Source: University of Maryland Medical Center
Common Forms: alpha-tocopherol, beta-tocopherol, D-alpha-tocopherol, delta-tocopherol, gamma-tocopherol
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.
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 studies have shown that the use of
vitamin E supplements help prevent heart disease and other types of
cardiovascular disease.
One large 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 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.
Study results have been mixed and 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, 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 improve risk
of cancer.
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 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 study comparing treatment with vitamins C and E
to no treatment found that the vitamin group became significantly less
sensitive to the sun. Another study, lasting for 50 days, also showed a
protective effect of the combination of vitamins C and E to UV rays.
Osteoarthritis
A few 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
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. In
fact, 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 (see Eye Health
below), 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 and 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 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 lowers 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
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 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
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
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
(IUs). There are both 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. Doses for oral vitamin E generally range from 50 IU to 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 to 800 IU per day. As with
all supplements, it is important to check with a healthcare provider
before giving vitamin E to a child.
Daily intakes of dietary Vitamin E are listed below. (Note: 1 mg vitamin E equals 1.5 IU.)
Pediatric
- Newborn to 6 months: 6 IU
- Infants 6 months to 1 year: 9 IU
- Children 1 to 3 years: 9 IU
- Children 4 to 8 years: 10.5 IU
- Children 9 to 13 years: 16.5 IU
- Adolescents 14 to 18 years: 22.5 IU
Adult
- Older than 18 years: 22.5 IU
- Pregnant females: 22.5 IU
- Breastfeeding females: 28.5 IU
Always check with your doctor before taking vitamin E supplements.
Vitamin E may interfere with certain medications, especially blood
thinners such as warfarin.
In November, 2004, the American Heart Association stated that high
amounts of vitamin E can be harmful. Taking 400 IU per day, or higher,
may increase the risk of death.
If you are currently being treated with any of the following
medications, you should not use vitamin E supplements without first
talking to your healthcare 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.
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. A third class of medications used to lower cholesterol levels
known as statins (such as atorvastatin, pravastatin, and lovastatin),
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 appears to be some controversy regarding the
nature of 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 the tamoxifen, counteracted this effect by
decreasing low density cholesterol and triglyceride levels while
increasing high density cholesterol. The antioxidants 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 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 US Food and Drug Administration (FDA) 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.
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- Review Date:
11/9/2005
- Reviewed By: Amy Paturel, MPH, MS Nutrition and A.D.A.M.
editorial. Previously reviewed by: Jacqueline A. Hart, MD, Department
of Internal Medicine, Newton-Wellesley Hospital, Harvard University and
Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff,
RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick,
Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001),
Veteran's Administrative Hospital, Londonderry, NH; Margie
Ullmann-Weil, MS, RD, specializing in combination of complementary and
traditional nutritional therapy, Boston, MA. All interaction sections
have also been reviewed by a team of experts including Joseph Lamb, MD
(July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico
Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T
Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant
Professor, University of Maryland School of Pharmacy; President, Your
Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA
(July 2000), President and Chairman, Hawaii State Consortium for
Integrative Medicine, Honolulu, HI.
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