Tuesday, August 14, 2007
Antioxidants not all they're cracked up to be?
One of the questions I get the most as a doctor has to do with antioxidants. No surprise, given that around a third of the nation's adults take them. The claims about their benefits range from anti-aging to memory preservation to warding off heart disease. Truth is, there isn't nearly as much research into these supplements as I would like. So, for a long time, there were a few small studies that people would use to support their arguments either for, or against, taking antioxidant supplements.

That is why I was so interested in one of the largest studies looking specifically at the effect of three different antioxidants and heart disease in women. The researchers looked at almost 8,200 women who were at risk of heart disease and followed them for almost 10 years. The bottom line: While there was no harm from the antioxidants, there was no benefit as well.

Still, there is no doubt that eating food high in antioxidants is heart healthy. So, where is the disconnect? Well, it most likely has to do with the fact that fruits and vegetables are loaded with all sorts of things. Besides the antioxidants, there is fiber and certain micronutrients that may play a significant role in the way our body absorbs the precious antioxidants. In short, simply taking the "good stuff" out of food and putting it into a pill doesn't seem to work so well, because food packages things much better than we can.

So, why is it that we as Americans continue to spend billions of dollars a year on something that doesn't have a lot of data showing that it even works or is beneficial? Is it blind faith or do you think the science is just slow to catch up?
I think the disconnect may come from the quality of the supplements used in the study. If you look in the Comparative Guide to Nutritional Supplements you can easily see how most over-the-counter supplements do nothing for your body while a very select few (3 companies in particular) are manufactured to pharmaceutical standards and are actually readily absorbed and utilized by the body. I would like to see a study of this magnitude done with some of these pharmaceutical-grade supplements and then see what the results are. And people need to remember that supplements are just that - supplementation. They are not a replacement for a proper diet.
Dr. Gupta

I think you stated it very well. There is something in the whole plant that is missing when components are extracted. I think that the most encouraging research has come from studies that use whole plant extracts like tomatoes and broccoli as they have demonstrated similar results to eating the whole vegatables and fruit. As for the last questions, since WWII, Americans have been taught that their solutions come in the form of a pill. That is very difficult to overcome.

Dr Chet Zelasko
I agree with Dr. Chet. When you take a specific chemical from a plant or synthesize something to be like that chemical you're missing out on the supporting cast. That chemical can only do so much on its own and often it's the other components working with it that activate it in the first place. I believe that we need to look at our medicines, preventions and treatments more wholistically in order to gain all the benefit of what we put into our bodies.

The only true benefit I've ever found from pills is that you know how much of an ingredient you're getting. For example, Aspirin vs White Willow bark. They both do about the same thing (as you know Aspirin exists because we looked at the bark) except that you can't easily regulate the ASA dosage from the plant.

So, if we all eat properly (like we were taught with all our food guides in grade school) we'd have greater benefit from our food... and it would be cheaper than buying fast food and adding the supplements! Too bad everyone doesn't have the time to do so every day...
Having HIV for 20 years, I've closely tracked the research on vitamins, supplements, and why people take unproven remedies. Supplement manufacturers are not tightly regulated the FDA. Thus, these companies get away with making unsupported claims simply to make money. For consumers with any chronic condition, taking supplements is like taking sedatives for anxiety: supplements ease our fears about disease, aging, and death. Rational or not, supplements (herbals, vitamins etc.) calm our fears about mortality.
Please provide the citation for the study mentioned. One hesitates to comment without an independent reading of the manuscript.

Thanks,
Dr. Tony Buffington
Columbus, OH
From my brief review of this study and others that included Dr. JoAnn Manson, these were all women, average age of 65, most had prior cardiovascular disease (5,000+ I think, but don't quote me) and the rest had at least three risk factors for CVD. With all due respect, I do not think the results of this study prove anything except as it relates to this specific population and I am not sure the study coordinators want the rest of us telling the public what it all means. These results simply do not apply to a cross-section of the population. I wonder if many (or any) of the "proven" medications would have any effect in this population?
The first thing you have to look at is antioxidants do work, If they did not, why would researchers with PHDs and MDs publish their articles on pubmed ? I have studied Dr. John Cooke's publications about the posisitve effects of L-arginine. You will discover the Nobel Prize in Medicine in 1998 was based on L-arginine. I agree every antioxidant does not work, but don't discredit the proven studies of America's top scientist.

