Prevention ProtocolsLife Extension Suggestions
Conventional Medicine Recommends Vitamin Supplements
For the greater part of the 20th century, mainstream medicine was openly hostile to the idea of healthy people taking vitamin supplements. This antivitamin position began to change in the 1990s as irrefutable evidence emerged that supplements could reduce the risk of age-related disease without inducing toxicity.
In 1998, an editorial titled "Eat Right and Take a Multi-Vitamin" was published in The New England Journal of Medicine. This article was based on studies indicating that certain supplements could reduce homocysteine serum levels and therefore lower heart attack and stroke risk. This was the first time this prestigious medical journal recommended vitamin supplements (Oakley 1998).
An even stronger endorsement for the use of vitamin supplements was in a 2002 issue of the Journal of the American Medical Association (JAMA). According to the Harvard University doctors who wrote the JAMA guidelines, it appeared that people who got enough vitamins may be able to prevent such common illnesses as cancer, heart disease, and osteoporosis. The Harvard researchers concluded that suboptimal levels of folic acid and vitamins B6 and B12 are a risk factor for heart disease, colon and breast cancers; low levels of vitamin D contribute to osteoporosis; and inadequate levels of the antioxidant vitamins A, E, and C may increase the risk of cancer and heart disease (Fairfield 2002).
The FDA's Suppression of Folic Acid
The Food and Drug Administration (FDA) has spent enormous resources trying to prevent people from supplementing with folic acid. The FDA argues against folic acid supplementation because the presence of folic acid in blood could mask a serious vitamin B12 deficiency. In a JAMA study, the authors addressed the FDA's concerns by recommending that folic acid supplements be fortified with vitamin B12 as a prudent way of gaining the cardiovascular benefits of folic acid without risking a B12 deficiency (Losonczy 1996).
Even though major medical journals (eg, New England Journal of Medicine) long ago endorsed the use of folic acid to reduce cardiovascular disease (Malinow 1998), the FDA still does not accept that folic acid has any benefit other than preventing a certain type of birth defect.
A study in the Annals of Internal Medicine showed how fatally flawed the position of the FDA is. Data from the famous Harvard Nurses' Health Study conducted at the Harvard Medical School showed that long-term supplementation with folic acid reduces the risk of colon cancer by an astounding 75% in women. The fact that 90 000 women participated in the Harvard Nurses' Health Study made this finding especially significant. The authors of this study explained that folic acid obtained from supplements had a stronger protective effect against colon cancer than folic acid consumed in the diet. This new study helps confirm the work of Dr. Bruce Ames, the famous molecular biologist who authored numerous articles showing that folic acid is extremely effective in preventing initial DNA mutations that can lead to cancer later in life. This Harvard report, showing a 75% reduction in colon cancer incidence, demonstrated that the degree of protection against cancer is correlated with how long a DNA-protecting substance (folic acid) is consumed. Women who took more than 400 mcg of folic acid daily for 15 years experienced the 75% reduction in colon cancer, whereas short-term supplementation with folic acid produced only marginal protection (Giovannucci 1998).
There now exists a massive body of evidence that supplementation with folic acid can prevent both cardiovascular disease and cancer, yet the FDA has proposed rules that would prohibit the American public from even learning about these benefits. Colon cancer will kill 47 000 Americans this year. It is unfortunate that the FDA did not "allow" these colon cancer victims to learn about folic acid in time.
The Vitamin C Controversy
Some doctors still believe that vitamin C causes kidney stones; however, a report from Harvard Medical School showed no increased risk of kidney stones when evaluating 85 557 women over a 14-year study period. This report in the April 1999 issue of the Journal of the American Society of Nephrology showed that women who consumed 1500 mg or more daily of vitamin C were no more likely to develop kidney stones than women who consumed less than 250 mg of vitamin C daily. The study did reveal that women who consumed 40 mg or more of vitamin B6 were 34% less likely to develop kidney stones compared to women taking fewer than 3 mg a day of B6 (Curhan 1999). Now that kidney stone risk has been ruled out, let's look at some of the human studies showing positive benefits to vitamin C supplementation.
