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 Vitamins C and E for pregnancy-associated hypertension 
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Vitamin C Expert
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Post Vitamins C and E for pregnancy-associated hypertension
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Background Oxidative stress has been proposed as a mechanism linking the poor placental perfusion characteristic of preeclampsia with the clinical manifestations of the disorder. We assessed the effects of antioxidant supplementation with vitamins C and E, initiated early in pregnancy, on the risk of serious adverse maternal, fetal, and neonatal outcomes related to pregnancy-associated hypertension.

Methods We conducted a multicenter, randomized, double-blind trial involving nulliparous women who were at low risk for preeclampsia. Women were randomly assigned to begin daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or matching placebo between the 9th and 16th weeks of pregnancy. The primary outcome was severe pregnancy-associated hypertension alone or severe or mild hypertension with elevated liver-enzyme levels, thrombocytopenia, elevated serum creatinine levels, eclamptic seizure, medically indicated preterm birth, fetal-growth restriction, or perinatal death.

Results A total of 10,154 women underwent randomization. The two groups were similar with respect to baseline characteristics and adherence to the study drug. Outcome data were available for 9969 women. There was no significant difference between the vitamin and placebo groups in the rates of the primary outcome (6.1% and 5.7%, respectively; relative risk in the vitamin group, 1.07; 95% confidence interval [CI], 0.91 to 1.25) or in the rates of preeclampsia (7.2% and 6.7%, respectively; relative risk, 1.07; 95% CI, 0.93 to 1.24). Rates of adverse perinatal outcomes did not differ significantly between the groups.

Conclusions Vitamin C and E supplementation initiated in the 9th to 16th week of pregnancy in an unselected cohort of low-risk, nulliparous women did not reduce the rate of adverse maternal or perinatal outcomes related to pregnancy-associated hypertension (ClinicalTrials.gov number, NCT00135707 [ClinicalTrials.gov])


http://content.nejm.org/cgi/content/short/362/14/1282

The trial didn't find a positive result for vitamin C, but I'm actually surprised they managed to run such a large trial. It challenges the notion that there is no money to study vitamin C.


Wed Apr 07, 2010 1:57 pm
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Post Re: Vitamins C and E for pregnancy-associated hypertension
1 gram is not really very much though...


Wed Apr 07, 2010 3:20 pm
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Ascorbate Wizard
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Post Re: Vitamins C and E for pregnancy-associated hypertension
Right, and who thought vit C/Ewould be of benefit in such a narrow application? On the surface, this appears to be a hit piece. I may take the time to read the study because usually the data tells a different story and holds many interesting and valuable secrets that the news stories/abstracts ignore. Every pregnant women would be wise to take vitamin C and E - and A and B-complex, etc. before conception!

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Wed Apr 07, 2010 11:23 pm
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Post Re: Vitamins C and E for pregnancy-associated hypertension
1000 mg is not a small amount by any means, considering it is more than most people consume through even a diet rich in fruits and vegetables. It is a therapeutic dose, even though it is still less than what Pauling therapy enthusiasts take.

Nevertheless, there is no evidence that a larger amount would reduce the rates of pre-eclampsia. This was a large trial, powered to detect even a modest benefit - and there was no sign of even a modest benefit of vitamin C in reducing the rates of pre-eclampsia.

As for why this trial was undertaken - this isn't in fact the first trial to look at this. As the introduction notes, this avenue was pursued based on evidence that oxidative stress might lead to preeclampsia as well as some studies showing that women with preeclampsia had lower ascorbate levels. There was a small trial in the 1990s that showed a benefit, but larger trials including this one have failed to confirm that finding.

The primary endpoint was not met - so this was a negative trial, plain and simple. If you're looking for "nuggets" to redeem vitamin C in this case, the only maternal secondary outcomes which favoured vitamin C were "postpartum pulmonary edema" (an absolute risk reduction of 0.1%) and "Hematocrit <24% with transfusion" (absolute risk reduction of 0.4%), but both are only marginally statistically significant and the clinical relevance is questionable. On the other hand, pregnancy-associated hypertension was higher in the vitamin C and E arm (absolute risk increase of 2.6%). In terms of neonatal secondary outcomes, there were no statistically significant differences between the two groups.


