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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.

"It remains possible that out of the blue, from the observation of a single patient, from local folklore, or even from alternative medicine, some principle that is of value emerges. After all, that is how medicine started with “willow bark” and “foxglove”; we ended with salicylates and digitalis...................The extreme challenge presented by alternative medicine is that some trials have positive findings when that is impossible; this situation leads us to reflect that the same happens in conventional medicine...........We should be grateful for debates about alternative medicine: They open our eyes to the nature of our reasoning in conventional medicine. We should forever keep an open mind......."

Jan P. Vandenbroucke and Anton J.M. de Craen (7).

There is No Truth Other Than Evidence Based Medicine

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
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):
 

"When only one method of knowledge production is promoted and validated, the implication is that health sciences are gradually reduced to EBHS (evidence-based health sciences). Indeed, the legitimacy of health sciences knowledge that is not based on specific research designs comes to be questioned, if not dismissed altogether. In the starkest terms, we are currently witnessing the health sciences engaged in a strange process of eliminating some ways of knowing. EBHS becomes a ‘regime of truth’, as Foucault would say – a regimented and institutionalised version of ‘truth’."

But Holmes and colleagues go further, likening EBM to the "Newspeak" described by  George Orwell (2):

"We argued above in terms that resonate immediately with Orwell’s totalitarian vision: The EBHS seldom question the authority of their own discourses, but deploy them unknowingly – they risk becoming the servo-mechanism of their own technology, unable to conceptualise the terms that would lead them to think outside this narrow world view. And indeed, why should they, when they can enjoy institutional promotions and accolades, public recognition and state contracts of all kinds? EBM and its related concepts are highly promoted in academic spheres, so much so that a research article free from these taken-for-granted concepts risks being labelled as scientifically unsound. Applying the work of Orwell in a critique of EBM in health sciences might surprise the reader; however, after an in-depth reading of 1984, we feel that Orwell’s vision is gradually becoming a reality. Currently, a large number of scholars in the health sciences follow their colleagues in medicine down a narrow path leading to uniformity and intolerance. There is therefore in our opinion, the creation and advancement of a new ‘language’ that is supplanting all others, attempting to discredit or to eliminate them from the discursive terrain of health. This is scientific Newspeak. It is a highly normative and recalcitrant scientific language that stands in opposition to that sense of hope that sustains every freedom-loving individual."

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):

"Perhaps the most worrying feature of EBM, and the one which most clearly betrays its non-scientific nature, is the fact that its advocates do not answer criticism. A magisterial attitude of lofty disdain for contradictory viewpoints is the norm in government circles where power is asymmetrically distributed and the agenda is controlled. Similarly there has not been any substantive debate about EBM, merely a one-sided onslaught of NHS/BMJ-subsidized propaganda. Dissenting views are muzzled, marginalized, met by non-sequiturs, or disappear into an echoing void. Backstairs wheeling-and-dealing has substituted for public discussion."

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: (organismarrow rightorganarrow rightreceptorarrow rightorganellearrow rightsubstratesarrow rightpathwayarrow rightenzymearrow rightgene). 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 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):

"Ames and others argue that vitamin and mineral deficiencies are common, present a serious health risk and can be corrected by supplementation. Human studies are exceedingly difficult when the goal is to establish evidence based arguments for or against taking supplements, establish a hierarchy of supplements, i.e. which are the most important, and determine what are the optimum amounts of each micronutrient. This is especially true if the goal is to investigate their impact on all aspects of health, from in utero to old age. There are too many variables, too much human variability, too many important endpoints, too many confounding factors, and too few cellular level biomarkers. Financing for intervention studies can be difficult to obtain since pharmaceutical companies, which typically assist in financing large clinical trials, have little or nothing to gain— vitamins and minerals cannot be patented. Also, because of inherent difficulties in achieving good design, execution and statistical power, studies that attempt to connect micronutrients with disease or health have proved to be very easy to criticize or dismiss as inconclusive."

As Ware points out (12):

"Those who refuse to consider micronutrient or antioxidant supplementation unless their effectiveness and safety have been examined in North American double blind, randomized, placebo controlled clinical trials for any endpoint required by a suggested use will probably wait a long time. These five antioxidants cannot be patented and offer no profit potential to the pharmaceutical industry."

Ware questions the wisdom of waiting for the blessing of mainstream medicine before using supplements (12):

"Thus while the free radical theory of aging and its related focus on mitochondrial decay appears to be accepted by the scientific community, individuals wishing to take action must realize that they are translating theory into a self-designed intervention program. But if the mix of micronutrients, and antioxidants in particular, is highly likely to be harmless at the doses used, it is hard to argue against this action, given that waiting for the blessing of mainstream medicine may require waiting for a period considerably exceeding ones life expectancy."

