Vitamin E

Vitamin E: Overview

Alternative Names: The tocopherols.

Vitamin E works alongside other antioxidant nutrients including selenium, vitamin C, beta-carotene and others to quench free radicals, peroxides and other potentially harmful substances.  Vitamin E has a sparing effect on other antioxidants and vice versa.

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Vitamin E is the major lipid-soluble, membrane-localized antioxidant in humans.  This has become an extremely popular antioxidant in the past few years.  Current studies of vitamin E's antioxidant, anti-aging, cancer protecting, and heart protecting abilities are ongoing and will continue for years to come.

Vitamin E describes a family of compounds of the tocopherol and tocotrienol type.  The four major forms of vitamin E are alpha, beta, gamma, and delta tocopherol; with alpha tocopherol as the most active form.  The natural form is the isomer d-α-tocopherol (or RRR-alpha tocopherol).  Synthetic forms are called all-racemic, or dl-α-tocopherol.  It is an important distinction because while the natural and synthetic forms have similar antioxidant properties, the body is able to recognize and transfer the natural form in ways that the synthetic is incapable of being used.

Vitamin E's versatility has led to fresh discoveries and consequent reports in the medical journals even today.

Source

Vitamin E occurs naturally in foods such as nuts and seeds, whole grains, cold-pressed vegetable oils and dark-green leafy vegetables.  There are 4 tocopherols occurring in foods – alpha, beta, gamma, delta or a, b, g and d.  d-alpha tocopherol accounts for 80% of the activity of the vitamin; DL-α-tocopherol is the name given to synthetic derivatives which are composed of equal amounts of all the stereoisomers.

Vitamin E occurs in foods in a variety of related forms.  The most potent and useful form of vitamin E is called alpha-tocopherol.  The best sources of vitamin E are vegetable oils, such as corn oil, soy oil, and peanut oil.  Animal fats, such as butter and lard, contain lower levels of the vitamin.  Corn oil contains about 16mg of alpha-tocopherol per 100gm; wheat-germ oil contains 120mg alpha-tocopherol per 100gm.  Fish, eggs and beef contain relatively low levels of the vitamin, with about 1mg per 100gm.

'Mixed tocopherols' on vitamin labels indicates that 80% of the natural d-alpha variety is present with the remaining 20% being a mixture of b, g and d.

Function; Why it is Recommended

The tocotrienols, which are less distributed in nature than the tocopherols, have not been well studied probably because they have 'less biological activity'.  However one study reported that it has greater anti-tumor effects than the most biologically active tocopherol.

Vitamin E requires the presence of bile for absorption and only 20-30% of normal dietary vitamin E is absorbed (the percentage decreases with increasing dose).  There is no correlation between serum levels and vitamin E stores.

The major function of vitamin E is the protection from lipid peroxidation, an effect of free radical oxidation in membranes and LDL particles.  Vitamin E is able to take free electrons and transfer them to vitamin C, glutathione, or CoQ-10; molecules that are less fat soluble than vitamin E.  The effects of vitamin E are so wide ranging because every cell is at risk of damage by free radicals.  Eventually DNA damage will result leading to further complications.  Aging, thought to be a free-radical process, is accompanied by brittle membranes (a result of long-term oxidation of the membranes) and accumulating DNA damage.

Vitamin E is a very potent antioxidant.  As an antioxidant, it protects the body from free radicals.  Vitamin E chelates heavy metals such as mercury.  It is important in protecting cell membranes from oxidative destruction.  It is the king of cardiovascular nutrients.  It prevents the buildup of LDL cholesterol in the arterial wall.  Vitamin E can decrease platelet adherence to damaged artery walls, much like Vitamin C.  While helping myocardium (heart muscle) use oxygen more efficiently, vitamin E can even lift HDL (good) cholesterol levels.  It protects against heart disease.

An amazing record of success with the use of vitamin E therapy in treating a number of skin conditions has been reported by dermatologists all over the world.  These successes include the treatment of plantar warts (warts on the bottom of the feet growing inward), scars from acne, chicken pox and burns, and the stretch marks of pregnancy.

Dr. Abram Hoffer has treated an advanced case of Huntington's Chorea and returned the patient to apparent normalcy with large amounts of vitamin E (4,800 IU per day) along with niacin.  This disease involves nerve and muscle degeneration and wasting.  It is said to be untreatable and invariably progresses to death, usually with severe mental deterioration to the point of insanity.

Dr. Antonio J.  DeLiz treated an advanced case of Crohn's disease (severe ileum or colon inflammation and ulceration with bloody diarrhea), another incurable disease, with remarkable results using 16,000 IU of vitamin E daily.  Dr. Wilfred Shute, too, was able to bring relief to several individuals with Crohn's disease who telephoned or wrote him after he lectured in Australia.

