There have recently been a number of newspaper that leaped feverishly upon the results of the SELECT research trial that concluded that men supplementing with 400IU of vitamin E had an increased risk of developing cancer. I would like to take a moment to examine this issue both in and with more depth.

Firstly, I think it bears reiterating first and foremost that vitamin E is an essential human nutrients and that attempts to avoid vitamin E intake entirely in an attempt lower prostate cancer risk would be misguided and cause serious health consequences, including potentially fatal disease. Furthermore, Vitamin E deficiency is the most prevalent nutrient deficiency in North America,with an estimate of over 90% of adults not meeting the daily requirements according to a 2004 study published in the Journal of the American Dietetic Association (1).

The role of Vitamin E and prostate cancer prevention seems to be controversial and there is presently no scientific consensus. The following information is provided by the Linus Pauling Institute at Oregon State University.

A recently published meta-analysis of 12 randomized controlled trials concluded that vitamin E supplementation was not associated with overall cancer incidence, cancer mortality, or total mortality(2). However, vitamin E supplementation may possibly reduce the risk of prostate cancer. A placebo-controlled intervention study that was designed to look at the effect of alpha-tocopherol supplementation on lung cancer development noted a 34% reduction in the incidence of prostate cancer in smokers given daily supplements of 50 mg of synthetic alpha-tocopherol (equivalent to 25 mg of RRR-alpha-tocopherol) daily(3). A meta-analysis that combined the results of this study with three other randomized controlled trials associated vitamin E supplement use with a 15% lower risk of prostate cancer (2). However, a large randomized,placebo-controlled intervention study using alpha-tocopherol and selenium supplementation (trial name: SELECT), alone or in combination, was recently halted because there was no evidence of benefit in preventing prostate cancer (4, 5). After an average of 5.5 years of follow-up in SELECT, participants taking vitamin E (400 IU/day of all-rac-alpha-tocopherol) alone had a higher risk of prostate cancer, but the increase was not statistically significant (6). A subsequent analysis (median follow-up of 7 years) after the trial was halted found that men who
took the vitamin E supplement had a statistically significant, 17% higher risk of prostate cancer compared to men who took a placebo (7).

Please note that the result of the SELECT study showing a 17% increase in prostate cancer risk are an anomaly and the reasons for these results, including potential problems with the methodology and data interpretation, are currently being debated. The form of vitamin E used in this trial was also synthetic, and there seems to be a greater tendency for synthetic vitamin E to produce negative results in trials.

Furthermore, the results of The Selenium and Vitamin E Cancer Prevention Trial (SELECT), also showed that group receiving either selenium or selenium plus vitamin significantly reduced their risk of prostate cancer, though this is largely ignored by the research in their conclusions on the trial, and in the media reporting.

If one were to err entirely on the side of caution, it is worth noting that many of the studies showing negative or conflicting results are with higher dosage vitamin
E (>400IU per day) of synthetic alpha-tocopherol only. There are no negative reports using mixed tocopherols that we are aware of, nor do there seem to be negative reports involving supplementation of equal to or less than 200IU per day.

Furthermore, there is ample, compelling positive research behind vitamin E supplementation for other health conditions.

Vitamin E has an effectiveness rating according to the Natural Medicines Comprehensive Database for the following conditions (Please note this list in not comprehensive: research citations are available though the website at http://naturaldatabase.therapeuticresearch.com):

Age-related macular degeneration (AMD). Taking vitamin E 400 IU orally, plus elemental zinc 80 mg, vitamin C 500 mg, and beta-carotene 15 mg daily seems to provide a risk reduction of 27% for visual acuity loss and a risk reduction of 25% for progression of AMD in patients with advanced AMD. Some research suggests that increasing dietary intake of vitamin E, either alone or along with increasing dietary vitamin C, beta-carotene, and zinc, seems to decrease the risk of developing AMD.

Alzheimer's disease. There's some evidence that all-rac-alpha-tocopherol (synthetic vitamin E) 2000 IU per day is similar to selegiline (Eldepryl), and superior to placebo, for slowing cognitive function decline in patients with moderately severe Alzheimer's disease. But there doesn't appear to be an additive effect when vitamin E is used in combination with selegiline (Eldepryl).
Retrospective data suggest that long-term combination therapy with donepezil (Aricept) 5 mg and vitamin E 1000 IU per day may help slow cognitive decline in patients with Alzheimer's disease.

Anemia. Two small studies in adults and children on chronic hemodialysis have shown improved response to erythropoietin with vitamin E supplementation. In one study, children given vitamin E 15 mg/kg in combination with erythropoietin had significantly increased hemoglobin (Hgb) and hematocrit (Hct) levels after 2 weeks of combination treatment compared to eight and five weeks in patients without combination treatment. In the other study of adults, concurrent supplementation with vitamin E 500 mg daily allowed dose reductions of erythropoietin from an
average of 93 U/kg/week to 74 U/kg/week with the same results on Hgb levels.