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):

"Many standard research methods are simply not applicable to CAM, and even where they are, effectiveness is a much more important means of assessing CAM than simply efficacy. Researchers however, must be conscious of the political motivations behind much of the demand for EBCAM (evidence-based complementary and alternative medicine)*. Where such demands are coming from allopathic medicine, they clearly form a continuing part of medical opposition to CAM and may be intended to perpetuate the dominance of the biomedical paradigm in healthcare."

*Definition added.

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.

 

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.
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 optimum nutrition is concerned one of the major difficulties for mainstream medicine which has resulted from the restrictive nature of reductionist science is the inability to understand the interdependent nature of nutrients ( 3-5 )*. Although all nutrients are part of a constructive team the overall strength of which is only as good as its weakest link ( 3-5 )*, modern medical science prefers to use nutrients singly, as though they are drugs ( 3-5 )*. Such a belief seems rather odd since most people, even scientists, do not consume ( 3,123 )* 'tryptophan on Monday, ascorbic acid on Tuesday, calcium on Wednesday etc.,' but rather consume balanced meals containing a broad range of nutrients. In fact, we are constantly reminded of the importance of balanced wholesome meals. In spite of this, science tells us that if we break the meal down into its constituent nutrients it is quite acceptable, and even scientific, to test these nutrients singly as though they are drugs. It is however, the fundamentally constructive nature of nutrients which distinguishes them from drugs. As is noted by Williams and co-workers ( 3, 5 )*: 'if a medicine were to act constructively, it would cease to be a medicine. It would be a nutrient.'

According to Williams (4 )* it is the inability of modern medical science to understand the teamwork nature of nutritional therapy which has resulted in the persistent misuse of clinical trials in attempts to demonstrate the clinical effectiveness of single nutrients. While drugs may be so tested because they do not rely on the presence of other drugs for their effectiveness, a nutrient on the other hand will only be maximally effective if it is the only missing link or limiting factor in the trial participants. Associated deficiencies will detract from the effectiveness of the trialled nutrient, a fact which seems to be little understood by medical scientists. As has aptly been pointed out by Williams (4 )*, nutrients 'work together, and no one of them can be tested as though it were an independent agent working by itself.' Williams draws attention to the enormous amount of money and resources which have been wasted on nutritional research simply through failure to understand the teamwork nature of nutrition ( 4 )*: 'up to now much of this money and effort has been wasted simply because we have failed to appreciate adequately that nutrients are always involved in teamwork; we have allowed preconceived notions, gained from our centuries-old experience in testing drugs, to dominate our thinking.'

To demonstrate the importance of the teamwork nature of nutrition Williams ( 4 )* cites the case of two trials of the effects of nutritional supplements upon tuberculosis patients ( 136, 137 )*. The first trial ( 136 )*, which used nutritional supplements which were lacking significant nutrients such as B5, B6, B12, folic acid and vitamin E, failed to reveal significant improvements in the supplemented patients. The second trial ( 137 )* ensured firstly that ALL participants were well nourished, while one group was additionally given a broad range of nutritional supplements. Williams describes the results in the supplemented group ( 4 )*: 'there was more improvement in chest X rays; more patients were discharged as cured; most patients had improved appetites; as a whole, they gained weight about twice as fast as the control group; and they showed .decreased restlessness and demand for attention.' Although the control group in this study was 'exceedingly well nourished' and the supplements used were 'not up to modern standards 'even at that time, the differences between the groups were nevertheless described as 'impressive' (4 )*."

* See Nutrition & Megavitamins for references.

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):

"In order to fully evaluate the progress of mainstream medicine in nutritional science over the past few decades it is appropriate to mention again the four fundamental principles of nutrition cited by Williams and colleagues three decades ago ( 5* ). Since Williams and colleagues noted at that time that these principles had yet to be adopted and applied by mainstream medicine it is pertinent that we explore progress in this regard. Let us examine these principles.
  1. Food is part of our environment and forms our internal environment. The fact that medicine still prefers toxic drugs as a first treatment option continues to show flagrant disregard for this principle which involves a general understanding and respect for the internal milieu. The reductionist interventionist approach of science is not conducive to understanding and applying this principle. 
  2. Suboptimal nutrition prevails in nature.  Although there has been limited acceptance of the importance of antioxidants, the wider perspective which comes from understanding this general principle is still seriously lacking.
  3. Individuality is a crucial factor in nutrition. Although significant gains have been made in this area, there is still a serious lack of appreciation of the general principles involved. Progress is made on a slow case by case basis rather than by an understanding of the underlying principles. However, it is indeed gratifying to see science finally proceeding in the right direction.
  4. In nutrition, teamwork is essential. Sadly, in this regard medicine appears to have learnt absolutely nothing."

* See Nutrition & Megavitamins for references.