Milroy's disease is another rare, incurable disease according to the medical texts and journals.  This disease is due to poor development of the lymphatic system, with a consequent chronic pooling of lymph in the legs evidenced by abnormal swelling.  Added to this is the insult of recurring attacks of thrombophlebitis, each of which adds damage to the veins and increases the swelling.  Every case Dr. Shute treated resulted in a positive response, with some cases being fully cured.

Vitamin E counters most of the pollutants in the air, minimizes the damage caused by the side-effects of many drugs, and combats several forms of industrial stress.  It helps boost the immune system when an illness puts stress upon it.

Vitamin E is anti-infective, anti-viral, and anti-fungal.  It has cleared up several cases of fungus infection under the fingernails or toenails.  It combats herpes simplex (cold sores on the lips), and since this has been published in dental journals, it is now used by many dentists as a local application to the lips before the patient leaves the chair.

Vitamin E relieves most cases of fibrocystic disease (breast lumps).

It is the answer – partially or completely – to most of the many complications of premature birth.  These tiny infants enter the world before their tissues and organs are fully developed for life outside the mother's body.  Often they must have oxygen supplementation in order to survive.  However, this oxygen, while life-saving, may lead to serious complications such as blindness, lung engorgement and fibrosis (scar tissue), a serious form of anemia, and heart and liver damage.  Vitamin E has proven very useful in combating all these conditions.  Indeed, Canada's renowned pediatric hospital, The Hospital for Sick Children, has been using vitamin E routinely for years in its premature ward.

Supplementation of vitamin E is considered by many to be one of the best ways to prevent non-genetic risk factors for cardiovascular, aging, cancer, and oxidation related diseases.

Instructions

The RDA for RRR-alpha-tocopherol (d-alpha-tocopherol) is 15mg for those over 14 years of age, 19mg for breastfeeding mothers, and a range of 4 to 11mg per day for those aged 0 to 13 years.  Vitamin E is measured in International units (IU), one IU being defined as 1.5mg of α-tocopherol.  Other tocopherols are less potent and require more product to equal the number of units supplied by the α version.

Counter-Indicators and Warnings

Caution: If you are taking anticoagulants, you should not take vitamin E supplements because vitamin E has its own anticoagulant properties.

Vitamin E can help with the following:

Addictions

Cigarette Smoke Damage

Smokers have been found to have a lower alpha tocopherol level than non-smokers.  Furthermore, persons with low physical activity levels were found to have a lower level than those with high activity.  [Journal of Internal Medicine, 1993;234: pp.53-60]

Aging

Alzheimer's Disease

Ensure sufficient antioxidant intake.  A study of more than 5,000 men and women found that people who consumed very high amounts of dark green, yellow, and red vegetables appear to reduce their risk of dementia by about 25%.  Several studies have shown that vitamin E, an anti-oxidant, can slow progression of Alzheimer's.

Allergy

Autoimmune

Childhood

Down's Syndrome

Down's Syndrome is associated with an increased oxidation problem.  Antioxidants such as vitamin E provide protection in such situations.

Circulation

Coronary Disease / Heart Attack

Vitamin E may protect the endothelial cells of the arteries from becoming oxidized.  Free radical stress can be reduced with antioxidants such as vitamin E.

In a study published in Epidemiology in 2002, a substantial inverse association with myocardial infarctions (MI) was found for total dietary vitamin E (assessed by food-frequency questionnaire), in a case-control study of 475 survivors of a first MI and 479 controls in Costa Rica.  Dietary gamma tocopherol intake was not associated with the risk of myocardial infarction.  This study again indicates that alpha tocopherol may be the preferred form of vitamin E for protection from MI.  [Epidemiology 2002; 13(2): pp.216-223]

See also: [Stephens NG, Parsons A, Schofield PM, et al.  Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS).  Lancet 1996; 347: pp.781-6]

Phlebitis / Thrombophlebitis

Milroy's disease is a rare, incurable disease due to poor development of the lymphatic system, with a consequent chronic pooling of lymph in the legs often with recurring attacks of thrombophlebitis.  Every case Dr. Shute, MD treated with vitamin E resulted in a positive response, with some cases being fully cured.  The dose of vitamin E used for thrombophlebitis is 600-1,600 IU daily.

Intermittent Claudication

400 to 2,000 IU per day of vitamin E for many months has lead to improvements.

Atherosclerosis

Dosage: 400 IU per day.