I do wonder though if they have funds to do a longer follow-up of the newborn children, since the initial follow-up was only for one month. It would be a good opportunity (albeit quite costly) to test hypotheses that maternal vitamin C supplementation would reduce the incidence of childhood diseases e.g. asthma, eczema, and neurodegenerative disorders.


Sun Apr 11, 2010 4:17 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
Several studies demonstrate vitamin D deficiency as a risk factor for preeclampsia.
For example, http://jcem.endojournals.org/cgi/content/full/92/9/3517?maxtoshow=&hits=10&RESULTFORMAT=1&andorexacttitle=and&titleabstract=vitamin+D+preeclampsia&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
These studies usually show vitamin D serum levels as a measure of sufficiency.

Why is it that vitamin C studies never report any serum ascorbate levels? Therapeutic doses are totally absurd without knowing individual capacities or oxidation levels. A 1 g dose may be excess for many people, but a 100 g dose may similarly be inadequate for individuals with extraordinary oxidative loads. If this study with vitamins C and E demonstrate little effect from 1000 mg of vitamin C, then it seems probable that the oxidative loads associated with preeclampsia are far greater than is appreciated.

The long history of vitamin C research is overflowing with faulty assumptions using inadequate dosages. This appears to repeat the same old flawed thinking. I do not have access to the full paper, just the abstract. But it seems to me that with the multitude of authors, you would think some of them would appreciate the potential discrepancies produced by wide ranging oxidative loads in the population group!!!


Tue Apr 13, 2010 1:00 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
scurvyencounters wrote:
Several studies demonstrate vitamin D deficiency as a risk factor for preeclampsia.
For example, http://jcem.endojournals.org/cgi/content/full/92/9/3517?maxtoshow=&hits=10&RESULTFORMAT=1&andorexacttitle=and&titleabstract=vitamin+D+preeclampsia&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
These studies usually show vitamin D serum levels as a measure of sufficiency.

Why is it that vitamin C studies never report any serum ascorbate levels? Therapeutic doses are totally absurd without knowing individual capacities or oxidation levels. A 1 g dose may be excess for many people, but a 100 g dose may similarly be inadequate for individuals with extraordinary oxidative loads. If this study with vitamins C and E demonstrate little effect from 1000 mg of vitamin C, then it seems probable that the oxidative loads associated with preeclampsia are far greater than is appreciated.

The long history of vitamin C research is overflowing with faulty assumptions using inadequate dosages. This appears to repeat the same old flawed thinking. I do not have access to the full paper, just the abstract. But it seems to me that with the multitude of authors, you would think some of them would appreciate the potential discrepancies produced by wide ranging oxidative loads in the population group!!!


A correlation between serum levels and pre-eclampsia risk does not mean there is a causal relationship. As I said before, one of the reasons the vitamin C and vitamin E trials were done was because serum levels of vitamin C were found to be low in women with pre-eclampsia. But this does not mean that increasing vitamin C serum levels will lower the risk of pre-eclampsia. Low vitamin C levels could be associated with other risk factors for pre-eclampsia.

And there's no indication that increasing the dose of vitamin C would have had any significant benefit. There wasn't even a slight trend favoring the vitamin C + vitamin E arm, and even in a WHO trial where the women had lower serum ascorbate levels, there was no benefit seen.


Wed Apr 14, 2010 2:08 pm
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Ascorbate Wizard
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Post Re: Vitamins C and E for pregnancy-associated hypertension
The following study result supports my pet theory about how the Big Pharma inspired misinformation campaign operates. A study favorable to taking prenatal vitamins was about to come out, so the unfavorable study was released to blunt its impact. (This theory depends on when the debunking study was actually run - if it was held for a high impact.) Once or twice is coincidence, but there is an undeniable pattern. Doesn't mean that every time it happens it is planned, but here is another study that was just released:

http://miscarriage.about.com/b/2010/04/25/prenatal-vitamins-could-cut-risk-of-low-birthweight-baby.htm