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):

"In a follow up interview about the proceedings of the conference, particularly the effect of vitamin E upon heart disease, Machlin ( 159 )* claims that preoccupation with "dietary fat as the main nutritional risk factor for cardiovascular diseases" has "probably slowed scientific progress." But Machlin also claims ( 159 )* that the matter of vitamin E and heart disease "was a field that had to be approached quite cautiously" because we are "still living under the shadow of the reports of the Shute brothers that were derided by most of the medical community." The Shute brothers of course, pioneered the use of large doses of vitamin E to treat heart disease at a time when medicine was obsessed with drugs and paranoid about vitamins ( 3, 42, 55, 56 )*. It is interesting to note that, according to Machlin ( 159 )*, the medical profession's "caution" regarding vitamin E was not because of its toxicity or because the Shute brothers were unsuccessful with their use of this vitamin to treat heart disease, but rather simply because they had been "derided by most of the medical community." As has been pointed out by Hoffer ( 11 )*, the refusal of the medical profession to acknowledge and accept the work of the Shutes has resulted in an enormous amount of human suffering. It is a tragedy that medicine was not equally cautious about the use of toxic iatrogenic disease causing drugs.

In a subsequent incriminating comment about the attitude of mainstream medicine to nutrition, Machlin ( 160 )* claims that following the elimination of classical vitamin deficiency diseases and the establishment of the RDA's "vitamin research appeared to languish." This period of "languishing" vitamin research of course, was characterised by the extensive and brilliant research of Williams, Hoffer, Pauling, the Shute brothers, and many others. To describe the contribution of these famous pioneers as languishing research is absolutely despicable. Perhaps Machlin was drawing attention to the fact that vitamin research just "appeared" to him to have languished. However, if the work of the Shutes had not been "derided" by most of the profession, perhaps nutritional research would not have had this languishing appearance. Medicine continues to reveal an extremely ugly and mercenary underside by its absolute determination to resort to any degree of vitriol and personal vilification to ostracise and destroy anyone who supports nutritional therapies. On the other hand, medicine regards perpetrators of medical disasters such as that caused by thalidomide with infinitely higher regard
."

* See Nutrition & Megavitamins for references.

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?):

"Perhaps the best known example of the difference between natural and synthetic vitamins is vitamin E, scientific evidence having clearly demonstrated the superiority of the natural form of this vitamin (  51, 95, 158 )*. From a quackery perspective, the recent history of vitamin E is indeed interesting. In 1972 nutrition students were taught that the only form of vitamin E with significant vitamin activity was alpha- tocopherol, all the other tocopherols and tocotrienols existing for no reason since they had no significant vitamin activity ( 93 )*. In 1996 however it was reported that heart disease patients were deficient in gamma- tocopherol and not alpha- tocopherol which is the form that is in virtually all supplements ( 95, 159, 160 )*. Subsequently it has also been shown that gamma- tocopherol, the predominant form of vitamin E in foods, and mixed tocopherols, are more effective forms of vitamin E than the universally used alpha-tocopherol ( 76 , 95, 158, 160, 161, 162, 164, 165, 168, 169, 170 )*. In fact, supplements of alpha-tocopherol actually may prevent uptake of gamma- tocopherol by cells and lower cellular vitamin E levels ( 158,160, 161, 168 )*. Additionally, food forms of vitamin E (mainly gamma- tocopherol ) have been shown to reduce heart disease deaths while alpha-tocopherol was ineffective ( 162 ). According to Chen and colleagues ( 76  )* the ineffectiveness of vitamin E in some clinical trials may be due to the use of alpha- tocopherol alone. Evidence increasingly indicates that the entire family of eight vitamin E compounds ( alpha, beta, delta and gamma tocopherol and alpha, beta, delta and gamma tocotrienol ) may have significant health benefits."

* See Holistic or Reductionist?  for references.

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):

"In the 1960s, Kilmer McCully was fired by Harvard Medical School because he had the nerve to state that lack of vitamin B12 and folic acid causes heart attacks and strokes. He was forced to leave the prestigious Massachusetts General Hospital for a small hospital in Rhode Island because he preached what other doctors called quackery. Today, his theories are solid and the quack is now a respected prophet."

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 nextScience 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):

"An expanding body of evidence support that members of the vitamin E family are functionally unique. In recognition of this fact, title claims in manuscripts should be limited to the specific form of vitamin E studied. For example, evidence for toxicity of a specific form of tocopherol in excess may not be used to conclude that high-dosage "vitamin E" supplementation may increase all-cause mortality. Such conclusion incorrectly implies that tocotrienols are toxic as well under conditions where tocotrienols were not even considered."