In the early 1990s, several large population studies showed a reduction in cardiovascular disease in those who consumed vitamin C. The media reported on some of these findings and this favorable publicity helped push a bill through Congress that prevented the FDA from banning high-potency vitamin C and other supplements.
The most significant report emanated in 1992 from the University of California in Los Angeles (UCLA), where it was announced that men who took 800 mg a day of vitamin C lived 6 years longer than those who consumed the FDA's recommended daily allowance (RDA) of 60 mg daily. The study, which evaluated 11 348 participants over 10 years, showed that high vitamin C intake extended average lifespan and reduced mortality from cardiovascular disease by 42% (Enstrom 1992).
A study in the British Medical Journal evaluated 1605 randomly selected men in Finland ages 42-60 years from 1984-1989. None of these men had evidence of preexisting heart disease. After adjusting for other confounding factors, men who were deficient in vitamin C had 3.5 times more heart attacks than men who were not deficient in vitamin C. Scientists concluded that "vitamin C deficiency, as assessed by low plasma ascorbate concentration, is a risk factor for coronary heart disease" (Nyyssonen 1997).
In a study in The Lancet, researchers at Cambridge University in England looked at serum vitamin C and length of life in 19 000 individuals. People with the lowest levels of vitamin C were twice as likely to die when compared to those with the highest serum vitamin C levels (Khaw 2001). The question for those who want to achieve maximum health is: Do you want your blood to contain the lowest levels or the highest levels of vitamin C? Because being at the lowest level may double the risk of dying, we suggest that you consume fruits, vegetables, and supplements that are high in vitamin C.
In a 1999 issue of the American Heart Association's journal Circulation, elevated homocysteine levels were shown to cause rapid onset of endothelial (arterial lining) dysfunction (Chambers 1999). This type of dysfunction reduces blood flow and can facilitate a lethal arterial spasm. Vitamin C inhibited arterial dysfunction by interfering with oxidative stress mechanisms. The doctors conducting the study stated that acute impairment of vascular endothelial function can be prevented by pretreatment with vitamin C.
In a double-blind study in the Journal of the American College of Cardiology, the authors compared the effects of nitrate drugs in people receiving vitamin C to a placebo group not receiving vitamin C. The doctors administered nitrate drugs to healthy people and patients with coronary artery disease and then measured vasodilation response and cellular levels of cyclic guanosine monophosphate (cGMP), an energy substrate that is depleted by nitrate drugs. At day 0, all participants were measured to establish a baseline. After 3 days of vitamin C administration (2 grams 3 times daily), there was no change in either group. After 6 days of vitamin C therapy, a 42% improvement in vasodilation response was observed, and a 60% improvement in cellular cGMP levels was measured in coronary artery disease patients receiving vitamin C compared to those receiving placebo. A similar improvement occurred in the healthy subjects taking vitamin C compared to the placebo group. Doctors concluded the study by stating that "these results indicate that combination therapy with vitamin C is potentially useful for preventing the development of nitrate tolerance" (Watanabe 1998).
In another study in the Journal of Clinical Investigation, the authors looked at the effects of nitrate drug therapy on human patients. Tolerance development was monitored by changes in arterial pressure, pulse pressure, heart rate, and activity of isolated patients. All patients experienced the deleterious effects of nitrate tolerance. However, when vitamin C was co-administered with nitrate drugs, the effects of nitrate tolerance were virtually eliminated. The most significant improvement was a 310% improvement in the arterial conductivity test. The nitrate drugs induced a dangerous up regulated activity of platelets, but this too was reversed with vitamin C supplementation (Bassenge 1998). The researchers indicated that vitamin C may be of benefit during long-term, non-intermittent administration of nitrate drugs in humans.
Chronic heart failure is associated with reduced dilating capacity of the endothelial lining of the arterial system. Scientists tested heart failure patients by high-resolution ultrasound and Doppler to measure radial artery diameter and blood flow. Vitamin C restored arterial dilation response and blood flow velocity in patients with heart failure. Scientists determined that the mechanism of action was that vitamin C increased the availability of nitric oxide, an important precursor to cGMP (Rodes 1998).