Bladder cancer. Taking vitamin E 200 IU orally for greater than 10 years seems to be associated with a reduced risk of bladder cancer mortality.

Cisplatin-induced neurotoxicity. Alpha-tocopherol administered before chemotherapy, and continued for 3 months after the completion of treatment, seems to reduce the incidence of peripheral neurotoxicity by 55% without affecting cisplatin efficacy.

Common-cold: A randomized, placebo-controlled trial in elderly nursing home residents reported that daily supplementation with 200 IU of synthetic alpha-tocopherol (equivalent to 90 mg of RRR-alpha-tocopherol) for one year significantly lowered the risk of contracting upper respiratory tract infections, especially the common cold, but had no effect on lower respiratory tract (lung) infections.

Dementia. A longitudinal cohort study of 3,385 elderly men aged 71 to 93 years found that men who consumed supplemental vitamin E and vitamin C had a decreased risk of developing vascular and mixed or other dementias; however, there was no protective effect for Alzheimer's dementia. This study did not distinguish between different forms of vitamin E.

Dysmenorrhea. Taking vitamin E 200 IU twice daily or 500 IU daily starting 2 days before menstruation and continuing through the first 3 days of bleeding seems to reduce menstrual pain severity and duration and decrease blood loss in teenage girls with primary dysmenorrheal.

Huntington's disease. RRR-alpha-tocopherol (natural vitamin E) can significantly improve symptoms in patients with early Huntington's disease, but this benefit is not seen in patients with more advanced disease.

Infertility. In one study, males with asthenospermia or oligoasthenospermia, receiving oral vitamin E supplementation, achieved impregnation at a rate of 21% compared to none for similar patients receiving placebo. In another study, males enrolled in an in vitro fertilization program who had previously had low fertilization rates were treated with oral vitamin E for three months. Fertilization rates increased significantly from 19% to 29% after one month of treatment. In a crossover trial, males found to have elevated reactive oxygen species in their semen, which might be associated with infertility, were treated with oral vitamin E. After treatment, in vitro sperm binding to the zona pellucida was significantly increased. Interestingly, high-dose vitamin
E in combination with vitamin C does not seem to offer any benefit to sperm functionality. Vitamin E plus selenium seems to improve sperm functionality. Studies did not differentiate between different forms of vitamin E.

Ischemic stroke. Some clinical research shows that taking all-rac-alpha-tocopherol (synthetic vitamin E) might reduce the risk of ischemic stroke in male smokers with hypertension and diabetes. A meta-analysis of studies shows that vitamin E in doses of 300-800 IU daily,
including both natural and synthetic forms, does not significantly affect total stroke risk.
However, it significantly reduces the risk of ischemic stroke by 10%. This means that one ischemic stroke will be prevented for every 476 patients taking vitamin E. In contrast to this finding, the analysis also found that vitamin E increases the risk of hemorrhagic stroke by 22%. This means that there will be one additional hemorrhagic stroke for every 1250 patients taking vitamin E.

Nonalcoholic steatohepatitis (NASH). In adults with NASH, taking vitamin E 800 IU daily for 24 months significantly improves liver enzymes, hepatic steatosis, and lobular inflammation. Other research also shows that taking vitamin E in combination with vitamin C might improve hepatic fibrosis in patients with NASH. However, it does not seem to affect inflammation. Taking vitamin E 400-1200 IU in children with NASH also seems to improve liver enzyme levels after 4-10 months of treatment.

Parkinson's disease. Preliminary evidence suggests that dietary vitamin E intake might be associated with a decreased occurrence of Parkinson's disease. But taking all-rac-alpha- tocopherol (synthetic vitamin E) 2000 IU supplements daily does not seem to have any benefit for patients who have Parkinson's disease.

Pre-eclampsia. Taking a combination of vitamin E 400 IU and vitamin C 1000 mg daily significantly reduced the risk of proteinuric hypertension in high-risk women when started in weeks 16 to 22 of pregnancy. Other researchers using vitamin E in combination with vitamin C and allopurinol beginning at 24 to 32 weeks gestation found the combination similar to placebo.

Premenstrual syndrome (PMS). Taking vitamin E orally seems to reduce symptoms of anxiety, craving, and depression in patients with PMS.

Physical performance. Population research suggests that increasing intake of dietary vitamin E is associated with increased physical performance and muscle strength in elderly people.

Rheumatoid arthritis (RA). Vitamin E taken orally in conjunction with standard therapy is superior to standard therapy alone for reducing pain in patients with RA.

