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Marvin Ackerman, MD - Vitamins, Antioxidants and Alzheimer's

Guess what, if you think you're helping to safeguard yourself from Alzheimer's disease by taking all that vitamin C, vitamin E, and carotene, and increasing your intake of foods containing antioxidants, you could be wasting your money and effort

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At least this seems to be the conclusion derived from a study by Luchsinger's group from the Taub Institute for Research on Alzheimer's disease and the aging brain writing in the February 2003 Archives of Neurology. Their article called "Antioxidant Vitamin Intake and Risk of Alzheimer Disease" based on 242 incident cases of the disease in 4023 person-years of follow-up, apparently deflates the idea that these antioxidants are capable of reversing the generation of oxygen free radicals known to be involved in the pathogenesis of Alzheimer's disease. See if you think their conclusion is justified after we go over their study without injecting prejudice one way or the other.

The 980 participants chosen randomly, after eliminating inappropriate elements, were all over the age of 65 years. Those entered in the study, came from a Columbia University program called the Washington Heights-Inwood Columbia Aging Project. All subjects were carefully screened for physical and neurological disease when they were examined initially from 1991 to 1996. They were then followed annually for the next several years. The follow-up period ranged from 1 year to about 5.5 years with a mean of 4 years. Food frequency was based on a telephone interview questionnaire in English or Spanish given to the participants. This apparently included questions about intake of vitamins. According to the report, "dietary data were obtained using a 61 item version of the semi-quantitative food frequency questionnaire developed by Willett et al. The findings were then subjected to rigorous statistical evaluation.

Determination of a diagnosis of dementia was made by the consensus of a group of neurologists, psychiatrists, and neuropsychologists. They based their opinions on the information gathered from the initial and follow-up visits using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Diagnosis of Alzheimer's disease was based on criteria from the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association.

The results were interesting. No one reported taking carotene supplements. A bit more than one third of the subjects claimed to have taken a mean supplemental dose of 302 mg. per day of vitamin C supplements. Slightly fewer individuals claimed to have taken a mean supplemental dose of 187 IU per day of vitamin E. Another key finding was those who took vitamin supplement had more years of education than those who didn't. An attempt to obviate the effect of education, age, sex, ethnicity, smoking status, and the presence of the APOE allele was made by adjusting the final result to account for these important variants. For example, although the vitamin C supplement intake after adjustment for age and sex did show less of a risk for Alzheimer's disease. When it was further adjusted for the remaining factors the difference became insignificant. Taking all factors into account the final conclusion was "neither dietary, supplemental, nor total intake of carotenes and vitamins C and E was associated with a decreased risk of AD in this study"

Other studies have reached varying results, but the study conditions tended to vary. Analysis of this study reveals several reasons for doubting the validity of the conclusion. Perhaps the most glaring are the small number of participants and the short duration of at most about 5.5 years. A participant aged 65 years would have reached no more than the age of 70 when the study ended. Even adjusting for age, as was done here, would have meant little if these limits were changed to 70 and 75, or even 75 and 80. At least in my experience, and I'm sure yours, no one that I know started showing evidence of Alzheimer's disease so early in life. However, I'm not so sure about how well someone over the age of 75 years might be trusted to accurately report vitamin food and supplement intake. This, of course, would vary with intelligence, but I truly wonder whether any statistical adjustment factors might be capable of accounting for such variants. Then there's the built-in intelligence problem wherein better-informed individuals tend to know more about dietary facts and so are more likely to take supplements or alter their intake. Furthermore, these same individuals are more likely to keep their minds occupied as they age, observe better nutritional standards overall, and be generally wealthier, the improved lifestyle thereby skewing the results in their favor. Going one step further, if a participant begins to develop symptoms of forgetfulness, the main deficit observed in Alzheimer's disease, how reliable would they be in reporting their vitamin intake? Having a spouse or some other family member monitoring them would create an overwhelming imposition of effort. Finally, who is to say whether the doses of vitamins taken by these elderly people were adequate for achieving the desired result?

Considering everything, if you can readily afford to pay for the vitamin supplements, are fully aware of appropriate dose levels, are willing and able to stick to a proper dietary routine, can remember to follow through every day, and above all, if you feel a good deal better about your chances for avoiding the horrifying prospect of losing your memory, then why worry about which study is correct, as long as no one has proven this routine to be unsafe?

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission.

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About Marvin Ackerman, MD

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission. Copyright © 2010 by Marvin Ackerman, M.D.

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