In 1998, another effect of vitamin C on coronary artery disease was discovered. A study in the Journal of the American College of Cardiology showed that low plasma ascorbic acid levels independently predict the presence of an unstable coronary syndrome in heart disease patients. According to the doctors, study results showed that the beneficial effects of vitamin C in treating coronary artery disease may result, in part, by an influence on arterial wall lesion activity rather than a reduction in the overall extent of fixed disease (Vita 1998).
Published research findings suggest that vitamin C may reduce mortality in coronary artery disease patients, increase life span, and possibly eliminate the effects of nitrate tolerance in those taking nitrate drugs. Although not recognized in the medical establishment as a therapy for coronary artery disease, there now exists an accumulated wealth of evidence that vitamin C has beneficial effects in the treatment of heart-related illnesses.
Historically, mainstream medicine has ridiculed vitamin C supplementation. Today, conventional medicine says that only 200 mg a day of vitamin C is needed, despite findings showing that high doses of vitamin C are required to produce optimal benefit. Meanwhile, the FDA continues to hold the position that no more than 90 mg daily for men and 75 mg daily for women of vitamin C is needed.
Saturating the Bladder
The most frequent criticism regarding supplemental vitamin intake is that it produces "expensive urine," because water-soluble vitamins, such as vitamin C and the B vitamins, are excreted into the bladder within hours of ingestion. For years, Life Extension has contended that these vitamins are beneficial in spite of their rapid excretion; moreover, it is desirable to have a bladder full of vitamins because certain vitamins inhibit chemicals that cause bladder cancer. In the September 1996 issue of the American Journal of Epidemiology, a study on the risk of bladder cancer in vitamin takers showed the following (Bruemmer 1996):
- High intake of vitamin A and beta-carotene was associated with a 48% reduction in bladder cancer incidence compared to the lowest levels of vitamin A and beta-carotene intake.
- People taking higher amounts of vitamin C had a 50% reduced rate of bladder cancer. Those who took 502 mg or more of vitamin C daily had a 60% reduction in bladder cancer compared to those who took no vitamin C.
- For those who took multivitamin supplements for at least 10 years, the reduction in bladder cancer was 61% compared to people who took no vitamin supplements.
- High intake of fried foods was associated with double the risk of bladder cancer.
It appears from this study that even low-potency "one-a-day" supplements (which do not protect against other types of cancer) can at least protect against bladder cancer.
Studies show that antioxidant supplements reduce the risk of cataracts. One study in the American Journal of Epidemiology evaluated 410 men for 3 years to ascertain the association between serum vitamin E and the development of cortical lens opacities (cataracts). Men with the lowest level of serum vitamin E had a 3.7 times greater risk of this form of cataract compared to men with the highest serum level of vitamin E (Rouhiainen 1996).
Although cataracts are usually treatable, a disease called wet macular degeneration is not. Those who eat spinach and collard greens have low rates of macular degeneration, and extracts from these vegetables thought to protect against this blinding disease are now available in dietary supplements that contain lutein and zeaxanthin.
Keeping Arteries Clean
In a study reported in the American Journal of Clinical Nutrition, antioxidant status was assessed and carotid artery occlusion was measured in 1187 men and women 59-71 years of age without any history of coronary artery disease or stroke. The results showed that the higher the level of vitamin E in red blood cells, the lower the risk of carotid atherosclerosis. In men with the highest levels of carotid atherosclerotic plaques, the lowest levels of vitamin E, selenium, and carotenoids were found. Scientists concluded by stating: "Our findings give some epidemiological support to the hypothesis that lipid peroxidation and low antioxidant status are involved in the early stages of atherosclerosis" (Bonithon-Kopp 1997).
A study in the journal Atherosclerosis showed that people who took a 900 mg garlic supplement every day for 4 years had 5-18% less plaque buildup in their carotid arteries compared to the placebo group. The women in the treatment group showed a 4.6% decrease in carotid plaque volume over a 4-year period, whereas the placebo group showed a 5.3% increase in artery-clogging plaque (Koscielny 1999).
There are more studies showing that atherosclerosis can be prevented than for any other degenerative disease. Because more people die or become disabled from vascular diseases than any other cause, it would appear prudent to follow a program that would reduce one's risk of suffering a vascular-related heart attack or stroke.
