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Topics in Nutrition and Holistic MedicineWhen There is Evidence for Nutrition but Little Evidence for Evidence Based Medicine.Dispelling the Vitamin E Myths: the truth about antioxidants, tocopherols, and tocotrienols.Experts say dietary supplements may save $billions in health care costs!! |
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When There is Evidence for Nutrition but Little Evidence for Evidence Based Medicine.There is No Truth Other Than Evidence Based MedicineFood & Nutrients are Not Essential & May be Dangerous Without Meta-analysis of Clinical Trials.
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There is No Truth Other Than Evidence Based Medicine |
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Previously I have pointed out some of the shortcomings of so called
evidence based medicine (Medical
Evidence or Medical Ignorance?) which include the following: 1.
Outcome or therapy based - not cause based While time has done nothing but confirm the validity of the abovementioned shortcomings, recent developments in medicine and nutrition suggest it is pertinent to briefly look again at the shortcomings of evidence based medicine (EBM) and the very need to keep changing the name of medicine. Medical experts are becoming increasingly aware of the shortcomings
of EBM and strident in their criticisms (1,2,3,4,5,8).
While the limitations of EBM I outlined above, and also its
fundamentally statistical and commercial basis (8)
and the need to
"standardise" patients (3),
are of considerable concern, what is most disturbing is that EBM is
considered the one and only "truth" (1,2)
or a "new and unchallengeable orthodoxy following its own political
agenda" (1).
As is pointed out by Holmes and colleagues (2),
the rigid exclusionary criteria of EBM results in 98% of scientific
literature being considered "scientifically imperfect" and
therefore the randomised controlled trials of EBM are the one and only
truth. According to Holmes and colleagues (2):
But Holmes and colleagues go further, likening EBM to the "Newspeak" described by George Orwell (2):
Similar views were expressed by Charlton and Miles (8) who note that advocates of EBM tend to "marginalize opponents as wicked or crazy." According to these workers (8):
It is this rigidity, intolerance of alternatives, and self serving nature of EBM which makes this form of medicine especially irrelevant as far as alternative medicine is concerned where randomised controlled trials have little relevance when it comes to individual nutritional needs and long term consequences of subclinical inadequate nutrient intake. EBM is after all, a commercial or statistical outgrowth of reductionist science, the limitations of which I have previously considered (Holistic or Reductionist?, Nutrition and Megavitamins). Not surprisingly, these reductionist limitations are increasingly being realised, as is noted by Bergman (6):
EBM is also limited by various forms of medical bias which invalidate much of the results of clinical trials (Medical Bias). Vandenbroucke and de Craen (7) have recently pointed out that sponsored trials of new NSAIDs frequently show definite advantages of the new drugs as compared to the competing drugs with which they are compared, even in spite of the fact that the new drugs are almost pharmacologically identical to the competitors products. Such examples underline the fundamentally commercial basis of RCTs which are such a useful marketing tool for drug companies. In view of these extremely serious limitations, acceptance of RCTs as the "gold standard" of EBM would be expected to have grave consequences. In fact, the limitations of reductionism and EBM have led to recent suggestions that EBM should be replaced by a more holistic form of medicine such as genomic medicine (Nutrition Breakthroughs).
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Food & Nutrients Not Essential & May be Dangerous Without Meta-analysis of Clinical Trials. |
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The above subtitle underlines the attitude of many advocates of EBM who
seem to believe that randomised controlled trials (RCTs) are the only
way of knowing. But there are many problems with EBM, particularly
in regard to alternative therapies, as I have outlined above. Since
clinical trials give preference to the demonstration of a rapid
symptomatic response for instance, slower cause based natural therapies
would be deemed ineffective by EBM. And how will clinical trials
determine the transgenerational effects of nutritional supplements or
nutritional deficiencies
during pregnancy? And how will clinical trials determine the
consequences of chronic subclinical deficiency of micronutrients? Is it
envisaged that people will be subclinically deprived of specific
nutrients for 20 years to satisfy the requirements of EBM? And what
about people who have highly individual nutrient requirements? How will
clinical trials for nutrients be organised when certain individuals have
a greatly increased need for specific nutrients? And how will the impact
of optimum nutrition be trialed when it cannot be defined or measured?
