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Supplements

vitamin E

What Is It?
Health Benefits
Forms
Recommended Intake
If You Get Too Little

If You Get Too Much

General Dosage Information

Guidelines for Use

General Interaction
Cautions

References

Evidence Based Rating Scale


What Is It?

Scientists identified Vitamin E about 80 years ago, but only in the past few decades has its power as an Antioxidant been revealed and fully appreciated. Initially, there was great interest and excitement regarding what this vitamin could do for a number of ailments, particularly heart disease. Well-designed studies completed recently, however, have found that the effect may be less beneficial than once thought.

One point on which most sources agree is that vitamin E-rich foods are the optimal way to ensure adequate levels of this nutrient in the body. Almonds and sunflower seeds are among the richest sources. Hazelnuts, green leafy vegetables, avocados, wheat germ, peanuts, and some vegetable oils (sunflower, cottonseed, safflower), are a few other prime sources: however cooking significantly reduces the vitamin E levels in vegetable oils. While these foods all contain healthy Fat, they may also be high in calories when taken in excess: for persons where that is a concern, it's also worth considering a vitamin E supplement of 400 IU daily. Actual vitamin E deficiency is rare; however it can occur in diseases associated with malabsorption in the intestinal tract.

When summoned from the body's fatty tissue where it's stored, vitamin E—and its antioxidant powers—go into action, protecting cells by deactivating or destroying the potentially damaging oxygen molecules called Free radicals. Vitamin E also helps in the formation of red blood cells and facilitates the use of the trace Mineral selenium and of vitamins A and K.

Vitamin E is actually an umbrella term for a group of compounds called tocopherols and tocotrienols. Until recently, most vitamin E products contained only tocopherols (alpha-, beta-, delta-, and gamma-tocopherols), with gamma-tocopherol being the form most readily available from food sources and alpha-tocopherol recognized as the body's predominant and most potent form.

But this thinking is changing as researchers also are identifying heart-healthy powers in the tocotrienols. Manufacturers now offer combination products, although tocotrienols are still easiest to find in single supplement form. To realize vitamin E's full health benefits, you really need both tocopherols and tocotrienols.

Health Benefits

As a key antioxidant, vitamin E appears to play a modest but notable role in protecting the body from many chronic disorders. It may even slow the aging process and guard against damage from secondhand smoke and other pollutants. According to test-tube studies, the tocotrienols (alpha-tocotrienol, specifically) appear to be the most powerful of the vitamin E antioxidants. Circulatory disorders, acne, shingles, rheumatoid arthritis,  high cholesterol, gum disease, hepatitis, immune-system function, and memory are also believed to benefit from vitamin E. Vitamin E may combat the side effects of conventional hepatitis and cancer treatments and improve the symptoms of premenstrual syndrome (PMS). In addition, animal studies indicate vitamin E may protect against the oxidative damage of hyperthyroidism, or overactive thyroid. To date, however, research has been more intriguing than definitive.

The healing powers of regular vitamin E supplements (that is, those containing tocopherols only) are often combined with those of vitamin C, a sister antioxidant that actually increases the effectiveness of vitamin E. This combination holds some promise for preventing and possibly easing complications of such disorders as congestive heart failure, alcoholism, cancer, HIV infection, lupus, multiple sclerosis and nail problems.

On the other hand, a number of disappointing or ambiguous clinical trial results were published in the late 1990s and early 2000s. For example, recent studies on Parkinson's disease, a neurologic condition, encourage eating foods rich in vitamin E and supplementing with only the 30 IU's present in a daily multivitamin.  Another study published in 2008 indicated antioxidants including vitamin E had no effect on the risk of developing asthma. On the other hand, recent animal studies show preventive vitamin E supplementation in conjunction with magnesium was more effective at improving plasma lipids in diabetic mice than magnesium alone (1,2,49,50)

Specifically, vitamin E may help to:

Prevent or delay heart disease and related complications. Vitamin E's ability to protect against cardiovascular disease has been intensively studied and was initially thought to be very promising. The vitamin appears to prevent the oxidation of LDL ("bad") cholesterol, the first step in the development of atherosclerosis, a buildup of plaque in the arteries that inhibits normal circulation. (3)  Additionally, vitamin E is believed to help prevent the formation of blood clots and to minimize the inflammatory process involved in heart disease development. Still a matter of debate, however, is whether an antioxidant such as vitamin E (including both tocopherols and tocotrienols) can prevent strokes, which aren't directly related to atherosclerosis.

