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Vitamin E

(Alpha-Tocopherol)

What is vitamin E and what does it do?

Vitamin E is a fat-soluble nutrient found in many foods. In the body, it acts as an antioxidant, helping to protect cells from the damage caused by free radicals. Free radicals are compounds formed when our bodies convert the food we eat into energy. People are also exposed to free radicals in the environment from cigarette smoke, air pollution, and ultraviolet light from the sun.

The body also needs vitamin E to boost its immune system so that it can fight off invading bacteria and viruses. It helps to widen blood vessels and keep blood from clotting within them.

Vitamin E has the following functions:

It is an antioxidant. This means it protects body tissue from damage caused by substances called free radicals. Free radicals can harm cells, tissues, and organs. They are believed to play a role in certain conditions related to aging.

It helps keep the immune system strong against viruses and bacteria.

It helps form red blood cells and widen blood vessels to keep blood from clotting inside them.

It helps the body use vitamin K.

Cells also use vitamin E to interact with each other. It helps them carry out many important functions.

How much vitamin E do I need?

The recommended dietary allowance for vitamin E (including different isomers) includes the amount you get from both foods and supplements.

Recommendations for different age groups are listed below in milligrams (mg).

Life Stage	RDA
Birth to 6 months	4 mg (6 IU)
Infants 7–12 months	5 mg (7.5 IU)
Children 1–3 years	6 mg/day (9 IU)
Children 4–8 years	7 mg/day (10.4 IU)
Children 9–13 years	11 mg/day (16.4 IU)
Teens 14–18 years	15 mg/day (22.4 IU)
Adults	15 mg/day (22.4 IU)
Pregnant teens and women	15 mg/day (22.4 IU)
Breastfeeding teens and women	19 mg/day (28.5 IU)

Speak to a doctor before taking more than these tolerable upper intake dosages:

Life Stage	Upper Limit (per day)
Birth to 6 months	50 mg (75 IU)
Infants 7–12 months	100 mg (150 IU)
Children 1–3 years	200 mg (300 IU)
Children 4–8 years	300 mg (450 IU)
Children 9–13 years	600 mg/day (900 IU)
Teens 14–18 years	800 mg/day (1,200 IU)
Adults	1,000 mg/day (1,500 IU)

What foods provide vitamin E?

Vitamin E is found naturally in foods and is added to some fortified foods. You can get recommended amounts of vitamin E by eating a variety of foods including the following:

Vegetable oils like wheat germ, sunflower, and safflower oils are among the best sources of vitamin E. Corn and soybean oils also provide some vitamin E.

Nuts (such as peanuts, hazelnuts, and, especially, almonds) and seeds (like sunflower seeds) are also among the best sources of vitamin E.

Green vegetables, such as spinach and broccoli, provide some vitamin E.

Food companies add vitamin E to some breakfast cereals, fruit juices, margarines and spreads, and other foods. To find out which ones have vitamin E, check the product labels.

What Vitamin E supplements are available?

Vitamin E supplements come in different amounts and forms. Two main things to consider when choosing a vitamin E supplement are:

The amount of vitamin E: Most once-daily multivitamin/mineral supplements provide about 13.5 mg of vitamin E, whereas vitamin E-only supplements commonly contain 67 mg or more. The doses in most vitamin E-only supplements are much higher than the recommended amounts. Some people take large doses because they believe or hope that doing so will keep them healthy or lower their risk of certain diseases.

The form of vitamin E: Although vitamin E sounds like a single substance, it is actually the name of eight related compounds in food, including alpha-tocopherol. Each form has a different potency, or level of activity in the body.

Vitamin E from natural sources is commonly listed as d-alpha-tocopherol on food packaging and supplement labels. Synthetic (laboratory-made) vitamin E is commonly listed as dl-alpha-tocopherol. The natural form is more potent; 1 mg vitamin E = 1 mg d-alpha-tocopherol (natural vitamin E) = 2 mg dl-alpha-tocopherol (synthetic vitamin E).

Some food and dietary supplement labels still list vitamin E in International Units (IUs) rather than mg. One IU of the natural form of vitamin E is equivalent to 0.67 mg. One IU of the synthetic form of vitamin E is equivalent to 0.45 mg.