And although no one disputes the benefits of a healthy diet, where are
all the double blind trials confirming the benefits of food? Have
proponents of EBM accepted the benefits of food without scientific
evidence? The fundamentally statistical and standardising nature of EBM is totally inconsistent with the holistic and individualised requirements of alternative medicine (9,10,11). EBM, which is average medicine for the average person, denies the existence of individuality. The problems for advocates of EBM are even more fundamental however. How can clinical trials for nutrients be organised when every trial participant has already been taking (ie. consuming, absorbing, metabolising, excreting) unknown quantities of every nutrient in their diets (13)? And why do clinical trials of the effectiveness of nutrients usually make no attempt whatsoever to determine pretrial nutritional status or dietary intake of nutrients of trial participants? This is akin to organising a RCT for drug x and including as participants people who are already taking unknown quantities of the same drug. But the situation with nutrients is worse than for drugs since nutrients, unlike drugs, tend not to have positive effects above a certain nutrient deficiency correcting threshold. For the reasons I have outlined above and elsewhere (Medical Evidence or Medical Ignorance?), EBM will further consolidate and perpetuate the medical bias against traditional alternative therapies (Medical Bias). This bias is so entrenched that only (9) 10% of the available alternative medicine journals are indexed by MEDLINE as compared to 35% of journals representing conventional medicine. While it is true that in some cases, particularly quick acting herbal medicines, the effectiveness of some alternative medicines may be demonstrated by RCTs, the fundamentally slow acting, individualised, and cause based nature of many such medicines will ensure their effectiveness can never be fully demonstrated by selective simplistic short term clinical trials. Such natural therapies will always be demonstrated more effectively by real life clinical trials of millions of people but such real life data is inconsistent with the requirements of EBM and is therefore not acceptable to doctors and scientists. Yet real life experience provides the basis for most alternative therapies (9) in addition therefore, to those alternative therapies which have subsequently been adopted by conventional medicine (7). In this sense, EBM dismisses the very foundation of both conventional medicine and alternative medicine. Ware has recently drawn attention to the fundamental limitations of EBM and commercially based clinical trials when it comes to nutritional therapies (12):
As Ware points out (12):
Ware questions the wisdom of waiting for the blessing of mainstream medicine before using supplements (12):
In acknowledgement of the consistent and pronounced pro-drug anti-nutrition bias of mainstream medicine, Ware aptly concludes (12): "it would almost appear that the only deficiency universally recognized and accepted is a prescription drug deficiency!" It is clear that the continuing dominance of reductionist conventional medicine is assured by the principles of EBM (11):
When commonsense fails it is clear we need something to guide us lest we fall into the same pit everyday. But is EBM really the best we can do, or is it simply a simplistic and convenient economically based option that suits politicians and drug companies? Of course EBM and RCTs are merely new developments in medical faddism which is more concerned with new names rather than the curing of patients. If all the time and space devoted to discussion about the correct name for medicine were devoted more directly to patient care, as occurs in alternative medicine, patients would be much better off.
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References 1.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1040
Goodman NW, Who will challenge evidence-based medicine?,
J R
Coll Physicians Lond. 1999 May-Jun;33(3):249-51. |
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Dispelling the Vitamin E Myths: the truth about antioxidants, tocopherols, and tocotrienols.When Nutrients are not Nutrients: problems in vitamin E & antioxidant research.The Vitamin E Story & Natural Vitamins: from quackery to scientific?The Folic Acid LessonFrom One Vitamin E to Four Tocopherols & Four Tocotrienols: medicine learns again about the ever changing definition of vitamin "deficiency".How Can Antioxidants be so Dangerous When Drugs are so Safe?
