The Vitamin Myth, Myth

An article by Paul Offit, MD, published in The Atlantic Monthly, July 19, 2013, reports the lack of evidence supporting the use of micronutrient supplements. Dr. Offit is a recognized infectious disease expert, co-developer of the rotavirus vaccine and a professor at the University of Pennsylvania. He is the author of 2013 book, “Do you Believe in Magic, the Sense and Nonsense of Alternative Medicine.”

Linus PaulingThe article begins by examining the illustrious career of Linus Pauling, PhD. Recipient of two Nobel prizes, Dr. Pauling’s contributions to science cannot be overstated as he is credited with originally describing the ionic bond and the discovery of the molecular basis of sickle cell disease. Later in his career, Dr. Pauling became interested in Vitamin C and its potential for chemo prevention and maintenance of cardiovascular health.

Unfortunately, the article deteriorates from an interesting discussion to a diatribe directed against micro-nutritional supplementation with Dr. Pauling’s focus on vitamin C as the principle point of departure. Where Dr. Offit may have missed his mark isn’t that he raises questions about micro-nutrition but that he selectively utilizes negative studies to support his position to the exclusion of any and all more favorable findings.

Vitamin CTo examine but a few of the points: Vitamin C is a profoundly important micronutrient, which is likely deficient in many American’s diets. The USRDA measured in tens of milligrams may well underestimate the human body’s requirements, characterizing instead the minimum amount required to avoid scurvy, that age-old disease of English mariners successfully managed with the consumption of citrus fruit (ergo the moniker of limey). As mankind evolved we lost the capacity to synthesize vitamin C (lacking the enzyme L-gulano-gamma-lactone oxidase) and now must rely on ingestible sources. Thus, Dr. Pauling’s attention to this vital micronutrient served us well in forcing a reexamination of the biologically relevant daily requirements.

Although, Drs. Pauling and Cameron’s (a Scottish surgeon), and Dr. Moertel’s, subsequent American studies did not establish vitamin C as a therapeutic, the choice of oral vitamin C in this pharmacologic application should have been recognized as an inadequate delivery mechanism in light of the diminishing absorptive efficiency of the human gastrointestinal tract associated with high dose oral administration. To wit, the therapeutic application of vitamin C, it could be argued, ultimately requires other vehicles for administration. More to the point, however, was Dr. Pauling’s original examination of primate diets, which included vitamin C rich foods and not vitamin C tablets. Albert Szent-Gyorgi, the co-discoverer of ascorbic acid, long held that the bioflavonoids in Vitamin C rich fruits participated in critical antioxidant reactions.

Above and beyond Dr. Offit’s pillorying of Dr. Pauling, is his inclusion of several ill-conceived clinical-proofs-of-concept that failed to support vitamin supplementation for cancer prevention.  The CARET study, which provided cigarette smokers and patients with asbestos exposure, high doses of beta carotene (30 mg/day) and retinyl palmitate (25,000 IU/day) identified an increased incidence and death rate from of lung cancer. In retrospect, any biochemist should have known that carotenoids serve both as antioxidants and prooxidants depending upon ambient oxygen-free radical conditions. Placing high concentrations of beta carotene into the circulation of cigarette smokers and asbestos exposed individuals was tantamount to throwing gasoline on a fire.

Similarly, the prostate cancer prevention study, SELECT, chose alpha-tocopherol as its vitamin E supplement and went vitamin Eon to report a higher incidence of prostate cancer in the treatment arm. Once again, the choice of a comparatively inactive tocopherol (the alpha form) that, in high doses, diminishes the bioavailability of the more active gamma tocopherol and tocotrienols, reflected a poorly conceived design and an inadequate understanding of the underlying biochemistry.

Dr. Offit’s article adds heat, but little light to this discussion. We should remember that micro-nutritional supplementation is designed to replace those trace elements and chemical species that would normally be found in a human diet. We evolved from scavengers, hunters and gatherers whose diet varied by season and included dozens, even hundreds of foodstuffs that few Western civilizations consume today. It is the intention of intelligently constructed micro-nutritional supplements to replace these deficient nutrients.

