All about vitamin E

VITAMIN E Overview Information

Vitamin E is a vitamin that dissolves in fat. It is found in many foods including vegetable oils, cereals, meat, poultry, eggs, fruits, vegetables, and wheat germ oil. It is also available as a supplement.

Vitamin E is used for treating vitamin E deficiency, which is rare, but can occur in people with certain genetic disorders and in very low-weight premature infants.

Some people use vitamin E for treating and preventing diseases of the heart and blood vessels including hardening of the arteries, heart attack, chest pain, leg pain due to blocked arteries, and high blood pressure.

Vitamin E is also used for treating diabetes and its complications. It is used for preventing cancer, particularly lung and oral cancer in smokers; colorectal cancer and polyps; and gastric, prostate, and pancreatic cancer.

Some people use vitamin E for diseases of the brain and nervous system including Alzheimer’s disease and other dementias, Parkinson’s disease, night cramps, restless leg syndrome, and for epilepsy, along with other medications. Vitamin E is also used for Huntington’s chorea, and other disorders involving nerves and muscles.

Women use vitamin E for preventing complications in late pregnancy due to high blood pressure (pre-eclampsia), premenstrual syndrome (PMS), painful periods, menopausal syndrome, hot flashes associated with breast cancer, and breast cysts.

Sometimes vitamin E is used to lessen the harmful effects of medical treatments such as dialysis and radiation. It is also used to reduce unwanted side effects of drugs such as hair loss in people taking doxorubicin and lung damage in people taking amiodarone.

Vitamin E is sometimes used for improving physical endurance, increasing energy, reducing muscle damage after exercise, and improving muscle strength.

Vitamin E is also used for cataracts, asthma, respiratory infections, skin disorders, aging skin, sunburns, cystic fibrosis, infertility, impotence, chronic fatigue syndrome (CFS), peptic ulcers, for certain inherited diseases and to prevent allergies.

Some people apply vitamin E to their skin to keep it from aging and to protect against the skin effects of chemicals used for cancer therapy (chemotherapy).

The American Heart Association recommends obtaining antioxidants, including vitamin E, by eating a well-balanced diet high in fruits, vegetables, and whole grains rather than from supplements until more is known about the risks and benefits of taking supplements.

How does it work?

Vitamin E is an important vitamin required for the proper function of many organs in the body. It is also an antioxidant. This means it helps to slow down processes that damage cells.

Effective for:

• Vitamin E deficiency.

Possibly Effective for:

• Bladder cancer. Taking 200 IU of vitamin E by mouth for more than 10 years seems to help prevent death from bladder cancer.
• Alzheimer’s disease. Vitamin E might slow down the worsening of memory loss in people with moderately severe Alzheimer’s disease. Vitamin E might also delay the loss of independence and the need for caregiver assistance in people with mild-to-moderate Alzheimer’s disease. But vitamin E does not seem to prevent moving from mild memory problems to full-blown Alzheimer’s disease.
• Painful menstruation (dysmenorrhea). Taking vitamin E for 2 days before and for 3 days after bleeding begins seems to decrease pain severity and duration, and reduce menstrual blood loss.
• Premenstrual syndrome (PMS). Taking vitamin E by mouth seems to reduce anxiety, craving, and depression in some women with PMS.
• Chemotherapy-related nerve damage. Taking vitamin E before and after treatment with cisplatin chemotherapy might reduce the chance of getting nerve damage.
• Ischemic stroke. Some research shows that taking vitamin E might slightly decrease the chance of having a stroke caused by a blood clot (ischemic stroke). But taking vitamin E might also increase the chance of having a more severe type of stroke, called hemorrhagic stroke. This kind of stroke occurs when there is bleeding into the brain.
• Liver disease called nonalcoholic steatohepatitis. Taking vitamin E 400-1200 IU daily seems to significantly improve symptoms in adults and children after 4-24 months of treatment.
• Huntington’s chorea. Natural vitamin E (RRR-alpha-tocopherol) can significantly improve symptoms in people with early Huntington’s disease, but it doesn’t seem to help people with more advanced disease.
• Macular degeneration. Taking vitamin E by mouth in combination with vitamin C, beta-carotene and zinc might slow the worsening of advanced age-related macular degeneration (AMD). There isn’t enough information to know if this combination helps people with less advanced macular disease or prevents AMD. Zinc needs to be present in the combination for there to be any effect on AMD.
• Rheumatoid arthritis (RA). Vitamin E taken along with standard treatment is better than standard treatment alone for reducing pain in people with RA. But this combination doesn’t reduce swelling (inflammation).
• Male infertility.
• High blood pressure during pregnancy (pre-eclampsia).
• Movement disorders called tardive dyskinesia and dyspraxia.
• Parkinson’s disease.
• Kidney problems in children (glomerulosclerosis).
• Helping to treat an inherited disorder called G6PD deficiency.
• Beta-thalassemia.
• Dementia.
• Healing a type of skin sore called granuloma annulare when put on the skin.
• Uveitis.
• Sunburn.
• Helping the eyes heal after surgery.
• Treating a type of eye disease in newborns called retrolental fibroplasia.
• Decreasing brain and heart bleeding in premature babies.
• Helping some heart medications called “nitrates” work better.
• Improving physical performance and strength in the elderly.
• Fibrosis caused by radiation.

