seemingly got this supplement. Strangely enough, nobody has yet pointed out this almost ludicrous error.
Still, you may wonder why the authors who even propose long-winded explanations for their "finding" have not recognized the mistake themselves. Do they know nothing about vitamin E? Could it be that they do not know the normal blood levels of vitamin E?
Well, yes, there are many examples of both ignorance and superficiality in the field of medical research. You do not have to look any further than to the official commentary in the same issue of JAMA that carried the HOPE-TOO article. In this commentary, Dr. B. Greg Brown complies with the conclusions issued in the study.
He was responsible for a similar study in 2001. It was supposed to establish whether or not antioxidants counteract coronary sclerosis. Brown concluded that this was not the case although his figures showed - with statistical significance - that they actually reduce the speed with which the coronary arteries calcify by 50%!
References:
The HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer. JAMA 2005;293:1338-47.
B. Greg Brown. Is there any hope for vitamin E? JAMA 2005;293:1387-90.
Greg Brown et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-92.
