Time - Man of the Year/Time_Man_of_the_Year_Compact_Publishing_3YX-Disc-1_Compact_Publishing_1993.iso/moy/040692/0406130.000

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                                                                                HEALTH, Page 54

COVER STORY

The New Scoop On Vitamins


They may be much more important than doctors thought in warding
off cancer, heart disease and the ravages of aging -- and, no,
you may not be getting enough of these crucial nutrients in
your diet

By ANASTASIA TOUFEXIS -- Reported by Janice M. Horowitz/New York,
Elaine Lafferty/Los Angeles and Dick Thompson/Washington


    It's raining. Flooding, to be precise. But business is as
brisk as ever at Mrs. Gooch's natural-foods market in West Los
Angeles. As usual, traffic is backed up along Palms Boulevard
as drivers wait for a spot in the store's parking lot. Inside,
crowds jam the supplement section, which gleams with row upon
row of small, white-capped vials. Here the true believers in the
gospel of vitamins linger over labels, comparing brand names and
dosages, trading health sermons and nutritional arcana. They
discuss the relative merits of Buffered C and Lysine, as opposed
to Bio-C Plus Rose Hips, or perhaps Bio-Absorbate Vitamin C
Complex capsules. There are no fewer than 10 types and dosages
of vitamin C to choose from, not to mention eight of vitamin E.

    Maryanne Latimer is among the faithful. A middle-age
massage therapist, she has been plagued by chronic fatigue
syndrome and has therefore expanded her usual menu of vitamins
and minerals. She shops at Mrs. Gooch's about once a week, in
addition to other vitamin shops. "I take tons of vitamin C and
E," she admits, plus calcium and a daily vitamin-mineral
complex. Recently she added to her regimen three tablets a day
of pantothenic acid (a lesser-known vitamin) "to help me wake
up." Basically, says Latimer, "I'm looking for anything to make
me feel better."

    But for every true believer in the power of vitamins --
and the U.S. has more devotees than any other country -- there
is an agnostic, a skeptic who insists that vitamins are the
opiate of the people. Among the doubters are many doctors. They
have been persuaded by decades of public-health pronouncements,
endorsed by the U.S. National Academy of Sciences and the
National Institutes of Health, that claim people can get every
nutrient they need from the food they eat. Popping vitamins
"doesn't do you any good," sniffs Dr. Victor Herbert, a
professor of medicine at New York City's Mount Sinai medical
school. "We get all the vitamins we need in our diets. Taking
supplements just gives you expensive urine."

    Wavering in confusion between these two schools of thought
are the vast majority of Americans, wondering whom to believe.
They have heard the gospel of vitamin C as preached by the
great chemist Linus Pauling, but they have also heard him
ridiculed by health authorities. They may feed their children
chewable vitamin tablets, but they question whether the pills
are worth the high price. "I'd be thrilled to know what's right
and to have someone tell me what to do," says Jane Traulsen, a
mother of two who lives in White Plains, N.Y. "But all the
information is so contradictory. It's like trying to make your
way through a fog."

    But now, thanks to new research, the haze is beginning to
lift. And it unveils a surprise: more and more scientists are
starting to suspect that traditional medical views of vitamins
and minerals have been too limited. While researchers may not
endorse the expansive claims of hard-core vitamin enthusiasts,
evidence suggests that the nutrients play a much more complex
role in assuring vitality and optimal health than was previously
thought. Vita mins -- often in doses much higher than those
usually recommended -- may protect against a host of ills
ranging from birth defects and cataracts to heart disease and
cancer. Even more provocative are glimmerings that vitamins can
stave off the normal ravages of aging.

