Topics in Nutrition and Holistic Medicine

When 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!!

Is Illness Holistic?

When There is Evidence for Nutrition but Little Evidence for Evidence Based Medicine.

There is No Truth Other Than Evidence Based Medicine

Food & Nutrients are Not Essential & May be Dangerous Without Meta-analysis of Clinical Trials.

There is No Truth Other Than Evidence Based Medicine

1. Outcome or therapy based - not cause based
2. Excessive reliance upon clinical trials favours a symptomatic reductionist perspective.
3. Favours therapies supported by commercial interests prepared to fund research and clinical trials.
4. Does not emphasise nutrition.
5. Disease oriented - not focused upon optimum health.

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):

"For several decades it has been popular to pursue a "reductionist" approach to studying disease (Fig. 1). The underlying concept is that understanding of disease will result from describing events at increasingly more microscopic levels: (organismorganreceptororganellesubstratespathwayenzymegene). This reductionist approach emerged naturally from the revolutionary development of molecular biology and molecular genetics...................But it is becoming increasingly clear that the massive amount of information provided by the molecular approach may not, in itself, allow us to explain disease."

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).

Food & Nutrients Not Essential & May be Dangerous Without Meta-analysis of Clinical Trials.

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.

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.
2 http://www.ucl.ac.uk/Pharmacology/dc-bits/holmes-deconstruction-ebhc-06.pdf  Dave Holmes et al, Deconstructing the evidence-based discourse in health sciences: truth, power and fascism, Int J Evid Based Healthcare 2006; 4: 180–186.
3. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1473 Valkenburg G, et al, Fundamental shortcomings of evidence-based medicine, J Health Organ Manag. 2003;17(6):463-71.
4. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=992 Couto JS, Evidence-based medicine: a Kuhnian perspective of a transvestite non-theory, J Eval Clin Pract. 1998 Nov;4(4):267-75.
5. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=167 Tonelli MR, Integrating evidence into clinical practice: an alternative to evidence-based approaches, J Eval Clin Pract. 2006 Jun;12(3):248-56.
6. http://www.medscape.com/viewarticle/557980 Richard N. Bergman, Orchestration of Glucose Homeostasis: From a Small Acorn to the California Oak, Diabetes, 2007;56(6):1489-1501.
7. http://www.annals.org/cgi/reprint/135/7/507.pdf Jan P. Vandenbroucke, Anton J.M. de Craen, Alternative Medicine: A “Mirror Image” for Scientific Reasoning in Conventional Medicine, Ann Intern Med. 2001;135:507-513.
8. http://qjmed.oxfordjournals.org/cgi/reprint/91/5/371 B.G. Charlton, A. Miles, The rise and fall of EBM, Q J Med 1998; 91:371–374.
9. http://www.annals.org/cgi/reprint/142/12_Part_2/1042.pdf Paul G. Shekelle et al, Challenges in Systematic Reviews of Complementary and Alternative Medicine Topics, Ann Intern Med. 2005; 142:1042-1047.
10.http://archfami.ama-assn.org/cgi/content/abstract/6/2/149 (no authors), Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine, Arch Fam Med, Vol 6 March 1997.
11.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=174 Coulter ID, Evidence based complementary and alternative medicine: promises and problems, Forsch Komplementarmed. 2007 Apr;14(2):102-8.
12.http://www.yourhealthbase.com/metabolic.htm William R. Ware, A Metabolic Tune-Up: What is This All About?, International Health News, Sept/Oct, 2004.
13.http://www.surgicaloncology.de/content/public/fremd/1819.html Walter C. Willett, and Meir J. Stampfer, What Vitamins Should I Be Taking, Doctor?, New Eng J Med, 345, 1819, 2001.
 

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 Lesson

From 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?