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When Nutrients are not Nutrients: problems in vitamin E & antioxidant researchIn the past decade the term "antioxidant" has become a trendy buzzword in the world of alternative medicine (1,2,3). The drive to emphasise the importance of antioxidants however, relegates other essential nutrients to a level of secondary importance even though a deficiency of such nutrients may have fatal consequences. This type of classification system is the result of applying orthodox medicine's reductionist (Holistic or Reductionist?) piecemeal approach to alternative medicine, which is intrinsically holistic in nature (Holistic or Reductionist?). As I have discussed elsewhere (Holistic or Reductionist?), the reductionist approach of modern medicine dictates that while there is infinite interest in minute details, there is no interest in the "whole truth" (The Reductionist Philosophy). This disinterest in the whole truth is a continuing impediment for medicine's research into intrinsically holistic subjects like nutrition since it establishes artificial boundaries within which all medical thought must be eternally confined (The Reductionist Philosophy). Although antioxidants cannot work in a vacuum, without the presence of other nutrients, modern medical research continues to demonstrate a single minded reductionist obsession with antioxidants as though no other nutrient is important. While there is no doubt amongst scientists about the benefits of 'natural' antioxidants in fruits and vegetables (3,4,5,6), science has been unable to consistently duplicate these benefits in trials with antioxidant supplements (6,7,8,9,10), a fact which continues to frustrate medicine's attempts to reproduce the holistic benefits of nutrition in a single magic antioxidant pill (Nutrition Breakthroughs). Given orthodox medicine's restrictive reductionist philosophy and disinterest in the "whole truth" however, the inconsistency of medical trials is hardly surprising. It is after all, exceedingly difficult to demonstrate the full holistic benefits of nutrition in simplistic trials. Let us explore some of the reasons why this is so. Unlike drugs, which frequently work in isolation, nutrients are members of a team and therefore they are dependent upon other members of the team being present in adequate quantities also, a fact which is frequently overlooked. As I have stated previously (Nutrition & Megavitamins):
As far as trials of antioxidants are concerned therefore, it is first necessary to ensure that trial participants have optimum nutrition in regard to every other nutrient before trials are begun otherwise poor results must surely be expected (Nutrition & Megavitamins). The difficulty here of course, is that medicine has been totally disinterested in defining or measuring optimum nutrition (Nutrition & Megavitamins, Dietary Supplements or Functional Foods). Though these comments of Roger Williams were made more than three decades ago it seems modern science and medicine has learnt very little about nutrition research since that time (Nutrition & Megavitamins):
Although the reasons why medicine cannot understand or duplicate the holistic benefits of nutrition are very clear it is astonishing that there is still a determination to attempt to force nutrition to conform to the artificial restrictive rules of reductionist science. As Williams so aptly pointed out (11): "all diseases need to be explored from the standpoint of what various nutrients can do when tested under conditions that allow the nutrients to function cooperatively." The shortcomings of medicine's reductionist approach can be demonstrated by a close look at one of the major antioxidants, vitamin E. The Vitamin E Story & Natural Vitamins: from quackery to scientific?Since medical science changes like modern fashions ( Science Today, Quackery Tomorrow) it is hardly surprising that the medical attitude to vitamin E is extremely inconsistent if not simply erratic. Although the use of Vitamin E to prevent or treat heart disease began more than 70 years ago (Nutrition & Megavitamins) this was generally regarded as quackery by mainstream medicine which was biased in favour of drug or surgical treatments, treatments which, 70 years later, have been demonstrated to be a dismal failure (Health Trends). As I have noted previously (Nutrition & Megavitamins):
While medicine was espousing the benefits of drugs and the dangers of vitamins, the alternative medicine industry on the other hand, in recognition of the constantly changing nature of medical science, recommended that natural vitamins were superior to isolated synthetic ones, a suggestion which was regarded as quackery by orthodox medicine (12,13,14; See also But isn't Holistic Medicine just Quackery?). According to Barrett and Herbert for instance (12), "each vitamin is a chain of atoms strung together as a molecule. With minor exception, molecules made in the "factories" of nature are identical to those made in the factories of chemical companies." Strangely, Herbert contradicted this stance elsewhere (3,3a) and emphasised the difference between natural and synthetic vitamins (3); "antioxidant vitamins as naturally present in food are balanced biochemistry, ie. part of a mixture of redox agents half in oxidized form and half in reduced form. Every supplement pill, including those containing vitamin C, is unbalanced biochemistry." In the case of vitamin E, the natural vitamin was considered to be D-alpha tocopherol as compared to synthetic DL-alpha tocopherol (15,16,17; see also But isn't Holistic Medicine just Quackery?), but this was only a very small part of the vitamin E story since natural vitamin E is now known to include eight different but related substances (15,16,17,18,19; see also But isn't Holistic Medicine just Quackery?, Nutrition & Megavitamins). Although medicine has traditionally regarded claims about the superiority of natural vitamins as quackery, since according to science both natural and synthetic vitamins are identical substances (But isn't Holistic Medicine just Quackery?), science is now beginning to learn just how superior natural vitamins may be: (But isn't Holistic Medicine just Quackery?):
The traditional medical belief, that claims of the
superiority of natural vitamins are quackery, has now been clearly
discarded as researchers accept the inferiority of synthetic vitamins
due to their inability to reproduce the effects of natural foods using
synthetic vitamins (6,7).
