Overview:

Vitamin E is a fat-soluble vitamin found in many foods, fats, and oils. It is also an antioxidant that protects body tissue from damage caused by unstable substances called free radicals. Free radicals can harm cells, tissues, and organs.

The build-up of free radicals over time is largely responsible for the aging process and can lead to various health conditions such as heart disease, cancer, and inflammatory conditions (for example, arthritis). Antioxidants provide some protection against these conditions and also help reduce the damage caused by toxic chemicals and pollutants.

Vitamin E is also important in the formation of red blood cells and it helps the body to use vitamin K.

People who are unable to absorb fat properly may develop vitamin E deficiency and other conditions such as:

• Pancreatitis (inflammation of the pancreas)
• Cystic fibrosis
• Biliary diseases (illnesses of the gallbladder and biliary ducts)

Symptoms of vitamin E deficiency include:

• Muscle weakness
• Loss of muscle mass
• Abnormal eye movements
• Impaired vision
• Unsteady gait

Chronic deficiency may also cause problems with kidney and liver function. In addition, severe vitamin E deficiency can be associated with serial miscarriages and premature delivery in pregnant women.

There is some concern that eating a diet rich in fish oil for many months may induce a deficiency of vitamin E. People who eat a diet high in fish or who take fish oil supplements should ask their doctor if they should take vitamin E supplements.

Uses:

Heart Disease

Vitamin E helps prevent arteries from clogging by blocking the conversion of cholesterol into the waxy fat deposits called plaque that stick to blood vessel walls. Vitamin E also thins the blood, allowing for blood to flow more easily through arteries even when plaque is present. In the last 10 years, clinical studies have reported that the use of vitamin E supplements help prevent heart disease and other types of cardiovascular disease.

One large clinical study suggested that vitamin E from foods may reduce the risk of death from stroke in postmenopausal women. The study results do not support the use of vitamin E supplements as part of a preventive strategy.

However, there is some evidence that vitamin E supplements may reduce atherosclerosis. A 2-year clinical study compared the use of aspirin with and without vitamin E in men with a history of stroke. Researchers found that vitamin E with aspirin significantly reduced the tendency of plaque to stick to vessel walls and decreased the risk of stroke.

Clinical study results have been mixed. More evidence is needed to determine if there are benefits to vitamin E supplementation, whether for prevention or for treatment of cardiovascular disease. However, evidence does support the contribution of vitamin E to the maintenance of vascular function and health -- particularly when used in combination with other antioxidants from fruits, vegetables and nuts.

Cancer

While researchers can draw no firm conclusions about vitamin E's ability to protect against cancer, clinical studies show that people with cancer often have lower levels of vitamin E. Plus, population based trials (observing groups of people over long periods of time) suggest that diets rich in antioxidants, including vitamin E, may be connected to a reduced risk of certain types of cancer, such as colon cancer. Supplementation with vitamin E, though, does not appear to increase the risk of developing cancer in humans.

Laboratory studies have shown that vitamin E inhibits the growth of some cancers in test tubes and animals, particularly hormone responsive cancers such as breast and prostate. Therefore, some researchers believe that supplementation may prove beneficial for both prevention and treatment of these types of cancers.

Despite the encouraging results from test tube and animal studies, research on people has been much less promising. One large clinical study involving nearly 35,000 women, looked at the dietary intake of antioxidants and occurrence of breast cancer after menopause. They found little evidence that vitamin E has a protective effect. More research is needed before researchers can come to any firm conclusions about whether added vitamin E has an impact on cancer and, if so, which forms of the vitamin are most effective for treatment and what the optimal dosage is.

Researchers have also pointed to the fact that the body’s antioxidant defense system is complex, which suggests that focusing on one vitamin in isolation may not be the best approach. In fact, experts believe that dietary forms of antioxidants taken together from foods may be the best way to stave off cancer.

Photodermatitis

This condition involves an allergic type reaction to the UV rays of the sun. An 8-day clinical study comparing treatment with vitamins C and E to no treatment found that the vitamin group became significantly less sensitive to the sun. Another clinical study, lasting for 50 days, also showed a protective effect of the combination of vitamins C and E to UV rays.

Osteoarthritis

A few clinical studies suggest that vitamin E may be helpful in both the treatment (pain relief, increased joint mobility) and prevention (at least in men) of osteoarthritis. In a study comparing vitamin E with diclofenac, a non-steroidal anti-inflammatory drug (NSAID) used to treat osteoarthritis, the two were equally effective. However, other clinical studies have found that vitamin E has a low level of effectiveness for both rheumatoid arthritis and osteoarthritis.

Alzheimer’s Disease

There are several reasons why vitamin E might help treat Alzheimer’s disease. The fat-soluble vitamin readily enters the brain and exerts its antioxidative properties. Since researchers believe oxidative stress contributes to the development of Alzheimer’s disease, in theory antioxidants like vitamin E should help prevent this condition. Clinical studies have suggested that vitamin E supplementation improves cognitive performance in healthy individuals and in those with dementia from causes other than Alzheimer’s (for example, multiple strokes). In addition, vitamin E, together with vitamin C may prevent the development of Alzheimer’s disease.

