An account of the vitamin E controversy 

VITAMIN E by Abram Hoffer, M.D., Ph.D.

The history of vitamin E, its early massive rejection for about 40 years and its increasing acceptance today is very interesting and contains many lessons for physicians and for medical schools. The only reason it was so thoroughly rejected is that physicians knew hardly anything about vitamins.

For decades, vitamin E pioneers Drs. Wilfred and Evan Shute were deprived of any recognition which was deservedly theirs. At the end of their lives they had some satisfaction from the recognition they received from orthomolecular physicians. They were the first doctors who had to face the unreasonable and unrelenting opposition of the medical establishment for their espousal of megadoses of a vitamin. This opposition was totally unscientific.

Unless we learn from history we are condemned to have to repeat it. I will quote Dr. Shute to give the reader a flavor of the controversy and how he reacted. In discussing coronary disease, he wrote:

"Hundreds of thousands more may die while scholars debate the etiological issue. Many more will go about clutching their anginal chests. What's to do meantime? Oxygen tents and anti coagulants, rest, reassurance by experts that this is really a mild disease, seem to meet the situation poorly. Indeed the whole Western world watches the progress of one famous patient after another, while celebrities by the score drop around us day by day.

"Into this situation we projected alpha tocopherol in 1947. One would have thought it would have been welcomed, since its rivals were so dangerous or so inadequate. But it was a far jump from abortion to coronary thrombosis, and an obstetrician was unduly hardy and audacious to try it. At the time so little was known of the accessory biochemical and physiological properties of alpha tocopherol that the proposal seemed doubly ludicrous. It met with a storm of rejection and is only now recovering from its hard reception. Had its vascular properties been recognized first (and at the International Congress on Vitamin E in Venice, Comel proposed it should henceforth be called the " angiophilic vitamin") it would have eased into Cardiology as gently and persuasively as heparin or dicumarol."

The Shute brothers in Ontario used 800 IU, and far more, to treat large numbers of patients with circulatory problems and heart disease, and to accelerate healing after burns. They were subjected to powerful opposition from the medical establishment, especially in Ontario. Still, they continued to add to their clinical experiences, but the medical journals would not publish their papers. Therefore, they published in their own journal, "The Summary."

Some recent reviews of vitamin E discuss the following indications.

(1) Cardiovascular disease.

(2) Premenstrual syndrome.

(3) Tissue ischemia, common in myocardial infarction, stroke and renal failure. Vitamin E reduces ischemia and will be very important in dealing with these conditions.

(4) Cancer prevention. Studies show an inverse relationship between vitamin E status and the development or risk of dying from cancer.

(5) Protection against environmental pollutants. It suppressed increased lipid peroxidation in cigarette smokers.

(6) Enhancing immune function.

It is clear that vitamin E will play an ever increasing role in the prevention and treatment of disease. It is no longer a vitamin in search of a disease. It is now an antioxidant vitamin intimately involved in the biochemistry and physiology of the body, and therefore involved with a host of diseases.

DOSE

Drs. W. Shute and E. Shute recommended doses from 400 IU to 8,000 IU daily. The usual dose range was 800 to 1600 IU but they report that they had given 8,000 IU (about 8 grams) without seeing any toxicity. I usually use between 400 and 1,200 IU daily but for Crohns disease have been giving 4,000 IU. I have not yet seen any side effects form vitamin E administration. Dr. Marks reports that adults can safely be given 100 to 800 IU but excludes adults with alteration of vitamin K status or metabolism. Ingestion of 1,200 IU has increased the coagulation defect produced by vitamin K deficiency or by warfarin (Coumadin) treatment. Dr. Shute advises starting with small doses for patients who have rheumatic heart disease. He starts with 90 IU and very slowly works up the dose. The reason for this is that if too much is given at the beginning the increased strength of the heartbeat may create some difficulty. The same applies to heart failure from hypertension. The initial dose should be small and gradually increased. If this is done the final dose can safely reach 800 to 1,200 IU.

The public is well acquainted with vitamin E and its usefulness. They have had ample literature from which to learn. 

In 1972 Dr. E. Di Cyan, a friend of mine, wrote his excellent book, "Vitamin E and Aging." (1) This book even today is very up-to date and in it is foreshadowed the many current interests in the medical profession which then were totally ignored and laughed at.

