On Monday October 19th 2009, the Daily Express featured the front page Headline ’Vitamin Pill Cancer Risk’. (http://www.express.co.uk/posts/view/134841/Vitamin-pill-cancer-risk-)
The story started as follows: ’VITAMIN supplements taken by millions of Britons do nothing to stave off illness and could even cause cancer, a leading expert warned last night’
Scarcely a week passes without a newspaper telling us that a wonder natural compound in red wine can help beat Alzheimer’s or that German scientists are saying selenium prevents cancer. Then 10 days later they carry articles contradicting that research and saying vitamins are all but worthless. Which is it?
In an attempt to help mere mortals trying to beat cancer understand the benefits and risks of supplements, we have reviewed exactly what the Daily Express’ article said, against the research we have covered in this magazine, and the studies you can find in our research centre Cancer Watch.
The Daily Express used expert research from Professor Martin Wiseman, medical and scientific advisor for the World Cancer Research Fund in their article. WCRF has also published recommendations on the use of supplements for the prevention of cancer on its website: http://www.wcrf-uk.org/preventing_cancer/recommendations/supplement_and cancer.php
What is the truth?
Statement 1. Vitamin Supplements taken by millions of Britons do nothing to stave off illness.
This opening statement of the Daily Express has the potential to mislead as it is an unfounded generalization when referring to all illnesses not just cancer.
Statement 1 is even against Government Health policy on heart disease and blood clotting in babies. For example, there are hundreds of studies from the likes of Harvard, UCLA and MD Anderson in Texas that show that the vitamin supplement folic acid has a positive benefit in heart disease, and for prevention of spinabifida in unborn babies. The WCRF even recommends that certain groups of people can benefit from supplements, and that all women of child bearing age intending to conceive a child should take a folic acid supplement before conception and during pregnancy. The UK Government Health bodies are even talking about including folic acid in a new 5-in-1 pill to prevent heart disease.
As the Daily Express article continues, the initial generalisation contained within the article title is somewhat amended and the reader’s attention is drawn to vitamin E and beta-carotene as the focus of the claim in statement 1. However, the claim still seems dubious. Consider this from top US medical center Memorial Sloan-Kettering in New York (http://www.mskcc.org/mskcc/html/69415.cfm) who state on their web site: ’Studies evaluating vitamin E supplementation suggest that it may improve immune response in the elderly, and slow the progression of Alzheimers disease’, for which it quote 4 references. And, ’Vitamin E was shown to reduce the risk of some cancers’ with 2 references.
The conflicting information on the effect of vitamin supplements undoubtedly leaves cancer patients and their relatives confused about the benefits of vitamin supplements.
Statement 2. People who take high dose vitamin and mineral pills may be doing themselves more harm than good.
Again, this statement is simply too general. It is rather like saying people who take a prescribed cocktail of drugs may be doing themselves more harm than good. (In fact, the latter statement has more research evidence to support it!)
One study reported in the press a couple of years ago on the dangers and risk of death associated with a high dose intake of vitamins and minerals was subsequently exposed as nonsense. We covered it in detain in icon and, of the 20 or so claims listed, one man did die from taking high dose cadmium supplementation, but he had used almost 100 times the Recommended Daily Allowance of the mineral! And that is another problem with Statement 2: Define ’high dose’. What levels are we talking about? The levels of vitamins in the high street supplements have all been significantly reduced in recent years. Arguably they are now all low dose - some would say, too low to do any good!
Statement 3. Professor Wiseman, medical and scientific advisor for the World Cancer Research Fund said, Many people think they can reduce their cancer risk by taking supplements, but the evidence is not there to support it.
Firstly, note the word change from ’vitamins’ to ’supplements’.
Arguably, the generalisation is now even more inaccurate as Tamoxifen is a supplement, when used in cancer prevention, designed to block oestrogen receptor sites, where rural residents of Asia use masses of phytoestrogens instead.