Menopause

According to a review article on alternatives to hormone replacement therapy (HRT) for women with breast cancer, vitamin E is the most effective option for reducing hot flashes among this group of women. Presumably, this would also be true for women who are not taking HRT. Vitamin E also helps reduce other long-term risks associated with menopause such as Alzheimer’s, macular degeneration and cardiovascular disease.

Eye Health

Because of its antioxidant action, vitamin E may help protect against cataracts (clouding of the lens of the eye) and age related macular degeneration (ARMD, a progressive deterioration in the retina, the back part, of the eye). Both of these eye disorders tend to occur as people age. These conditions seriously compromise eyesight (ARMD is the number one cause of blindness in the United States). To minimize risk of ARMD, experts advocate diets high in vitamins C and E and carotenoids, especially spinach, kale, and collard greens. Taking supplements as a preventive measure, as opposed to getting vitamin E from food sources, remains controversial.

Uveitis is another eye disorder for which the antioxidant vitamins C and E may be helpful. A clinical study of 130 patients with uveitis compared treatment with oral vitamins C and E to placebo and found that those who took the vitamins had significantly better visual clarity than those who took a “dummy pill.” Uveitis is inflammation of the uvea, the middle layer of the eye between the sclera (white outer coat of the eye) and the retina. The uvea contains many of the blood vessels that nourish the eye, so inflammation in this area can affect the cornea, the retina, the sclera, and other important parts of the eye. Uveitis occurs in acute and chronic forms.

Diabetes

People with diabetes tend to have low levels of antioxidants. This may provide an explanation about why they’re at increased risk for conditions such as cardiovascular disease. Vitamin E supplements and other antioxidants may help reduce the risk of heart disease and other complications in people with diabetes. Research shows that antioxidants help control blood sugar levels and lower cholesterol levels in those with type 2 diabetes while protecting against the complications of retinopathy (eye damage) and nephropathy (kidney damage) in those with type 1 diabetes.

Vitamin E may also play a role in the prevention of diabetes. In one clinical study, 944 men who did not have diabetes at were followed for 4 years. Low levels of vitamin E was associated with an increased risk of developing diabetes during that time course.

Pancreatitis

Oxidative stress plays a role in pancreatitis (inflammation of the pancreas). In fact, those with pancreatitis have low levels of vitamin E and other antioxidants. This may be due to lack of absorption of fat-soluble vitamins (such as vitamin E) because the enzymes from the pancreas, which are required to absorb fat, are not functioning properly. Or, this may be due to poor intake because those with pancreatitis are not eating due to pain and need for bowel rest. Some experts advise taking vitamin E and other antioxidants to help reduce the pain and inflammation associated with pancreatitis.

Other

Vitamin E, along with other standard treatments, may also be beneficial for the following:

• Slowing the aging of cells and tissues
• Protecting from frostbite and other cold-induced injuries
• Diminishing the negative effects of environmental pollutants
• Improving anemia
• Speeding wound and burn healing
• Reducing scarring
• Lowering blood pressure
• Slowing progression of Parkinson’s disease
• Easing premenstrual discomfort, especially breast tenderness
• Treating lupus
• Replacing necessary nutrients in those with inflammatory bowel disease, such as ulcerative colitis
• Avoiding miscarriage (also called spontaneous abortion), which may be associated with very low levels of this nutrient
• Helping weight gain and relieving oxidative stress in those with HIV or AIDS

Dietary Sources:

The richest source of vitamin E is wheat germ.

Other foods that contain a significant amount of vitamin E include:

• Liver
• Eggs
• Nuts (almonds, hazelnuts, and walnuts)
• Sunflower seeds
• Corn-oil margarine
• Mayonnaise
• Cold-pressed vegetable oils, including olive, corn, safflower, soybean, cottonseed, and canola
• Dark green leafy vegetables like spinach and kale
• Greens (beet, collard, mustard, turnip) sweet potatoes
• Avocado
• Asparagus
• Yams

Available Forms:

Vitamin E refers to a family of eight related fat-soluble compounds, the tocopherols and tocotrienols (in four different forms, alpha, beta, delta, and gamma). Dosages are usually listed in international units (IU). There are natural and synthetic forms of vitamin E. Health care providers usually recommend natural vitamin E (d-alpha-tocopherol) or natural mixed tocopherols. The synthetic form is called dl-alpha-tocopherol.

Some clinicians prefer mixed tocopherols because it most closely represents whole foods.

Most vitamin E supplements are fat-soluble. However, water-soluble E is available for people who have trouble absorbing fat, such as people with pancreatic insufficiency and cystic fibrosis.

Vitamin E is available in softgels, tablets, capsules, and topical oils.

