Vitamin Information Center

Attributable Risk Fraction
Definition
The attributable risk fraction is an epidemiological
parameter. If there are several causes for the development
of a health problem, the attributable risk fraction
describes the percentage of the risk that is due to a certain
risk factor, e. g. the percentage of risk for lung cancer
caused by smoking.

A new study finds high dose injections of Vitamin C can reduce cancerous tumors by half.

And what’s more — the treatment does not harm healthy cells, meaning
There are fewer difficult side-effects, often experienced with traditional cancer treatments like chemo and radiation.

Go home and die. That’s what doctors told 59 year old Arlindo Olivera.
His lung cancer was so advanced, it had spread to his brain and doctors
Said there was nothing they could do. Today, Arlindo is cancer free.

Arlindo believes his cancer is gone because of Vitamin C treatment.

Dr. Scott Greenberg says he has successfully treated many people with
Vitamin C infusions, including Arlindo.

Some doctors believe Vitamin C treatment works by killing the cancer
cells.

Researchers at the national institutes of health say it may also work as
An anti-oxidant protecting cells from the damage of free radicals.

The national institutes of health study treated mice with aggressive brain, ovarian and pancreatic tumors.
Tumor growth and weight was reduced by 41 to 53 percent and the brain cancer stopped spreading.
Doctor Greenberg says it only works in very high intravenous doses and can be used along with traditional chemo and radiation.
He says it’s a valuable option for those who don’t respond to other treatment.

Arlindo continues to be cancer free.
The treatment is not covered by insurance, but costs considerably less
Than standard chemotherapy or radiation.
It’s about 125 dollars per treatment versus several thousand dollars.

UroToday.com - Many of the 10 million cancer patients in the US are taking nutritional supplements, but an accurate assessment of the frequency is not well appreciated. In the February 1, 2008 issue of the Journal of Clinical Oncology, Christine Velicer and Cornelia Ulrich report a systematic review of supplement use among US cancer patients. Prostate cancer patients are among the lowest users of supplements.

A total of 32 studies published between 1999 and 2006 met the criteria for review of prevalence of vitamin and mineral supplement use among patients undergoing active cancer treatment. The review revealed that a range of 64% to 81% of survivors reported any vitamin or mineral supplement use and 26% to 77% reported using any vitamins. Nine studies reported use among breast cancer survivors, and use of any vitamins or minerals was 67%-87% and multivitamin use was 57%-62%. The increase in use after breast cancer diagnosis was up to 32%. Complimentary and alternative medicine (CAM) use was associated with younger age, higher education, greater physical activity and psychosocial factors. Use of any vitamins was 38%-43% for colorectal cancer patients and 60% for lung cancer patients.

In comparison, use of any vitamins among prostate cancer patients was 26%-35% and multivitamin use ranged from 13%-23%. Megavitamin use was 4%-24%. CAM use for prostate cancer patients was associated with higher education and higher income, but not cancer stage. Age and ethnicity were not clearly associated. In one study, 15% of patients undergoing radiotherapy used high-dose vitamins, but the treating physicians actually estimated that less than 5% were using them. After a diagnosis of prostate cancer, 15% of patients began using CAM (57% were already using CAM) but only 51% informed their physicians. In one study 20% of patients reported that their treating urologist or radiotherapist never raised the issue of CAM use with them.

The authors point out that while some therapies such as St. John’s wort may interfere with drug metabolism, a great understanding of the effects and utilization of CAM among cancer patients is needed. At the very least, physicians should gather intake about CAM use among their patients.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

What’s your favorite drink? Mine is a body shot off of Miranda Kerr’s navel (and by “navel,” I mean breasts), but I digress. Unfortunately for you, I’m not asking for your favorite beer or liquor. Instead, I’m more interested in what non-alcoholic beverage you sip during class (that is, if you go to class). Is it a legendary Vitamin Water, an acidic Vault, a misleading diet Coke or a new 30 percent-less-plastic-but-still-not-biodegradable Poland Spring bottle of water?

Scientists have taken a new look at vitamin C and its health benefits. I’m going to go out on a limb here and say that most people like orange juice. What’s not to like? It’s made from a fruit that is named after a fashionable color, contains vitamin C and is downright delicious. It can also be healthy for you in a number of ways.

If I asked you what vitamin C was, you’d probably give the following eloquent response: “Dude, it’s a vitamin.” But it’s so much more. It’s an antioxidant and it can help protect your heart, though it may not stop your heart from being broken on Valentine’s Day (Don’t worry Jimmy, I’m sure your girlfriend has a perfectly good explanation for sleeping with the entire starting five of Duke’s basketball team … at the same time).