Even if we confine ourselves to ’vitamin supplements’, it still seems an inaccurate statement. For example, there are several hundred studies with vitamin D showing that it definitely does prevent cancer (Professor Hollick of Harvard said that 25 per cent less women would die from breast cancer if they took adequate levels of vitamin D as a supplement). The WCRF itself recommends that pregnant women, nursing mothers, older people and people of Asian origin should take vitamin D supplements. Vitamin D may be generated through the action of sunshine on the cholesterol layers below the skin. A little is found in oily fish. Many of the research studies used supplements.
Another example might be Vitamin K has been shown by Washington University and Tokyo Medical Centres to stop some liver cancers when used in high doses as a supplement. We have covered the research studies in Cancer Watch.
In the US National Cancer Institute’s ’China Study’, 38,000 people in rural China were given different combinations of supplements and followed over a five year period to 1993, against control groups. The group taking vitamin E, beta-carotene and selenium at twice the US RDA saw a 13 per cent decline in cancer death rates and a 21 per cent reduced mortality over the control group.
A similar 7 year study by the French (the SuVi Max study) ended in 2003, this time using 5 supplements the above 3 plus vitamin C and zinc and showed a decline in cancer rate amongst men of 31 per cent and an overall decline in adult cancer death rate by 37 per cent.
The truth is that there is evidence to support a belief that taking supplements may reduce cancer risk. The responsible position is to look into the research to sort out ’which ones?’
Statement 4. Just because a dietary pattern that provides a relatively high level of a particular nutrient might protect against cancer, it does not mean that taking it in a tablet form will have the same effect.
Here the report is absolutely correct. A side-by-side study of freshly prepared orange juice versus a mass-market synthetic vitamin C pill showed that the pill had no antioxidant effect at all, whereas the fresh orange juice kept providing antioxidant activity for more than 24 hours. Researchers suggested that the reason was that synthetic vitamin C had no co-factors, like natural bioflavenoids, to actually ’make it work’.
Other synthetic vitamins are equally unimpressive when compared to the natural version. For example: The natural form of vitamin E in foods may appear in up to 8 variants 4 tocopherols and 4 tocotrienols. But the high street synthetic version has only one (alpha-tocopherol). Similarly natural beta-carotene occurs in both the cis- and trans- forms, but only one is available in the high street synthetic form.
Unfortunately even some scientists seem to get confused about this vitally important difference too. And if they can’t get the science right, what chance has the man or woman in the high street?
To return to what Memorial Sloan-Kettering says on its web site: ’Vitamin E is a fat-soluble vitamin derived from plants. Natural food sources include plant oils, wheat germ, eggs, green leafy vegetables, and whole grains. Vitamin E acts as an antioxidant and is thought to help prevent and treat many diseases’. Absolutely correct; and those natural foods listed will provide all 8 variants of vitamin E in your diet. However the heading for vitamin E, and the research quoted on the Sloan-Kettering web site then only defines Vitamin E as (synthetic) alpha-tocopherol. This is just one of the 8 variants and could not possibly deliver the benefits of all those foods listed: Seven-eighths of the natural activity is missing!
It is no surprise to CANCERactive that these three common ’antioxidant’ vitamins (E, beta-carotene and C) found in the high street most often in the synthetic form seem to do little good.
Statement 5. Rather than protecting people, vitamins A and E may actually cause illness, research has found.
This statement is both true and false!
False: There are several interesting studies on vitamin A and carotinoids preventing and even restricting cancers. One study we covered recently in Cancer Watch showed that natural carotenoids had a big effect on breast cancer.
False, we are learning more and more about the natural tocotrienol forms of vitamin E and they appear (for example, in Japanese and US research) to be offering health and anti-cancer benefits. Unfortunately it appears that synthetic alpha-tocopherol (the only form that the EU permits on British high streets as ’vitamin E’) may actually block the action of two forms of the tocotrienol vitamin E.
True: Vitamin A can damage the liver if too much is consumed. This is why it may be better to take natural beta-carotene (the pre-cursor of vitamin A) and let the body convert what it wants and needs into vitamin A.