SOME CARDIOVASCULAR DISEASE STUDIES

Two recent reports show that vitamin E helps heart patients get well from bypass surgery and angioplasties. Dr. D. S. Sgoutas, Dept of Pathology and Laboratory of Medicine at Emory University, found that 35.5 % of the angioplasty patients taking vitamin E suffered from restenosis, while 47.5% of the control placebo group did. J. American College of Nutrition, 11, 68-73, 1992 . Dr. T. Yau, U. of Toronto, reported that presurgical supplementation of vitamin E helped the heart pump during the high-risk five-hour postoperative period. Controls did not do as well.

On November 19, 1992 New York Newsday carried a report that Vitamin E had decreased the risk of heart disease between one-third and one-half. Two studies were conducted at the Harvard School of Public Health. In one study Dr. M. Stampfer et al (2) found that during an eight year follow up, women who had taken at least 100 IU of Vitamin E daily for two years had a 46 percent lower risk of having an heart attack. This was based on a population study involving 87,245 women. The second study, on men by Dr. E. Rimm et al (3), based upon 51,529 subjects, showed a 37 percent lower risk. They found that there was not enough vitamin E in food to reach these daily levels. Dr. Stampfer was so convinced by the data that he is himself taking the vitamin. Dr. Stampfer was very skeptical before the study. He thought it was implausible that a simple maneuver like taking vitamin E would have such a profound effect.

These findings are not surprising to anyone familiar with the Shutes' research on over 30,000 patients. Neither Stampfer, nor Rimm and their colleagues in their two papers make any reference to the pioneering work done much earlier by the Shute brothers, whose work was a model of good clinical research but the idea then so novel it was attacked. The Shutes were considered quacks since everyone knew that Vitamin E had no value for anything. The medical profession, instead of investigating these claims, carefully persisted in downgrading the work. In fact, one of the publications widely distributed to doctors did a hatchet job on the Shutes' work many years ago. By doing so it effectively killed interest for many decades. In this medical letter they reviewed four studies published between 1940 and 1950 which they claimed were definitive studies which proved Vitamin E had no therapeutic value for treating heart disease. I then read the four papers and found them to be inept and inadequate and so badly done that today no medical journal would publish them. They did not follow Dr. Shutes' directions, as they used too little vitamin for too short a period. Now scientists report a 35 to 50 percent reduction in heart disease.

Today, 40% of all deaths are caused by heart disease. Each day 2,000 people, or about 750,000 persons per year, die from heart disease. Let us assume that the reduction in risk is exaggerated, and that in reality there is only a 10 percent reduction. This means that each year about 50,000 fewer people would have died, a saving of about 200 patients daily. It is difficult to calculate overall how many would have been saved if the Harvard group has taken their responsibility seriously and examined the Vitamin E claims in 1950 instead of waiting until 1992. This is the real cost of medical cynicism. Had they been merely skeptical, they could have done the studies to satisfy their own curiosity. But they were so convinced the Shutes' findings were meaningless they went out of their way to destroy them. They succeeded. I wonder if the editors of that medical letter today have given any thought to the cost of this type of inexcusable delay. This happened several hundred years ago when Sir James Lind proved that citrus fruits could prevent scurvy in British sailors. The Navy began to issue limes 40 years later. In the meantime, 100,000 sailors died. This again illustrates the true cost of delay in examining seriously claims made by physicians.

The medical establishment consoles itself by claiming that the onus for proving new findings is on the original investigator. This is merely an excuse for doing nothing. The price is enormous. How much longer will society permit doctors the luxury of doing nothing, especially when the suggested treatments are safe, economical and the opinion of doctors who follow the treatments, so effective. The medical establishment should be ashamed of itself, and owes the American people an apology.

1. Di Cyan, E. Vitamin E & Aging. Pyramid Books, New York 1972.

2. Stampfer,M.J., Hennekens,C.H., Manson,J., Colditz, G.A., Rosner,B. & Willett, W.C. Vitamin E consumption and the risk of coronary disease in women. New England J. Med. 328: 1444 - 1449, 1993.

3. Rimm, E.B., Stampfer, M.J., Ascherio, A., Giovannucci, E., Colditz, G.A. & Willett, W.C. Vitamin E consumption and the risk of coronary heart disease in men. New England J Med 328; 1450-1456, 1993.

More information on by Dr. Hoffer on the Shutes' use of vitamin E:
http://www.doctoryourself.com/hoffer_shute.html