The Emperor’s New Clothes: HOPE-TOO

April 5, 2005

Reputable American researchers claim that even large amounts of natural Vitamin E do not benefit established atherosclerosis. But their study do not reveal it. The participants got almost no Vitamin E.

Perhaps somebody have heard about the praised American HOPE study from 2000. It was to reveal that natural Vitamin E would not make any difference for people with atherosclerosis. This was a disappointment, and with it the issue could then have been dismissed.

That is not how it went. The HOPE study, which lasted 4,5 years and included 9,000 participants was prolonged with 2,5 years. They wanted to be absolutely sure, they said. In the follow-up study called HOPE-TOO only 4,000 people participated. Some did not want to participate, others had died, and others only wanted to be examined, but did not want any medication.

Half of the participants took 400 units natural Vitamin E daily (alpha-tocopherol), while the rest took placebo. They certainly had serious atherosclerosis: Every other one had had a heart attack, just as many suffered from angina pectoris (atherosclerosis ), and more than every third had diabetes.

The HOPE study showed that Vitamin E did not cause more or less cancer, more or less heart attacks, strokes, deaths or anything else. HOPE-TOO showed the same result, though with a single addition: Those who took Vitamin E slightly more often had heart failure; that is to say a decreased functioning of the heart.

The difference was so small that it could very well have been coincidental, even though it was statistically significant. Nevertheless the authors took the opportunity to strongly warn against dietary supplements. But yet they might as well have taken the opportunity to recommend them. They found that Vitamin E protected against lung cancer!

This finding, which was also statistically significant, was rejected, as an “error.” This conclusion was preceded by a lengthy discussion, in which reference is made to studies with beta-carotene, which as we all know, is something completely different.

No clothes on
But there is a far more serious surprise, which totally overshadows this biased opinion: During the whole study the participants did not have any more Vitamin E in their blood than all other people, who do not take supplements. The average value was 17,6 μmol/l. The normal value is 12 – 42. Despite the Vitamin E they only just managed to get their minimal need covered.

Before the study the participants actually had even lower values, averaging 10 μmol/l. This fits well with the fact that they were seriously ill, overweight heart patients who were kept on a low fat diet. A low fat diet may lead to deficiency of vitamin E.

Here we may also find the explanation of the low blood values. Vitamin E can only be absorbed from the intestine when fat is present. If you eat non-fat foods you might as well not take Vitamin E, even when you take 20 – 40 times the recommended dosage.

One is reminded of the Emperor’s New Clothes. HOPE-TOO has no clothes on. It claims to examine the effects of mega doses of Vitamin E, but the participants are only seemingly getting it. Strangely enough nobody has pointed out this almost ridiculous mistake before. In particular one wonders, why the authors themselves have not seen this mistake. Could it be that they do not know the normal values of Vitamin E in the blood?

This is not completely out of the question although it sounds strange. There are many examples of superficiality in scientific research. You do not have to look any further than the official commentary in the same issue of JAMA, which published the HOPE-TOO study. Here doctor Greg Brown by and large agrees with the conclusion of the study. He was also in charge of a similar study from 2001, which was supposed to show if antioxidants prevent atherosclerosis in the coronary arteries. This study concluded that antioxidants did not prevent atherosclerosis, even though the figures showed in black and white that the antioxidants halved the growth of atherosclerosis in the coronary arteries, compared to placebo.

By: Vitality Council

1. The HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer. JAMA 2005;293:1338-47.
2. B Greg Brown. Is there any hope for vitamin E? JAMA 2005;293:1387-90.
3. Greg Brown et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-92.