Some vitamin E supplements provide other forms of the vitamin, such as gamma-tocopherol, tocotrienols, and mixed tocopherols. Scientists do not know if any of these forms are superior to alpha-tocopherol in supplements.

Most vitamin E supplements are fat soluble. However, people who have trouble absorbing fat, such as those with pancreatic problems or cystic fibrosis, can take water-soluble E.

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

What happens if I don’t get enough vitamin E?

Vitamin E deficiencies (meaning intake of all isomers) have long been thought to be rare, and when they do happen, it’s commonly believed that it’s almost never caused by a poor diet. However, some experts believe that many people today are actually not getting enough vitamin E from their diets in natural form, especially too little tocotrienols.

When a deficiency does occur, symptoms can include loss of muscle coordination and impaired vision and speech.

There are specific situations that may lead to a vitamin E deficiency. Usually this is due to problems with absorption of nutrients and other metabolic issues.

At risk populations include:

Premature infants born weighing less than 3.5 pounds. A pediatrician who specializes in the care of newborns will typically evaluate the nutritional needs of an infant to help spot and treat this early.

People with fat absorption problems, which is a common problem for those who struggle with inflammatory bowel disease, Crohn’s disease, liver disease or pancreatic insufficiency.

Those who have been diagnosed with cystic fibrosis.

People who have had gastric bypass surgery.

Vitamin E is also important in helping your body make red blood cells, and it helps the body use vitamin K.

People who cannot absorb fat properly may develop vitamin E deficiency. Symptoms of serious vitamin E deficiency include:

Muscle weakness

Loss of muscle mass

Abnormal eye movements

Vision problems

Unsteady walking

Long-term deficiency may also cause liver and kidney problems. Although most people in the United States are not seriously deficient in vitamin E, many people may have slightly low levels.

What are some effects of vitamin E on health?

Scientists are studying vitamin E to understand how it affects health. Here are several examples of what this research has shown.

Heart disease

Many population studies have found that people with higher levels of vitamin E in their bodies have a lower risk of heart disease. Researchers have investigated whether taking vitamin E supplements might help prevent heart disease, but the results have not shown any benefit.

One of the largest studies, the Heart Outcomes Prevention Evaluation (HOPE) trial, found that taking 400 IU of vitamin E (d-alpha-tocopherol) daily did not lower the number of heart attacks, strokes, or deaths from heart disease among men and women who already had heart disease, or those who were at high risk for developing it.

Among otherwise healthy people who were at low risk for heart disease, two large trials also found no protection from vitamin E. In one, the Physicians' Health Study II, vitamin E was associated with a higher risk of stroke. This study generated a lot of controversy and is still being debated today.

One large clinical study suggested that vitamin E from foods, not supplements, may reduce the risk of death from stroke in postmenopausal women.
Cancer

Population studies (observing large groups of people over time) suggest that eating foods high in vitamin E and other antioxidants may help prevent cancer. Other studies show that people with cancer often have lower levels of vitamin E. Researchers wondered if antioxidants like vitamin E can help prevent cancer. But evidence about vitamin E supplements has not backed this up.

Several large studies show that women who take vitamin E supplements do not have a lower risk of developing breast cancer. One large study found that men who took 400 IU of vitamin E every other day for 8 years did not have a lower risk of overall cancer than those who took placebo.

Vitamin E also does not seem to protect against colorectal cancer in women or people with diabetes. There is some evidence that taking vitamin E, along with vitamin A and vitamin C, or as part of a multivitamin, may offer some protection to people who had colorectal adenomas. Colorectal adenomas are considered to be a precursor to developing colon cancer.

Vitamin E does not seem to protect against lung cancer or pancreatic cancer. In fact, one study of more than 77,000 men showed a small but significant increase in lung cancer associated with taking vitamin E supplements.

The evidence about vitamin E and prostate cancer is mixed. Some population studies suggest that people who take more vitamin E have a lower risk of prostate cancer. Other studies suggest the opposite: One study found that men who took a multivitamin more than 7 times per week, along with a separate vitamin E supplement, had a higher risk of prostate cancer. Another study of 35,000 men found that those who took a vitamin E supplement had a 17% increase in the risk of developing prostate cancer than those who took placebo.

