Vitamin E

Vitamin E is key for strong immunity and healthy skin and eyes. In recent years, vitamin E supplements have become popular as antioxidants. These are substances that protect cells from damage.

Why do people take vitamin E?

Many people use vitamin E supplements in the hopes that the vitamin’s antioxidant properties will prevent or treat disease. Early lab studies of vitamin E supplements were promising. But studies of vitamin E in people have been disappointing. Studies of vitamin E for cancer, heart disease, diabetes, Alzheimer’s disease, cataracts, and many other conditions have been inconclusive.

So far, the only established benefits of vitamin E supplements are in people who have an actual deficiency. However, vitamin E deficiencies are rare. They’re more likely in people who have diseases, such as digestive problems and cystic fibrosis. People on very low-fat diets may also have low levels of vitamin E.

How much vitamin E should you take?

The recommended dietary allowance (RDA) includes the vitamin E you get from both the food you eat and any supplements you take.

Category Vitamin E (alpha-tocopherol): Recommended Dietary Allowance (RDA)
in milligrams (mg) and International Units (IU)
1-3 years 6 mg/day (9 IU)
4-8 years 7 mg/day (10.5 IU)
9-13 years 11 mg/day (16.5 IU)
14 years and up 15 mg/day (22.5 IU)
Pregnant 15 mg/day (22.5 IU)
Breastfeeding 19 mg/day (28.5 IU)
14 years and up 15 mg/day (22.5 IU)

The tolerable upper intake levels of a supplement are the highest amount that most people can take safely. Higher doses might be used to treat vitamin E deficiencies. But you should never take more unless a doctor says so.

(Children & Adults)
Tolerable Upper Intake Levels (UL) of
Vitamin E (alpha-tocopherol)
in milligrams (mg) and International Units (IU)
1-3 years 200 mg/day (300 IU)
4-8 years 300 mg/day (450 IU)
9-13 years 600 mg/day (900 IU)
14-18 years 800 mg/day (1,200 IU)
19 years and up 1,000 mg/day (1,500 IU)

Because vitamin E is fat-soluble, supplements are best absorbed with food.

Can you get vitamin E naturally from foods?

Most people get enough vitamin E from food. Good sources of vitamin E include:

  • Vegetable oils
  • Green leafy vegetables, like spinach
  • Fortified cereals and other foods
  • Eggs
  • Nuts

What are the risks of taking vitamin E?

  • Side effects. Topical vitamin E can irritate the skin. Overdoses of vitamin E supplements can cause nausea, headache, bleeding, fatigue, and other symptoms.
  • Interactions. People who take blood thinners should not take vitamin E supplements without talking to a doctor first. If you take any medication, it’s best to check with your doctor to make sure vitamin E supplements won’t interfere.
  • Risks. Vitamin E supplements have unclear benefits and risks. So don’t use them in high doses or for the long term unless your doctor suggests .

What are the risks of taking vitamin E? continued…

The American Heart Association recommends obtaining antioxidants, including vitamin E, by eating a well-balanced diet high in fruits, vegetables, and whole grains rather than from supplements until more is known about the risks and benefits of supplementation.

Some evidence indicates that for non-healthy patients high doses of vitamin E may actually increase the risk of dying. Vitamin E use is associated with a significantly increased risk of dying in people with a history of severe cardiovascular disease according to some supplementation studies. In an analysis of clinical trials, patients who took either synthetic vitamin E or natural vitamin E in doses of 400 IU per day — or higher — had an increased risk of dying from all causes, which seems to increase even more at higher doses. Cardiovascular studies also suggest that patients with diabetes or cardiovascular disease who take natural vitamin E at 400 IU per day have an increased risk of heart failure and heart failure-related hospitalization.

Vitamin E supplements might be harmful when taken in early pregnancy. Vitamin E supplementation during the first 8 weeks of pregnancy was associated with a 1.7 to nine-fold increase in congenital heart defects. The exact amount of vitamin E supplements used by pregnant women in this study is unknown.

A large population study showed that men using a multivitamin more than seven times per week in conjunction with a separate vitamin E supplement actually had a significantly increased risk of developing prostate cancer.

source: webMD

Apples Good for Your Heart

Eating Apples Daily Lowers Cholesterol, Inflammation, Study Finds



Eating an apple or two each day may reduce heart disease risk factors, a new study shows.

The study, which is the latest to polish the apple’s heart-healthy reputation, found that eating apples daily appeared to lower levels of cholesterol and two other markers associated with plaques and inflammation in artery walls.