Finnish researchers reviewed the studies of 300,000 people over the course of 10 years and found that taking 700 milligrams of vitamin C daily can reduce the risk of developing cardiovascular disease by 25 percent. Experts say that vitamin C helps slow the clogging of arteries, lower blood pressure and enhance the functionality of blood vessels. It’s great news because you know you need all the blood vessel help you can get with all the McDonald’s you eat.

Vitamin C may also be able to shun cancer like Britney Spears at a feminist convention. It may lower your risks of getting bladder, esophagus, stomach and lung cancer. Some scientists are even optimistic that taking vitamin C intravenously may also treat existing cancer; research has shown that when cancer cells are injected with vitamin C, it triggers the formation of hydrogen peroxide, which in turn kills the cancer cells while leaving healthy cells unharmed.

Vitamin C helps fight off age-related macular degeneration [AMD] (aka blindness). AMD affects more women than men and if you’re overweight (those pants don’t make you look fat …) or have a family history, you are at an even higher risk of developing AMD. So our lovely Binghamton female students should consider consuming more orange juice.

Another incentive, vitamin C prevents wrinkles. That’s right; it forms collagen, which smooths those fine lines. (Note: Pouring orange juice over your face and body will not prevent wrinkles. Must be consumed in order to have desired effects.)

Do you take a multivitamin? Or a single vitamin, mineral, or combination supplement? If so, you are in the company of tens of millions of U.S. adults.

Why do you take them? Most people say it makes them feel healthier or they believe it will prevent chronic diseases, or colds and flu. But you may be surprised to know that what is in your bottle and on the label is not strictly regulated. And there is no system in place to collect reports of adverse affects.

Over the past few years there has been increasing evidence that multivitamins and single or combination type vitamin/mineral supplements may not provide the health benefit sought by you, the consumer. In some cases the opposite or no beneficial effects have been reported.

Alarming to think that vitamin or mineral supplements could actually cause more harm than good. An example of this is the use of beta carotene by smokers actually increased the incidence of lung cancer. This is echoed by a recent study out of the University of Washington that reports the use of multivitamins, vitamin C, vitamin E and folate did not reduce the risk of lung cancer.

It is not all bad news though; there are studies to support the use of folate (folic acid) prior to and during pregnancy in the prevention of neural tube defects in the developing fetus. And history has proven that vitamins and minerals play a critical role in our health — the reason we know about the benefits of vitamins and minerals in food is because of the major discoveries in disease prevention such as vitamin C and scurvy and thiamine, a B vitamin, and beri beri (a wasting type disease).

This may leave you wondering if those vitamin mineral supplements in your medicine cabinet are doing what they should or even worth your money.

Let’s look at this way — do you eat a well balanced diet? If so, you may not need a multivitamin and if you take one as a “safety net” know that you may exceed what your body needs or can use.

Are you concerned about a chronic disease? If so, making changes in your diet and exercise habits, not smoking and following through with recommended screenings by your physician are more likely to benefit your overall health picture.

Consider your current state of health, talk to your doctor and/or dietitian, and weigh the possible benefits and risks of a multivitamin and mineral supplement for you.

To your health,

Katherine

The increased risk of lung cancer with vitamin E was small.

“Vitamin E supplements ‘could cause up to 27 per cent increase in lung cancer’”, according to a news story in the Daily Mail. Several other news sources report a study of more than 77,000 people that found a “slight but significant increase” in lung cancer risk with a moderate to high intake of vitamin E supplements. The reports also say the study sounded a similar warning for beta-carotene supplements.

The study behind the news report looked at the use of supplemental vitamins (multivitamins, vitamin C, vitamin E and folate) and new cases of lung cancer. Overall, the study found no protective effect of supplements on lung cancer. It also found a barely significant increase in risk of lung cancer associated with vitamin E supplementation. The increased risk was small – a five per cent increase in risk for every 100mg of vitamin E taken per day over 10 years – and this translated to a small increase in the participants with lung cancer.

By far the largest predictor of lung cancer from this large study was smoking, with most cases occurring in current or past smokers.

Where did the story come from?Dr Christopher Slatore and colleagues from the University of Washington, the VA Puget Sound Health Care System, the University of North Carolina at Chapel Hill, and the Fred Hutchinson Research Centre, Seattle carried out the research. The research was supported by a grant from the National Cancer Institute.

The study was published in the peer-reviewed: The American Journal of Respiratory and Critical Care Medicine.

What kind of scientific study was this?In this cohort study, the researchers aimed to investigate the links between supplemental multivitamin use, vitamin, C, E and folate, and incidence of lung cancer.

