04Evidence A

Don’t take antioxidant supplements to prevent cancer (beta-carotene, vitamin E, vitamin A)

Antioxidant supplements are not merely useless. Pooling 78 trials and nearly 300000 people, in the more rigorously designed trials those who took them had a slightly higher death rate. In two large trials done specifically on smokers, beta-carotene raised the share who got lung cancer by 18% to 28%. Deaths were also higher by 8% to 17%. Smokers and people exposed to asbestos especially should not take them.

Cost

Roughly 0.5 to 2 yuan per day. For smokers, the real cost…

Benefit

Cochrane analyzed 78 randomized controlled trials with 296707 participants. Overall, those taking antioxidant…

Cost

Roughly 0.5 to 2 yuan per day. For smokers, the real cost is a higher risk of lung cancer.

Benefit

Cochrane analyzed 78 randomized controlled trials with 296707 participants. Overall, those taking antioxidant supplements had a relative risk of death of 1.02 (a value of 1 means no difference; the 95% confidence interval was 0.98–1.05). When only higher-quality trials were considered, the relative risk rose to 1.04 (1.01–1.07). Specifically, beta-carotene raised the risk to 1.05 (1.01–1.09) and vitamin E to 1.03 (1.00–1.05). The ATBC trial followed 29133 male smokers who took 20 mg of beta-carotene daily; it found a 18% higher rate of lung cancer (range 3%–36%) and an 8% higher overall mortality rate (range 1%–16%). The CARET trial included 18314 smokers and asbestos-exposed individuals; it showed a 28% higher risk of lung cancer (relative risk 1.28, 1.04–1.57) and a 17% higher risk of all-cause death (relative risk 1.17, 1.03–1.33). The perception that these supplements are beneficial stems from the flawed logic that antioxidants prevent aging, which in turn prevents cancer — each step of this chain seems intuitive at first glance. RR means relative risk; 1 means equal risk in the two groups.

Original sources

Bjelakovic G et al. (2012). Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007176.pub2;The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group (1994). The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. NEJM. https://doi.org/10.1056/NEJM199404143301501;Omenn GS et al. (1996). Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. NEJM. https://doi.org/10.1056/NEJM199605023341802

Open source link
Book note

The US Preventive Services Task Force, the official US body that evaluates preventive measures, assigned a grade D to beta-carotene and vitamin E in 2022, meaning these supplements are not recommended. Smokers and asbestos-exposed individuals have already suffered harm from their use. Antioxidants naturally present in fruits and vegetables are not covered by this recommendation, so they can still be consumed as normal.

My note