As has recently been noted by Although medical science regarded the use of vitamin E as quackery for most of the 20th century, now there is renewed scientific interest in the entire family of vitamin E compounds as scientists realise the potential health benefits of gamma-tocopherol and the tocotrienols, substances which science declared previously played no role in human nutrition (But isn't Holistic Medicine just Quackery?, Nutrition & Megavitamins). It is absolutely astonishing how, for the past half century, the entire scientific world virtually ignored seven out of eight members of the vitamin E family. Such was this disinterest of medical science that of almost 24,000 studies into vitamin E only 200 or less than 1% have been devoted to tococotrienols (19,26). Like many other medical discoveries, science continues to rely on therapies which they claim had previously been shown to be quackery for some of their most significant scientific breakthroughs. This is especially true of natural or nutritional therapies such as megavitamin therapy (Nutrition Breakthroughs, B Vitamins) and folic acid therapy(Nutrition & Megavitamins, Nutrition is For the Birds ). The Folic Acid LessonThe history of folic acid is indeed tragic. Although Roger Williams named folic acid and reported the ability of folic acid deficiency to cause birth defects nearly 40 years ago (11; see also Nutrition & Megavitamins, Nutrition is For the Birds), mainstream medicine scoffed at this suggestion and regarded it as quackery. And when Kilmer McCully was the first to suggest that folic acid deficiency could cause heart disease because of its effect on homocysteine metabolism he promptly lost his job and was ostracised by his colleagues (48,49). According to Mirkin (48):
The medical establishment were ruthless in their condemnation of McCully for his theory about folic acid and homocysteine. His ideas were attacked as (49) ''errant nonsense'' and a ''hoax that is being perpetrated on the public.'' According to Stacey (49): "McCully says that when he was interviewed on Canadian television after he left Harvard, he received a call from the public-affairs director of Mass. General. 'He told me to shut up,' McCully recalls. 'He said he didn't want the names of Harvard and Mass. General associated with my theories.' Now McCully's work on folic acid and homocysteine is generally accepted it his critics and detractors who, in retrospect, have become quacks. Although Roger Williams' claim that folic acid deficiency could cause birth defects was also regarded as quackery for 2-3 decades, fortification of flour with this vitamin in the 1990s has led to significant reductions in the incidence of birth defects (50,51,52,53,54,55). According to Grosse and colleagues (52), this has resulted in an annual net cost savings in America of from $88 million to $145 million, but the cost in terms of reduced human suffering is beyond measure. Although the addition of folic acid to foods in Australia has been permitted for some time (59), it has not been mandatory and food manufacturers have generally been slow to adopt folic acid fortification, even in spite of overseas experience (59). Now however, both the Australian and New Zealand governments are moving to enforce folic acid fortification (60,61,62). In fact, according to Annette King, the Food safety Minister in New Zealand (62), the mandatory fortification with folic acid is "a triumph for humanity and common sense." If this is true, why did it take humanity and common sense so long to triumph and who was delaying or preventing this triumph? And how would Ms King describe the practice of processing nutrients out of our foods? Of course the freedom to choose subsidised supplements should always be preferred to removal of choice by mandatory medicalising of the food supply. Notwithstanding the fact that medicine has traditionally sought to discourage people from taking vitamins such as folic acid, even regarding such a practice as quackery, more recently health authorities have expressed concern that women cannot be relied upon to take folic acid supplements (51,54), hence the need for fortification. After allowing the wholesale adulteration of staple foods by processing and condemning anyone who tried to correct this by taking supplements as food faddists or quacks, now it seems the widespread use of folic acid supplements is regarded as a great "public health challenge" (54). How medical science changes, quackery one day, scientific the next ( Science Today, Quackery Tomorrow, Dietary Supplements or Functional Foods)! The vitally important lesson learned by mainstream medicine and nutrition as a result of the folic acid experience is the extremely naive and simplistic nature of the traditional medical belief that it is impossible to have any other nutritional disorder apart from the so called "classical nutritional deficiency diseases." It is now clear, even to mainstream medicine, that there exists a whole world of nutritional disorders other than those traditionally believed to exist because of this incredibly