References

When Nutrients are not Nutrients: problems in vitamin E & antioxidant research

In 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 Bjelakovic and Gluud  (6): "why is it not possible to take a vitamin pill to obtain the same effect as a balanced diet? Antioxidant supplements in pills are synthetic, factory processed, and may not be safe compared with their naturally occurring counterparts." It is hardly surprising that vitamin manufacturers have been unsuccessful in their attempts to reduce the holistic benefits of nutrition to a single magic pill, however, this continues to be a major surprise for reductionists. While the evidence clearly shows that natural vitamins are frequently superior to synthetic, the question of the alleged 'dangers' of synthetic vitamins is far from being proven. It is indeed interesting to note that allegations of the dangers of vitamins almost always seem to originate from those whose expertise and experience are more closely associated with orthodox medicine and pharmaceutical drugs rather than nutrition and vitamins (Nutrition Breakthroughs). Experts in nutrition tend to take the opposite stance and testify to the safety of vitamins (Nutrition Breakthroughs). In fact, it seems vitamin E is considered so safe that scientists are exploring means of producing food crops with genetically increased vitamin E levels (57,58,59).

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 Lesson

The 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:

References

1. http://www.csiro.au/resources/ps8h.html The facts on antioxidants, CSIRO.
2. http://www.australianprescriber.com/magazine/22/6/142/4/ Mark L. Wahlqvist, Antioxidant Nutrients, Aust Prescr 1999;22:142-4.
3. http://www.ajcn.org/cgi/reprint/60/2/157?ijkey=14228bcd43bce229ae14f6a119654947a949af58&key Victor Herbert, The Antioxidant Supplement Myth, Amer J Clin Nutr, 60,157, 1994.
3a.http://www.victorherbert.com/BehavioralNeurology.htm Victor Herbert, Vitamin, Mineral, Antioxidant, and Herbal Supplements: Facts and Fictions, Chapter 21 in the book ìBehavioral Neurology in the Elderlyî, edited by J. Leon-Carrion    and M. Giannini. Published June 2001 by CRC Press LLC, Boca Raton, FL.
4. http://www.pnas.org/cgi/content/abstract/90/17/7915?ijkey=9fc97e81819310c7d324d0c8424674862 BN Ames, MK Shigenaga and TM Hagen, Oxidants, Antioxidants, and the Degenerative Diseases of Aging, Proc Nat Acad Sci, 90, 7915, 1993.
5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_ui G Block et al, Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence, Nutr Cancer. 1992;18(1):1-29.
6. http://jnci.oxfordjournals.org/cgi/content/full/99/10/742 Goran Bjelakovic, Christian Gluud, Surviving Antioxidant Supplements, J Nat Cancer Inst, 99, 742, 2007.
7. http://jama.ama-assn.org/cgi/content/abstract/297/8/842 Goran Bjelakovic et al, Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention, JAMA. 2007;297:842-857.
8. http://www.nutraingredients-usa.com/news/ng.asp?n=69640-antioxidants-vitamin-e-beta-carotene Stephen Daniells, New Scientist slams antioxidant supplement benefits, Nutraingredients.com. 8/4/2006; see also Ref (9).
9. http://www.newscientist.com/channel/health/mg19125631.500-the-antioxidant-myth-a-medical-fairy-tale Lisa Melton, The antioxidant myth: a medical fairy tale, New Scientist, 2563, p40, 5th Aug 2006.
10.http://www.foodnavigator.com/news/ng.asp?n=69668-antioxidants-vitamin-e-beta-carotene
11.Williams, R.J., Nutrition Against Disease, Pitman Publishing Corporation, New York, USA, 1971.
12.http://www.quackwatch.org/01QuackeryRelatedTopics/spotquack.html Stephen Barrett,
Victor Herbert, Twenty-Five Ways to Spot Quacks and Vitamin Pushers, Quackwatch.
13.http://www.healthresearch.com/vitamins.htm Thiel RJ, Natural Vitamins May Be Superior to Synthetic Ones. Medical Hypotheses, 2000; 55(6):461-469.
14.http://www.dietitian.com/quack.html Joanne Larsen, Top Ten Tips to Spot Nutrition Quackery, Ask the Dietitian.
15.http://www.naturalmedicine.co.za/sajnm_main/article.php?story=20030730095929435 Tandy McLeod, Natural vs Synthetic Vitamins and Minerals, South Afric J Natural Ther, Issue 10.
16.http://en.wikipedia.org/wiki/Vitamin_E
17.http://juvenon.com/jhj/vol2no09.htm Benjamin V. Treadwell, The Eight Faces of E, Juvenon Health Journal, Vol 2 Sept 2003.
18.http://www.yasoo.com/news_vtamin%20_and%20_health.html Vitamin E and Health - The 2004 New York Academy of Sciences Conference.