“We were pleasantly surprised …” that apples so effectively lowered LDL (bad) cholesterol, says study researcher Bahram H. Arjmandi, PhD, RD, Margaret A. Sitton Professor and Chair, Department of Nutrition, Food and Exercise Sciences at The Florida State University in Tallahassee.

The study was presented at Experimental Biology 2011, in Washington, D.C.

Experts said the study’s results were consistent with previous evidence that apples do indeed live up to the famous adage about keeping the doctor away.

“When we look at the whole composite of human studies and animal studies and in vitro lab studies, when you look at the active components in apples and apple juice, there’s definitely benefit,” says Dianne A. Hyson, PhD, RD, a nutritionist and researcher at the University of California at Davis.

Hyson, who was not involved in the current research, recently completed a review of 80 studies, published since 2005, on the health benefits of apples, and she says that in addition to their cardiovascular benefits, there’s some evidence that apples help regulate blood sugar and control appetite, protect against cancer, and safeguard the lungs.

Pitting Apples Against Prunes

For the study, researchers recruited 160 women and randomly assigned them to eat daily servings of either dried apples or prunes, which are dried plums.

Study participants received blood tests to look for markers of heart health after 3, 6, and 12 months.

After a year, the women in the apple group saw their total cholesterol drop by an average of 14%. Their LDL cholesterol was reduced by an average of 23%. Levels of lipid hydroperoxide, a biochemical involved in the formation of heart-clogging plaques, and C-reactive protein, which is a marker of inflammation, were both down by about one-third.

And the women in the apple group lost weight — an average of about 3 pounds over the course of a year.

Arjmandi says the women in the prune group also saw some slight reductions in those heart markers, but not to the same extent as those who ate apples.

Apple Advantages

Experts say there are several possible explanations for how apples aid the heart.

Apples are rich in pectin, a soluble fiber, which blocks cholesterol absorption in the gut and encourages the body to use, rather than store, the waxy stuff.

Apple peels are also packed with polyphenols — antioxidants that prevent cellular damage from free radicals.

Though the study used dried apples for convenience, Arjmandi says fresh are likely to be even better.  And it doesn’t matter if they’re green, red, or golden. “Any varieties of apples are good,” he says.

Another key, Dyson says, is eating the whole fruit, rather than looking for individual components in supplements.

“Most of the time, in many studies, the whole is better than the sum of its parts,” she says.

As far as how much to eat, just follow the apple-a-day adage, though Arjmandi says, two-a-day might be even better.

“That’s doable and practical and people like apples,” he says.

source: webMD

New Pancreatic Cancer Treatment Activates Immune System

In Early Study, Strategy Shrank Tumors in Some Patients


senior woman in deep thought

March 24, 2011 — A novel approach to pancreatic cancer treatment that activates the immune system works in some patients, according to a new study.

The treatment works by destroying the ”scaffolding” around cancer cells, says researcher Robert H. Vonderheide, MD, DPhil, an associate professor of medicine in the division of hematology/oncology and the Abramson Family Cancer Research Institute, University of Pennsylvania.

“The therapy is an antibody,” he says. ”Instead of binding to the cancer, this antibody binds to a molecule in the immune system, and that is CD40,” he tells WebMD. Next, the immune system is activated, allowing it to attack the so-called scaffolding around the cancer cells. The scaffolding is destroyed and the tumor falls apart.

The process is somewhat like attacking a brick wall by dissolving the mortar in the wall, he says.

In the study, the new approach extended overall survival by nearly two months compared to conventional treatments. Progression-free survival, the length of time during which the tumor did not grow, was more than three months longer.

The results are encouraging, says William C. Phelps, PhD, director of preclinical and translational cancer research at the American Cancer Society, Atlanta. He reviewed the findings for WebMD.

“Pancreatic cancer is probably one of the most dismal of cancers, because there is very little effective treatment available and the course is rapid,” Phelps tells WebMD.

The study findings are published in Science.

Pancreatic Cancer Treatment: Back Story

In 2010, about 43,140 people were diagnosed with pancreatic cancer, according to the American Cancer Society; 36,800 died.

Treatment is a challenge, Vonderheide says, because about 80% of people diagnosed have a tumor that is not operable.

For those patients, the standard treatment is chemotherapy with a drug known as gemcitabine (Gemzar). Another option, Vonderheide says, is to combine it with another drug, erlotinib (Tarceva).

But better options are needed, he says. “There is a huge need to find new approaches,” he tells WebMD.

Pancreatic Cancer Treatment: Study Details

The researchers studied the new immune therapy for pancreatic cancer in mice and in people. In the human study, 21 patients with surgically incurable pancreatic ductal adenocarcinoma, the most common type of pancreatic cancer, were given the combination of gemcitabine with the new antibody treatment, known as CP-870,893.