One study found that taking a combination of 30 mg vitamin E (alpha-tocopherol), 120 mg vitamin C, 6 mg beta-carotene, 100 mcg selenium, and 20 mg zinc did not lower the overall risk of prostate cancer, but it might reduce the risk in men whose PSA levels were normal. High PSA levels can indicate prostate cancer.

Another large study of 29,133 smokers found that those taking 50 mg daily of vitamin E (dl-alpha-tocopherol, or synthetic vitamin E) had a lower risk of prostate cancer and deaths caused by prostate cancer.

Researchers note that taking antioxidant supplements may not work as well as eating antioxidant foods. Many experts believe getting antioxidants from foods may be the best way to protect against cancer.

Also, there is only limited evidence that taking large doses of vitamin E may help with cancer treatment. One study of 108 people taking the chemotherapy therapy drug cisplatin found that taking a vitamin E supplement during, and as long as 3 months after, treatment reduced nerve damage that can happen when taking cisplatin. However, some doctors worry that large doses of antioxidants from supplements could interfere with chemotherapy medications. If you are undergoing chemotherapy, talk to your doctor before taking vitamin E or any supplement.

The most recent evidence seems to suggest that dietary vitamin E and low-dose tocopherols are cancer preventive, while high-dose supplementation with alpha tocopherol is not. Research is ongoing. Consult a physician to determine the role of vitamin E in specific cases.

Eye disorders

Vitamin E (400 IU) combined with other antioxidants, including zinc (80 mg), beta-carotene (15mg), and vitamin C (500 mg), seems to protect against developing age-related macular degeneration (AMD). AMD is the leading cause of legal blindness in people over 55 in the United States. People with advanced AMD seemed to get the biggest benefit. Researchers do not know whether this combination of nutrients helps prevent AMD or helps people with less advanced AMD.

Vitamins E and C may also help treat uveitis. Uveitis is inflammation of the uvea, the middle layer of the eye between the sclera (white outer coat of the eye) and the retina. A clinical study of 130 people with uveitis found that those who took these vitamins had clearer vision than those who took placebo.
Mental function

Evidence is mixed as to whether vitamin E can help prevent or treat Alzheimer disease. Some researchers believe that antioxidants may help prevent Alzheimer disease. One study found that people who had levels of all the forms of vitamin E, not just d-alpha-tocopherol, the kind usually found in supplements, were less likely to develop Alzheimer's. But another study found that people who had early symptoms of Alzheimer's and took vitamin E supplements went on to develop the disease at the same rate as those who took placebo.

In one study with positive results, 341 people with Alzheimer disease took either 2,000 IU of vitamin E (dl-alpha-tocopherol), the drug selegiline, or placebo. Those who were given vitamin E took about 200 days longer for the disease to progress to severe than those who took placebo. However, selegiline worked even better.

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 placebo found that people who took the vitamins became significantly less sensitive to the sun. Another clinical study, lasting for 50 days, also showed a protective effect of the vitamin C and E combination.

Menstrual Pain

A few studies have found that vitamin E may help relieve menstrual pain or dysmenorrhea. In one study, women who took 500 IU of vitamin E for 2 days before and 3 days after their periods started had less pain than those who took placebo.

A few studies also suggest that vitamin E supplements may help reduce PMS symptoms, including anxiety, food cravings, and depression.

Diabetes

People with diabetes tend to have low levels of antioxidants, which has led some researchers to believe that this might explain why they are at increased risk for conditions such as heart 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 may help control blood sugar levels and lower cholesterol levels in people with type 2 diabetes while protecting against the complications of eye damage (retinopathy) and kidney damage (nephropathy) in those with type 1 diabetes. One study found that people with type 2 diabetes who took 400 IU of vitamin E daily reduced their risk of heart attack and of dying from heart disease.

However, not all studies have found that taking vitamin E supplements helps people with diabetes. If you have diabetes, ask your doctor whether a vitamin E supplement is right for you.

