No more a quick-fix: Experts have begun telling people to put away their bottles of Vitamin E supplement

In a world hungry for medical magic bullets, vitamin E seemed to have it all. It?s cheap. It?s available. And, for years, doctors and patients alike believed it really worked, showing particular promise as ammunition against heart disease. There were even studies that appeared to prove it.

So consumers ? figuring that if a little of something is good, a lot must be better ? decided that it wasn?t enough to derive their daily dose of vitamin E from a multivitamin. They began downing capsules that, in a single dose, contained 400, 1,000, even 2,000 milligrams of vitamin E, dozens of times the amount carried in a multivitamin.

Now, luminaries in cardiology are issuing a very different advisory to patients: Vitamin E won?t help your heart condition, they said in August. And if you take too much, they added this month, it could hurt you. ?Help me convince patients to stop taking vitamin E,? Dr Raymond Gibbons, a Mayo Clinic cardiologist, recently told a roomful of journalists. ?From a scientists? standpoint, the question has been answered ? vitamin E doesn?t work.?

The vitamin E findings also reflect a reality that can prove bewildering to patients: Science is dynamic. Yesterday?s cure can become tomorrow?s toxin. Sometimes that happens because of research recklessness. Other times it?s because new knowledge emerges about a disease, or longer-term experience with a medicine shows unanticipated side effects.

Even with vitamin E, with experts telling people to put down their supplement bottles, the evidence is still conflicting. Most researchers seem to agree that lower doses ? 200 milligrams or less ? are safe and may provide some protection against respiratory illnesses. Where they disagree is how high to go. The story of this vitamin supplement is in many respects the latest chapter in a pharmaceutical epic. The blockbuster arthritis medication Vioxx, for example, was recently pulled from the market after it was found to cause heart problems. Early suggestions of problems didn?t become indisputable until the drug had been on the market for several years.

In the case of the diet remedy ephedra, the US drug regulators banned the herb last December, saying it might be associated with as many as 155 deaths nationwide.

Vitamin E?s reputation as a cure-all for heart disease, researchers said, can be traced to two long-term studies of thousands of doctors and nurses. Those who took vitamin E seemed to remain relatively free of cardiovascular ailments for more than a decade. Laboratory experiments supported the idea that vitamin E should prevent heart disease in people, and the same was found in animals, with pigs fed vitamin E experiencing less hardening of the arteries. But there was a problem: The studies did not start out to specifically examine the effects of vitamin E. Instead, the effects were all incidental findings, conclusions reached almost by accident.

?The unfortunate thing is that such studies can?t really be translated into cause and effect,? said Dr Edgar R. Miller III, a Johns Hopkins University researcher who debunked the preventive powers of vitamin E in last month?s study in the Annals of Internal Medicine. ?The fact that they were taking vitamins probably meant they were eating well, exercising, and not smoking and were active. But it was vitamin E that got credit.?

Vitamin E was discredited in August in Circulation. In that report, scientists concluded that an expanding body of rigorous research showed that the vitamin did not protect against cardiovascular diseases, and they advised heart patients to stop taking it. Now, Miller?s research adds to the concerns. He reviewed 19 studies published since 1993, synthesising existing research. Some trial participants got the vitamins, some got placebos, and all were in the dark about what they were getting. Those who took higher doses of vitamin E were somewhat more likely to die over five years than those who took less. There was about a 5 per cent incr-ease in deaths from all causes am-ong patients taking a daily dose of roughly 400 milligrams or more of the vitamin. But, he pointed out, the studies were of people with chronic illnesses, making it hard to generalise to everyone.

Simin Nikbin Meydani, a Tufts nutrition researcher, said she?s not convinced by Miller?s findings, which lump together different studies. ?I don?t want to put down this study, but if you just come up with this kind of recommendation, it?s going to confuse the public,? Meydani sa-id. She has performed her own research using vitamin E and found no adverse effects with daily doses as high as 800 milligrams.

Four years ago, Norman Krinsky, another Tufts researcher, chaired an Institute of Medicine panel that established what it believed to be safe maximum dosages of vitamin E: Capsules of as much as 1,000 milligrams could be taken without danger.

Krinsky, too, is unmoved by Miller?s research and questioned the power of his conclusions. Another problem, he said: the study did not precisely quantify the level at which vitamin E begins to pose a risk.

And, Krinsky warned, telling people to abruptly stop downing 800 or 1,000 milligrams of vitamin E could also be dangerous. ?When you take any medicine at that dosage, you can?t stop taking it blindly. Taper off slowly.?

NYTNS