Q. I read that a big, new study just found that taking vitamin E and low-dose aspirin doesn’t protect women from cancer or heart disease. Your thoughts?

A. The study you’re referring to is part of the Women’s Health Study (WHS) conducted between September 1992 and March 2004. It included 39,876 women and was a randomized, double-blind, placebo-controlled trial to evaluate the benefits and risks of taking 100 mg of aspirin every other day and 600 IU of vitamin E (as alpha tocopherol) every other day. Approximately half of the women took the aspirin/vitamin E combination and half took a placebo.

Results showed that taking the aspirin had no observed effect on the women’s risk of all types of cancer — including breast and colon cancer — with the exception of lung cancer. The study found a 22 percent reduced risk of lung cancer among the women taking the aspirin/vitamin E combination. Over the years, a number of observational studies have suggested that taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) reduced the risk of various types of cancer by 20 to 50 percent. However, another randomized control trial, the Physician’s Health Study, found no reduced risk of colon cancer among participants who took 325 mg of aspirin every other day for five years. And a large study from California published in the June 1, 2005 issue of the Journal of the National Cancer Institute found no protection from breast cancer among women who regularly took aspirin or ibuprofen, both of which are NSAIDs.

As far as vitamin E is concerned, the WHS was looking for a protective effect against cancers of all types and against cardiovascular disease. The study did find a 24 percent reduction in cardiovascular deaths among women in the vitamin E group. Earlier observational studies have suggested that vitamin E reduces the risk of heart disease and that its antioxidant activity lowers cancer rates. Apart from the reduction in heart disease deaths, this study showed no such benefits. The results were published in the July 6, 2005 issue of the Journal of the American Medical Association.

I still recommend taking 400 IU of vitamin E in the form of mixed tocopherols and tocotrienols for general antioxidant and health-protective effects. I would like to see more research assessing the health benefits of the whole, natural vitamin E-complex. As for low-dose aspirin, it offers many benefits, especially in lowering risk of heart attacks. I continue to take both of these myself.

Q. I’ve heard that you’re changing your vitamin D recommendation. Why? And how much do you now recommend?

A. Yes, I am raising my recommendation for vitamin D from 400 IU to 1,000 IU per day. That may sound like quite a leap, but evidence has been accumulating to suggest that the 400 IU now recommended for adults isn’t enough for optimum health. We need vitamin D to facilitate calcium absorption and to promote bone mineralization as well as for protection from a number of serious diseases. I recently reviewed a series of studies on vitamin D and bone health with Walter Willett, MD, professor of epidemiology and medicine at Harvard Medical School. Dr. Willett has assembled a compelling review of clinical evidence suggesting that current vitamin D recommendations, including my own, are too low.

To sum up, most adults are simply not getting enough vitamin D for good bone health. We get vitamin D from such foods as fortified milk and cereals as well as from eggs, salmon, tuna, mackerel and sardines, and our bodies make vitamin D with exposure to sunlight. Unfortunately, many people don’t spend enough time in the sun to get optimal exposure, particularly in northern latitudes during the gray winter months. In addition, sunscreen blocks vitamin D synthesis in the skin, and dermatologists have made people so paranoid about sun exposure that many people in lower latitudes and in summer don’t get enough either.

And, clearly, many people are falling short of their vitamin D needs. A study published in the February 2001 issue of the American Journal of Clinical Nutrition showed that even while taking a 1,000 IU supplement, fewer than half of the participants in a Canadian study were getting enough to achieve optimal blood levels of vitamin D. And research published in the January 2003 issue of the American Journal of Clinical Nutrition showed that 1,700 IU was needed to bring blood levels of vitamin D to optimal levels during winter months in Nebraska.  Dr. Willett told me that other studies have shown that an intake of 400 IU of vitamin D per day has no impact on the risk of fractures, but that 700 to 800 IU per day, with or without calcium supplements, does seem to reduce fracture incidence. He noted that some evidence further suggests that a higher intake of vitamin D may reduce the risk of prostate cancer, colon cancer, other malignancies, and multiple sclerosis.

Don’t be concerned that 1,000 IU will give you too much vitamin D — exposure to sunlight in the summer can generate between 10,000 and 20,000 IU of vitamin D per day with no ill effects. What’s more, no adverse effects have been seen with supplemental vitamin D intakes up to 10,000 IU daily.

Increasing my vitamin D recommendation to 1,000 IU daily may not be the last word on this subject. Depending on the amount of sunshine available where you live, you may need to take even more. Stay tuned.

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