Look at www.pubmed.com if you have any doubt about the effectiveness of a supplement.
Dr. Guta,

The truth appears to be even darker than the picture you paint. In a recently published meta-study in the Journal of the American Medical Association with a combined >200.000 participants, a modest increase in mortality was found. The paper reports increased death rate with intake of supplements of beta-carotene, vitamine A and E.

Surely, different studies can result in different results. But it is clear that this common intake of supplements should be reconsidered carefully.
Dear Dr.Sanjay :) A few days ago what I read in the newspaper, this antioxident is found in most red, orange-colored juices. Despite manufacturers claims to the contrary, no product or treatment on the market today has deen proven to slow the human aging process. I think, fresh vegetables and fruits contains not only antioxidant, but also a plenty of natural vitamin will be helpful to many kinds of human diseases. Absolutely I love your daily blog, your blog is interesting and, what is more, very instructive. Thanks a lot... :D
To CNN's Medical Correspondent Dr. Sanjay Gupta,
Coment /questions, regarding "Western Diet"
Too much red meat, too much sugar, more whole grains. How do you find whole grains in the regular grocery?
Dr. Gupta:

What you seem to be referring to here is the Antioxidant Supplements in Pill form; but the TITLE DOES NOT PROPELY that.

This fact was more clear during your short actual TV segment on the American Morning on 8/14, but that did not translate well to your blog piece.

You should clarify that you are NOT claiming actual fruits and vegetables across the various pigments (i.e. Blueberries, Cranberries, Acai Berry, Pommagranate, and other exotic colorful fruits and vegetables, and a rich high in antioxidants) not good for you???

I personally feel that I benefited from the consumption of natural antioxidant-rich fruits and juices. I think the science is slow in catching up here.

K. E.
We eat Juice Plus which is whole fruits and vegetables, dehydrated and in capsule form. Are you familiar with Juice Plus? Is it, in fact, one of the three companies you alluded to that meet the highest pharmaceutical standards? Perhaps you can't promote Juice Plus on TV, but I would be very interested in your response. We eat a lot of fruits and vegetables and Juice Plus is in addition to that because as good as we try to do, we still don't eat the large numbers of fruits and vegetables recommended. According to what we understand, Juice Plus contains the essence of 17 fruits and vegetables in dehydrated form, in the capsules. We have experienced noticeably improved health since starting with Juice Plus about four years ago and some family members have as well. Thank you.
I think K E should read the blog before commenting. Dr Gupta clearly states that antioxidants in pills probably dont provide the benefit, but antioxidants in foods do. Is that correct?
Dear Dr. Gupta;

I hope this find you well. With respect to the study in Arch Int Med, there are some critical flaws that should have been accounted for by the authors, that undermine much of their hard work in creating such an elaborate study design. Considering the following points it would be difficult to accept the study as the final word on the benefits of antioxidants for secondary prevention of cardiovascular events.

While study subjects had to be willing to forgo individual supplements of vitamins A, C, E, and beta carotene at levels beyond the U.S. recommended daily allowance during the trial to control intake levels, the study makes a critical error in that there are no controls in place for dietary intake of vitamins C and E and beta-carotene through fruits and vegetables. We have no baseline of what the subjects' nutrient status was from food, thus to draw any comparison or conclusion doesn't really offer a complete view of the research picture. If any of the subjects had a diet that was fruit and vegetable rich, which there is no way of knowing this from the study, and we're already at an optimal level of these nutrients through food, how much additional benefit can be expected from a supplement. This is the research question that has yet to be answered.