19.http://juvenon.com/jhj/vol6no01.htm Benjamin V. Treadwell, Vitamin E: which one is in your supplement?, Juvenon Health Journal, Vol 6 Jan 2007.
20.http://en.wikipedia.org/wiki/Tocotrienol
21.http://www.doctormurray.com/newsletter/1-06-2003.htm Dr Murray, Delta-tocotrienol - The 21st Century Vitamin E?, Newsletter, 6th Jan 2003.
22.http://www.lef.org/magazine/mag2006/apr2006_report_gamma_01.htm Lyle MacWilliam, What Makes Gamma Tocopherol Superior to Alpha Tocopherol, Life Extension, April 2006.
23.http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstra Wagner KH et al, Gamma-tocopherol--an underestimated vitamin?, Ann Nutr Metab. 2004;48(3):169-88.
24.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1 Sen CK et al, Tocotrienols in health and disease: The other half of the natural vitamin E family. Mol Aspects Med. 2007 Mar 27.
25.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1 Khanna S et al, Characterization of the potent neuroprotective properties of the natural vitamin E alpha-tocotrienol, J Neurochem. 2006 Sep;98(5):1474-86.
26.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1 Sen CK et al, Tocotrienols: Vitamin E beyond tocopherols, Life Sci. 2006 Mar 27;78(18):2088-98.
27.http://stroke.ahajournals.org/cgi/content/full/36/10/e144 Savita Khanna et al, Neuroprotective Properties of the Natural Vitamin E {alpha}-Tocotrienol, Stroke. 2005;36:e144.
28.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1 Sen CK et al, Tocotrienol: the natural vitamin E to defend the nervous system?, Ann N Y Acad Sci. 2004 Dec;1031:127-42.
29.http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed&cmd=search&term=Baliarsingh%20S%2C%20 Baliarsingh S, et al, The therapeutic impacts of tocotrienols in type 2 diabetic patients with hyperlipidemia, Atherosclerosis. 2005 Oct;182(2):367-74.
30.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15 Miyazawa T et al, Antiangiogenic potency of vitamin E, Ann N Y Acad Sci. 2004 Dec;1031:401-4.
31.http://www.lef.org/magazine/mag2002/may2002_cover_vitamine_01.html  Does Vitamin E Prevent Breast Cancer, Life Extension, May 2002.
32.http://www.ncbi.nlm.nih.gov/sites/entrezdb=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16  Wolf G., How an increased intake of alpha-tocopherol can suppress the bioavailability of gamma-tocopherol, Nutr Rev. 2006 Jun;64(6):295-9.
33.http://www.ajcn.org/cgi/content/full/81/2/508 Martha Clare Morris et al, Relation of the tocopherol forms to incident Alzheimer disease and to cognitive change, American Journal of Clinical Nutrition, Vol. 81, No. 2, 508-514, February 2005.
34.http://jn.nutrition.org/cgi/content/full/135/2/151 Sebastian Schaffer et al, Tocotrienols: Constitutional Effects in Aging and Disease, J. Nutr. 135:151-154, February 2005.
35.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17 Bourre JM, Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients, J Nutr Health Aging. 2006 Sep-Oct;10(5):377-85.
36.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17 Ajuluchukwu JN et al, Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report, Niger Postgrad Med J. 2007 Mar;14(1):30-3.
37.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1033 Moyad MA et al, Vitamin E, alpha- and gamma-tocopherol, and prostate cancer, Semin Urol Oncol. 1999 May;17(2):85-90.
38.http://www.msnbc.msn.com/id/18742328/site/newsweek/ Alexandra Gekas, A Multivitamin Mystery, Newsweek, May 18, 2007.
39.http://www.medpagetoday.com/Urology/ProstateCancer/tb/5654 Crystal Phend, Mega Multivitamin Use Risks Prostate Cancer, Medpage Today, May 15 2007.
40.http://www.huffingtonpost.com/jeff-stier/no-precautionary-principl_b_48719.html Jeff Stier, No Precautionary Principle When it Comes to Dubious Vitamins, The Huffington Post, May 17, 2007.
41.http://blogs.orlandosentinel.com/features_healthblog/2007/05/excess_vitamins.html
42.http://jnci.oxfordjournals.org/cgi/content/full/99/10/754  Karla A. Lawson et al, Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health–AARP Diet and Health Study, Journal of the National Cancer Institute 2007 99(10):754-764.
43.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1700 Robinson I et al, Vitamin E in humans: an explanation of clinical trial failure, Endocr Pract. 2006 Sep-Oct;12(5):576-82.
44.http://www.natap.org/2007/HIV/052207_09.htm
45.http://www.geronova.com/deltagold.htm
46.http://www.tocotrienol.org/en/index/scientific_references.html
47.http://www.tocotrienol.org/en/index/feature_article.html See: Andre Theriault, The Right Vitamin E - Tocotrienols, Total Health, Vol 23, Number 2.