This study - the VITAL study (VITamins And Lifestyle) - was set up to examine the effects of long term supplement use on lung cancer in people aged between 50 and 76 in Washington state.

The researchers mailed 364,418 questionnaires between October 2000–December 2002 asking about medical history, cancer risk, supplement use and diet. Responses were obtained from 21.3% of those sent the questionnaire and this provided 77,719 people for analysis.

The questionnaire asked the participants about their supplement and vitamin use in the 10 years leading up to the start of the study. Supplement intake was classified as current, past, or never used, with specific details about the extent of use (e.g. dose per day, per week etc.). From this data, the researchers calculated the amount of multivitamins taken over 10 years, and the quantities of individual vitamins by looking at those contained in multivitamins (estimated from a reference manual) and from individual supplement tablets.

The researchers also examined other factors that could have an effect on lung cancer risk, such as smoking (years and number of cigarettes per day), age, sex, past cancer history, family history, airways disease, ethnicity, education, marital status, BMI and diet. They carried out statistical analysis of relationships between lung cancer and supplement use allowing for age, sex and smoking. They tested whether any of the other factors were affecting any observed link between these relationships and took into account those that were in their final analysis.

The participants were monitored to see if they developed lung cancer. For this, the researchers used a cancer registry called SEER, which, they said, contains accurate and complete information on cancer and lung cancer histology. The researchers excluded people who had already been diagnosed with lung cancer at the beginning of the study, those whose cancer was only diagnosed after they had died, and those who had relevant data missing. The participants were followed up until they withdrew from the study, moved out of the catchment area, died, or when the study terminated in December 2005.

What were the results of the study?The analysis included 77,126 subjects who were followed for an average of four years. Of these, 521 developed lung cancer with most cases occurring in current or previous smokers. Few cases developed in people who had never smoked.

There was no link between risk of lung cancer and use of multivitamins, vitamin C, or folate, at any dosage for 10 years. The participants’ age, sex and smoking status were taken into account.

When the researchers looked at vitamin E alone, they found a minimal link to lung cancer (all lung cancers) – with a five per cent increase in risk with every 100mg increase in dose of vitamin E taken per day over 10 years. This result was only just statistically significant.

When the researchers looked at risk for different types of lung cancer, they found that vitamin E was associated with an increased risk in non-small cell lung cancer (the most common type). They say that this amounted to a “28% increased risk of lung cancer at a dose of 400mg/day for 10 years”.

Looking at risk of cancer by vitamin use and dividing people into categories of current and ex-smokers, they only found statistical significance between lung cancer and highest dose vitamin E in current smokers.

What interpretations did the researchers draw from these results?The researchers concluded that no supplement protected against lung cancer; however, vitamin E was associated with a small increase in risk, especially in smokers.

What does the NHS Knowledge Service make of this study?This study looked for associations between lung cancer risk and supplement use in a large number of people. However, the links between vitamin E and lung cancer should be considered in context:

• The researchers found no protective effect of any type of vitamin for lung cancer.
• The increased risk from vitamin E overall was quite small - a five per cent increase per 100mg per day – and was of borderline statistical significance.
• The researchers report that the risk was  “largely confined to current smokers” with minimal cases occurring in non-smokers.
• There may have been errors in the participants’ 10-year history of vitamin use. The usage was estimated by the participants themselves and it is possible that their vitamin use may have been inconsistent over that time period. Likewise, the researchers may have introduced inaccuracies when they estimated the amount of each individual vitamin contained in multivitamin tablets.
• Although there was an increased risk associated with vitamin E, it cannot be assumed that it was caused by the supplement itself. There could be other reasons causing the increase in risk that have not been taken into account.
• The results cannot be reliably generalised outside of the predominantly white, US population from which the data was obtained. The researchers also point out that the study had a smaller proportion of current smokers than is present within the actual US population as a whole.

Sir Muir Gray adds…I see no evidence of vitamin E deficiency in England and so therefore no need for taking extra vitamin E.

Not ready to quit smoking cold turkey? A new study shows that just cutting down on the number of cigarettes you smoke can reduce your risk of lung cancer.

Noting that “many smokers are unable or unwilling to completely quit smoking,” a team of researchers from Denmark set out to determine the impact reducing the amount people smoke could have on their lung health. Their findings appear in the Journal of the American Medical Association.

The researchers looked at data from nearly 20,000 men and women who had undergone two physical examinations with five to 10 years between checkups as part of a larger study. At both exams, participants filled out questionnaires on their lifestyle habits, including questions about how much and how often they smoked. Former smokers were asked about past habits and the amount of time since they had quit.

