Sunday, September 9, 2007

More on Antioxidants and the WACS Controversey

Hey, Hey! Looks like old "Hawky" hit a nerve with my jab at antioxidants! That's great because it's an area that deserves considerable debate given the fact that many of us consume significant amounts of them. Thanks go to "Captnsaj" and "Anonymous" for getting the debate going. Let's see where it goes!

First, let me confirm I am not an antioxidant "hater." Although, I do think Linus Pauling's and Mathias Rath's advice about ingesting mega-doses of Vitamin C is kinda loopy. What I AM saying is that, statistically, the WACS Study says they are not effective at reducing CVD. Lord knows I believe in the value of supplements and have had my share of disagreements with the drug companies. Drug company funding is ALWAYS problematic in any study but WACS was funded by the National Heart, Lung, and Blood Institute.

It seems Mike Adams is taking the lead in attacking the WACS study. So, for the time being, I will play devil's advocate and take the opposite side. Here goes ...

1. Let's start by refuting Mike's claim the study supports the use of antioxidants. In fact, the ONLY conclusion it draws is they are no more effective than placebo. The two exceptions were the findings that Vitamin E reduced risk once non-compliant subjects were removed and was duly noted in the report. However, the study produced dozens of statistical findings and the only one that showed statistical significance (just barely with a P=0.04) was the use of Vitamin E in women with confirmed prior CVD (but not women with risk factors but no confirmed CVD). There was also a "suggestion" Vitamin E in combination with Vitamin C should be looked at for effectiveness as reducing stroke risk as it showed statistical significance (P=0.o3). Frankly, when you generate that many statistics on a sample population, one or two may produce a false positive (in fact, statistics say it is likely). You have to consider the overwhelming body of statistics generated.

2. One needs to understand a little bit more of the math behind statistics. The study said the relative risk ratio (RR) for heart disease related events (heart attack, stoke, revascularization, and death) was not improved by any of the supplements. The key is to look at the confidence intervals (CI) and "P" values for each statistic. When P values exceed the "significance level" (o.o5 in this case) or the CI encompasses the value "1" then statisticians assume the null hypothesis is not rejected. In other words the tested agent did not produce any result that could not be explained by other than random chance. Note that the P values are all far greater than 0.05 in almost every case and the CI's encompass "1". In the few cases where marginal significance was achieved, the P values where only modestly below 0.05. Normally, I like to see these values in the range of 0.001 to 0.01 before I completely reject the null hypothesis. Required reading at this point should be Chapter 3 of Steven Milloy's treatise SCIENCE WITHOUT SENSE: The Risky Business of Public Health Research. There is also a good layman's description of the subject at http://sportsci.org/resource/stats/pvalues.html

3. Mr. Adams claims that non-compliant subjects were used to "dilute" the results. Unfortunately, that is not neccesarily the way statistics work. I put a call in to Dr. Nancy Cook the bio-statistician that oversaw the project. Perhaps she will provide more data. The example Adams gives where 50% of the test subjects did not receive "sandwiches" is a little outrageous and does not correspond at all with the way the WACS Study was run. I might also add that even using his fictitious example, the efficaciousness of "sandwiches" would still be borne out using the WACS statistical methodology.

4. Mr. Adams makes patently ridiculous statements like "If we taught people the truth about nutrition, they wouldn't need prescription drugs!" and "Drugs don't make people healthy." Tell that to all the people who died of infections or lost limbs before the advent of antibiotics (yeah, I know what you are thinking, but ANYTHING can be over-prescribed and misused). These sorts of patently false claims leads me to discount much of his other rhetoric.

5. Most drugs are simply purified and concentrated forms of naturally occurring substances. And just because a supplement is not a prescription agent does not mean it is not a drug. In fact, supplements like L-Carnitine require a prescription in Canada. Also, I doubt the Vitamin C Mr. Adams takes is distilled from oranges. It is likely made in a big chemical plant just like all the drugs he rants about. Finally, he mentions what he feels to be relatively low doses used in the WACS study. Linus Pauling routinely advises doses like 10 grams of Vitamin-C. How is THAT natural?

As always, the truth is somewhere in the middle. That is why I always advise people get their info from multiple sources - even zealots like HeartHawk and Mike Adams!

As for me, what the heck, I say hedge your bet. If you got the time, inclination, and money, a daily dose of 1000mg C and 400IU of E can't hurt. In fact, the WACS study makes a point of saying that it did not find any dangerous effects as were found for Vitamin E in earlier studies. Just don't expect any miracles!

More comments are encouraged!

Regards,


HeartHawk

3 comments:

Anonymous said...

HeartHawky, I've got to give you props for the follow up. Thanks for checking it out. Sound as if antioxidants might provide some protection but they're no magic bullet. I don't believe there are any magic bullets just a lot of small steps that when combined and used consistantly have a good chance of slowing, stopping or possibly reversing the damage. Thanks again.

Pascal said...

Pauling and Rath advocated 6g - 18g/ day of Vitamin C as ascorbic acid taken in divided doses (very important since Vitamin C has a very short half life less than a few hours in the body) to control heart disease. They also advocated 6g of L-Lysine/day taken in divided doses. The WACS study used only 0.5g of Vitamin C apparently taken once a day. This is about 12 to 36 times less than the amounts advocated by Pauling and Rath. They also did not use any L-Lysine.

How can this possibly refute the assertion of Pauling and Rath if you are not going to use anywhere close to the doses they advocated???

HeartHawk said...

Pascal:

This particular blog was not about Pauling and Rath. I mentioned them as a pertinent sidebar in my diatribe on anti-oxidants.

Regardless of the above, taking their prescribed amounts of Vitamin C is intolerable to many. Also, the notion that oral ingestion of L-Lysine (not to mention Proline) will produce useable chemical ligands in vivo after digestion seems a bit farfetched.

I am willing to believe anything but would like to see a preponderance of hard evidence from multiple corroborating sources. I didn't belive the initial reports on Vitamin D either until it got rammed down my throat by hard evidence.

Trust me, I have high lipoprotein(a) and would like nothing more than for Pauling's and Rath's work to be verified. It just hasn't happened yet - and I do not believe in "magic bullets." There is no "one size fits all" solution to heart disease!

Regards,


HeartHawk

 
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