48.http://www.drmirkin.com/nutrition/9218.html Gabe Mirkin, Folic Acid and Alzheimer's Disease, DrMirkin.com.
49.http://query.nytimes.com/gst/fullpage.html?res=9D0DE2D8153DF933A2575BC0A961958260&sec= Michelle Stacey,  The Fall and Rise Of Kilmer McCully, The New York Times, 10th Aug, 1997.
50.http://www.sciencedaily.com/releases/2005/05/050513230056.htm Neural Tube Defects Decrease With Folic Acid Fortification, Science Daily, April 21 2005.
51.http://www.bmj.com/cgi/content/full/322/7301/1510 Jacqui Wise, Neural tube defects decline in US after folic acid is added to flour, BMJ 2001;322:1510.
52.http://www.ajph.org/cgi/content/abstract/95/11/1917 Scott D. Grosse et al, Reevaluating the Benefits of Folic Acid Fortification in the United States: Economic Analysis, Regulation, and Public Health, American Journal of Public Health , November 2005, Vol 95, No. 11 .
53.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=174 Mosley BS et al, Folic acid and the decline in neural tube defects in Arkansas, J Ark Med Soc. 2007 Apr;103(10):247-50.
54.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=166 Eichholzer M et al, Folic acid: a public-health challenge, Lancet. 2006 Apr 22;367(9519):1352-61.
55.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=125 Ray JG, Association of neural tube defects and folic acid food fortification in Canada, Lancet. 2002 Dec 21-28;360(9350):2047-8.
56.http://www.npicenter.com/anm/templates/newsATemp.aspx?articleid=16126&zoneid=164 New Studies Indicate That Tocomin® / Tocomin® SupraBio(TM) Supplementation Elevates Blood Levels Sufficiently to Protect Against Stroke-Induced Neurodegeneration, 2006-07-18 - Carotech, Inc.; see also, Journal of Antioxidant & Redox Signaling May 2006, June 26th issue of the Journal of Neurochemistry, Stroke (Oct 2005).
57.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSe  Hunter SC, Cahoon EB, Enhancing vitamin E in oilseeds: unraveling tocopherol and tocotrienol biosynthesis, Lipids. 2007 Mar;42(2):97-108.
58.http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearc Cahoon EB et al, Metabolic redesign of vitamin E biosynthesis in plants for tocotrienol production and increased antioxidant content, Nat Biotechnol. 2003 Sep;21(9):1082-7.
59.http://www.wsahs.nsw.gov.au/folate/documents/Australia-NZBriefversion2.pdf  GF Maberly, Choose to Act Now: Fortify all flour in Australia & New Zealand with folic acid March 2004, Flour Fortification Initiative, Western Sydney Area Health Service, NSW Government.
60.http://www.foodstandards.gov.au/standardsdevelopment/proposals/proposalp295considerationof  Proposal P295 - Consideration of mandatory fortification with folic acid, Food Standards Australia, 23rd May 2007.
61.http://www.ausfoodnews.com.au/db/node/41305 FSANZ affirms draft standard on mandatory fortification of food with Folic Acid, Australian Food News, 22nd June 2007.
62.http://www.nzherald.co.nz/topic/story.cfm?c_id=294&objectid=10447345 Bread to be fortified with folic acid, New Zealand Herald, 22nd June 2007.
63.http://archinte.ama-assn.org/cgi/content/short/167/15/1610 Nancy R. Cook et al, A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women, Arch Intern Med. 2007;167:1610-1618.
64.http://www.cbsnews.com/stories/2007/08/14/earlyshow/contributors/emilysenay/main3165798.shtml Emily Senay, Vitamins May Be No Match For Mother Nature - Study Found Heart Disease Is Reduced By Eating Fruits And Vegetables, Not Taking Pills, CBS News, 14th Aug 2007.
65.http://www.abcnews.go.com/Health/Diet/story?id=3474385&page=1  Sharon Bord, Study: Vitamins No Magic Bullet for Heart Health, ABC News, Aug 13 2007.
66.http://www.americanchronicle.com/articles/viewArticle.asp?articleID=35252 Bill Haymin, Antioxidants, bad science and failure of the press to tell the truth, Mike Adams, American Chronicle, 16th Aug 2007; see also Mike Adams, http://www.newstarget.com/021976.html 14th August 2007.
66.http://clinicaltrials.gov/ct/show/NCT00000541;jsessionid=E904EDACC6A82C9ED31F9485FB5C3 Women's Antioxidant and Cardiovascular Study (WACS).
67.http://newswithviews.com/Richards/byron39.htm Byron Richards, NATURAL VITAMIN E DRAMATICALLY REDUCES HEART DISEASE, NewsWithViews.com, 17th August 2007.
68.http://www.newstarget.com/021981.html Mike Adams, NewsTarget readers demand retractions from major media outlets over erroneous reporting of antioxidant study, NewsTarget, 16th August 2007.
 