How to Take It:

Doses for oral vitamin E generally range from 50 - 1,000 IU, though experts recommend obtaining vitamin E from food sources rather than supplements. The Food and Nutrition Board of the Institute of Medicine has set an upper tolerable intake level (UL) for vitamin E at 1,000 mg (1,500 IU) per day for any form of supplementary vitamin E.

Based on clinical trials, the recommended dose for disease prevention and treatment for adults is 400 - 800 IU per day. As with all supplements, it is important to check with a health care provider before giving vitamin E to a child.

Daily intakes of dietary vtamin E are listed below. (Note: 1 mg vitamin E equals 1.5 IU.)

Pediatric

• Newborn to 6 months: 6 IU
• Infants 6 months - 1 year: 9 IU
• Children 1 - 3 years: 9 IU
• Children 4 - 8 years: 10.5 IU
• Children 9 - 13 years: 16.5 IU
• Adolescents 14 - 18 years: 22.5 IU

Adult

• Older than 18 years: 22.5 IU
• Pregnant females: 22.5 IU
• Breastfeeding females: 28.5 IU

Precautions:

Always check with your doctor before taking vitamin E supplements. Vitamin E may increase the risk of bleeding in sensitive individuals, including as those taking blood thinners, such as warfarin (Coumadin), aspirin, and clopedigrel (Plavix).

In November, 2004, the American Heart Association (AHA) stated that high amounts of vitamin E can be harmful. Taking 400 IU per day, or higher, may increase the risk of death.

Possible Interactions:

If you are being treated with any of the following medications, you should not use vitamin E supplements without first talking to your health care provider:

Antidepressant medications -- Vitamin E interferes with the body’s absorption of the antidepressant desimpramine, which belongs to a class of drugs known as tricyclics. Other members of that class include imipramine and nortriptyline.

Antipsychotic medications -- Vitamin E can interfere with the body’s absorption of the antipsychotic medication called chlorpromazine, which belongs to a class of drugs known as phenothiazines.

Aspirin -- A study evaluating the effects of vitamin E and aspirin suggests that the combination appears to be safe and may benefit patients at risk for stroke. However, if bleeding or bruising occurs, talk to your health care provider.

AZT -- Vitamin E may protect against toxicity and side effects from AZT, a medication used to treat HIV and AIDS.

Beta-blockers -- Vitamin E interferes with the body’s absorption of propranolol, a member of a class of medications called beta-blockers used for high blood pressure. Other beta-blockers include atenolol and metoprolol.

Cholesterol-lowering medications -- Cholesterol-lowering medications such as colestipol and cholestyramine, called bile-acid sequestrants, decrease the absorption of vitamin E. Gemfibrozil, a different type of cholesterol-lowering medication, called a fibric acid derivative, may also reduce vitamin E levels. Statins (such as atorvastatin, pravastatin, and lovastatin), a third class of medications used to lower cholesterol levels, may reduce the antioxidant activity of vitamin E. On the other hand, the combination of vitamin E supplements with statins may help protect blood vessels from dysfunction.

Cyclosporine -- Vitamin E may interact with cyclosporine, a medication used to treat cancer, reducing the effectiveness of both the supplement and the medication. However, there is controversy about this interaction. Another study suggests that the combination of vitamin E and cyclosporine may actually increase the effects of the medication. More research is needed to determine the safety of this combination.

Hormone replacement therapy -- Vitamin E supplements may benefit women taking hormone replacement therapy by improving lipid profiles.

Mebendazole -- Simultaneous supplementation with vitamins A, C, E, and selenium significantly reduced the effectiveness of this vermifuge (treatment to eradicate intestinal worms) in a study.

Tamoxifen -- Tamoxifen, a hormonal treatment for breast cancer, boosts blood levels of triglycerides, increasing one’s chances of developing high cholesterol. In a study of 54 women with breast cancer, vitamins C and E, taken along with tamoxifen, counteracted this effect by decreasing low density lipoprotein (LDL, or "bad") cholesterol and triglyceride levels while increasing high density lipoprotein (HDL, or "good") cholesterol. Vitamins C and E also enhanced the anti-cancer action of the tamoxifen.

Warfarin -- Taking vitamin E at the same time as warfarin, a blood-thinning medication, increases the risk of abnormal bleeding, especially in vitamin K-deficient individuals.

Weight loss products -- Orlistat (also known as alli) is a medication used for weight loss. Olestra is a substance added to certain food products. Both are intended to bind to fat and prevent the absorption of fat and the associated calories. Because of their effects on fat, orlistat and olestra may also prevent the absorption of fat-soluble vitamins such as vitamin E. Given this concern and possibility, the U.S. Food and Drug Administration now requires that vitamin E and other fat soluble vitamins (vitamins A, D, and K) be added to food products containing olestra. How well the body uses and absorbs vitamin E from such food products is not clear. In addition, doctors who prescribe orlistat may add a multivitamin with fat-soluble vitamins to the treatment regimen.