True: Amongst the 900 plus research studies on vitamin E there are some, predominantly using the synthetic alpha-tocopherol form, that do show some evidence that this can cause an increase in cancer risk. However, we know of no studies showing either vitamin ’causes illness’, but then we are experts in cancer, not in general illness.
So there is evidence that NATURAL vitamins A and E do protect people from cancer. However, there is also some evidence that using the synthetic version of just one variant form of vitamin E and just one variant form of beta-carotene get decidedly mixed reviews! Unfortunately, if the EU continues to get its way and Codex is passed worldwide, those are all you will be able to buy in a British high street!
Statement 6. US Scientists have also raised doubts about the benefit of multivitamins. They point to the danger of overdosing and bad interaction with prescription medicines.
Any scientist can raise a doubt about anything! US Scientists have raised doubts about the benefits of Tamoxifen and HRT, mammograms and drug cocktails, CAT scans and Taxol. But you don’t see the powers-that-be rushing to ban them because they understand the benefits some people get from them!
Firstly, multivitamins and minerals do have their benefits. For example, the 170,000 person Boston Nurses Study showed that taking a multivitamin and mineral supplement at least 4 times per week was linked with a 40 per cent reduction in colon cancer across a 30 year period.
A recent US study showed 40 per cent of the population was magnesium deficient. Another study showed that our vegetables were 70 per cent depleted in calcium over the last 60 years and osteoporosis is on the increase. Doctors have told patients for years to increase their calcium intake (this now turns out to be wrong - it’s vitamin D and magnesium that matter, but that’s another story!). Yet how many people are told what foods to eat for magnesium and calcium? Surely supplementation has a role?
Yes, there is clearly a danger of ’overdosing’ as the vast majority of the public, are not nutritionists and could quite easily take a B complex vitamin as well as a multivitamin and thus double their dose of certain B vitamins. But this is exactly what the EU reductions in dosage levels are trying to avoid.
However, if we continue to lower doses, will the supplements provide any benefit? It is highly debatable whether the Boston nurses study would have seen the same results using today’s lowered dose multivitamins and mineral supplements.
There is very little research to show that vitamins negatively interact with ’certain drugs’. Even if you go to the several ’Integrative Health’ web sites in the US that are paid for by the drug companies and actually want to highlight such conflict.
This claim borders on mythology, and is often trotted out by ’experts’ who have no knowledge of nutrition. We have repeatedly asked Doctors and researchers to send in evidence of conflict - and in seven years we have received not one single research study!
On the contrary, we have covered separate research by UCLA and MD Anderson, plus a ’mega-review’ by US expert Ralph Moss, all of which conclude that antioxidants can actually help the effects of chemotherapy drugs. We have also covered several specific research studies by MD Anderson each naming the cancer drug and the vitamin that enhances it it’s all in Cancer Watch.
Furthermore, stop and think - the claim is also illogical. If we are being told that synthetic beta-carotene, vitamin E, and vitamin C are almost nutritionally worthless and provide no benefit, how are they going to interfere with anything?
Moreover, if your oncologist is going to tell you that he thinks you will derive more benefit from the UK Government recommendation to eat 5 lots of fruit and vegetables a day, I suppose we must conclude that he believes the vitamin E from your cabbage or the vitamin C from your red pepper does not interfere with his drugs. If we are to believe that the high street ’tablet form is not as effective as the real food’ (See point 3) then surely oncologists would be telling us to avoid food not ’tablets’! Confused? They are!
For your information, we have just reviewed the top 90 cancer drugs for our web site. Only one or two have any research evidence that there might be any negative interaction with foodstuffs and on both occasions it was eggs!
Statement 7. There is evidence that beta-carotene can increase lung cancer risk amongst smokers.
True: After a general study indicated this, some specific research was done in Scandinavia and it did show that synthetic beta-carotene did indeed increase the risk of lung cancer for smokers. If these two studies are correct, then either it highlights a dangerous side-effect of this synthetic high street vitamin (in its limited form). Importantly, how many Doctors are telling smokers that they had better also avoid a whole host of foods including red peppers, yellow peppers, carrots, sweet potatoes, cherries, spinach and tomato juice, to name just a few good sources of beta-carotene. Maybe this just highlights the need for the presence of both variant forms of beta-carotene in the supplement?