Experts say dietary supplements may save $billions in health care costs!!

The more scientific evidence reveals the increasing need for nutritional supplements the more governments seek to ban or restrict the publics access to such supplements.

While the US and other governments move to restrict access to health promoting dietary supplements (Pan Crisis, TGA & Pan, Codex in Australia, Pan Crisis & Future of Alternative Medicines, Alternative Medicine Takeover, Response to Government Inquiry, Global Trends in Health Care) scientific researchers are increasingly uncovering the tragic health consequences of the nutritional deficiencies which abound in modern society (see Nutrition and Megavitamins, B vitamins, Nutrition Breakthroughs, Doctors Discover Malnutrition in Elderly). As science discovers the prevalence of, and terrible consequences of, nutritional deficiencies however, politicians seek to bring such products under the exclusive control of doctors and pharmaceutical companies (Pan Crisis, TGA & Pan, Codex in Australia, Pan Crisis & Future of Alternative Medicines, Alternative Medicine Takeover, Response to Government Inquiry, Global Trends in Health Care).

Nutritional surveys continue to reveal the alarming and disgraceful prevalence of nutritional deficiencies with an increasing number of nutrients being declared "public health issues" as more is learned about micronutrients (1). While governments have long been unconcerned about the public health consequences of micronutrient deficiencies, now, as authorities seek to ban supplements, it is increasingly being realised that poor nutrition is costing health authorities billions of dollars in unnecessary health care costs (2,3,4,6,12,13,15,18,19) with global malnutrition costing twice as much as obesity (16,17). It has even been recommended that elderly patients "should receive a multivitamin infusion on a daily basis" if they are unable to take oral supplements (5). According to scientific researchers, vitamin supplements significantly reduce the risk of cancer, heart disease and other diseases and improve recovery time and resistance to illness in the elderly (9,10, 11,12,13,12,13,14,15; see also Nutrition and Megavitamins, B vitamins, Nutrition Breakthroughs, Doctors Discover Malnutrition in Elderly). The Lewin group concluded, as a result of their inquiry into the use of nutritional supplements (7):

According to David Heber, director of the UCLA Center for Human Nutrition and a co-chair of Multivitamins and Public Health (7): "Despite our efforts to maintain a healthy diet, research indicates most of us fall short of getting the vitamins and minerals we need. A daily multivitamin is a simple and cost-effective way to help ensure good health." Yet, in spite of all the modern scientific knowledge of the importance of nutrition, according to Gardner and Halweil (18), "the century with the greatest potential to eliminate malnutrition instead saw it rise to record levels."

While scientists have only recently realised the importance of folic acid for preventing birth defects, now they are finding, not surprisingly, that the use of multivitamins can also significantly reduce birth defects although they are uncertain which component/s of the tablets are responsible (8,9,14).

As science discovers that those who do not take nutritional supplements are much more susceptible to serious diseases, politicians on the other hand, seek to interfere with the public's right to prevent these diseases by taking dietary supplements.

CONTACT YOUR POLITICIAN NOW!!

References
1.http://www.cdc.gov/nchs/data/misc/tronm.pdf Marvin Snyder, Carol A. Rilley, et al, Third Report on Nutrition Monitoring in the United States, 1995.