    "The field is currently undergoing a paradigm shift," says
Catherine Woteki, director of the food and nutrition board at
the Institute of Medicine of the National Academy of Sciences.
"We are now entering the second wave of vitamin research,"
explains Jeffrey Blumberg, associate director of the Human
Nutrition Research Center on Aging at Tufts University. "The
first wave was the discovery of vitamins and their role in
combatting nutritional deficiencies such as rickets and
beriberi. That occurred in the first half of the century. Now
we're on the second wave. You don't need to take vitamin C to
prevent scurvy in this country today. But you could need it for
optimal health and the prevention of some chronic disease."

    Scientists have so far identified 13 organic substances
that are commonly labeled vitamins. In the human body, they
play a vital role in helping regulate the chemical reactions
that protect cells and convert food into energy and living
tissue. Some vitamins are produced within the body. Vitamin D,
for example, is manufactured in the skin during exposure to
sunlight, and three other vitamins (K, biotin and pantothenic
acid) are made inside the human gut by resident bacteria. But
most vitamins must be ingested.

    Mystique and faddish lore have long surrounded these
essential biochemical compounds. Consider vitamins C and E.
"Somebody has made practically every claim you could dream of
about these vitamins," points out John Hathcock, chief of the
experimental-nutrition branch of the Food and Drug
Administration. People have been gobbling vitamin C for 20 years
in the certainty that it can cure the common cold, though
evidence is still lacking. Vitamin E has been wildly popular for
four decades because of its putative power to enhance sexual
performance. In fact, studies indicate only that it is necessary
for normal fertility in lab animals.

    More recently, B6 has won favor as a relief for
premenstrual syndrome. Vitamin A is touted as a rejuvenator by
people who mistakenly believe that it, like its synthetic
relative Retin-A, can give wrinkled, mottled skin that youthful
rosy glow. "We never know what next year's fad is going to be,"
says Hathcock.

    It is just this whiff of quackery that made vitamins a
research backwater for years. Most reputable scientists steered
clear, viewing the field as fringe medicine awash with kooks and
fanatics. A researcher who showed interest could lose respect
and funding. Certainly Linus Paul ing lost much of his
Nobel-laureate luster when he began championing vitamin C back
in 1970 as a panacea for everything from the common cold to
cancer. Drug companies too have been leery of committing
substantial energy and money to studies, since the payoff is
relatively small: vitamin chemical formulas are in the public
domain and cannot be patented.

    But attitudes have been shifting over the past few
decades. Despite all the sneering, Pauling's speculations did
get more scientists thinking about vitamins' impressive powers.
As a class of compounds, they are known to produce hugely
dramatic effects when missing from the diet: scurvy, pernicious
anemia, rickets. What other exciting properties might they --
or related compounds -- have?

    Another driving force in the U.S. is the new "demographic
imperative." With a rapidly aging population, America has moved
its medical focus from treating acute illness to caring for
chronic maladies like heart disease and cancer -- a shift that
has sent health-care costs skyward. "There's a growing
appreciation of the need to find the most economical way to
treat and prevent chronic disease," notes Dr. Charles
Butterworth Jr. of the Uni versity of Alabama. "Food and
vitamins are not that expensive." Calculates Tufts' Blumberg:
"We could save billions of dollars if we could delay the onset
of chronic diseases by as little as 10 years."

    Overriding all else, however, is the impact of scientific
studies. Beginning in the 1970s, population surveys worldwide
started to uncover a consistent link between diet and health.
A diet rich in fruits and vegetables, for instance, became
associated with a lowered incidence of cancer and heart disease.
Researchers then turned to examining the data nutrient by
nutrient, looking at minerals as well as vitamins, to see which
are tied most closely with specific ailments. Low vitamin C
intake appears to be associated with a higher risk of cancer,
low levels of folic acid with a greater chance of birth defects,
and high calcium consumption with a decreased danger of
osteoporosis.

    Intrigued by such clues, the National Institutes of
Health, universities and other research organizations began
funding laboratory and clinical investigations. By the late
'80s, research exploring vitamins' potential in protecting
against disease was on its way to respectability. Though the
evidence is still preliminary, scientists are excited about
several nutrients.

