Epidemiology Strengthens Link of Vitamins E and C to Alzheimer’s

Two studies in the June 26 JAMA report that high intake of vitamins E and C was correlated with reduced risk of AD, pointing to the role of antioxidant activity in warding off the disease. The finding held only when the vitamins were consumed from foods, not in the form of supplements.

Both reports were drawn from large-scale, prospective community studies of aging, one in Rotterdam, the Netherlands, and the other in Chicago, Illinois (the latter being noteworthy for having equal numbers of black and white participants). In their analysis of data from the Rotterdam study, Monique Breteler and colleagues at Erasmus Medical Center there found a protective effect in those whose diets were high in vitamins E and C. The Chicago data, reported by Martha Morris and colleagues, showed a protective effect only of vitamin E. Other dietary antioxidants examined (beta carotene in both studies, flavonoids in the Chicago study) did not correlate with AD risk.

Interestingly, neither study found a protective effect for vitamin supplements. This could mean that supplements are useless in protecting against AD because their biological activity differs from vitamins in food, but other possible explanations exist, as well. Breteler et al. point out that users of supplements tend to either have existing health problems or engage in a range of other “health-seeking” behaviors, any of which might affect the progression of AD. Numerous confounding factors argue against deriving conclusions from this kind of epidemiological data.

Echoing the authors' cautionary remarks, Daniel Foley of U.S. National Institute on Aging in Bethesda, Maryland, and Lon White of the Pacific Health Research Institute in Honolulu, Hawaii, present some of the arguments for reserving judgment until results from long-term clinical trials become available. Among their concerns about the present data are the reliability of the questionnaires on dietary habits, which ask about large numbers of foods consumed over long periods of time. There is an inherent possibility that people in preclinical stages of AD would be increasingly unable to provide accurate data. Similarly, preclinical disease might affect eating habits or the use of supplements.

“Nonetheless, the idea that vitamin E and vitamin C might have beneficial effects on the underlying AD process makes sense, and it seems unlikely that antioxidant-rich foods would negatively affect brain aging,” conclude Foley and White in an accompanying editorial.—Hakon Heimer

Comments

  1. Interventions to modify oxidant balance to provide protection from Alzheimer disease (AD) are as hotly debated as it has been for other age-related diseases. In recent studies ( Engelhart et al., Foley and White, Morris, et al.), dietary intake of vitamin E and C was associated with a mild lowered risk of AD, yet vitamins supplied by supplements had no benefit. That dietary antioxidants provide protections should be of little surprise given the massive oxidative damage that is a prominent and early feature of AD (Nunomura, et al). However, oxidative phenomena are well-regulated events such that in AD there is a compensatory antioxidant response (Smith, et al., Russel, et al.) and regulatory control of oxidative damage (Wataya, et al). Uni-dimensional antioxidants found in supplements would only perturb this system whereas complex antioxidants found in fruits and vegetables would synergize with endogenous protectants, and may increase neuronal signaling to increase the efficacy of conventional treatments, or may serve to prevent the disease in individuals genetically predisposed to AD (Joseph et al., 1998, 1999; Casadesus et al., 2002). To expect health from a bottle may be too much , but it hopefully heralds a new direction for treatment and prevention.

    George Perry, Gemma Casadesus*, James A. Joseph*, and Mark A. Smith Institute of Pathology, Case Western Reserve University, 2085 Adelbert Road, Cleveland, Ohio; *USDA-HNRC at Tufts University, 711 Washington Street, Boston, Massachusetts

    References:

    Joseph JA, Shukitt-Hale B, Denisova NA, Prior RL, Cao G, Martin A, Taglialatela G, Bickford PC. Long-term dietary strawberry, spinach, or vitamin E supplementation retards the onset of age-related neuronal signal-transduction and cognitive behavioral deficits. J Neurosci. 1998 Oct 1;18(19):8047-55. PubMed.

    Joseph JA, Shukitt-Hale B, Denisova NA, Bielinski D, Martin A, McEwen JJ, Bickford PC. Reversals of age-related declines in neuronal signal transduction, cognitive, and motor behavioral deficits with blueberry, spinach, or strawberry dietary supplementation. J Neurosci. 1999 Sep 15;19(18):8114-21. PubMed.

    Nunomura A, Perry G, Aliev G, Hirai K, Takeda A, Balraj EK, Jones PK, Ghanbari H, Wataya T, Shimohama S, Chiba S, Atwood CS, Petersen RB, Smith MA. Oxidative damage is the earliest event in Alzheimer disease. J Neuropathol Exp Neurol. 2001 Aug;60(8):759-67. PubMed.

    Russell RL, Siedlak SL, Raina AK, Bautista JM, Smith MA, Perry G. Increased neuronal glucose-6-phosphate dehydrogenase and sulfhydryl levels indicate reductive compensation to oxidative stress in Alzheimer disease. Arch Biochem Biophys. 1999 Oct 15;370(2):236-9. PubMed.

    Smith MA, Kutty RK, Richey PL, Yan SD, Stern D, Chader GJ, Wiggert B, Petersen RB, Perry G. Heme oxygenase-1 is associated with the neurofibrillary pathology of Alzheimer's disease. Am J Pathol. 1994 Jul;145(1):42-7. PubMed.

    Wataya T, Nunomura A, Smith MA, Siedlak SL, Harris PL, Shimohama S, Szweda LI, Kaminski MA, Avila J, Price DL, Cleveland DW, Sayre LM, Perry G. High molecular weight neurofilament proteins are physiological substrates of adduction by the lipid peroxidation product hydroxynonenal. J Biol Chem. 2002 Feb 15;277(7):4644-8. PubMed.

    Casadesus G, Shukitt-Hale B, Joseph JA. Qualitative versus quantitative caloric intake: are they equivalent paths to successful aging?. Neurobiol Aging. 2002 Sep-Oct;23(5):747-69. PubMed.

    View all comments by George Perry

  2. As a background reading please do not miss the following article:

    Brain Cholesterol Pathology is the cause of Alzheimer’s disease [ Full Text ]

    View all comments by Alexei Koudinov

  3. As a followup on the subject of 'diet and Alzheimer's disease' please do not miss the following article:

    Brain Cholesterol Pathology is the cause of Alzheimer’s disease [ Full Text ]

    View all comments by Alexei Koudinov

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Primary Papers

  1. Engelhart MJ, Geerlings MI, Ruitenberg A, van Swieten JC, Hofman A, Witteman JC, Breteler MM. Dietary intake of antioxidants and risk of Alzheimer disease. JAMA. 2002 Jun 26;287(24):3223-9. PubMed.
  2. Morris MC, Evans DA, Bienias JL, Tangney CC, Bennett DA, Aggarwal N, Wilson RS, Scherr PA. Dietary intake of antioxidant nutrients and the risk of incident Alzheimer disease in a biracial community study. JAMA. 2002 Jun 26;287(24):3230-7. PubMed.
  3. Foley DJ, White LR. Dietary intake of antioxidants and risk of Alzheimer disease: food for thought. JAMA. 2002 Jun 26;287(24):3261-3. PubMed.

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