Additionally with respect to secondary prevention, diet and exercise are extremely important components of secondary prevention, yet this study makes no mention of the exercise habits of the subjects, nor does it track some of the dietary habits like sodium (salt) intake, which are potential study confounders and should be controlled accordingly in the study. Sodium intake and exercise patterns certainly have the ability to reduce the risk of a subsequent cardiovascular event. http://www.americanheart.org/presenter.jhtml?identifier=4723

Lastly, the risk factors for eligibility in the study are rather broad and range from self-reported diagnosis of hypertension, high cholesterol level, or diabetes mellitus; parental history of premature myocardial infarction (MI) before age 60 years; obesity (body mass index [BMI] greater than 30 [calculated as weight in kilograms divided by height in meters squared]); current cigarette smoking; and inconsistent reporting of the subjects’ prior medical CVs. This variability of subjects has the potential to introduce bias and doesn’t reflect the scientific objective of secondary prevention. Obviously the risk for those with diabetes is quite different than for those with a familial history. These risks need to be weighted accordingly with respect to secondary prevention (i.e. what is the incidence of a secondary cardiovascular event of those subjects who smoke, have diabetes and a familial history versus those subjects who have a BMI > 30, a familial history and high cholesterol).



Very truly yours,
Daniel Fabricant, Ph.D.
Vice President, Scientific and Regulatory Affairs
Natural Products Association
Dr. Gupta's end question, "why is it that ...Americans continue to spend billions of dollars a year on something that doesn't have a lot of data showing that ...is beneficial" can cut both ways.
Why is it that Merck's Gardasil vaccine was put on FDA's fastrack approval list when years of research was ethically still in order. This happens too often with all new and "miraculous" pharmaceuticals. Certainly there is no sudden rash of health-conscience folks overdosing on vitamin C, or green tea extract, or other antioxidants.
We know the body needs antioxidants. Consumers should have every right to buy antioxidant supplements without traditional Western Medicine professionals pooh-poohing or criticizing people's desire to try to gain optimal health and avoid toxic FDA approved injections and drugs. And while supplementation will not cure an ailment all together, it sure can help when a body is deficient (as many American bodies are.)
Regarding earlier comment: "Consumers should have every right to buy antioxidant supplements without traditional Western Medicine professionals pooh-poohing or criticizing people's desire to try to gain optimal health and avoid toxic FDA approved injections and drugs."

Why shouldn't health professionals hold vitamins and supplements to the same medical standards as pharmaceutical drugs?

If vitamins and supplements held up under clinical examination, they should be recommended. And when they do hold up, health professions do recommend them to patients.

It's not an either-or proposition (pharmaceuticals or supplements), it's just a matter of science.

I understand that science is not popular for those on the far right and the far left. Should science better address the placebo effect? Yes, absolutely. Has science proved (or disproved) the effectiveness of antioxidants? Not yet.

Should we discard science in favor of anecdotal evidence, marketing ploys, and blind faith? I say no.

-Brett Grodeck
I think we need to have more dimensional dialogue about supplements. dl tocopherol(lab made vitamins E)should never be blindly basketed with a vitamin E supplement made from foods such as nuts. Infact synthetic vitamin E is a derivative of petroleum by product while vitamin E consist 8 different complex naturally occuring molecule. The study also noted that active vitamin C & E showed positive effect and needed more investigation. A supplement made from food verses synthetic are far more likely to be more active and ready used by the body. Also food derived supplement is also more likely to have the co factors from the food that make nutrients more useful.

A cold processed food supplement is probably more likely to be nutrient dense than one produced with heat. More education is necessary so that consumers can make informed choices in light of conflicting studies. A more informed consumer would rightly ask,if active vitamin c and e leaned positive,which supplements contained these active form? Do synthetics vitamins such as centrum contain the acive or non active form? Do food derived supplements contain active or inactive form? As consumers We're smart,after all our whole life is invested in this;we don't want the baby thrown out with bath water.That baby happen to be our well being. The reality is with our busy lifestyle a combination eating better with some supplementation is probably the most practical path.
Actually, the study referenced by Dr. Gupta did in fact show benefits regarding decreasing the risk of stroke to a certain degree.