    One vitamin attracting attention is folic acid, also known
as folate, which was first isolated from spinach. This B
vitamin appears to guard against two of the most common and
devastating neurological defects afflicting newborns in the
U.S.: spina bifida, in which there is incomplete closure of the
spine, and anencephaly, in which the brain fails to develop
fully. British researchers found that when women who had already
given birth to a malformed child received folic acid supplements
during a subsequent pregnancy, the chances of a second tragic
birth fell sharply.

    Another enticing finding reported last January established
a link between folic acid and prevention of cervical cancer.
According to a study at the University of Alabama's medical
school, women who have been exposed to a virus that causes this
cancer are five times as likely to develop precancerous lesions
if they have low blood levels of folic acid. The discovery may
help explain why cervical cancer is more common among the poor.
Indigent women usually eat few vegetables and fruits, which are
prime sources of folate. Says Butterworth, head of the research
team: "It looks like many cases of cervical dysplasia [a
precancerous condition] could be prevented with a healthy
diet."

    Vitamin K, long known to promote blood clotting, appears
to help bones retain calcium. Rapid calcium loss is a major
plague among postmenopausal women, giving rise to the
fragile-bones syndrome called osteoporosis. A recent Dutch study
of 1,500 women ages 45 to 80 found that calcium loss (as
measured in urine samples) could be halved with daily
supplements of vitamin K.

    Most of the excitement, however, is being generated by a
group of vitamins -- C, E and beta carotene, the chemical parent
of vitamin A -- that are known as antioxidants. These nutrients
appear to be able to defuse the volatile toxic molecules, known
as oxygen-free radicals, that are a byproduct of normal
metabolism in cells. These molecules are also created in the
body by exposure to sunlight, X rays, ozone, tobacco smoke, car
exhaust and other environmental pollutants.

    Free radicals are cellular renegades; they wreak havoc by
damaging DNA, altering biochemical compounds, corroding cell
membranes and killing cells outright. Such molecular mayhem,
scientists increasingly believe, plays a major role in the
development of ailments like cancer, heart or lung disease and
cataracts. Many researchers are convinced that the cumulative
effects of free radicals also underlie the gradual deterioration
that is the hallmark of aging in all individuals, healthy as
well as sick. Antioxidants, studies suggest, might help stem the
damage by neutralizing free radicals. In effect they perform as
cellular sheriffs, collaring the radicals and hauling them away.

    Supporters of this theory speculate that antioxidants may
one day revolutionize health care. Biochemist William Pryor,
director of the Biodynamics Institute at Louisiana State
University, foresees screening people through a simple urine,
blood or breath test to assess how much damage free radicals
have done to tissue, much as patients today are screened for
high cholesterol. "If you can predict who is most susceptible
to oxidative stress," notes Pryor, "you can treat them with
antioxidants more effectively." Ultimately, says biochemist
Bruce Ames at the University of California, Berkeley, "we're
going to be able to get people to live a lot longer than anyone
thinks."

    In that brave new world, people might pop vitamins C and
E to deter the development of cataracts, the clouding of the
lens in the eye that afflicts 20% of Americans over 65.
Patients taking high doses of both vitamins appear to reduce the
risk of cataracts by at least 50%, according to a Canadian
study. Vitamin C may be especially efficient because it
concentrates in the eye. Scientists at the National Eye
Institute estimate that if cataract development could be delayed
by 10 years, about half of cataract surgery could be eliminated.

    Vitamin E may be particularly helpful in preventing free
radicals from injuring the heart. Doctors speculate that giving
the vitamin to patients during or shortly after a heart attack
might help preserve heart muscle. One clue from a study at
Toronto General Hospital: rabbits injected with vitamin E within
two hours of a heart attack showed 78% less damage to heart
tissue than was expected. The vitamin appears to speed recovery
in patients who have had coronary-bypass operations, suggesting
that nutrient supplements may one day become part of standard
pre-op procedure.