Vasculitis

A membrane's lipid bilayers are high in polyunsaturated fatty acids which are subject to oxidation.  Vitamin E's function in maintaining membrane integrity might be attributed to its prevention of the membrane damage.  It has been hypothesized vitamin E protects the lysosomal membranes from rupturing and destroying the cells.

Aneurysm / Rupture

In evaluating 83 patients, it was found that serum cholesterol and triglyceride levels were higher in patients with aortic occlusive and aneurysmal disease than in control organ donors.  Vitamin E concentrations were highest in peripheral occlusive diseased tissue and as much as 3 times greater than in organ donors compared to patients with aortic occlusive disease and aneurysmal disease.  Signs of lipid peroxidation were markedly elevated in all diseased arterial tissue compared to controls.  These data supply evidence of altered vitamin E metabolism and free radical processes in the tissues of patients with various manifestations of atherosclerosis.  [Atherosclerosis, 1996;126: pp.289-297]

Digestion

IBS (Irritable Bowel Syndrome)

See the link between IBS and Vitamin B12.

Environment / Toxicity

Tendency To Sunburn Easily

Vitamins C and E (antioxidants) help reduce the damage due to free radicals produced through exposure to UV light.  If you happen to burn, apply vitamin E oil directly to your skin.  It's been shown to reduce the redness and inflammation caused by the sun.

Immunity

Immune System Imbalance (TH2 Dominance)

Vitamin E increases TH1 cytokines, which help balance a TH2 dominant immune system.

Infections

Athletes Foot

Apply Vitamin E twice daily.

Lab Values

A Low Platelet Count

Five patients with thrombocytopenic purpura received 200-400mg of alpha-tocopherol acetate daily.  Within 7-14 days, platelet counts and capillary fragility returned to normal or near normal.  [Science 163: 762, 1946)] Note, however, that vitamin E is known to increase bleeding tendency by reducing platelet aggregation, so higher doses may be contraindicated for some patients.

LDL/HDL Ratio, High

Vitamin E causes an increase in HDL levels.

Mental

Metabolic

Cystic Fibrosis

Cystic fibrosis is associated with defective absorption of vitamin E because of a lack of lipase and poor formation of chylomicrons (small fat clusters).

Syndrome X / Metabolic Syndrome

Vitamin E is an important antioxidant that protects against free radical damage caused by high glucose and insulin levels in the blood.  It is also known to reduce the risk of heart disease and cancer.

Musculo-Skeletal

Osgood-Schlatter Disease

400 I.U.  bid of vitamin E along with selenium at 200mcg per day has proven beneficial against Osgood-Schlatter disease.  Vitamin E can be applied topically along with DMSO.  This can also be used for growing pains in the legs, inside or around the shins.  [Marz, p.186, 1997]

Leg Cramps At Night

Nocturnal leg cramping often responds to 400-800 IU of vitamin E per day.  In one of the largest studies, 103 of 125 people who had been experiencing leg and foot cramps at night reported relief after taking vitamin E.  A daily dose of 300 IU was effective for half of the participants, while the others required 400 IU or more for relief [Ayres, Mihan.  South Med J.  67(11): pp.1308-12,1974]

Muscle Pains (Myalgia)

Three months of supplementation with vitamin E at 1000 IU per day prevented muscle soreness after a 45-minute downhill run in young men (mean age 24 years), but not older men (mean age 71 years), in a placebo-controlled study of 32 men.
[Experimental Biology, April 20-24, 2002, New Orleans, LA, USA; abstract]

Restless Leg Syndrome

400 to 800 IU per day of vitamin E has helped in cases of RLS.  In one trial involving 9 patients, 7 had complete relief following supplementation, one had almost 75% relief and one had 50% relief.  It may take up to three months for the full benefit to become apparent.  [Calif Med 111: pp.87-91, 1969]

Osteoarthritis

A clinical trial using 600 IU of vitamin E in patients with osteoarthritis demonstrated significant benefit.  The benefit was thought to be due to vitamin E's antioxidant and membrane stabilizing actions.  Later studies have shown that vitamin E has an ability to inhibit the enzymatic breakdown of cartilage as well as to stimulate cartilage synthesis.

Muscular Dystrophy

Severe deficiency results in muscular dystrophy-like symptoms.  Some cases have shown improvement.

Nervous System

Tardive Dyskinesia

See the link between Tardive Dyskinesia and Melatonin.

Nutrients

Vitamin E Requirement

Vitamin E deficiency that occurs with cholestatic liver disease or other malabsorption syndromes can be treated with weekly injections of 100mg alpha-tocopherol that may continue for six months.  Vitamin E deficiency in premature infants may require treatment for only a few weeks.  The prognosis for correcting the neurological symptoms of vitamin E deficiency is fair to excellent.