Are You Concerned about Cancer?
Fear of cancer is a major reason why people take dietary supplements. As has already been shown, there is a compelling body of evidence that cancer risk can be reduced by taking the proper supplements over an extended period of time.
An article in JAMA showed that 200 mcg of supplemental selenium a day reduced overall cancer mortality by 50% in humans compared to a placebo group not receiving supplemental selenium. This 9-year study demonstrated that a low-cost mineral supplement could cut the risk of dying from cancer in half in certain individuals (Clark 1996).
In a 1999 issue of the Journal of the National Cancer Institute, associations between intakes of specific nutrients and subsequent breast cancer risk were investigated in 83 234 women participating in the Harvard Nurses' Health Study. Breast cancer risks were significantly lower in women who consumed alpha-carotene, beta-carotene, lutein/zeaxanthin, and vitamins A and C. Among premenopausal women who consumed moderate amounts of alcohol (a known risk factor in breast cancer), beta-carotene lowered risk. Premenopausal women who consumed 5 or more servings of fruits and vegetables daily had a modestly lower risk of breast cancer than those who had less than 2 servings daily (Zhang 1999).
A study in the March 1999 issue of Cancer Research reported that the tomato extract lycopene was the most effective nutrient shown to protect against the development of prostate cancer. This study, started in 1982, followed 578 men for 13 years. Lycopene strongly reduced prostate cancer risk and more importantly, lowered the risk for aggressive cancer. This study confirmed many previous studies showing that lycopene can help prevent pancreatic, prostate, and a host of other cancers (Gann 1999). A surprising finding revealed at the April 1999 meeting of the American Association of Cancer Research showed that 30 mg of lycopene supplements daily slowed the growth of existing prostate cancer and lowered serum prostate-specific antigen (PSA) readings by 20%.
Men with high intake of vitamin E were 35% as likely to develop colorectal adenomas as men with low vitamin E intake (Tseng 1996). Adenomas are neoplastic lesions that are considered precursors to colon cancer. In a related study in the February 1999 issue of Diseases of the Colon and Rectum, the use of multivitamins, vitamin E, and calcium supplements was found to be associated with a lower incidence of recurrent adenomas in 448 patients with previous neoplasia who underwent follow-up colonoscopy. This study found a protective effect against the recurrence of precancerous adenomas when any vitamin supplement was used (Whelan 1999). On this same subject, a report in the American Journal of Epidemiology showed that women with high folate intake were 40% less likely to develop adenomas of the colon than women with low folate intake (Tseng 1996).
For those who already have cancer, the research shows a prolongation of lifespan with proper supplementation.
In a study in Cancer Letters, animals with malignant tumors given high doses of vitamins C and E and selenium manifested a significant prolongation of the mean survival time. Complete remission of tumors developed in 16.8% of the animals. Low-dose administration of these vitamins failed to exert any beneficial effect on mean survival time of the animals. Results indicated that high doses (mega doses) of vitamins C and E in combination with other carefully selected antioxidants are likely needed in order to achieve sufficient prevention and treatment of malignant diseases. This study indicated that low-potency supplements are of little value (Evangelou 1997).
In a study in Cancer Research, vitamin E succinate was shown to inhibit growth and induce apoptotic cell death of estrogen receptor-negative human breast cancer cells (Turley 1997). These findings suggest that vitamin E succinate may be of clinical use in the treatment and possible prevention of human breast cancers.
Research clearly shows the risk of cancer is reduced in those who supplement with adequate amounts of nutrients, such as selenium, folate, carotenoids, vitamins, and other plant extracts.
One of the most compelling reports that high-potency supplements extend lifespan in humans was in the August 1996 issue of the American Journal of Clinical Nutrition. This study involving 11 178 elderly people attempted to establish the effects of vitamin supplements on mortality. The use of vitamin E reduced the risk of death from all causes by 34%. Effects were strongest for coronary artery disease, where vitamin E resulted in a 63% reduction in death from heart attack. In addition, use of vitamin E resulted in a 59% reduction in cancer mortality. When the effects of vitamins C and E were combined, overall mortality was reduced by 42% (compared to 34% for vitamin E alone) (Losonczy 1996). These results provided significant evidence about the value of vitamin supplementation, yet the media failed to report on it. What made this study so credible was that:
- It compared people who took low-potency "one-a-day" multiple vitamins to those who took higher-potency vitamins C and E. Previous studies measuring the life expectancy of the "one-a-day" crowd did not show significant benefits, thereby causing most doctors to conclude there is no value in vitamin supplementation. In this new report, those taking "one-a-day" multivitamins did not do any better than people taking nothing at all, which supports Life Extension's position that higher doses of antioxidants than those found in conventional supplements are required to reduce the risk of heart disease and cancer.
