The Medical Letter on Drugs and Therapeutics
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1213
Vitamin Supplements
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Many patients ask their physicians whether they should take vitamins. Since the last Medical Letter article on this subject,1 more data have become available on the benefits and risks of taking vitamin supplements.

VITAMIN E — Vitamin E in food, which is mostly gamma-tocopherol, acts as an antioxidant. Vitamin E in supplements is mostly alpha-tocopherol, which may block the antioxidant activity of gamma-tocopherol and have a pro-oxidant effect in vivo. High doses of vitamin E may interfere with vitamin K metabolism and platelet function. A meta-analysis of clinical trials using vitamin E dosages higher than 400 IU/day found an increased risk of mortality.2 A randomized controlled trial in more than 9000 patients with vascular disease or diabetes found that longer term supplementation with 400 IU of vitamin E per day did not prevent cancer or major cardiovascular events ... more      

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