Organ Health

Diabetes Type II

In a study published in the July 11, 2000 issue of Circulation, Drs. Ishwarlal Jialal and Sridevi Devaraj found that increased inflammation caused by white blood cells – monocytes – was reduced when diabetics were given 1,200 IU per day of natural vitamin E (alpha-tocopherol) for three months.

Another study showed that vitamin E (680 IU) along with vitamin C (1200mg) will reduce the albumin excretion rate in urine which reduces the risk of end stage renal disease associated with diabetes.  [DiabetMe 2001;18: pp.756-760]

Chronic Renal Insufficiency

Vitamin E levels, independent of dietary intake, have been found to be lower in patients with chronic renal failure.  This reflects increased oxidative activity and suggests the need for antioxidants such as vitamin E.  [Dietary Intake and Plasma Levels of Antioxidant Vitamins in Health and Disease: A Hospital-Based, Case-Control Study, Singh, Ram, B., M.D., et al, Journal of Nutritional & Environmental Medicine, 1995;5: pp.235-242]

Hepatitis

Vitamin E levels have been shown to be low in people with hepatitis [1], as well as in those who go on to develop liver cancer from long-standing hepatitis.[2] Vitamin E levels in the liver may also be decreased in some people with hepatitis.[3]

In a study of individuals with hepatitis B, half received 600 IU of vitamin E per day for nine months, while the others received no vitamin E (control group).  In five of the twelve people receiving vitamin E (compared with none of those in the control group), all signs of hepatitis disappeared.[4]

In a study of adults with hepatitis C, administering 1,200 IU per day of vitamin E for eight weeks appeared to reduce liver damage to some extent.[5] In a preliminary study of people with hepatitis C, 544 IU of vitamin E per day for 24 weeks improved the response to interferon/antioxidant therapy, although the results did not reach statistical significance.[6] However, in children with viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any benefit.[7]

[1] Von Herbay A, Stahl W, Niederau C, et al.  Diminished plasma levels of vitamin E in patients with severe viral hepatitis.  Free Radic Res 1996;25: pp.461-6
[2] Pan WH, Wang CY, Huang SM, et al.  Vitamin A, vitamin E or beta-carotene status and hepatitis B-related hepatocellular carcinoma.  Ann Epidemiol 1993;3: pp.217-24
[3] Mezes M, Par A, Nemeth P, Javor T.  Studies of the blood lipid peroxide status and vitamin E levels in patients with chronic active hepatitis and alcoholic liver disease.  Int J Clin Pharmacol Res 1986;6: pp.333-8
[4] Andreone P, Gramonzi A, Bernardi M.  Vitamin E for chronic hepatitis B.  Ann Intern Med 1998;128: pp.156-7
[5] Houglum K, Venkataramani A, Lyche K, Chojkier M.  A pilot study of the effects of d-alpha-tocopherol on hepatic stellate cell activation in chronic hepatitis C.  Gastroenterology 1997;113: pp.1069-73
[6] Look MP, Gerard A, Rao GS, et al.  Interferon/antioxidant combination therapy for chronic hepatitis C – a controlled pilot trial.  Antiviral Res 1999;43: pp.113-22
[7] Yurdakok M, Kanra G.  Vitamin E therapy in viral hepatitis.  Mikrobiyol Bul 1986;20: pp.91-4 [in Turkish]

Glomerulonephritis

The evidence in favor of vitamin E for kidney diseases in general is not strong, but there are some studies which suggest that the antioxidant effect of vitamin E may be beneficial in cases of chronic kidney disease.  The usual dose is one 400 IU capsule per day.  Vitamin E is also sometimes "prescribed" for people with more advance renal failure who experience leg and foot cramps.  The evidence supporting this use is not strong either, but it is commonly used for this purpose.

Not recommended for
Rheumatic Heart Disease

Do not start with high doses of vitamin E in chronic rheumatic heart disease.

Reproductive

Pregnancy-Related Issues

Several studies imply that harmful free radicals called lipid peroxides contribute to pre-eclampsia [Khan KS, Chien Pl.  Brit J of Obst & Gyn 1997;104(10): pp.1173-9], and that women with this condition are low in the antioxidants that combat them.  [Ziari SA, et al.  Am Jl of Perinat 1996;13(5): pp.287-91]

The U.S.  RDA is 10mg.

Menorrhagia (Heavy Periods)

Free radicals may have a causative role in endometrial bleeding, particularly in the presence of an intrauterine device.  One study showed that supplementation with 100 IU for 10 weeks resulted in improvement in all patients.  [Int J Fertil 1983;28: pp.55-6] Caution must be exercised as higher doses have a blood thinning effect.