Studies designed to answer the question of whether vitamin E can actually prevent heart disease in people who are currently healthy (with no heart disease) are generating confusing and conflicting results. In two large studies at the Harvard School of Public Health, vitamin E supplements lowered the risk of heart disease in both women and men by about 40%. Other positive lifestyle factors may partially account for this apparent benefit, however, leaving the true contribution of the supplements in question. (4,5) In 2003, a major study published in the American Heart Association's journal, Circulation, indicated that vitamin E showed no benefit for preventing heart attacks. The researchers, again from Harvard, followed the levels of major carotenoids (including beta-carotene) and certain tocopherols from vitamin E in the blood of otherwise healthy physicians over the course of 13 years. They found that levels of beta-carotene and tocopherols in 531 physicians who went on to have a heart attack were similar to levels in a group of 531 similar men who did not have a heart attack. (6)

Vitamin E supplements also appear to produce no actual therapeutic (healing) effect in people who are already sick with heart disease. A 2009 review of trials indicated vitamin E showed no benefit in the primary and secondary prevention of heart disease. Furthermore, vitamin E supplementation might be associated with an increase in total mortality, heart failure, and stroke. (7) Disappointing results were reported from the widely publicized HOPE study (Heart Outcomes Prevention Evaluation Study), which followed nearly 10,000 people at high risk for heart attack or stroke for more than four years. The participants who took 400 IU of vitamin E daily experienced about the same number of heart disease complications and hospitalizations for chest pain or heart failure as did those participants on a placebo. On the other hand, a drug tested in the study (the ACE inhibitor, ramipril) proved very effective. (8) An extension of the HOPE trial (called HOPE-TOO), published in September, 2003, found that after seven years, there was no apparent heart-health benefit from taking vitamin E: 21.4% of patients given vitamin E experienced heart attack, stroke, or death from heart disease compared with 20.6% of participants on a placebo. (9)

Still, the subject of vitamin E and heart benefits remains muddled. Earlier investigations seemed to indicate that the supplement can clearly inhibit the progression of atherosclerosis in individuals with existing heart disease. In the Cambridge Heart Antioxidant Study, published in the British medical journal Lancet in 1996, people with coronary atherosclerosis who took vitamin E had a 77% lower risk of subsequent (nonfatal) heart attack than those who took a placebo. A separate study investigating the cholesterol-lowering effects of tocotrienols specifically--they appear to inhibit the liver's synthesis of cholesterol--found that large doses could lower LDL cholesterol by 10%. (3) And vitamin E supplementation was found to improve vasodilation (widening of arteries) in patients with coronary artery disease, or angina. (20)

Protect against pancreatic and other cancers. As an antioxidant, vitamin E helps to safeguard cell membranes from the damaging effects of free radicals that can play a role in the development of cancer. The vitamin may also help fight cancer by boosting the immune system. It remains unclear, however, whether these beneficial actions on reducing free-radical (DNA oxidation) activity actually leads to a protective effect against cancer, a complex disease.

Research findings so far are confusing at best. One Finnish study reported a non-significantly increased incidence of pancreatic cancer (and death from the disease) in male smokers who took vitamin E (50 IU daily) for five to eight years (10); while a US study found that men with the highest blood levels of gamma-tocopherol had a significantly reduced risk of developing prostate cancer. (24)

Other trials indicate that increased dietary vitamin E may reduce the risk of colon cancer, particularly in women under age 65. But, in a separate study of nearly 2,000 adults who developed colon cancer, the amount of vitamin E they took was no different than dosages taken by those without cancer. (10-12) Note the distinction, which is often found in nutritional studies, between apparent beneficial effects from dietary sources of a nutrient compared to smaller or non-existent effects observed in studies of supplementation.

However, for chemotherapy patients, topical vitamin E in conjunction with DMSO seems to prevent skin ulcerations, while supplemental vitamin E may reduce neural toxicity (16, 44,45) And in a small double-blind study of 18 patients undergoing chemotherapy, treatment with liquid vitamin E (1 ml with 400 mg vitamin E twice a day) reduced mucositis lesions (mouth ulcers that result from chemotherapy) in significantly more patients than placebo. (53)

Prevent or delay cataracts and slow progression of macular degeneration. Animal studies indicate that vitamin E protects against cataracts, a clouding of the lens of the eye that is a leading cause of blindness in older people. However, a randomized study of 39,876 women indicated vitamin E supplementation had no effect on age-related cataracts; several large-scale studies are still ongoing. Also, a recent study in humans found that vitamin E in combination with other antioxidants may slow the progression of age-related macular degeneration (AMD), but they had no effect on the prevention of AMD.(13,14,42) 