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Mon May 03, 2010 2:31 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
ofonorow wrote:
The following study result supports my pet theory about how the Big Pharma inspired misinformation campaign operates. A study favorable to taking prenatal vitamins was about to come out, so the unfavorable study was released to blunt its impact. (This theory depends on when the debunking study was actually run - if it was held for a high impact.) Once or twice is coincidence, but there is an undeniable pattern. Doesn't mean that every time it happens it is planned, but here is another study that was just released:

http://miscarriage.about.com/b/2010/04/25/prenatal-vitamins-could-cut-risk-of-low-birthweight-baby.htm


Owen, your conspiracy-mongering is just plain silly at times! :lol:


Mon May 03, 2010 12:14 pm
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Ascorbate Wizard
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Post Re: Vitamins C and E for pregnancy-associated hypertension
So in your view, these damaging reports that invariably are released just prior to an emerging positive study are pure coincidence! I am not a statistician, but how many examples would you require to take this seriously? Fifteen? 100? They are all in the public record.

A former poster (Zucic) who has passed away, posted examples of a series of damaging stories about vitamin C that were released on or just prior to dates significant with Linus Pauling. E.g., his birthday, the dates of his Nobel prizes, his death, etc. Many are based on the work of Bjelakovic et. al. (Danish researchers). The obvious theory: keep some enterprising young reporter from writing a story favorable to Pauling.

What you cannot seem to grasp is the staggering amount of money involved. Clearly, if vitamin C does compete with pharmaceuticals, this would create an economic incentive that would drive people profiting from illness to such lengths.

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Wed May 05, 2010 3:52 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
ofonorow wrote:
So in your view, these damaging reports that invariably are released just prior to an emerging positive study are pure coincidence! I am not a statistician, but how many examples would you require to take this seriously? Fifteen? 100? They are all in the public record.

A former poster (Zucic) who has passed away, posted examples of a series of damaging stories about vitamin C that were released on or just prior to dates significant with Linus Pauling. E.g., his birthday, the dates of his Nobel prizes, his death, etc. Many are based on the work of Bjelakovic et. al. (Danish researchers). The obvious theory: keep some enterprising young reporter from writing a story favorable to Pauling.

What you cannot seem to grasp is the staggering amount of money involved. Clearly, if vitamin C does compete with pharmaceuticals, this would create an economic incentive that would drive people profiting from illness to such lengths.


Firstly, what is the big brand-name pharmaceutical that is used to prevent pre-eclampsia? There is none, to my knowledge. What exactly is vitamin C competing with?

Secondly, you're comparing apples and oranges. The negative trial looked at a 500mg dose to prevent adverse outcomes related to pregnancy-related hypertension. The positive trial was evaluating a multi-vitamin for different outcomes. Prenatal vitamins are already recommended in guidelines - so the outcome is hardly going to be practice-changing, regardless of whether or not it is drowned out by the bigger study.

Thirdly, you're proposing a conspiracy between Big Pharma (who exactly? who is coordinating the anti-vitamin C agenda?), the investigators of two completely different trials, the journal editors of two completely different journals, and finally various media outlets. To what end? There is no incentive for any of these parties.

It's not a coincidence, it's paranoia.


Wed May 05, 2010 3:17 pm
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Post Re: Vitamins C and E for pregnancy-associated hypertension
Quote:
It's not a coincidence, it's paranoia.


Quote:
Murder by Injection: The Story of the Medical Conspiracy Against America (Hardcover)
~ Eustace Mullins (Author)

The present work, the result of some forty years of investigative research, is a logical progression from my previous books: the expose of the international control of monetary issue and banking practices in the United States; a later work revealing the secret network of organizations through which these alien forces wield political power — the secret committees, foundations, and political patties through which their hidden plans are implemented; and now; to the most vital issue of all, the manner in which these depredations affect the daily lives and health of American citizens. Despite the great power of the hidden rulers, I found that only one group has the power to issue life or death sentences to any American — our nation's physicians.