At the first checkup, participants were categorized as heavy smokers (15 or more cigarettes per day), light smokers (one to 14 cigarettes per day), ex-smokers and never smokers. At the second visit, the researchers divided the participants into further categories: continued heavy smokers, reducers (reduced smoking from 15 or more cigarettes per day by a minimum of 50% without quitting), continued light smokers, quitters (quit since the first examination), continued ex-smokers and never smokers.

Between exams, 832 people reduced their smoking by at least 50%, with the average reducer going from 22.2 cigarettes per day to 8.5 cigarettes per day. More than 7,300 participants remained categorized as heavy smokers, smoking an average of 20 cigarettes per day at both exams. Compared to those who continued to smoke heavily, reducers were older, more likely to be male and had smoked slightly more and for a longer period.

Participants were followed from their second examination for an average of 18 years, during which time 864 people developed lung cancer.

After analyzing the data, the researchers found that while consistent light smoking or quitting smoking after being a light smoker carried a bigger reduction in lung cancer risk, heavy smokers who managed to reduce their daily number of cigarettes from about 20 to fewer than 10 cut their risk by 27%.

But this finding doesn’t mean that if you are a smoker your goal shouldn’t still be to butt out altogether. The researchers note that other studies haven’t found that reducing the number of cigarettes smoked per day cuts the risk of heart attack or chronic obstructive pulmonary disease (COPD), and they conclude that the focus should be on quitting, not cutting down.

“More data from long-term studies of smoking reduction are warranted, but for the present, smoking cessation and not smoking reduction should still be advocated as the ultimate method of reducing harm from smoking,” they write.

Editor’s note:  A recent study found that use of vitamin E supplements was not associated with reduced risk of lung cancer among the general population. Among current smokers, taking vitamin E supplements may even dramatically increase the risk of the cancer up to 28%.  The following is compiled by a foodconsumer.org editor for those who want to know more about this vitamin. The key point is that vitamin E by definition is essential to your health and you should not avoid it.  The best source is of course food. But when you take a supplement, make sure you are taking the natural form of vitamin E.  Read on for detail.

Vitamin E: What you need to know

What is vitamin E?

Vitamin E is a group of eight nutrients including four tocopherols, (alpha-, beta-, gamma- and delta-) and four tocotrienols (alpha-, beta-, gamma- and delta-). Alpha-tocopherol is the only form of vitamin E that is active in the body.

What does vitamin E do in the body?

The form of vitamin E most known today is alpha-tocopherol, which is believed to be used in the body mainly as an antioxidant. Antioxidants are expected to neutralize free radials endogenously and oxidative environmental pollutants.

Alpha-tocopherol is fat-soluble and helps protect against oxidation of fatty components in the cell membrane and also protect fats in low density liporpoteins (LDLs), which transport cholesterol from the liver to the tissue of the body. Oxidation of LDLs could lead to development of cardiovascular diseases.

Alpha-tocopherol also affects some enzymes and the production of immune and inflammatory cells among other things.

The functions of other forms of vitamin E are not as well understood.

What are the consequences of vitamin E deficiency?

Vitamin E deficiency could be caused either by low intake of the vitamin or by some conditions that disable the alpha-tocopherol transfer protein or by some problem with fat absorption.  Those who can’t absorb fat such as patients with cystic fibrosis or cholesterol liver disease would have a problem with absorbing this vitamin from the diet, potentially leading to vitamin E deficiency.

The main consequences of severe vitamin E deficiency are neurological symptoms such as ataxia (impaired balance and coordination), peripheral neuropathy (injury to sensory nerves, myopathy (muscle weakness) and pigmented retinopathy (damage to the eye retina). People who experience these symptoms should be checked for their vitamin E status.  Children are more sensitive and thus more vulnerable to vitamin E deficiency and they can quickly show neurological symptoms while adults may not develop symptoms due to the deficiency for 10 to 20 years.

Vitamin E deficiency due to low intake of this nutrient rarely results in any reported symptoms.  In effect, vitamin E deficiency due to low dietary intake is rare although suboptimal intake of this nutrient is found common in the U.S. population. A study known as the U.S. National Health and Nutrition Examination Survey III (NHANES III) showed 27 % of whites, 41% of blacks, 28% Mexican Americans and 32% of others have less than 20 micromoles/liter, a level of vitamin E that is believed to pose a risk for cardiovascular disease.

What is the recommended dietary allowance for vitamin E?