Slow the progression of Alzheimer's disease and dementia. No one knows exactly what causes this progressive loss of memory and nerve function, but one theory is that over time, free radicals gradually damage nerve fibers. Columbia University researchers reported that very high doses of vitamin E (2,000 IU a day) slowed the progression of diagnosed Alzheimer's disease. In fact it proved as effective at this as selegiline, a prescription drug commonly used to treat Alzheimer's. However, vitamin E was no better than placebo in slowing the rate of progression of Alzheimer's in patients with mild cognitive impairment. To date, no research has shown that vitamin E can actually prevent Alzheimer's disease from developing in the first place.(1,39,40) 

Retard the aging process and boost immune function. With age, the immune system becomes less efficient at fighting off microbes and viruses. Part of this decline may be due to low levels of vitamin E in the bloodstream. A 1999 study showed improved immune responses in older people who took 100 mg-vitamin E supplements. Vitamin E may also slow the effects of aging by protecting cells from free-radical damage. (15) 

Improve anemia. Studies in humans and children indicate vitamin E supplementation enhances response to treatment of anemia with erythropoietin—a hormone that controls red blood cell production, given as a drug to persons with chronic anemia.  Children who took vitamin E had increased levels of hemoglobin (the oxygen carrying component of red blood cells), while adults needed smaller dosages of erythropoietin. However, no effect was seen on anemia in pre-term and premature infants. (46-48) 

Promote healing of burns, eczema, and other skin problems. When applied to the skin, vitamin E-containing creams or oils are believed to promote healing, protecting cells from free-radical damage and reducing itchiness. Many people use such products to ensure optimal skin health. (16,44,45)

 

Improve Male Infertility. Vitamin E may also increase fertilization rates in males with low fertilization rates. In one study, 21% of the men who took 200 mg per day of vitamin E impregnated their spouses after one month of treatment compared with no pregnancies in the placebo group. (17,18)

Treat the effects of diabetes. In a placebo controlled study of forty diabetics, 600 mg/day of vitamin E for eight weeks reduced oxidative stress indices and improved blood flow as measured by the brachial (upper arm) artery diameter. (51) In another study, 1800 iu/day for four months significantly improved blood flow to the retina and normalized kidney function. (52) In a study of diabetic neuropathy, 900 mg/day for six months significantly improved two of twelve electrophysiological parameters. (53)

Note: Vitamin E has also been found to be useful for a number of other disorders. For information on these additional ailments, see our Dosage Recommendations Chart for Vitamin E.

Forms

  • tablet
  • softgel
  • oil 
  • liquid
  • cream
  • capsule

Recommended Intake

The current Recommended Intake (or RDA) for vitamin E is 15 mg, equal to about 23 IU daily.

If You Get Too Little

A vitamin E deficiency can lead to neurological damage. This is quite rare, however, occurring primarily in people suffering from metabolic diseases that inhibit fat absorption (vitamin E is a fat-soluble vitamin). The RDA is easy for most people to obtain if they eat a well-balanced diet containing even a minimum amount of polyunsaturated fat.

If You Get Too Much

Vitamin E appears to be safe when consumed in amounts up to 1,000 IU a day, although diarrhea and headaches have been reported in some people. Doses of over 800 IU a day of vitamin E are believed to interfere with the body's ability to clot blood, posing a risk to people taking blood thinners (anticoagulants). However, in actual studies examining bleeding risks, most increased bleeding effects have been found when vitamin K deficiency is also present. One patient being treated with warfarin (Coumadin) had increased bruising and prothrombin time (a measure of blood clotting ability) taking 1,200 iu/day. (55) And in a study of male smokers taking 50 mg/day who also took aspirin, increased gum bleeding was observed with dental probing. (56) However, studies with healthy participants over 65 found no increased bleeding risk with doses up to 800 mg/for four months, and in a small study of patients on chronic warfarin therapy, doses up to 1200 mg/day for four weeks did not affect laboratory assessment of the INR—a measure of warfarin activity. (57)

In addition, high doses of vitamin E may inhibit the absorption of vitamin A.

General Dosage Information

Special tips: For most people, supplement dosages for vitamin E should be relatively low (400 IU or less), as there are apparent risks in taking very high doses. Adverse effects are a particular concern with doses higher than 1500 IU (1000 mg) of natural vitamin E for healthy people and 400 IU for unhealthy people. It turns out that in some situations antioxidants such as vitamin E can actually turn into potentially cancer-promoting pro-oxidants. The exact amount of vitamin E needed for disease-protecting effects remains to be determined. It most likely varies from person to person.