While it may seem that the last thing the press wants is a multifaceted debate, the majority of the evidence does not support the damnation that vitamin E supplements have received in the press, and it would be far more beneficial to their readers to bear this out more in the reporting of health news.

There are doubtless people are more at risk of the adverse effects of supplementing any substance, but knowledgeable healthcare professionals who are intimately familiar with their patients are the best people for assessing these risks, not the media.

And fear mongering has no place in patient care.

References:

1. Maras JE, Bermudez OI, Qiao N, Bakun PJ, Boody-Alter EL, Tucker KL. Intake of

alpha-tocopherol is limited among US adults. J Am Diet Assoc. 2004;104(4):567-575.

2. Alkhenizan A, Hafez K. The role of vitamin E in the prevention of cancer: a meta-
analysis of randomized controlled trials. Ann Saudi Med. 2007;27(6):409-414. (PubMed)

3. Heinonen OP, Albanes D, Virtamo J, et al. Prostate cancer and supplementation with
alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl
Cancer Inst. 1998;90(6):440-446. (PubMed)

4. Klein EA, Thompson IM, Lippman SM, et al. SELECT: the next prostate
cancer prevention trial. Selenum and Vitamin E Cancer Prevention Trial. J Urol.
2001;166(4):1311-1315. (PubMed)

5. National Cancer Institute. Review of Prostate Cancer Prevention Study Shows No Benefit
for Use of Selenium and Vitamin E Supplements. [Web page]. Available at: http://
www.cancer.gov/newscenter/pressreleases/SELECTresults2008. Accessed 10/28/08.

6. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on risk of
prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial
(SELECT). JAMA. 2009;301(1):39-51. (PubMed)

7. Klein EA, Thompson IM, Jr., Tangen CM, et al. Vitamin E and the risk of prostate
cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA.
306(14):1549-1556. (PubMed)

One of the things that I have noticed practicing is that many people do not have an accurate gauge of either how much calories they need daily nor how much they are actually getting from their meals. It is very difficult with the amount of nutritional knowledge available from both the education system and the media to also truly understand the nutritional value of foods in term of density of essential vitamins and minerals, fibre, high quality protein, fibre and slow-digest carbohydrates, and essential fatty acids. In the absence of this information, people tend to assume that there needs are being met by their food, regardless of what it is, and that calorically, it probably isn't all that bad. However, the ever increasing trend towards obesity and diet-related illness demonstrates that those assumptions are often horribly flawed

Therefore, it comes as little surprise that people are thirsty and receptive to nutritional information when readily available. The following in an excerpt from a Science direct article:

People Will Make Healthier Choices If Restaurants Provide Nutritional Data, Study Finds

ScienceDaily (Mar. 31, 2009) — As more and more Americans eat meals outside the home, the country also faces an epidemic of obesity. An association between eating out and weight-related diseases has led to demands for nutritional labeling of restaurant foods. A new study examines the potential benefits of such labeling.

"Using only the sense of taste, smell, and sight to accurately estimate the levels of calories, saturated fat, trans fat, and sodium found in a typical restaurant food serving is extremely difficult, if not impossible, for most consumers," write authors Elizabeth Howlett (University of Arkansas), Scot Burton (Sam M. Walton College of Business), Kenneth Bates (University of San Diego), and Kyle Huggins (James Madison University).

The authors set out to examine how providing calorie and nutrient information on restaurant menus and menu boards influences consumers' food-related evaluations and choices. They looked at how participants' prior expectations came into play and whether providing calorie and nutrient information after the consumptive experience changed their subsequent food choices.

The researchers found that providing nutritional information can influence subsequent food consumption, especially when consumers' expectations are not fulfilled when they examine the information. "When a 'great taste' claim was used to describe a restaurant menu item, the provision of calorie information did not affect consumers' perceptions, presumably because foods that claim great taste are typically expected to be relatively high in calories," the authors explain. "On the other hand, when a 'low calorie' claim was presented but the menu item was higher in calories than expected, the provision of nutritional information increased the perceived likelihood of 1) gaining weight and 2) developing heart disease."

The study shows that nutritional information can help consumers moderate their eating over time. In one study, participants ate a sandwich that they later found was unexpectedly high in calories. After this discovery, the participants consumed fewer snacks throughout the rest of the day.

This research further highlights the need for a governmental directive to require this information to be readily available. Please don't hesitate to add your voice to the many in demanding that this be legislated so that Canadians can make healthier choices more easily. Health Minister Leona Aglukkaq can be reached via http://www.hc-sc.gc.ca/contact/ahc-asc/minist-eng.php

I have recently had the pleasure of being interviewed on the CHLY radio program "A Sound Constitution" by Vancouver Island University nursing student Candace Buckler.