Pre-eclampsia

Some studies suggest that taking vitamin E along with vitamin C may help prevent pre-eclampsia in women who are at high risk. Women with pre-eclampsia have high blood pressure and too much protein in the urine. Pre-eclampsia is a common cause of premature births. Not all studies agree, however. Women should speak with their physicians before taking vitamin E during pregnancy.

Tardive dyskinesia

Some small studies have suggest that vitamin E supplements may help treat tardive dyskinesia, involuntary, repetitive movements that are a side effect of taking certain medications for a long time. However, not all studies have found that vitamin E can help. The largest study found that taking 1,600 IU of vitamin E daily for at least one year was no better at reducing tardive dyskinesia symptoms than placebo.

Rheumatoid arthritis

One study suggests that taking vitamin E, along with standard medications for rheumatoid arthritis, may help reduce pain, but not inflammation, better than standard medications alone.

Can vitamin E be harmful?

What happens if you take vitamin E every day? Vitamin E may be unsafe when taken in very high amounts, especially for people who have conditions with blood clotting or heart disease or diabetes. If you suffer from these health issues, do not take doses of 400 IU/day or more.

Most people do not experience any side effects when taking the recommended dose, but in high doses there are adverse reactions that have been recorded.

Some studies show that taking high doses of vitamin E, which are between 300–800 IU each day, might increase the chance of having a serious stroke called hemorrhagic stroke by 22 percent. One serious side effect of too much vitamin E is an increased risk of bleeding, especially in the brain.

Avoid taking supplements containing vitamin E or any other antioxidant vitamins immediately before and following angioplasty, a type of heart procedure. These vitamins seem to interfere with proper healing.

Supplementing with very high levels of vitamin E could potentially lead to the following health concerns:

Heart failure in people with diabetes.

Worsened bleeding disorders.

Increased risk for head, neck and prostate cancers returning among people who previously had these cancers.

Increased bleeding during and after surgery.

Increased chance of death after a heart attack or stroke.

Some studies have found that vitamin E supplements can also be harmful to women who are in the early stages of pregnancy. Women who take high doses of vitamin E supplements during their first eight weeks of pregnancy may increase the risk of congenital heart defects.

High doses of vitamin E can also sometimes lead to:

nausea

diarrhea

stomach cramps

fatigue

weakness

headache

blurred vision

rash

bruising

bleeding

Topical vitamin E can irritate some people’s skin, so try a small amount first, and make sure you don’t have a sensitivity.

Interactions with medications or supplements?

Vitamin E dietary supplements can interact or interfere with certain medicines that you take. Here are some examples:

Vitamin E can increase the risk of bleeding in people taking anticoagulant or antiplatelet medicines, such as warfarin (Coumadin).

In one study, vitamin E plus other antioxidants (such as vitamin C, selenium, and beta-carotene) reduced the heart-protective effects of two drugs taken in combination (a statin and niacin) to affect blood cholesterol levels.

Taking antioxidant supplements while undergoing chemotherapy or radiation therapy for cancer could alter the effectiveness of these treatments.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines, or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.
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 absorption of the antidepressant desipramine (Norpramin). Desipramine belongs to a class of drugs known as tricyclics. Other tricyclics include imipramine (Tofranil) and nortriptyline (Pamelor).

Antipsychotic medications. Vitamin E can interfere with the body's absorption of the antipsychotic medication called chlorpromazine (Thorazine). Chlorpromazine belongs to a class of drugs known as phenothiazines.

Aspirin. Because vitamin E can increase the risk of bleeding, people who take aspirin should talk to their doctor before taking vitamin E supplements.