simplistic and unscientific view of nutrition. In the case of folic acid, women who were thought by medicine to suffer from no nutritional disease nevertheless gave birth to deformed babies, deformations which could be prevented by folic acid therapy. But how could this be possible? Doctors knew that these women had perfect nutritional status because they did not suffer from classical deficiency diseases such as pellagra or scurvy. And everyone knew vitamins would have no benefit unless there is a deficiency. Here was an absolutely enormous problem for mainstream medicine and nutrition. Could it be that virtually the entire scientific world had been teaching nutrition quackery and scientists like Roger Williams were correct? Such was the enormity of this lesson for those who rigidly accepted the simplistic traditional view of nutrition that they are still struggling to come to terms with it. We now know that the traditional means of diagnosing nutritional disorders is completely invalid and unscientific. Science, as taught by most medical and nutrition scientists in the world, was completely wrong. They were teaching quackery and the health of the community has paid a very heavy price indeed. The questions that need to be answered urgently are: how did science get it so wrong? how did millions of doctors, scientists and nutritionists all around the world conclude that it was impossible to have any nutritional disorder other than the so called classical deficiency diseases? And how could scientists possibly believe, if a severe nutritional deficiency is possible, that less severe or subclinical nutritional disorders are impossible? And how could scientists develop a rigid belief in dietary RDA's without evidence that we all metabolise nutrients with identical efficiency? It is a matter of the utmost urgency to discover how science fostered such erroneous beliefs so that such enormous and tragic public health mistakes can be avoided in future. As has occurred with folic acid, with vitamin E also the simplistic reductionist and biased approach of modern medical science has been found wanting because they turned a blind eye to the "whole truth" and they thought they could simplistically reproduce all the effects of vitamin E with a single synthesized substance. How many times must this same lesson be learned by doctors and scientists? They know it is not possible to reproduce the real world in a test tube but yet they continue to attempt to force nutrition to abide by the artificial rules of reductionism. Once again the teachings of alternative medicine have been decades ahead of the teachings of modern medical science (Mainstream Medicine Plays the Catch-up Game). It is abundantly clear from the history of vitamin E exactly where medical science has gone wrong in past vitamin research but what has been done about this? Have they abandoned their simplistic reductionist approach? From One Vitamin E to Four Tocopherols & Four Tocotrienols: medicine learns again about the ever changing definition of vitamin "deficiency".In spite of the fact that scientists, doctors, and nutrition experts around the world have been busy teaching that alpha-tocopherol is the only important member of the vitamin E family, the other seven members of the family playing no part in human nutrition (But isn't Holistic Medicine just Quackery?), this has turned out to be quackery as increasing scientific evidence confirms the importance of other tocopherols and tocotrienols (15,16,17,18,19,20,21,22,33; see also But isn't Holistic Medicine just Quackery?, Nutrition & Megavitamins). Current research reveals not only that gamma-tocopherol may be more effective than alpha-tocopherol for heart disease and cancer (19,22,23; see also But isn't Holistic Medicine just Quackery?), but furthermore, the tocotrienols also have many unique health promoting properties not shared by alpha-tocopherol (19,21,24,25,26,27,28,29,30,31,45,46,47). In fact, not only is gamma-tocopherol believed to hold more potential for treatment or prevention of heart disease than alpha-tocopherol, but furthermore, supplements of alpha-tocopherol can actually reduce blood and tissue levels of gamma-tocopherol and interfere with the actions of the tocotrienols (21,32,45,47; see also But isn't Holistic Medicine just Quackery?). While scientific evidence continues to confirm the importance of gamma-tocopherol, even though it is alpha-tocopherol which is the form of vitamin E found in nearly all vitamin E supplements, it is the tocotrienols that are making even more headlines. Not only do tocotrienols have potentially greater antioxidant effects than alpha-tocopherol (19,21,45,46,47), but they also have other non-antioxidant effects including anticancer (19,21,24,26,31,45,46,47) and cholesterol lowering effects (19,24,26,29,45,46,47) and an ability to protect the nervous system from toxic damage (19,21,24,25,26,27,28,45,46,47). Whereas research seems to show limited benefits of alpha-tocopherol (19), delta-tocotrienol and gamma-tocotrienol on the other hand, are claimed to be beneficial for the