The RDA set by the Food and Nutrition Board of the Institute of Medicine in 2000 varies with age.  The RDA for both adult males and females is 15 mg or 22.5 IU per day.  Pregnancy does not require extra vitamin E, but breastfeeding mother need 19 mg or 28.5 IU per day.

What are the conditions or diseases on which vitamin E may have an effect?

Observational studies have showed an association between increased vitamin E intake and decreased risk of myocardial infarction or heart attack or death from heart disease in both men and women.  Studies also found plasma levels of alpha-tocopherol were inversely linked to the severity of carotid atherosclerosis. But trials often failed to see any protective effect of this vitamin on heart attacks and death.

Observational studies also showed vitamin E may protect against cataracts, but interventional trials did not find any protective effect when 400 IU of vitamin E was used for 7 years.

Alpha-tocopherol was also found to boost the immune response. One study showed 200 mg of synthetic-tocopherol daily for a few months increased production of antibodies in response to hepatitis B vaccine and tetanus vaccine in elderly people.

Because free radials are believed to cause damage to DNA, neutralization of these compounds by antioxidant vitamins such as vitamin E is believed to have a preventative effect against cancer.  But many studies showed that vitamin E supplements were not linked to reduced risk of cancer.  In a recent study, vitamin E supplementation for ten years was found even to increase the risk of lung cancer in current smokers.

What are the foods that contain high levels of vitamin E?

The major dietary sources of alpha-tocopherol include vegetable oils such as olive, sunflower and safflower oils; nuts such as almonds, hazelnuts and peanuts; whole grains products; and green leafy vegetables such as spinach.  All eight forms of vitamin E occur naturally in foods.

Those who would use vitamin E supplements should check and see if the form they buy is natural or synthetic.  They may better off buying and using only the natural form.  The synthetic form of vitamin is biochemically not usable by the body and potentially cause a physiologic problem in the body.  The natural form in food (not the fortified) is the form of the isomer, RRR-alpha-tocopherol.  In supplemental vitamin E, dl-alpha-tocopherol or all-rac-alpha-tocopherol means the vitamin is synthetic.

There are some other forms of vitamin E or derivatives used in supplements.  Foodconsumer.org recommends use of the natural form d-alpha-tocopherol.

What are the possible side effects of vitamin E?

Vitamin E is fat-soluble and too much of its intake through supplements may cause some side effects. But the Food and Nutrition Board of the Institute of Medicine believes 1000 mg or 1500 IU of alpha-tocopherol per day can be tolerated by adults aged 19 or older.  The dietary intake of this vitamin rarely poses any risk.

Women who smoke are no more likely to develop lung cancer than men, US researchers have concluded.

There had been conflicting evidence on women’s risk, but the National Cancer Institute study of over 450,000 people found no gender difference.

The study published in Lancet Oncology found a difference of only 0.9% between the risk for men and that for women.

The most recent UK statistics show that in 2006, 23% of men and 21% of women were cigarette smokers.

Lung cancer kills around 30,000 people a year in the UK.

‘Vigorous efforts needed’

The researchers analysed data on smoking habits, diet, exercise and alcohol use for 279,214 men and 184,623 women aged between 50 and 71 living in eight US states.

They then looked at lung cancer rates.

The difference in risk for women and men who smoked was just 0.9%.

Men and women who smoke more than two packs per day were about 50 times more likely to develop lung cancer than people who had never smoked.

The team, led by Dr Neal Freedman, said their study benefited from its size, giving reliable findings

They conclude: “Our findings suggest that women are not more susceptible than men to the carcinogenic effects of cigarette smoking in the lung.

“Vigorous efforts should continue to be directed at eliminating smoking in both sexes.”

Andy McEwen, assistant director of tobacco studies at Cancer Research UK’s Health Behaviour Research Centre, said: “Smoking has a devastating effect on the health of people trapped by their tobacco addiction.

“The risk of a smoker, male or female, developing lung cancer is 15 times greater than that of a non-smoker and smoking continues to be the biggest preventable cause of death for men and women.”

“Smoking accounts for the vast majority of cases of lung cancer worldwide.

“More has to be done to help all smokers to quit if we are to prevent future deaths from lung cancer.”

By Michelle Carolla

Americans spend more than $7 billion a year on vitamins. But how do you know if you need vitamins and supplements?

A study in the Journal of American Medical Associations reports insufficient vitamin intake is an apparent cause of chronic disease. The American diet does not normally provide adequate amounts of vitamins.

Mary Ellen Scarborough, a registered dietician, told News 13 what’s important is what you eat. Eating whole, fresh foods and not processed, fatty foods is the best way to ensure you’re getting the proper amount of vitamins. Continue Reading…