And, according to here - http://www.newstarget.com/021973.html

The reason for the negative reports on this study has to do with the fact that the authors also included people who didn't fully comply with taking their vitamins. If this is true (not sure it is), it would benefit Dr. Gupta to read the report himself in detail and not rely on media reports.
This comment is directed to the mention of "Pharmaceutical Grade" manufactured supplements.

My industry supplies the actual raw materials/vitamins to the tabletting industry whom make the supplements that appear on store shelves. These tabletting companies do not make the actual raw materials and/or antioxidants that go into finished products.

The phrase "Pharmaceutical Grade" really has no meaning other than marketing hype in the OTC Supplement Industry. Most ingredients used in the industry must only conform to what are known as USP or NF Monograph Specifications. As long as the supplement company can verify the ingredient meets it's correpsonding USP specification, they can then legally use it to produce a supplement product. Most companies fully lab test their incoming raw materials, but some only rely what the foreign lab is stating on the incoming paperwork.

The truth is, many Supplement companies have somewhat lose Quality Control programs in place. Certainly nothing that can be assosciated with the term "Pharmaceutical Grade." Further, a very large majority of Raw Ingredients & Vitamins used in this industry are coming from guess where? CHINA - where there is very little Quality Control sometimes. This is a little secret the industry doesn't want you to know about.

I myself, would recommend using only the large brand-name supplements on the market. Stay away from smaller, no-name brands.

It's not to say that all OTC supplements coming out of China are bad, it's just better to stick with the major, national manufactured brands where stringent QC measures are more likely in place.
Dear Dr Sanja Gupta,

You implied that the study found no protective benefits for women taking antioxidants, when in fact, the study found a significant reduction in the risk of stroke (31 percent reduction) and heart attacks (22 percent reduction) for those women who actually took the antioxidants. This is even more substantial given that the antioxidants were provided in low doses and only taken every other day.

The absence of protective benefits was observed in those women who did not actually take the vitamins. (Those women who took no vitamins experienced no benefits, which is expected.) These facts are openly stated in the full text of the study, which is available from the journal's website at http://archinte.ama-assn.org/current.dtl (study name is "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women: Results From the Women's Antioxidant Cardiovascular Study")

The AMA's statement on antioxidants having no benefits in this study is based on the inclusion of all those women who did not take the antioxidants. I believe this conclusion to be biased in favor of drug company interests and wholly incorrect from a scientific point of view. I believe the article you originally published in this study may have been based on an erroneous press release issued by the AMA which, in my opinion, distorted the findings of the study and presented a biased position that happens to coincide with the financial interests of drug companies - a primary source of revenue for the AMA.

By reprinting the AMA's conclusions without fact checking your article, you have made a classic journalism error and likely played into the hands of an organization that has a long history of discrediting natural alternatives to pharmaceuticals. As such, you have done a great disservice to your readers who will now be less likely to seek out these safe, natural and highly effective therapies for preventing heart disease and stroke.

I respectfully request that you retract your original story on this antioxidant study and print a correction that accurately describes the factual findings of the study. Please reply and let me know your intentions in making this correction.
Dear Dr. Gupta,

I sincerely believe you do have a true sense of Altruism about you. I also believe big money advertising revenues create censorship and it must eat you up inside at times. From what I understand Big Pharma spends billions annually. What is CNN's share? Does the major media outlets actually have any interest in reporting the truth these days? Or is "IT" all about what my Grandma liked to refer to as "The Root of All Evil". What happened to objective non-bias journalism anyhow? This study and it's results are worth the due dilligence it deserves. I personally have seen with my own eyes, in and on my own body the healthy benefits of high quality supplements. Not once have I learned a single thing about being healthy from a doctor visit in this country. I was hoping you would be the exception! You have the means to make a real positive difference if you choose to be independent.