Fibrocystic Breast Disease

Several studies report that 200-600 IU of vitamin E per day, taken for several months, reduces symptoms.  Most double blind research has not found vitamin E to relieve fibrocystic breast disease symptoms, however.  Nevertheless, many women take 400 IU of vitamin E for three months to see if it helps.

Painful Menstruation (Dysmenorrhea)

Supplementation with vitamin E (500 IU per day) from 2 days before menstrual onset through the third day of bleeding, for two consecutive menstrual cycles, reduced pain in a placebo-controlled trial of 100 young women with primary dysmenorrhea.  [BJOG 2001;108(11): pp.1181-3]

Another study used vitamin E successfully at a dosage of 75-400 IU tid.  [Butler & McKnight.  Lancet 1: pp.844-47, 1955]

Menopausal Issues

Vitamin E, at a dose of 800 IU per day, is modestly effective in reducing hot flashes, on average cutting the number by one per day.  [The Lancet Oncology 2001;2: pp.199-204]

Vitamin E is worth trying because it is safe, inexpensive, and has demonstrated efficacy.  Up to 3,000 IU per day is considered more effective by some doctors, but will have somewhat of a blood thinning effect.

Premenstrual Syndrome

Although vitamin E research concerning PMS has focused primarily on mastalgia, significant reduction of other PMS symptomatology has been demonstrated in double-blind studies.  Nervous tension, headache, fatigue, depression, and insomnia were all significantly reduced.

Respiratory

Asthma

Vitamin E has multiple actions that makes it a useful supportive agent in asthma treatment.

Skin-Hair-Nails

Adult Acne

Vitamin E regulates retinol levels in humans.  Male acne patients have significantly decreased levels of erythrocyte glutathione peroxidase, which normalizes with vitamin E and selenium treatment.  The acne of both men and women improves with these treatments, probably by reducing the development of lipid peroxides.

Adolescent Acne

Acne in both men and women can show improvement with vitamin E and selenium treatment.

Tumors, Malignant

Breast Cancer

Vitamin E succinate is a derivative of fat-soluble vitamin E and has been shown to inhibit tumor cell growth.  In one study, vitamin E succinate inhibited growth and induced apoptic cell death in estrogen-receptor-negative human breast cancer cell lines.  The study concluded that vitamin E succinate may be of clinical use in the treatment of aggressive human breast cancers, particularly those that are resistant to anti-estrogen therapy.  Those with estrogen-receptor-negative breast cancers should consider taking 1200 IU of vitamin E succinate each day.

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Vitamin E can help prevent the following:

Circulation

Stroke

Vitamin E at 300 IU or above reduces platelet aggregation, as do the tocotrienols.  It is interesting to note that some doctors report that starting to take large doses of vitamin E immediately after a stroke will encourage a higher level of recovery than without the use of vitamin E.  For example, instead of having to use a walker, a patient may become mobile with just a cane.

A study reported in the June 15, 1999, issue of the "Annals of Internal Medicine" presented data derived from over 40,000 subjects – male health professionals whose dietary intake, use of vitamin supplements and health status were followed starting in 1986.

The researchers found no difference in risk of stroke between the high vitamin E- and C-consuming subjects and those who consumed lower levels of the two nutrients.  Similarly, the researchers found that a higher intake of most of the carotenoids did not decrease the risk in these men of either total stroke or ischemic stroke.  Only with respect to lutein (a carotenoid found mainly in dark-green leafy vegetables) did the investigators find a weak trend of decreased risk of stroke with increased intake.

Skin-Hair-Nails

Concern Over Wrinkled Skin

The skin's natural defenses against the free radicals produced by UV light are vitamin C and vitamin E.  These two antioxidants intercept free radicals before they can damage your skin.  Vitamin C protects significantly better against UVA phototoxicity than vitamin E; vitamin E, on the other hand, is more efficient against UVB.

Tumors, Malignant

Lung Cancer

High levels of alpha-tocopherol (a form of vitamin E) in the blood appear to reduce the risk of developing lung cancer in smokers by about 20%.  The researchers attribute the decrease in cancer to vitamin E's antioxidant properties and anticancer properties.  The researchers report that the men most likely to experience a benefit from high serum levels of alpha-tocopherol included those younger than 60, men who had smoked for less than 40 years and men who took vitamin E supplements containing alpha-tocopherol during the study.  [Journal of the National Cancer Institute October 20,1999;91: pp.1738-1743]

Non-Hodgkin's Lymphoma

Observational Study: Serum vitamin E concentrations were significantly lower in leukemia and lymphoma patients than in normal controls.

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