We talked about the various roles of water is human physiology, including some of the side effects of chronic dehydration, vulnerable populations, bottled water, and related health issues.

Click on the link to the podcast to hear all the latest.

Nourish Nutritional Therapy has gone back to being a mobile practice. Thanks to the good people at Heart Quest for hosting us for the summer. Take care, and we'll see you at the place of your choosing in the future.

Friendly flora, or probiotics, are defined as “live microorganisms which when consumed in adequate amounts, confer a health effect on the host”. There are between 400-700 different species of literally trillions of organisms living throughout the intestines; the greatest concentration of bacteria is in the colon, building up from the end of the small intestine in the ileum. The organisms referred to as intestinal probiotic bacteria include Lactobacillus acidophilus, L. bulgaricus, L. casei, L. rhamnosus, L. Plantarum, and the bifidobacteria Bifidobacterium bifidum, B. longum, and B. infantis. Friendly flora also includes organisms such as the yeast, Saccharomyces boulardii, which is very effective (more so than Lactobacillus or Bifidobacteria) in controlling the proliferation Clostridium difficile (C-diff) – a bacteria that is rampant in hospitals and causes potentially fatal ulcerating diarrhea.

The impact of bowel flora on health continuously being examined by medical researchers, and journals such as the American Journal of Clinical Nutrition are constantly giving us new food for thought on their importance. One recent issue to crop up and further complicate bowel health is the presence of genetically modified organisms (GMOs) in the food supply. GMO’s are present in 60% of processed, pre-packaged, and fast foods – all staples of Standard North American Diet.  Many believe with good reason that they pose grossly under-researched potential dangers. Processed food giants Nestle, Quaker, Kraft, Nabisco, Kellogg’s, Heinz’s, Pepsi, and Coca Cola (to name a few) use common GMO ingredients and derivatives from soy, sugar, corn, canola, and cotton in virtually all of their products . Even in the EU, which has banned GMO’s for human consumption, copious amounts of GMO feed are given to livestock all over the world which are consumed by humans, and tests confirm the presence of GM DNA in animal feces, casting doubt as to the presence of any truly GMO-free food left in the world.  All GMO’s have an antibiotic marker gene for identification which could confer antibiotic resistance to pathogens, and may have antibiotic properties, causing speculation that these genes could have the same negative impact on bowel flora that medicinal antibiotics do, though proper research is still pending. University of Newcastle research found that patient who had undergone a colostomy retained GM DNA in their small intestines, while those with complete bowels were able to remove all detectable traces of it, illustrating again the importance that bowel flora have in detoxifying even altered genetic material.
 

Probiotic bacteria are the foundation of long-term health. If you are at all concerned about your bowel and immune health, or have done a course of antibiotics, consult your health professional about your probiotic status.

Starting this month in May, Nourish Nutritional Therapy will be practicing Monday's out of Heart Quest, a multi-disciplinary clinic at 204-2250 Commercial Drive, Vancouver, BC.

Please check the calendar for hours, and I look very much forward to meeting you the new location. Take care.

Dear Nourish Clients,

This is just a quick note to let you know that I will be away from April 23-27 doing another clinical practicum at my university in London. I will be back soon though, and I hope to see you all then. Take care and best wishes.

Vanessa

Thank you all for coming to visit my site. I am happy to after years of training be ready to make nutritional therapy my vocation, and to offer some much needed assistance to those struggling their health and diet.

There has been a great deal more media attention to questions of diet and chronic health problems, and refreshingly, there has also been a good deal of creative minds setting about to try to change it.

My favourite among these is Jamie Oliver, hands down.  He is a British chef who successfully changed Britian's school lunch program, and has gone on to the statistically most unhealthy city in the US to attempt the same there.

He has passion and insight, and is dedicated to changing how people have come to view food as being secondary to their lives, something incidental that you remember to mind when you're hungry. And he is also funny and honestly appalled over it. I have become quite addicted to his show actually: he doesn't even try to force people to make radical changes. He simply wants us to understand that food should be REAL. Nevermind, vegan, raw-food, macrobiotic…the problem is much more basic than that. A startling number of people in the developed world never eat freshly prepared, unprocessed food. Even regular pasta with vegetables and home-cooked tomato sauce is alien to them. And that is the experience and the relationship to food that must be remedied before anything else.

I hope you enjoy this opening clip of the show, and come to follow it and cheer for Jamie as I have.

Jamie Olivers Food Revolution on Youtube

Welcome to my site. 

I'll be adding blog posts very soon. 

Have a look around and if you have any questions just give me a call or email me.  I'm here to help you with your health. Thanks