Statement 8. There is recent research that selenium does not prevent cancer
True. After numerous studies that either showed selenium (a mineral, not a vitamin) had a significant cancer preventative effect (for example, a recent, major German study on prostate cancer), we have just had a US study that claims there is no effect. The jury is out, and that is what the Daily Express article infers too. Personally, I will keep taking my selenium supplement!
So what is going on??
I wouldn’t wish to criticise Professor Wiseman at all and everybody is entitled to an opinion on public health.
But the real issue is to sort the fact out from the myth; and to try to understand what the Daily Express seek’s to do by writing a front page story on this?
I, for one, think that far better than using the general terms ’supplements’ or ’vitamins’, they should just have referred to synthetic high street vitamin E, beta-carotene and vitamin C.
Whilst there are definitely studies indicating benefit, there are definitely studies indicating lack of benefit and even concern. At CANCERactive, we are not surprised at this. Making a chemical equivalent, often from petrochemical origins, of just a part of an active compound and expecting it to work as well as ’the real, whole thing’, and without the possibility of side-effects, is surely too much to ask. We have seen the side-effect problems of the synthetic supplement HRT. Why should it be any different for synthetic supplement alpha-tocopherol?
Whilst we are talking about these ’synthetics’, let me be 100 per cent clear. These fabrications are ’drugs’ and should be regulated as such. Moreover, in my opinion, they are often the equivalent of Thai copies of Gucci handbags. Why should we be surprised if the handle drops off?
But surely Wiseman and the Daily Express would be better to take the matter up with the EU or Codex. They are, after all, the people arguing for and approving these ’drugs’ for the high street.
We would all rather have all natural vitamin E containing all 8 forms that nature intended; natural beta-carotene with both variants, natural vitamin C with bioflavonoids available in the shops.
A few natural health companies do make these. That they are not commonplace anymore in the high street is down to EU regulation, mass marketing, cost controls and profiteering. We have seen it with mass market ’nutritionally worthless’ breakfast cereals and pasta, and it has taken 30 years for people to wise up that trans fats are bad for you, whilst olive oil is good. And that includes Governments and Food Regulators. Do we really need to go through this learning process all over again for ’vitamins’?
Nutrition research is actually in its infancy. The truth is that there is new and impressive research on other vitamins such as vitamin D and vitamin K and NATURAL COMPOUNDS such as omega-3 (fish oils), resveratrol, quercitin, indole3carbinol, curcumin, linoleic acid, ellagic acid and about 20 others. These are clearly shown to be reduced in mass market food production and so we consume far less than our forefathers 100 years or more ago. Supplementation is virtually essential.
These natural compounds have benefits with all manner of illnesses from cancer to Alzheimer’s but, being natural compounds, they cannot be patented, so they cannot command the sorts of vast profit margins that drugs do from gullible health authorities.
Right now the Pharmaceutical companies are currently working hard on these natural compounds all in an attempt to concentrate them, change them slightly and create synthetic and patentable versions.
To put this in context, with one example, while vitamin D has a mass of impressive research behind it suggesting that it can prevent, and may even help beat, cancer, the vitamin still has its critics and detractors. Yet a synthetic, concentrated vitamin D is currently in stage III Clinical Trials as an anti-cancer agent in California and has been dubbed ’extremely impressive’.
Only time will tell whether the synthetic forms of these compounds bring side-effects. Only time will tell if they work as well as the real thing. Somehow I doubt it.
Maybe Professor Wiseman and the Daily Express would do better addressing their comments directly to the purveyors of these products (the pharmaceutical companies) and the regulators. Maybe they should be leading the case against Codex if they feel this strongly. After all, apparently, worthless vitamin pills that may cause harm is front page news. And the Codex agreement could unleash those on us all.
See also:
Eat Your Vitamins, Vitamin E, Chlorella, Vitamin D, Indole3carbinol, Curcumin, Nutritionals.