The antibody infusion, given once a month, was added to the routine gemcitabine treatment.

“They could keep receiving it until the tumor progressed or toxicity developed,” Vonderheide tells WebMD.

The new treatment was found to be well tolerated in this phase 1 trial, Vonderheide says. Side effects included chills and fevers and usually went away within 24 hours.

After two cycles, the patients were scanned to evaluate the tumors. “We are reporting that five patients who received the antibody went on to tumor regression that was at least 30% or more,” he says. That 30% is considered the cutoff for an acceptable response, he says.

To put the results in perspective, Vonderheide says that ”the response rate for gemcitabine alone is 5%, one out of 20. In a study this size [with the 21 patients] we would have expected one to have a response.”

The median time for progression-free survival was 5.6 months (half longer, half less). The median overall survival time was 7.4 months.

In comparison, gemcitabine alone produces a median progression-free survival of 2.3 months and a median overall survival time of 5.7 months.

One surprise: the researchers thought the antibody treatment would activate white blood cells known as T cells to attack the tumor. But the treatment actually turned on another kind of white blood cells called macrophages.

The study was funded by the Abramson Family Cancer Research Institute, the National Cancer Institute and Pfizer Corp., which makes the antibody.

Pancreatic Cancer Treatment: Future and How It Works

Although the results are encouraging, Vonderheide says ”we have a lot of work to do.” It will require several years of study and development before the approach is available, he says.

The concept reflects new understanding about cancer cells and what they need to thrive. “It’s often thought that if you take out the tumor, 100% of what you take out is cancer cells, but that’s not true,” he tells WebMD. “A small part of the dense tumor is cancer; the rest of the material is this scaffolding, which the tumor uses to grow.”

The tumors rely on this surrounding tissue for blood flow and for a defense against the immune system.

The antibody, he says, activates the immune system in other tissues outside the scaffolding, such as the lymph nodes and the spleen. These activated white blood cells then travel to the scaffolding around the tumor and destroy it.

”Without the scaffolding, the tumor cells don’t survive as well,” he says.

Pancreatic Cancer Treatment: Perspective

The effect of the treatment is small but important, Phelps says. “In pancreatic cancer, any effect is remarkable. The fact that he sees even in a small study some benefit is pretty remarkable.”

The treatment approach reflects recent discoveries about how cancer grows, he says. “We’ve come to understand in the last three to five years that the somewhat normal cells that surround the tumor play an important role in allowing the tumor cell to grow. The environment of the tumor makes a difference.”

source: webMD

PPIs Help Adult Asthma Physiology, but Not Symptoms, Analysis Finds

Routine use of proton-pump inhibitors in asthma significantly improves physiologic measures of airway flow, but it doesn’t similarly improve patients’ symptoms or quality of life, according to an Archives of Internal Medicine meta-analysis.

Researchers examined data from 11 randomized trials including some 2500 adult patients. Morning peak expiratory flow rates improved significantly more among those taking PPIs, especially among patients with confirmed gastroesophageal reflux. However, symptom scores and quality-of-life measures did not show an advantage for PPI treatment.

The authors argue that their analysis provides a 20-fold increase in available data compared with older analyses, but they conclude: “There is insufficient evidence to support the routine use of PPIs in the treatment of asthma.”

source: Archives of Internal Medicine article


Experts Issue Guidelines on Treating Painful Diabetic Neuropathy

Pregabalin should be offered for the treatment of painful diabetic neuropathy (level A evidence), according to new guidelines from the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

Among the other recommendations (level B or C evidence), published in Neurology:

  • Anticonvulsants: Gabapentin and valproate should be considered for treatment, while evidence is insufficient to recommend for or against using topiramate. Oxcarbazepine, lamotrigine, and lacosamide “probably” should not be given.
  • Antidepressants: Amitriptyline, venlafaxine, and duloxetine should be considered, and venlafaxine can be added to gabapentin. Evidence is insufficient to recommend for or against other agents (e.g., fluoxetine).
  • Opioids: Dextromethorphan, morphine sulfate, tramadol, and oxycodone should be considered.
  • Other pharmacologic agents: Capsaicin or the Lidoderm patch may be considered.
  • Nonpharmacologic methods: Electrical stimulation should be considered, while magnetic field treatment is not recommended.

source: Neurology article

Neoadjuvant Androgen-Deprivation Therapy for Prostate Cancer

Adding 6 months of neoadjuvant ADT to radiotherapy improved survival in patients with locally advanced disease.