2.http://www.nutraingredients-usa.com/news/ng.asp?n=76320-dsea-the-lewin-group-healthcare See also; http://www.npicenter.com/anm/templates/newsATemp.aspx?articleid=18424&zoneid=2 Supplements could save $24b in healthcare costs, Dietary Supplement Education Alliance, 5/4/2007.
3.http://www.medicalnewstoday.com/medicalnews.php?newsid=40078 Barry Jones, NHS Patients 'Risk Complications And Death' Because Of Poor Nutrition In Hospitals, British Society Of Gastroenterology, 23rd March 2006.
4.http://www.nutrasanus.com/nutritional-supplements-hearing.html Congressional Hearing Examines
Nutritional Supplements' Impact on Health Care, study done by Dietary Supplement Education Alliance presented at White House Subcommittee on Human Rights and Wellness entitled "Dietary Supplements: Nature's Answer to Cost Preventive Medicine by Representative Dan Burton (R-Ind.), chairman of the House Government Reform Subcommittee on Human Rights & Wellness.
5.http://www.mvi-us.com/pdf/37-4.pdf
6.http://www.sdearthtimes.com/et1198/et1198s12.html Natural vitamin E supplements could save millions in U.S. health care costs; see American J Cardiol, 15th Aug 1998; Western Journal of Medicine (1997 May; 166:306-312).
7.http://www.lewin.com/NR/rdonlyres/A1F7ECFC-B495-4EF3-9D14-C724BECCB0DD/0/CostEffects Al Dobson et al, A Study of the Cost Effectiveness of Daily Multivitamins for Older Adults, The Lewin Group, Jan 14 2004: See also Appendices of Report, Fact Sheet, Press Release, Other reports.
8.http://news.bbc.co.uk/1/hi/health/2136577.stm Multivitamins 'cut birth defect risk', BBC News, 21st July 2002.
9.http://pediatrics.aappublications.org/cgi/content/abstract/111/5/S1/1146Adolfo Correa, et al, Do Multivitamin Supplements Attenuate the Risk for Diabetes-Associated Birth Defects?, Pediat, Vol. 111 No. 5 May 2003, pp. 1146-1151.
10.http://www.ahrq.gov/clinic/3rduspstf/vitamins/vitcvdsum.htm Cynthia D. Morris, Susan Carson, Routine Vitamin Supplementation to Prevent Cardiovascular Disease, Ann Intern Med 2003;139(1):56-70.
11.http://www.annals.org/cgi/content/full/129/7/517 Edward Giovannucci et al, Multivitamin Use, Folate, and Colon Cancer in Women in the Nurses' Health Study, Ann Intern Med, 129, 517, 1998.
12.http://thyroid.about.com/cs/newsinfo/l/blvitamins2.htm Mary Shomon, Scientific Research Documents Health Benefits of Multivitamins, Other Nutritional Supplements: The Benefits Of Nutritional Supplements, Council For Responsible Nutrition, July 2002.
13.http://www.lef.org/magazine/mag2004/dec2004_itn_01.htm Life Extension Magazine, Dec 2004.
14.http://www.medsci.org/v01p0050.htm Czeizel AE. The primary prevention of birth defects: Multivitamins or folic acid?. Int J Med Sci 2004; 1:50-61.
15.http://www.supplementinfo.org/anm/templates/?a=265&z=11 Health Impact II Study Finds Seniors Who Take Certain Dietary Supplements Live Longer, More Independent Lives, Dietary Supplement Education Alliance, 2nd Nov 2005.
16.http://www.novartisnutrition.com/Intl/pdf/NMN%20ESPEN%20Symposium%20release%2013-11.pdf Malnutrition in the elderly – a more significant global problem than obesity, Novartis press release, 13th Nov 2006.
17.http://www.epha.org/a/2080, The Cost of Malnutrition in the UK, European Public Health Alliance, see British Association for Parenteral and Enteral Nutrition, Dec 2005.
18.http://www.iht.com/articles/2000/03/09/edgary.t.php Gary Gardner and Brian Halweil, The World Pays a Heavy Price for Malnutrition, International Herald Tribune, 9th March 2000.
19.http://www.bapen.org.uk/pdfs/health_econ_exec_sum.pdf, M. Elia et al, The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements(ONS) in adults,  British Association for Parenteral and Enteral Nutrition (BAPEN).