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

Beta-blockers. This type of medication is used to treat high blood pressure. Vitamin E interferes with the body's absorption of propranolol (Inderal), a kind of beta-blocker. Other beta-blockers include:

Acebutolol (Sectral)

Atenolol (Tenormin)

Bisoprolol (Zebeta)

Carteolol (Cartrol)

Metoprolol (Toprol XL)

Nadolol (Corgard)

Propranolol (Inderal)

Bile acid sequestrants. These medications, used to lower cholesterol, may reduce how much vitamin E your body absorbs. These medications include:

Cholestyramine (Questran, Prevalite)

Cholestipol (Colestid)

Statins. Taking a combination of antioxidants, including vitamins E and C, selenium, and beta-carotene, along with niacin and simvastatin (Zocor) seems to keep niacin and Zocor from raising HDL (good) cholesterol. Researchers do not know whether vitamin E alone would have the same effect, or whether it would happen with other statins. Ask your doctor before taking vitamin E if you also take a statin. Statins include:

Lovastatin (Mevacor)

Simvastatin (Zocor)

Pravastatin (Pravachol)

Atorvastatin (Lipitor)

Fluvastatin (Lescol)

Rosuvastatin (Crestor)

Gemfibrozil. This medication, used to lower cholesterol, may also reduce vitamin E levels.

Cyclosporine. Vitamin E may interact with cyclosporine, a medication used to treat cancer, making both vitamin E and cyclosporine less effective. However, another study suggests that the combination of vitamin E and cyclosporine may actually make cyclosporine work better. Ask your doctor before taking vitamin E if you take cyclosporine.

Chemotherapy drugs. Some doctors worry that antioxidants like vitamin E may reduce the effectiveness of chemotherapy drugs, including chlorambucil, busulfan, doxorubicine, carmustine, thiopeta, and cyclophosphamideradicals. However, other researchers think that antioxidants may make chemotherapy work better. Talk to your oncologist before taking vitamin E or any supplement.

Tamoxifen. Tamoxifen, a treatment for breast cancer, boosts blood levels of triglycerides, increasing the risk of developing high cholesterol. In a study of 54 women with breast cancer, vitamins C and E, taken along with tamoxifen, reduced this side effect. These vitamins reduced LDL (bad) cholesterol and triglyceride levels while raising HDL (good) cholesterol. Vitamins C and E also made the anticancer action of the tamoxifen stronger.

Warfarin (Coumadin). Taking vitamin E at the same time as other blood thinners can increase the risk of bleeding.

Orlistat (Alli). This medication is used for weight loss. It stops your body from absorbing some fat and calories. It may also prevent the absorption of fat-soluble vitamins, including vitamin E. Doctors who prescribe orlistat may add a multivitamin with fat-soluble vitamins.

Vitamin E may also interact with:

Calcium channel blockers, including:

Nifedipine (Procardia)

Amlodipine (Norvasc)

Verapamil (Calan, Isoptin)

Diltiazem (Cardizem)

Felodipine (Plendil)

Nisoldipine (Sular)

Bepridil (Vascor)

Others include:

Cisapride (Propulsid)

Fluoxetine (Prozac)

Fexofenadine (Allegra)

Omeprazole (Prilosec)

Vitamin E and healthful eating

People should get most of their nutrients from food and beverages, according to the federal government’s Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber and other components that benefit health. In some cases, fortified foods and dietary supplements are useful when it is not possible to meet needs for one or more nutrients (for example, during specific life stages such as pregnancy). For more information about building a healthy dietary pattern, see the Dietary Guidelines for Americans and the U.S. Department of Agriculture’s (USDA’s) MyPlate.

Conclusion

Vitamin E is a collective description for eight compounds, four tocopherols and four tocotrienols, and they provide different benefits. It’s best to get a variety of vitamin E isomers from your diet, given that different types have different benefits.

What are benefits of vitamin E? It acts as an antioxidant and helps fight free radicals and inflammation.

It can help in balancing cholesterol, repairing damaged skin, thickening hair, balancing hormones, helping PMS symptoms, improving vision, helping people with Alzheimer’s, and offering protection against prostate and breast cancers.

Nuts, seeds and whole grains are the best sources. What fruits and veggies are rich in vitamin E? Good sources include mango, avocado, butternut squash, broccoli, spinach, kiwi and tomato.

It’s safest and most beneficial to get this vitamin from your diet.

Can I take vitamin E capsules every day? It may be unsafe when taken in very high amounts, especially for people who have conditions such as heart disease or diabetes. If you suffer from these health issues, do not take doses of 400 IU/day or more.

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