Several large randomized trials have demonstrated that patients with locally advanced prostate cancer have improved outcomes when long-term (2- to 3-year) androgen-deprivation therapy (ADT) is combined with external beam radiotherapy. However, these studies typically involved short periods of neoadjuvant ADT and much longer periods of adjuvant ADT.

In an initial report of a phase III trial that evaluated relatively long periods of neoadjuvant ADT (Lancet Oncol 2005; 6:841), investigators in Australia and New Zealand randomized 802 men with locally advanced prostate cancer (T2b, T2c, T3, and T4 N0 M0) to receive radiotherapy alone or with 3 or 6 months of neoadjuvant ADT. Data from a median 5.9 years of follow-up suggested that 6 months of neoadjuvant ADT, versus radiotherapy alone, significantly reduced risk for the primary endpoint, prostate cancer mortality (hazard ratio, 0.56; P=0.04).

Now, reporting data from a median 10.6 years of follow-up, the same researchers showed that 6 months of neoadjuvant ADT plus radiotherapy, versus radiotherapy alone, significantly reduced risk for the primary endpoints, prostate cancer mortality (HR, 0.49; P=0.0002) and all-cause mortality (HR, 0.63; P=0.0005). In contrast, 3 months of neoadjuvant ADT, versus radiotherapy alone, did not reduce risk for prostate cancer mortality or all-cause mortality.

Comment: As noted by an editorialist, the benefit of ADT plus radiotherapy versus radiotherapy alone confirms the findings of several prior studies, although the lack of improvement from 3 months of therapy is an important finding. Ongoing trials are testing neoadjuvant ADT versus adjuvant therapy as well as the effect of radiotherapy dose escalation in this context.

Published in Journal Watch Oncology and Hematology

Does High-Quality Care Protect Against Litigation?

Not much: Good nursing homes were sued only slightly less often than bad ones.

Legal theory holds that personal-injury litigation serves a social purpose, improving overall medical care by punishing substandard practice. However, a correlation between bad care and litigation risk has been difficult to establish, either for individual practitioners or for institutions.

Researchers tallied tort claims filed against 1465 nursing homes belonging to five large U.S. chains during 1998–2006. Overall, weak but significant inverse correlations were found between risk for being sued and 5 of 10 commonly accepted measures of quality care, including compliance with federal standards, staffing ratios, and clinical indicators such as rates of pressure ulcers and falls. These correlations persisted in low-litigation environments but vanished in high-litigation environments. Further, the actual numerical differences were quite small: The overall best nursing homes faced an estimated 40% annual risk for suit, while the worst faced a 47% annual risk. For specific clinical measures, the best-quality nursing homes had absolute litigation risks that were only 2%–7% lower than the worst.

Comment: This thought-provoking study suggests that institutional litigation risk has little to do with overall quality of care. If confirmed, this finding casts doubt on many of the principles underlying modern medical care, including the now widely accepted premise that risk management and quality assurance are two sides of the same coin.

Published in Journal Watch General Medicine

Opioid Prescribing and Overdose-Related Deaths

Larger doses were associated with elevated risk for overdose-related death.

Deaths related to opioid overdose have risen sharply during the past decade. To examine the relation between maximum prescribed opioid dose and opioid overdose–related death, researchers used Veterans Health Administration data from 2004 through 2008 in a case-cohort analysis of patients with cancer, chronic or acute pain, or substance abuse disorders. A total of 750 decedents with unintentional opioid overdose were compared with >150,000 patients who received opioid therapy.

Overall frequency of fatal overdose was 0.04%. Compared with all opioid users, patients who died after overdose were more likely to be white and middle-aged, more likely to have chronic pain or substance disorders, and less likely to have cancer.

In analyses adjusted for demographic and clinical variables, patients whose maximum prescribed daily opioid dose was 100 mg had significantly higher risk for overdose-related death than those whose doses were <20 mg. Hazard ratios for death from doses >100 mg in patients with chronic pain, acute pain, substance abuse disorders, and cancer were 7.2, 6.6, 4.5, and 12.0, respectively. The dosing schedule (i.e., regularly scheduled vs. as-needed dosing) was not associated with a difference in risk.

Comment: These results from a large, national study confirm the obvious: Larger daily doses of opioids are associated with elevated risk for unintentional overdose and death. Whereas the overall rate of overdose was lower in patients with cancer compared with that in all patients, risk for overdose with higher daily doses was particularly high. The desire to lessen pain and suffering with opioids must be weighed more carefully against risk for unintentional overdose.

Published in Journal Watch General Medicine