Is Illness Holistic?

Given the fragmented reductionist nature of modern health care it is pertinent that we consider whether human illness fully abides by the rules of scientific reductionism. Does illness really conveniently quarantine itself within specific tissues or organs or is it, being devoid of respect for artificial boundaries, intrinsically holistic in nature? Is diabetes for instance, just a disease of a pancreas which is absolutely remote from the rest of the body, or is this organ part of a hormonal team which is dependent upon a nutrient rich blood supply? Is asthma really just a disease of the airways - airways which have no need of an adequate nerve supply or a competent immune system? Is mental disease merely a causeless disruption of brain function, or is their a possibility that the brain is dependent upon adequate nourishment and absorption of nutrients by the intestine? The answer to such questions is absolutely vital in determining the relevance of reductionist science to modern health care.

Nutrition of course, which may be considered to be the basis of both health and disease, is intrinsically holistic in nature. Every cell of the body is dependent upon an adequate supply of nutrients, absorbed by the intestine, metabolised by the liver, and transported by blood and cell membranes. This nutrient delivery system is both complex and extensive. As has been noted by Williams ( 1 ), "the dispersing of suitable amounts of oxygen and about forty nutrients to billions of cells all over the body is a huge logistic undertaking. It can never be done with absolute perfection, giving every cell at all times exactly what it needs to be most active."