I discovered that these physicians, despite their great power, were themselves subjected to very strict controls over every aspect of their professional lives. These controls, surprisingly enough, were not wielded by any state or federal agency, although almost every other aspect of American life is now under the absolute control of the bureaucracy. The physicians have their own autocracy, a private trade association, the American Medical Association. This group, which is headquartered in Chicago, Illinois, had gradually built up its power until it assumed total control over medical schools and the accreditation of physicians.

http://www.whale.to/b/mullins33.html


To put things in perspective, read Chapter 10 first:
The Rockefeller Syndicate
http://www.whale.to/b/mullins7.html

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"Unless we put medical freedom into the constitution...medicine will organize into an undercover dictatorship..force people who wish doctors and treatment of their own choice to submit to only what..dictating outfit offers." Dr. Benjamin Rush


Wed May 05, 2010 6:33 pm
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Ascorbate Wizard
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Post Re: Vitamins C and E for pregnancy-associated hypertension
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It's not a coincidence, it's paranoia.


In this case, probably. But you did not answer my question, how many examples are required before a pattern can be established, before it is no longer coincidence?

You actually deny the existence of an organized campaign to "debunk" competitors to prescription drugs? Or are you simply agnostic?

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Thu May 06, 2010 3:44 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
ofonorow wrote:
In this case, probably. But you did not answer my question, how many examples are required before a pattern can be established, before it is no longer coincidence?


It is human nature to look for patterns - it's partly why people believe Jesus appeared in their morning toast. Given the number of studies that are done on vitamins - both in animals and in humans - and assuming that success rates of these trials are about 50-50 (just for argument's sake, but it doesn't really matter so long as the positive trials vastly outnumber negative trials, or vice versa), then one would expect that a negative study reported in the media would be preceded by a positive one.

Quote:
You actually deny the existence of an organized campaign to "debunk" competitors to prescription drugs? Or are you simply agnostic?[/color]


In this particular case, I don't even see what vitamin C was supposed to be competing with.
But even in general, I find many of the conspiracies that you propose to be implausible, given the various parties that are supposedly involved.


Fri May 07, 2010 2:29 pm
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Ascorbate Wizard
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Post Re: Vitamins C and E for pregnancy-associated hypertension
Quote:
In this particular case, I don't even see what vitamin C was supposed to be competing with.
But even in general, I find many of the conspiracies that you propose to be implausible, given the various parties that are supposedly involved.


There is one common denominator - pharmaceutical advertising in all medical journals.

Implausible, yes.

Effective, yes.

Lets take the recent widely disseminated "news" that vitamins C/E in test tubes is harmful to stem cells, and from that, megadoses may cause cancer. How and why, in your opinion, does a story like that get widely disseminated? By accident?

By the way, Tim Bolen identified the "marketing group" in New York that Big Pharma uses to run this campaign, (or at least he publicly threatened to expose them.)

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Sat May 08, 2010 2:44 am
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Post Re: Vitamins C and E for pregnancy-associated hypertension
I think the problem of this study is clear it is dosage timing and main outcome. 1g of ascorbig acid is not much and a once per day dose will not change blood levels long enough.
The vitamin e, i do not know what they have used, but there is enough evidence, that synthetic tocopherol is not as effective as natural ones and to much alpha tocopherol dos deplete the other tocopherols esp the gama ones.
This hampers the quenching of some peroxy radicals. LE has a lot of research on this.

Furthermore, believing that only two supplements in a low dose and wrong schedule should prevent a problem probably caused by a broad nutritional deficiency is laughable, but that reflects the sorry state of the majority of so called science today.
And particular it shows the incredible bias in medicine against anything beyond the dogma of poisonous pharmaceuticals.
This bias is not a natural one, it is the result of propaganda created by great, evil men.

Is is not for the faint of heart looking for the truth and realizing, that we are living in a dark age, where real wisdom & knowledge is replaced by propaganda. And certainly it will affect every personal live to stand up against the party line, as Pauling has done repeatedly. And he faced the harassment of his own country and government. So i understand, why todays scientist do not have the courage to suggest real studies with real outcomes.

Blackballing, ceasing job opportunities etc. That is not fiction. And the objectivity of peer reviewed journals is laughable and it is known that it does not exist. Just put into Google: "Conflict of interest in peer-reviewed medical journals"

Peer review dos neither guarantee even minimal scientific standards nor does it guarantee anything else. The reason for this is simply the huge amount of money paid to the journals or to medical authorities to influence their "peers".


Fri May 25, 2012 10:50 pm
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