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):

"Disappointments with outcomes-based clinical studies testing the efficacy of alpha-tocopherol need to be handled with caution and prudence recognizing the untapped opportunities offered by the other forms of natural vitamin E. Although tocotrienols represent half of the natural vitamin E family, work on tocotrienols account for roughly 1% of the total literature on vitamin E. The current state of knowledge warrants strategic investment into investigating the lesser known forms of vitamin E."

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):

"The possible factors implicated for failure of vitamin E therapy include the following: (1) the inclusion of patients without biochemical evidence of increased oxidative stress, (2) the relatively short duration of treatment, (3) the use of suboptimal dosages of vitamin E, (4) the suppression of gamma-tocopherol by alpha-tocopherol, (5) the use of vitamin E supplementation without the concurrent use of vitamin C, (6) the lack of inclusion of biochemical markers of oxidative stress and markers of vascular response, (7) the inappropriate administration of vitamins relative to meal ingestion, and (8) the poor patient compliance and the lack of monitoring of vitamin E levels."

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):

"For vitamin E, there have been suggestions that gamma tocopherol is a more powerful antioxidant. Supplementation with alpha tocopherol depletes gamma tocopherol, which may explain the lack of effect seen in vitamin E trials. Single antioxidants may not reflect the complex vitamins and nutrients found in foods, which may explain the discrepancies between most intervention trials and studies of fruits and vegetables."

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):

"The distortion in question concerns the assessment of women who participated in a nine year trial measuring the effects of vitamins E and C. According to the results published in the Archives of Internal Medicine, women who took these vitamins on a regular basis experienced a remarkable and statistically significant reduction in stroke risk (31 percent) and heart attack risk (22 percent). Not all the women in the study, of course, actually took the vitamins on a regular basis, and when you count the results of those women who never took the vitamins, the study shows no statistically significant benefits for vitamins E and C. In other words, the vitamins didn't work on those who didn't take them. (Is this surprising to anyone?) The mainstream media has taken hold of this statistical distortion and declared that antioxidants are now useless for preventing heart disease."

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):

"A new randomized, double-blind, placebo-controlled cardiovascular study evaluating natural vitamin E, synthetic vitamin C, and synthetic beta-carotene shows that natural vitamin E significantly reduced heart disease and is a wonderful dietary supplement for any person concerned about their heart and cardiovascular health......In an absolutely unbelievable reporting of their own study information the authors erroneously concluded “There were no overall effects of ascorbic acid, vitamin E, or beta carotene on cardiovascular events among women at high risk for cardiovascular disease.” This is a flat out lie based on their own study data that they report in the American Medical Association’s Archives of Internal Medicine. They concocted this false and misleading conclusion by including the people who said they were supposed to be taking vitamin E but really didn’t take the vitamin E in the final statistical analysis. The study participants who actually took the natural vitamin E had the dramatic benefits listed in the first paragraph, which the authors failed to report in the study abstract. Instead, the authors fed a false and negatively slanted view of the study to the media, none of whom bothered to check the actual study. The media then proceeded to spread a false negative view of truly remarkable findings on vitamin E and heart health.

Taking a Closer Look at the Study Results
The following two paragraphs are what the study actually says about vitamin E. The first paragraph says that vitamin E did not do much of anything, which is what the authors reported. The second paragraph says that when they re-evaluated the Vitamin E data by removing people from the vitamin E group who failed to actually take the vitamin E, the results were extremely good. This is the important information about what natural vitamin E actually did. The authors didn’t tell the media about this and the media didn’t bother looking into the study
."

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):

"We considered several possible biases that could be responsible for the observed associations. Early-stage or localized prostate cancers are particularly prone to detection bias with current PSA-screening practices (17). The increased risk of localized prostate cancer with heavy multivitamin use among men concomitantly using a vitamin E, selenium, or folate supplement could be due to detection bias if supplement users were more likely to undergo PSA screening. In our study, prostate cancer PSA screening was most frequent among heavy users of multivitamins, consistent with survey data (18) showing men who used supplements were more likely to have PSA examinations than nonusers. Thus, it is possible that the positive association with heavy use of multivitamins along with certain supplements was spurious because more intensive screening led to increased diagnosis of localized prostate cancer in groups that used the supplements."

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:

"Let us cease merely 'dabbling' in nutritional research ( 3, 123, 293 )* and give this matter the attention it deserves. According to Williams and colleagues ( 3, 5 )* what is needed is a change in the fundamental philosophical direction of medicine: 'scientifically, nutritional science is a mere shadow of what it will be when medical science throws its weight behind its development by promoting a health-oriented instead of a disease-oriented discipline.' This fundamental change in medical philosophy must result in the matter of nutrition being regarded much more seriously by medical schools ( 293 )*: 'the future of nutritional science is bright and unparalleled, provided we cease merely dabbling into nutritional problems and carry out in our medical schools and elsewhere extensive and intensive study and research'."

* See Nutrition & Megavitamins for references.

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.