It is for the above reasons that nutritional disorders are particularly likely to cause widespread cellular malfunction throughout the different areas of the body ( 1, 2 ). This type of general cell sickness has been termed "generalised cytopathy" ( 2 ) and contrasts sharply with the modern scientific concept of illness which is commonly considered to be confined to a specific organ or tissue of the body ( 2 ). According to Williams ( 2 ) "this type of general cell sickness unquestionably exists in different degrees whenever even mild nutritional deficiencies exist." Williams continues: "since cellular environments like human environments are commonly not optimal or perfect, this type of illness is probably the most prevalent of all." It should be noted that, unlike orthodox medicine, generalised cytopathy readily embraces the concept of optimum health and the reality of subclinical diseases. In fact, the occurrence of a generalised cell sickness could readily explain subclinical diseases which may be regarded by medicine as being "functional" ( 1 ) or imaginary.

The inability of medicine to understand, or even acknowledge the existence of, subclinical disorders, is one of the more serious failings of reductionist science. Traditionally, diseases which could not be positively diagnosed were often callously dismissed by doctors as being due to hypochondriasis ( 3, 4 ) or somatizing, although the favoured term now is "psychosomatic" ( 3 ). As has been pointed out by Barnes ( 3 ), "there is no justification for a blithe assumption that any complaint for which a physical explanation isn't immediately apparent must be imaginary." Such assumptions of course, are very largely the result of the effects of reductionist science upon the thinking and diagnostic procedures employed by doctors. Even today, any disorder which produces vague systemic symptoms which are not obviously related to a specific organ or anatomic region are likely to be diagnosed as imaginary. Reductionism simply cannot embrace the concept of an holistic illness.

We can see a typical example of this with the disease of hypothyroidism which produces a "cell sickness" which effects the whole body and therefore produces many vague systemic symptoms. Although doctors now accept that it is possible to suffer from hypothyroidism without having the extreme fully fledged syndrome of myxedema ( 3 ), a fact which was only learned by diagnostic mistakes rather than medical training, even with modern scientific knowledge hypothyroidism still commonly remains undiagnosed or misdiagnosed ( see Thyroid page ) because of the intrinsically systemic or holistic nature of the illness. In a reductionist setting, it is hardly surprising that such holistic illnesses are commonly dismissed as being psychosomatic or imaginary.

Since holistic medicine is concerned with any deviation from optimum health, psychosomatic  illness does not form such a prominent part of this form of medicine as it does with reductionist medicine. For instance, although a minor loss of vitality may be dismissed as psychosomatic or subclinical by reductionist medicine, to the holistic practitioner this would be seen as a significant departure from optimum health. Psychosomatic illness therefore, being predominantly an invention of reductionism, has no definite existence in its own right but merely exists because no other disease is diagnosable. In other words, the incidence of psychosomatic or imaginary diseases would be expected to be inversely proportional to the efficiency of diagnostic techniques.

As doctors learn to diagnose, as a result of missed or mistaken diagnosis of patients, what they previously thought were imaginary diseases, the total number of such diseases will continue to decline. According to Hoffer ( 2 ), this process has had a significant impact upon the field of psychiatry where an increasing number of diseases which were once considered psychiatric in nature have been found to have a definite physiological basis. Such diseases of course, then become lost to the field of psychiatry as they are claimed by other medical disciplines ( 2 ). In the words of Hoffer ( 2 ): "it seems as if only syndromes of unknown origin and useless treatment remain within the grasp of psychiatrists."

We must reject as a matter of absolute urgency, medical training which teaches that real diseases conform strictly to the rules of reductionism and therefore may be identified by the fact that they are confined to specific organs or anatomic regions and do not effect the whole body. Health, and ill health, are intrinsically holistic.

References

1. Williams, R.J., Nutrition Against Disease, Pitman Publishing Corp., New York, 1971. 
2. Williams, R.J., Kalita, D.K. (eds), A Physician's Handbook on Orthomolecular Medicine, Keats Publishing Inc., New Canaan, Connecticut, USA, 1979. 
3. Barnes, B.O., Galton, G., Hypothyroidism - The Unsuspected Illness, Harper and Row, New York, 1976. 
4. Langer, S.E., Scheer, J.F., Solved: The Riddle of Illness, Keats Publishing Inc., New Canaan, Connecticut, USA, 1995.