There is ample evidence to support intelligent dietary supplementation and a growing body of evidence that suggests that many, if not most, modern human maladies reflect our diets and lifestyles. Epidemiology is a difficult field under the best of circumstances. It took Doll and Peto decades to prove that cigarette exposure caused cancer, a simple fact that today is accepted by every grade school child in America.

It was Mark Twain who quipped that “There are three kinds of lies: lies, damned lies and statistics.” Perhaps he should have considered including nutritional epidemiology as a fourth.

About Dr. Robert A. Nagourney
Dr. Nagourney received his undergraduate degree in chemistry from Boston University and his doctor of medicine at McGill University in Montreal, where he was a University Scholar. After a residency in internal medicine at the University of California, Irvine, he went on to complete fellowship training in medical oncology at Georgetown University, as well as in hematology at the Scripps Institute in La Jolla. During his fellowship at Georgetown University, Dr. Nagourney confronted aggressive malignancies for which the standard therapies remained mostly ineffective. No matter what he did, all of his patients died. While he found this “standard of care” to be unacceptable, it inspired him to return to the laboratory where he eventually developed “personalized cancer therapy.” In 1986, Dr. Nagourney, along with colleague Larry Weisenthal, MD, PhD, received a Phase I grant from a federally funded program and launched Oncotech, Inc. They began conducting experiments to prove that human tumors resistant to chemotherapeutics could be re-sensitized by pre-incubation with calcium channel blockers, glutathione depletors and protein kinase C inhibitors. The original research was a success. Oncotech grew with financial backing from investors who ultimately changed the direction of the company’s research. The changes proved untenable to Dr. Nagourney and in 1991, he left the company he co-founded. He then returned to the laboratory, and developed the Ex-vivo Analysis - Programmed Cell Death ® (EVA-PCD) test to identify the treatments that would induce programmed cell death, or “apoptosis.” He soon took a position as Director of Experimental Therapeutics at the Cancer Institute of Long Beach Memorial Medical Center. His primary research project during this time was chronic lymphocytic leukemia. He remained in this position until the basic research program funding was cut, at which time he founded Rational Therapeutics in 1995. It is here where the EVA-PCD test is used to identity the drug, combinations of drugs or targeted therapies that will kill a patient's tumor - thus providing patients with truly personalized cancer treatment plans. With the desire to change how cancer care is delivered, he became Medical Director of the Todd Cancer Institute at Long Beach Memorial in 2003. In 2008, he returned to Rational Therapeutics full time to rededicate his time and expertise to expand the research opportunities available through the laboratory. He is a frequently invited lecturer for numerous professional organizations and universities, and has served as a reviewer and on the editorial boards of several journals including Clinical Cancer Research, British Journal of Cancer, Gynecologic Oncology, Cancer Research and the Journal of Medicinal Food.

3 Responses to The Vitamin Myth, Myth

  1. I can understand the disbelief that vitamin C clinical trials in cancer had been disappointing, because most clinicians were giving it orally. It was not realized at the time that only injected ascorbate delivered the concentrations needed to see anti-tumor effect.

    The same was said with endostatin clinical trials. There, most clinicians had injected the hormone directly into patients, where the hormone broke down in the body before it had a chance to slow the spread of cancer. But some researchers “rethought” the situation by understanding that by allowing talc (pleurodesis) in the chest cavity, thus constantly causing the normal cells to produce endostatin, inhibits the growth of tumors.

    Thanks to scientists that take the time to think through “whiz bang” science that often gets a pass without much thought. The problem is that few scientific discoveries work the way they think and few physicians/scientists take the time to think through what it is they’ve discovered.

  2. JIM says:

    I lost my wife to pancreatic cancer in Feb . I have been conducting research for well over a year now and have found many cancer cures. Had I know in may 2012 what I know today my wife would still be alive. Western medicine overall is an atrocity and this era and the treatment of cancer patients will be referred to as barbaric in the future. There are doctors who agree with me and plenty of data to back up what I am saying. Many doctors do not know what is going on because of what they are taught in medical school. The truth is if the cure cannot be patented they will let you die. Western medicine treats the symptoms not the cancer. That way you remain a revenue stream. Please feel free to challenge me.

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