    Chugging vitamin E seems to boost the immune system in
healthy old people, raising the possibility that supplements
could help thwart life-threatening infections. The nutrient may
also turn out to be a potent lung saver, warding off the
depredations of cigarette smoke, car exhaust and other
pollutants. "The effects of air pollution are chronic," says Dr.
Daniel Menzel of the University of California at Irvine. "Over
a lifetime people develop serious diseases like bronchitis and
emphysema. We have fed animals in our labs vitamin E and have
found that they have fewer lung lesions and that they live
longer." Menzel suggests that priming children with doses of
antioxidants could protect them against lung disease as adults,
much the way fluoridated water protects them against tooth
decay.

    For patients found to have Parkinson's disease, vitamin E
may hold special promise. The nutrient seems to delay the
appearance of tremors, rigidity and loss of balance, thus
postponing the need for therapy with dopamine. The vitamin also
appears to alleviate some of the unpleasant side effects of
antipsychotic drugs, such as twitchy hands, face and feet.

    Holding center stage in antioxidant circles, however, is
beta carotene, a complex deep orange compound that is naturally
abundant in sweet potatoes, carrots and cantaloupes. Beta
carotene is turned into vitamin A by the body as needed. That
makes it impossible to overdose on beta carotene, even though
taking too much vitamin A can lead to liver damage and other
effects.

    Doctors at Harvard Medical School, who have been following
22,000 male physicians as part of a 10-year health study, have
made a stunning discovery about beta carotene. They found that
men with a history of cardiac disease who were given beta
carotene supplements of 50 mg every other day suffered half as
many heart attacks, strokes and deaths as those popping placebo
pills. No heart attacks occurred among those in this group who
received aspirin along with the beta carotene capsules. The
Harvard researchers have begun a trial in 45,000 postmenopausal
women to see if a similar effect occurs in women. Scientists
speculate that the antioxidant helps prevent those nasty
oxygen-free radicals from transforming LDL, the bad form of
cholesterol, into an even more menacing artery clogger.

    Beta carotene may prove powerful in combatting cancer as
well. In countries such as Japan and Norway, where diets are
rich in beta carotene, the populations have a low incidence of
lung, colon, prostate, cervical and breast cancer. And a study
at the University of Arizona Cancer Center found that three to
six months of daily beta carotene pills dramatically reduced
precancerous mouth lesions in 70% of patients. Pharmaceutical
giant Hoffmann-La Roche is so enamored with beta carotene that
it plans to open a Freeport, Texas, plant next year that will
churn out 350 tons of the nutrient annually, or enough to
supply a daily 6 mg capsule to virtually every American adult.

    As vitamin research surges, confusion swirls around two
basic questions: How much of these nutrients is needed, and
what's the best way to get them -- in food or in supplements?
For half a century, Americans' vitamin intake has been guided
by the Recommended Daily Allowances, or RDAs. Introduced during
World War II as a way to ensure that military recruits did not
suffer from malnutrition, the levels quickly became a standard
for the general population. Technically the National Academy of
Sciences sets different RDAs for people of different ages and
sexes, but to simplify matters, the FDA has since 1968 taken the
highest RDAs -- those appropriate for teenage boys -- and
endorsed them as the national standard. These are the numbers
that appear on cereal boxes.

    Two years ago, the FDA announced plans to change this
policy. Instead of endorsing an allotment appropriate to
ravenous, fast-growing teenage males, it would simply average
the RDAs for different age groups. The new figures are
considerably lower and, says the agency, are a better barometer
of the typical American's nutritional needs. Essentially they
reflect the requirements of adult women. The agency has proposed
slashing the RDAs for many vitamins, including A, B, C and E,
as well as nutrients such as iron, by 10% to 80%. The RDA would
also acquire a new name: the Reference Daily Intake, or RDI. (On
food labels the RDI would be listed as the Daily Value, or DV.)
"By using the old RDAs, you're trying to make the entire
population consume more nutrients than it needs," explains John
Vanderveen, director of the FDA's nutrition division. "Young
males need more nutrients than women, children and the elderly."