  • Vitamin E is particularly effective when taken with vitamin C, which increases its absorption by the body.

  • For topical use, commercial creams containing vitamin E are easy to find. Alternatively, you can break open a capsule or prick at softgel and gently rub the oil directly into the affected area.

  • Vitamin E is available in natural and synthetic forms. The latest findings indicate natural vitamin E supplements seem to be superior to the synthetic forms. Most studies showing health benefits for vitamin E have used synthetic forms, which are cheaper and more widely available than the natural ones. (Natural forms will be designated with a "d," as in d-alpha. Synthetic forms will be designated with a "dl," as in dl-alpha.)

  • Products marked as "mixed tocopherols" (alpha, beta, delta and gamma) are absorbed well and also make a better choice.

  • In addition to the following vitamin E dosages for tocopherols indicated below, take 100 mg tocotrienols daily.

* For general health: Take 200-400 IU daily.

* For cancer prevention: Take up to 800 IU daily.

Be sure to check out our Dosage Recommendations Chart for Vitamin E, which lists therapeutic dosages for specific ailments at a glance.

Guidelines for Use

  • Try to take vitamin E at the same time each day.

  • To promote absorption and lower the risk of stomach irritation, take this fat-soluble vitamin with food that contains some fat.

  • Once vitamin E squelches free radicals, it becomes a weak free radical itself. For this reason, make sure to get plenty of vitamin C as well; it not only recycles vitamin E that has used up its antioxidant fuel but also restores its free-radical-fighting power.

  • Tocotrienols can't perform many of the important health functions of tocopherols, so don't substitute tocotrienol supplements for your regular vitamin E capsules. The two can safely be combined, however. You can also get tocotrienols naturally by eating foods that contain it, such as cereal brans (barley, oats, rice) and palm oil.

General Interaction

Vitamin E's mild blood-thinning effect could cause problems if it is routinely taken with anticoagulant (blood-thinning) drugs such as warfarin or blood-thinning dietary supplements such as ginkgo. Aspirin could also present problems in this regard. Consult your doctor before taking such a combination.

Note: For information on interactions with specific generic drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.

Cautions

  • Because of vitamin E's effect on blood clotting, don't take supplements for one week before or after any type of surgery (including dental surgery). The minimum amount of vitamin E it takes to alter blood clotting is about 30 IU a day.

  • A number of chemotherapy and radiation treatments are designed to actually create free radicals for the purpose of killing cancer cells. There is still controversy about whether antioxidants may interfere with cancer treatments. If you are undergoing cancer treatment, consult your oncologist before taking antioxidants such as vitamin E. Otherwise, you may be working counter to what the cancer treatment is designed to do.

  • Consult your doctor before taking vitamin E if you have high blood pressure that is poorly controlled; the increased risk for bleeding with vitamin E could possibly lead to a greater risk for the complications of high blood pressure, such as hemorrhagic stroke (bleeding in the brain).

References

1. Pham DQ, Plakogiannis R. Vitamin E supplementation in Alzheimer's disease, Parkinson's disease, tardive dyskinesia, and cataract: Part 2. Ann Pharmacother. 2005 Dec;39(12):2065-72.
2. Kamat CD, Gadal S, Mhatre M, Williamson KS, Pye QN, Hensley K. Antioxidants in central nervous system diseases: preclinical promise and translational challenges. J Alzheimers Dis. 2008 Nov;15(3):473-93.
3. Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996 Mar 23;347(9004):781-6.
4. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med. 1993; 328:1444-9.
5. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. 1993; 328:1450-6.
6. Hak AE, Stampfer MJ, Campos H, Sesso HD, Gaziano JM, Willett W, Ma J. Plasma carotenoids and tocopherols and risk of myocardial infarction in a low-risk population of US male physicians. Circulation. 2003 Aug 19;108(7):802-7.
7. Saremi A, Arora R. Vitamin E and Cardiovascular Disease. Am J Ther. 2009 May 15. [Epub ahead of print]8. Sleight P. The HOPE Study (Heart Outcomes Prevention Evaluation). J Renin Angiotensin Aldosterone Syst. 2000 Mar;1(1):18-20.
9. Bosch J, Lonn E, Pogue J, Arnold JM, Dagenais GR, Yusuf S;

Date Published: 04/19/2005
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