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To the Editor: Dr Morris and colleagues¹ and Dr Engelhart and colleagues² found an inverse relationship between intake of vitamin E from food, but not from supplements, with risk of Alzheimer disease (AD).³ I would like to suggest a mechanism for this finding. The predominant dietary form of vitamin E, -tocopherol, but not the form found in supplements, -tocopherol, has been demonstrated to inhibit cyclooxygenase 2 (COX-2) production of prostaglandin E₂ in macrophages and epithelial cells.⁴ Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibition may protect against AD.⁵ The same mechanism could explain the benefit of foods high in vitamin E.

Arthur E. Varner, MD
Allergy Diagnostic
Beachwood, Ohio

1. Morris MC, Evans DA, Bienias JL, et al. Dietary intake of antioxidant nutrients and the risk of incident Alzheimer disease in a biracial community study. JAMA. 2002;287:3230-3237. FREE FULL TEXT 2. Engelhart MJ, Geerlings MI, Ruitenberg A, et al. Dietary intake of antioxidants and risk of Alzheimer disease. JAMA. 2002;287:3223-3229. FREE FULL TEXT 3. Foley DJ, White LR. Dietary intake of antioxidants and risk of Alzheimer disease: food for thought. JAMA. 2002;287:3261-3263. FREE FULL TEXT 4. Jiang Q, Elson-Schwab I, Courtemanche C, Ames BN. -Tocopherol and its major metabolite, in contrast to -tocopherol, inhibit cyclooxygenase activity in macrophages and epithelial cells. Proc Natl Acad Sci U S A. 2000;97:11494-11499. FREE FULL TEXT 5. in t'Veld BA, Ruitenberg A, Hofman A, et al. Nonsteroidal anti-inflammatory drugs and the risk of Alzheimer's disease. N Engl J Med. 2001;345:1515-1521. FREE FULL TEXT

To the Editor: Dr Morris and colleagues¹ and Dr Engelhart and colleagues² found that dietary antioxidants were associated with a reduction in risk for development of AD. Plant-based foods such as grains and cereal products, which have high levels . . . [Full Text of this Article]

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