    But the move to slash RDAs, scheduled to go into effect
next year, flies in the face of research that suggests benefits
from higher doses of vitamins. The current RDA for vitamin C,
for example, is 60 mg. But to get a protective effect against
cataracts or cancer may require as much as 100 mg. Similarly,
vitamin E may need a boost from the RDA of 10 mg to 100 mg.
(There is no RDA for beta carotene, but scientists speculate
that 25 mg or more a day could be needed.)

    Already many people consider the old RDAs, with their
focus on preventing scurvy and other rare deficiency problems,
to be irrelevant to real health needs. "Our clientele generally
thinks of the RDA as a kind of joke," says Sandy Gooch, owner of
the chain of seven Mrs. Gooch's markets in Southern California.
What's actually needed, vitamin advocates suggest, is
guidelines for optimal consumption. That amount may very well
depend upon age, sex and life-style habits.

    Do people have to take supplements to get enough vitamins?
Nutritionists and doctors agree that everyone's basic needs
could be met by eating a diet rich in vegetables and fruits. The
U.S. government's 1990 dietary guidelines urge an ambitiously
varied meal plan: three to five servings daily of vegetables,
two to four of fruit, as well as six to 11 of breads, rice,
pasta and grains and two to three of meat, eggs, poultry and
dried beans.

    As far as America is concerned, most people don't even
come close. A mere 9% of adults manage to consume five servings
of fruits and vegetables each day, according to the National
Center for Health Statistics. By and large, Americans simply
don't like vegetables. The most prominent example: President
Bush, who once admitted he detested broccoli, now has taken to
deriding carrots as "orange broccoli."

    Nonetheless, failing to match daily dietary guidelines is
no reason to go running for the vitamin bottle. "What you do
one day or one week isn't the whole story," stresses Jeanne
Goldberg, assistant professor of nutrition at Tufts. "It's what
your general eating patterns are." Blitzing on junk food for a
day or two is no problem if over the long haul a diet regularly
contains fruits and veggies. If it does not, popping pills is
a good insurance policy, especially important for those who
reject greens outright. Supplements are also useful to people
with special conditions, including shut-ins, alcoholics and
those on very restrictive diets, who tend to be poorly
nourished.

    Virtually all experts agree that a daily multivitamin
won't hurt anybody. Opinion is divided, however, about whether
people should be taking high doses of vitamins to prevent
chronic disease or delay aging. Some argue that enough evidence
is in to justify taking moderately high amounts of antioxidants.
Several researchers admit they are already doing so.

    Others believe it is too soon to be making recommendations
to the public. The long-term effects of high-dose supplements
are still unknown, and doctors warn of dangers even in the
short term. Too much vitamin D, for example, can cause damaging
calcium deposits in muscle tissue, including the heart.

    Last February the FDA rejected as premature applications
by vitamin makers to promote folic acid as a means of
preventing neural-tube birth defects, antioxidants as a hedge
against cancer, and zinc as a booster of aging immune systems.
Both federal and state regulatory agencies have been cracking
down on nutrient health claims. The FDA says it will hold label
claims to standards similar to those applied to drugs. Advises
Dr. Walter Willett of the Harvard School of Public Health: "At
this time I say don't take megadoses, but I'm not ruling out
that in two or three years we might change our mind."

    The wisest strategy right now may be to redouble those
efforts to eat more broccoli and carrots, spinach and squash.
And to follow the familiar exhortations: get up and get moving,
cut down fat and cut out smoking. No matter how powerful
antioxidants and the other nutrients turn out to be, they will
never be a substitute for salutary habits. But stay tuned.
Vitamins promise to continue to unfold as one of the great and
hopeful health stories of our day.