One thing that is fascinating to me is that 2 to 5% of all hospital admissions result from severe adverse effects from prescription drugs. Yet, doctors have no COMPUNCTION in prescribing these. Today, 290 people in the United States will die from the adverse reaction to prescription medicines. (New England Journal of Medicine 1998:279: 1200-1205, 1216-1217). Are these quotes true? Are vaccines safe? Could you possibly do an objective, factual report on these matters in the near future? We have a baby on the way.

Regards,

Hopefull
I don't think anyone or any company can package nutrition quite like mother nature. That's not very capitalistic for me to say so I'm sure companies will try to convince consumers to buy these products through many more studies, but I agree with you, mother nature knows best. Eat Your Veggies!
I feel it is just plain WRONG---to report on a scientific study without reading the entire study. In this case---I totally agree with the above posts---the study actually proved how well antioxidants can work.

You have taken a press release and run with it---not checking facts---shame on you!!!
Dear Dr Gupta,

This posting implied that the study found no protective benefits for women taking antioxidants, when in fact, the study found a significant reduction in the risk of stroke (31 percent reduction) and heart attacks (22 percent reduction) for those women who actually took the antioxidants. This is even more substantial given that the antioxidants were provided in low doses and only taken every other day.

The absence of protective benefits was observed in those women who did not actually take the vitamins. (Those women who took no vitamins experienced no benefits, which is expected.) These facts are openly stated in the full text of the study, which is available from the journal's website at http://archinte.ama-assn.org/current.dtl (study name is "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women: Results From the Women's Antioxidant Cardiovascular Study")

The AMA's statement on antioxidants having no benefits in this study is based on the inclusion of all those women who did not take the antioxidants. I believe this conclusion to be biased in favor of drug company interests and wholly incorrect from a scientific point of view. I believe the article you originally published in this study may have been based on an erroneous press release issued by the AMA which, in my opinion, distorted the findings of the study and presented a biased position that happens to coincide with the financial interests of drug companies - a primary source of revenue for the AMA.

Regards,

M
The study does not seem to have included factors such as diet and exercise. In addition, they seem to have included people who did not comply with the vitamin regiment. What is the quality of the supplements they used? Also, what you said about natural packaging in food is very rational. The bottom line is that there is countless research into the negative effects of oxidative stress in obesity-linked insulin resistance, diabetes, cardiovascular disease, etc. It has been shown in a laboratory setting that anti-oxidants are able to mitigate symptoms of diabetes-induced hyperglycemia, such as neuropathy. In conclusion, the result of this study seems unreasonable. The study was not nearly detailed enough to draw such conclusions, the statistical methodology is suspect, and from my own knowledge as a biologist/chemist, it doesn't mesh with what I know about diabetes, cardiovascular disease, oxidative stress, and inflammation. Also, I don't like how you can only read the abstract or people's interpretation of the study online without paying for it. I don't think you should have to pay to verify that such provocative claims are in fact based on reasonable science. Thank you.
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Delilah Brantly
dear Dr sanja gupta ,
Yoy say that antioxidants have no protective benefits for women . How does over oxidanting Ones system with beverages that are injected with stimulating Oxygen such as "red bull" effect the body?
How do you prevent over oxidenting and keep Your body healthy and maintain a body wellness lifestyle?

awaiting comment

wellness advisor
So interesting that the exact same post appears from different bloggers -- probably agents of the anti-oxidant industry. They put out a note and people copy and paste it. Shameful bloggers. Gupta is right on the money on this one and I am someone actually in the industry.

Dr William DeSook
Antioxidants are but a brush stroke in a complex piece of art. They are no more than a nut or bolt in a complex machine. Antioxidants are important in the overall dynamic but in no way can be directly linked to a substantial improvement in ones health. Instead, Antioxidants may work in synergy with a person who is able to manage their daily stress, maintain a healthy body weight, as well as a regular exercise regiment.