heart and have both cholesterol lowering and anticancer properties (19,21,45,46,47). In fact, the physiological effects of tocotrienols reveals not only their potential usefulness for fighting or preventing cancer, but because of their effects on cholesterol and the nervous system they may hold much promise for heart and vascular diseases (21,29,36,45,46,47) as well as degenerative brain disorders such as Alzheimer's disease, neurodegeneration due to strokes, and other ageing diseases (33,34,56). Even though it has been shown that tocotrienols do in fact reach the brain (28), some researchers still claim this is not so. According to Bourre for instance (35), "among the various vitamin E components (tocopherols and tocotrienols), only alpha-tocopherol is actively uptaken by the brain and is directly involved in nervous membranes protection." Such statements are contradicted by accumulating scientific evidence. So what does the future hold for the tocopherols and tocotrienols? Will they ultimately provide the key for reduced human suffering as occurred with folic acid? And if so, will medical scientists learn the error of their ways and abandon reductionism in favour of holism? Or will they continue making the same types of mistakes in the future? Will researchers finally heed the words of one of the greatest nutrition researchers of all, Roger Williams (11); "all diseases need to be explored from the standpoint of what various nutrients can do when tested under conditions that allow the nutrients to function cooperatively." Or will researchers continue to research nutrients as though they are drugs, ignoring their synergistic and constructive effects? Although the interaction of nutrients is well known (Nutrition & Megavitamins, B Vitamins), even today clinical research usually does not even consider these interactions. If we take B vitamins for instance, various other nutrients or cofactors are necessary in order to activate and transport these vitamins but yet clinical trials usually make no attempt to eliminate deficiencies of cofactors or presence of vitamin antagonists before performing trials of B vitamins (B Vitamins). In the case of vitamin E, we now know that supplements of alpha-tocopherol may actually lower the levels of gamma-tocopherol in the blood and tissues and also interfere with the action of tocotrienols, but yet researchers continue to perform clinical trials on the efficacy of vitamin E by using alpha-tocopherol alone. Though they ignore the other 7 members of the vitamin E family they then express surprise about inconsistent results. When will nutrition researchers get serious about nutritional tests and trials? But another huge problem also remains for reductionist science (Nutrition & Megavitamins): what is a vitamin deficiency? At what point does a person become deficient? How can this be diagnosed? Although science seems no closer to answering these questions the answers are of critical importance for nutrition research. Victor Herbert has pointed out that (3) "it has been known for many years that nutrient deficiencies promote cancers" and yet science still cannot precisely define or identify a nutrient "deficiency". It is true that vitamins can be measured in the blood, but they cannot be measured in the cells where vitamins work, let alone in every cell of the body (Nutrition & Megavitamins). Even in the blood the exact optimum level is unknown, scientists preferring to conduct surveys of apparently normal people and calculate normal ranges for each nutrient (Nutrition & Megavitamins). If for instance, most people in their survey were in fact deficient in a particular nutrient, then this deficient level may then be considered normal. And what about the presence or absence of other factors in the body which may effect nutrient utilisation in some way? Such factors are usually not even considered when checking for a nutrient deficiency. But individual differences pose even greater difficulties for scientists. It has long been known that there are considerable idiosyncratic variations in the efficiency with which we metabolise certain nutrients (Nutrition & Megavitamins, B Vitamins). This is being increasingly confirmed by nutrigenomics which reveals that some people require much greater dietary intake of certain nutrients in order to avoid a deficiency (Nutrition Breakthroughs). With such uncertainty it is impossible to state for certain that a given individual is obtaining every nutrient from his or her diet in sufficient quantities, thereby rendering the nutrient content of the diet as being irrelevant as a means of determining nutritional status. In spite of this well known variation in nutrient metabolising efficiency, experts still commonly assess nutritional status by diet. According to Herbert (3), and Bjelakovic (6), "dietary vitamin E deficiency has never been reported in the United States." This may well be true but what does it mean? It certainly does not mean no human in the United States has ever suffered from a vitamin E deficiency. It makes the preposterous assumption, in