Monday, June 7, 2010

About Antioxidants

Antioxidants are substances that may prevent potentially disease-producing cell damage that can result from natural bodily processes and from exposure to certain chemicals. There are a number of different antioxidants found in foods and available as dietary supplements. This fact sheet provides a general overview of antioxidants—with a focus on dietary supplements—and suggests sources for additional information.

* People take antioxidant supplements in an effort to improve their health and to prevent various diseases. Examples of commonly used antioxidant supplements include vitamins C and E, selenium, and beta-carotene.
* Although observational studies suggest that eating a diet high in antioxidant-rich vegetables and fruits is associated with a lower risk for many chronic diseases, there is limited evidence to support the use of antioxidant supplements to prevent disease. Additional research, including studies supported by the National Center for Complementary and Alternative Medicine (NCCAM) and other components of the National Institutes of Health (NIH), is under way.

Oxidation—one of the body's natural chemical processes—can produce "free radicals," which are highly unstable molecules that can damage cells. For example, free radicals are produced when the body breaks down foods for use or storage. They are also produced when the body is exposed to tobacco smoke, radiation, and environmental contaminants. Free radicals can cause damage, known as "oxidative stress," which is thought to play a role in the development of many diseases, including Alzheimer's disease, cancer, eye disease, heart disease, Parkinson's disease, and rheumatoid arthritis. In laboratory experiments, antioxidant molecules counter oxidative stress and its associated damage.

The body can produce its own antioxidants and also obtain them from food. Antioxidants are abundant in vegetables and fruits and are also found in grain cereals, teas, legumes, and nuts. Examples of antioxidants include anthocyanins, beta-carotene, catechins, coenzyme Q10, flavonoids, lipoic acid, lutein, lycopene, selenium, and vitamins C and E. Many antioxidants are also available as dietary supplements.

Although antioxidant molecules counter oxidative stress in laboratory experiments, there is some debate as to whether consuming antioxidants—in food or supplement form—actually benefits health. Antioxidant supplements are often synthetic (man-made), but some of these synthetic forms may not have the same effects on the body as antioxidants that occur naturally in foods. In addition, some beneficial properties may be lost when antioxidants are extracted from foods to manufacture supplements. There is also some concern that consuming antioxidants in excessive doses may have negative effects.

In the National Health and Nutrition Examination Survey (NHANES, 1999–2000), over 5,000 of the approximately 10,000 respondents (52 percent), reported taking a dietary supplement in the previous month. Of the 1,900 dietary supplements included in the survey, more than 900 (47 percent) contained an antioxidant: vitamin C, vitamin E, beta-carotene, selenium, flavonoids, or isoflavones. More than 3,000 of the respondents (37 percent) reported taking dietary supplements that contained one of the antioxidants mentioned.

A 2009 study looked at data from NHANES (1999–2000 and 2001–2002) and the U.S. Department of Agriculture Flavonoid Database to estimate the total antioxidant intake (from diet and supplements) of adults in the United States. The researchers calculated the daily intake of vitamin C, vitamin E, carotenes, selenium, and flavonoids. They found that supplements accounted for 54 percent of vitamin C; 64 percent of vitamin E (alpha-tocopherol); 14 percent of carotenes; 11 percent of selenium; and 2 percent of flavonoid intake.

There is limited scientific evidence to support the use of antioxidant supplements to prevent disease. Observational studies (which track a group of people without changing their activities or providing special treatments) have shown that a higher intake of antioxidant-rich vegetables and fruits is associated with a reduced risk of certain chronic diseases. It is not clear, however, that the benefits are due to the antioxidants. Although observational studies, as well as laboratory research on the biochemistry of antioxidants, suggest that antioxidant supplements may have beneficial effects, clinical trials (controlled studies in people) have generally found no benefit.

Systematic reviews of the research literature have analyzed the use of antioxidant supplements for preventing cancer, cardiovascular disease, and eye disease, and reducing overall mortality in healthy people and people with various diseases. In general, these reviews have concluded that there is not enough evidence to support the use of antioxidant supplements for these purposes.

Large, long-term studies (randomized, controlled trials) funded primarily by NIH have generally found that antioxidant supplements have no beneficial effects. For example:

* The Physicians Health Study II, which included more than 14,000 healthy male physicians aged 50 or older, found that neither vitamin E nor vitamin C supplements reduced the risk of major cardiovascular events (e.g., heart attack, stroke, or death) or cancer.
* The Selenium and Vitamin E Cancer Prevention Trial (SELECT)—a study of more than 35,000 healthy men aged 50 or older—found that selenium and vitamin E taken alone or together did not prevent prostate cancer. (Two earlier reviews suggested that preliminary evidence for selenium appeared promising).
* The Women's Health Study, which included almost 40,000 healthy women at least 45 years of age, found that overall, vitamin E did not reduce the risk of death, major cardiovascular events (e.g., heart attack, stroke, or death), or cancer. However, it was associated with reduced deaths from cardiovascular causes and also reduced major cardiovascular events in a subgroup of women aged 65 or older.
* The Women's Antioxidant Cardiovascular Study found no beneficial effects of vitamin C, vitamin E, or beta-carotene on cardiovascular events (e.g., heart attack, stroke, or death) in more than 8,000 female health professionals, aged 40 years or older, who were at high risk for cardiovascular disease.

An important exception to this trend is a National Eye Institute study of age-related eye disease, which found that the combination of antioxidants and zinc reduced the risk of developing advanced stages of age-related macular degeneration (AMD) by 25 percent in people who had intermediate AMD or advanced AMD in only one eye. Antioxidant supplements used alone reduced the risk by about 17 percent.

Thus, despite widespread scientific interest and clear plausibility of benefit, the body of evidence for antioxidant supplements has not, to date, demonstrated substantial health benefits. Additional research, some of it aimed at understanding the "disconnect" between findings of laboratory and observational studies and results of clinical trials, is under way.

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