If one were extremely overweight, living and working in a high stress environment and were sedentary, antioxidants meager contribution to overall health would be void. Like someone prior had stated "we look for our answers in a pill". No tablet can suffice for what nature provides in the vast biochemical make up of a fruit or vegetable as Dr. Gupta states.

Although antioxidants may have some positive effects on the elimination of free radicals leading to generalized improvements in an individuals overall health, they are in no way a substitute for maintaining a healthy body weight through regular physical activity and proper nutrition in the way of whole foods.
It is a sad commentary indeed that CNN's Dr. Gupta uses his medical credentials to authoritatively comment on a published study -- but one which he clearly did not read! This is the worst form of duplicitous behaviour. A comment by "Dr William DeSook" falls into the same trap by saying "Gupta is right on the money on this one" -- neither doctor read the study!! Shame on the medical class!

Had they actually read the study (I have a copy of it right in front of me right now), they would have seen what the study actually discovered, the point of which was made in a comment here, which is that only 68% of the subjects actually took their vitamin regimen during the course of the study, yet the researchers pooled the results of all 100% of the people enrolled. As some wag suggested, it's like going into a room full of 100 people and giving sandwiches to 50 of them and then concluding that sandwiches to not work as food.

Here's the salient part of the study, to wit -- with my comments in brackets: "Censoring participants on noncompliance [this is the 68%] led to a significant 13% reduction in the primary end point [which was heart attack, stroke, coronary artery bypass and cardiovascular mortality]. Reductions in secondary study end points [called "the individual components of MI, stroke, coronary revascularization, and CVD death"] were also stronger, with a 22% reduction in MI [myocardial infarct, or heart attack], a 27% reduction in stroke, and a 9% reduction in CVD mortality. There was a 23% reduction in the combination of MI, stroke, or CVD death."

Why did Dr Gupta -- and, to be fair, the entire corporate mainstream media journalist class -- fail to inform readers and consumers of the real and positive effects of supplemental antioxidant vitamins on cardio health? You can easily slough off journalists as being lazy stenographers to power (their failures in the Iraq war run-up are well-documented at this point). But for medical writers with medical credentials to fall into the same laziness trap when writing on their specialty of medicine should be an embarrassment to CNN. I would recommend CNN start looking for a more diligent medical correspondent.

Todd Runestad
Science Editor
Functional Ingredients magazine
Today, a search on "antioxidant" in PubMed returns 248,351 results. Tomorrow, there will be more. Apparently, there are a lot of doctors and research scientists who didn't get the memo that antioxidants aren't "all they're cracked up to be."

Can someone tell me how a study that shows a 23% reduction in heart attacks, and a 27% reduction in strokes, ends up with the media headline "Antioxidants Don't Work"? Shades of Lewis Carroll! Or George Orwell...

Why wasn't the headline, "Vitamin E Reduces Heart Attack, Stroke Risk?"

This is more than ignorance of the facts, or a careless mistake. It is an outrage, and a disservice. America's drug-based "health care" system is a disaster. Our S.A.D. diet is a scourge, spreading like a contagious disease to the rest of the world. Here at home, we are growing a whole generation of fat, diabetic ADHD children, raised on processed, sprayed, depleted, microwaved food.

And still, there are those who insist that we throw away our nutritional supplements because they are "worthless," or even harmful. Antioxidants don't work, vitamins are useless, pharmaceuticals are healthy, and down the rabbit hole we go.

The health system is a broken shame and the American people are smarter than you think. That is the reason we continue to spend billions of dollars a year on supplements, why major cities are outlawing trans-fats in restaurants, and why Big Food is scrambling to reformulate with healthier ingredients. We are finally demanding it.

After looking at the real numbers in this study, I was surprised to see such a high rate of benefit from a relatively weak antioxidant. There's a new generation of more potent antioxidants with greater potential to affect human health and aging, and new research emerging every week.

If your antioxidants don't work, perhaps you're taking- and studying- the wrong antioxidants.
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