contradiction of the principles of nutrigenomics, that the precise individual dietary vitamin E requirements are known for every person in America, irrespective of metabolic variations. And since science has absolutely no idea of the precise dietary requirements for 7 (if not 8!) out of 8 of the vitamin E compounds, what is the point of such a statement? It would seem scientifically meaningless. Nutrition has absolutely nothing to prove. Everyone knows nutrients are essential for life and health. Scientists admit that nutritional deficiencies may cause cancer yet they claim that very few people actually suffer from nutritional deficiencies, even in spite of the fact there is no precise way of diagnosing such deficiencies. As I have stated elsewhere (Nutrition & Megavitamins), the first and foremost task of the scientist, doctor, and nutritionist, is to maximise the efficiency with which nutrients are transported from soil to their final destination inside human cells. In reality, scientists do the very opposite with the use of impoverished soils, artificial fertilisers, food processing, and generally reducing the availability of nutrients. Given medicine's traditional unscientific anti-nutrition bias (Medical
Bias) it is little wonder that there is such a preoccupation with
the alleged danger of antioxidants on the one hand, and relative
disinterest in the toxicity of pharmaceutical drugs on the other (Dietary
Supplements). Bearing the above limitations of reductionism in mind,
as well as medicine's anti-nutrition bias, let us briefly examine some
recent reports about the alleged dangers of antioxidants. How Can Antioxidants be so Dangerous When Drugs are so Safe?Since vitamins have become so popular and governments have commenced moves to take control of the supplement industry (Pan Crisis) there are continuous media reports about the dangers of antioxidants or other supplements (6,7,8,9,10,39,40,41; see also Dietary Supplements, Nutrition Breakthroughs, Pan Crisis). Not surprisingly, these reports are based on studies which usually avoid mentioning any evidence of the dangers of the most hazardous therapeutic products, namely, pharmaceutical drugs (7; see also Dietary Supplements, Nutrition Breakthroughs, Pan Crisis). Additionally, these studies are often poorly researched, biased, or fail to provide clear proof of the dangers of supplements, and even apply a different standard of proof to that which is required for drugs (Nutrition Breakthroughs, Pan Crisis). Anti-nutrition bias or 'vitaminphobia' is so prominent in fact, that when I did a quick search of Google News recently for news reports about "vitamins", "prescription drugs", and "pharmaceutical drugs", around 64% of vitamin reports were negative compared to 3%-9% for drugs. Negative reports about vitamins outnumbered those for drugs by more than 8 to 1. In the real world however, actual adverse reactions to drugs outnumber those due to supplements by around 98 to 2 (Alternative Medicine Enquiry) yet this is never reflected in media reports. There are three recent negative studies about antioxidants and multivitamins which have generated considerable publicity (7,42,63).The first of these studies (7) I have considered elsewhere (Nutrition Breakthroughs). Suffice to say here that this study by Bjelakovic and colleagues failed to identify the types of vitamin E used in the studies they analysed, even though the scientific evidence clearly demonstrates that alpha-tocopherol does not have the same effects as other members of the vitamin E family. As has been pointed out by Sen and coworkers (26):
Of course, as is pointed out by Sen and coworkers, no definite scientific conclusions can be drawn regarding the effects of "vitamin E" or its 8 constituents if only one of these substances is trialed. Continuing concern by these workers resulted in further comments about improper research of the effects of vitamin E (24):
Similarly, after conducting a review of the medical literature concerning vitamin E between 1981 - 2005, Robinson and colleagues have outlined various problems they identified with clinical trials of vitamin E (43):
It is clear that current vitamin E research leaves much to be desired with most researchers only choosing to trial one of the eight members of the vitamin E family, alpha-tocopherol, and make absolutely no allowance for the impact of this tocopherol upon other tocopherols or tocotrienols. Similar problems were demonstrated yet again in a recent study by Cook and colleagues (63), a study which again lead to negative headlines in the media (64,65). Unfortunately Cook and colleagues (63) fail to provide conclusive baseline pretrial control data which would enable an accurate assessment of the effects of the vitamins. Other than (66) "baseline dietary assessments" using "food frequency questionnaires" it seems there was no detailed assessment of the baseline individualised nutritional status of trial participants. And like so many other researchers Cook and colleagues (63) also avoided using natural vitamin C containing the bioflavonoids and natural vitamin E containing the eight members of the vitamin E family as they occur in nature. Strangely however, although the study was limited to use of these unnatural vitamins without the cofactors which occur in nature, Cook and colleagues draw attention to the superiority of natural vitamins such as are found in foods (63):