- It lasted 9 years. Most studies that attempt to evaluate the benefits of vitamin supplementation are for shorter time periods. It should be noted, however, that the famous Harvard Nurses' Health Study found that vitamin E reduced coronary artery disease mortality by more than 40% after only 2 years.
- It included 11 178 people, a larger group than most previous studies.
The National Academy of Sciences published 3 reports showing that the effects of aging may be partially reversible with a combination of acetyl-L-carnitine and lipoic acid (Hagen 2002). One of these studies showed that supplementation with these 2 nutrients resulted in a partial reversal of the decline of mitochondrial membrane function while consumption of oxygen significantly increased. This animal study demonstrated that the combination of acetyl-L-carnitine and lipoic acid improved ambulatory activity, with a significantly greater degree of improvement in the old rats compared to the young ones. Human aging is characterized by lethargy, infirmity, and weakness. There is now evidence that supplementation with 2 over-the-counter supplements can produce a measurable anti-aging effect.
The second study published by the National Academy of Sciences showed that supplementation with acetyl-L-carnitine and lipoic acid resulted in improved memory in old rats. Electron microscopic studies in the hippocampus region of the brain showed that acetyl-L-carnitine and lipoic acid reversed age-associated mitochondrial structural decay. In the third National Academy of Sciences study, scientists tested acetyl-L-carnitine and lipoic acid to see if an enzyme used by the mitochondria as biologic fuel could be restored in old rats. After 7 weeks of supplementation with acetyl-L-carnitine and lipoic acid, levels of the enzyme carnitine acetyl-transferase were significantly restored in the aged rats. Supplementation also inhibited free radical-induced lipid peroxidation, which enhanced the activity of the energy-producing enzyme in the mitochondria. The scientists concluded that feeding old rats acetyl-L-carnitine and lipoic acid can ameliorate oxidative damage and mitochondrial dysfunction.
Proper hormone replacement can produce an immediate improvement in quality of life and prevent many diseases. Dehydroepiandrosterone (DHEA) is one of several important hormones whose production in the body diminishes rapidly as people age past 35 years. There now exists a wide body of evidence that supplementation with DHEA can prevent many degenerative diseases, while improving feelings of well-being and alleviating depression.
In the October 1996 issue of the journal Drugs and Aging, an overview of published studies on DHEA revealed the following (Watson 1996):
- In both humans and animals, the decline of DHEA production with aging is associated with immune depression, increased mortality, increased risk of several different cancers, loss of sleep, and decreased feelings of well-being.
- DHEA replacement in aged mice significantly normalized immune function to youthful levels.
- DHEA replacement has shown a favorable effect on osteoclasts and lymphoid cells, an effect that may delay osteoporosis.
- Low levels of DHEA inhibit energy metabolism, thus increasing the risk of heart disease and diabetes mellitus.
- Studies conducted on humans show essentially no toxicity at doses that restore DHEA to youthful levels.
- DHEA deficiency may expedite the development of some diseases that are common in the elderly.
Hundreds of additional studies have substantiated DHEA's role as an anti-aging hormone-replacement supplement. In a study published in Biological Psychiatry, DHEA was tested on middle-aged and elderly patients with major depression. DHEA was administered for 4 weeks in doses ranging from 30-90 mg daily. This level of dosing elevated DHEA serum levels to those observed in younger people. Depression ratings, as well as aspects of memory performance, significantly improved. This data suggested that DHEA may have antidepressant and promemory effects and corresponded with previous human studies in which DHEA supplementation (50 mg daily) significantly elevated mood in elderly people (Wolkowitz 1997).