Even in spite of all these limitations however, Cook and colleagues (63) contradicted other studies and admitted the vitamins not only caused no harm, but there was also evidence of reduced incidence of strokes and "major cardiovascular events", especially amongst those with a history of cardiovascular disease. As so often seems to occur with nutritional research, these positive aspects were not highlighted by Cook and colleagues (63) or the ensuing media coverage (64,65), which was described by Adams (66) as representing a "distortion" of the actual results of the study. According to Adams the real significance of the study was concealed by inclusion of trial participants who did not take the vitamins on a regular basis (66):
Similar views were expressed by Richards (67) who also draws attention to the fact that the positive aspects of this study were not highlighted by the authors of the study or the ensuing media headlines. According to Richards (67):
Anti-nutrition bias or vitaminphobia, especially in the medical profession, has such a long history (Medical Bias) negatively biased articles are to be expected and this cannot be expected to completely change in the short term. What is most concerning however are the motivating reasons behind deliberate bias which represents a deliberate attempt to deceive or mislead and therefore represents an abandonment of science (Medical Bias). Concerns about the negatively biased reporting of the Cook study were such that a campaign was initiated by Adams (68) to appeal to media outlets to publish retractions or corrections. Another recent study attempted to link vitamin consumption to an increased risk of prostate cancer (38,42,44). Interestingly, according to Leitzmann (38), co-author of the study, this study was established to "assess the association between the use of multivitamins and prostate-cancer risk," although, as is noted by these workers, there was very little reason to suspect a relationship between vitamin consumption and cancer. It seems the approach to drug research is rather different to the approach used to research vitamins. Is drug research initiated to establish a connection between the use of pharmaceutical drugs and cancer? In spite of the various media headlines warning of the dangers of vitamins which resulted from this study, the researchers themselves point out that the study fails to provide any evidence that the incriminated vitamins were actually the cause of the increased risk of cancer which they observed (38,42,44). Furthermore, the researchers also noted that the group with the higher incidence of cancer was also more thoroughly tested for cancer so this could have resulted in an increased diagnosis of cancer in the affected group (42,44). According to Lawson and colleagues (42,44):
In spite of the alarming headlines which resulted from this study it seems these workers were unable to provide any evidence that vitamins may cause or aggravate prostate cancer. Interestingly, as far back as 1999, Moyad and coworkers (37) compared the ability of alpha-tocopherol and gamma-tocopherol to suppress the growth of human prostate cancer cells in the laboratory and found that gamma-tocopherol was the more effective of the two. In spite of the fact that researchers are continually surprised by the influence of missing cofactors in clinical trials they still persist with their attempts to reduce the holistic benefits of nutrition to a single substance. On the one hand they emphasize the superiority of natural nutrients found in fruits and vegetables because of the presence of necessary cofactors in such foods, but when they organise trials they deliberately choose to use the most unnatural form of vitamins which are completely devoid of any cofactors. When will they learn? As I have pointed out elsewhere (Nutrition & Megavitamins; see also Dietary Supplements or Functional Foods, Nutrition is for the Birds), medical progress in nutrition is shamefully slow as a result of medicine's anti-nutrition bias : "one hundred years ago mainstream medicine vehemently argued that pellagra and beri beri were caused by infections and were not caused by nutritional deficiencies. One hundred years later mainstream medicine argues about whether heart disease and cancer are caused by nutritional deficiencies. With most diseases we have not yet even begun to consider the nutritional possibilities." As I have stated previously (Nutrition & Megavitamins), what is needed today is a fundamental change of attitude similar to that outlined by Roger Williams more than three decades ago:
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http://www.csiro.au/resources/ps8h.html The facts on antioxidants,
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