Possibly Ineffective for:

• Anemia in people having hemodialysis.
• Chest pain (angina).
• Hot flashes in people who have had breast cancer.
• Hardening of the arteries (atherosclerosis).
• Breathing problems in newborns.
• Lung infections in elderly persons.
• Heart failure.
• Treating muscle diseases called Duchenne muscular dystrophy and myotonic dystrophy.
• High blood pressure.
• Helping people walk without pain when they have a disease called intermittent claudication.
• A type of arthritis called osteoarthritis. Vitamin E does not seem to decrease pain or stiffness and does not seem to prevent osteoarthritis from getting worse.
• Head and neck cancer.
• Sores in the mouths of people who smoke.
• Cancer of the pancreas.
• Pharyngeal cancer.
• Reducing scarring after surgery.
• Colorectal cancer.
• An eye condition called retinitis pigmentosa.

Likely Ineffective for:

• Preventing heart disease. Taking vitamin E supplements does not prevent heart disease. But increasing vitamin E in the diet might be beneficial.
• Benign breast disease.
• Breast cancer.
• Lung cancer.
• Prostate cancer. Research on the effects of vitamin E on prostate cancer risk has produced results that don’t agree. Some studies suggest that taking more vitamin E seems to prevent prostate cancer. But other large studies find no benefit. Some research has also shown that taking vitamin E might increase the chance of developing prostate cancer. Overall, the best research indicates that vitamin E does not help prevent prostate cancer and might increase the chance of developing prostate cancer.

Insufficient Evidence for:

• Asthma. There is inconsistent evidence about the role of vitamin E in asthma. Some research suggests that getting more vitamin E from the diet seems to prevent asthma. But getting vitamin E from supplements doesn’t have the same benefit.
• Cancer. Some research suggests a combination of vitamin E with vitamin C, beta-carotene, selenium, and zinc lowers the risk of cancer in men, but not women. Researchers suspect that men get a lower amount of these vitamins from food, so they might benefit more from supplements.
• Stomach cancer. Taking vitamin E plus beta-carotene or vitamin C and beta-carotene does not seem to prevent stomach cancer. But there is limited evidence that getting more vitamin E from the diet might slow the progress of stomach cancer.
• Sickle cell disease. Taking vitamin E with aged garlic extract and vitamin C might be useful for sickle cell anemia.
• Stroke caused by a clot (ischemic stroke). There is some evidence that synthetic vitamin E (all-rac-alpha-tocopherol) might help prevent stroke in male smokers who have high blood pressure and diabetes.
• Skin disorders.
• Cloudy vision in older people (cataracts).
• Diabetes.
• Esophageal cancer.
• Allergies.
• Chronic fatigue syndrome (CFS).
• Oral cancer.
• Skin cancer.
• Epilepsy.
• Menstrual disorders.
• High blood fat levels.
• Leg cramps.
• Common cold.
• Other conditions.

More evidence is needed to rate vitamin E for these uses.

VITAMIN E Side Effects & Safety

Vitamin E is LIKELY SAFE for most healthy people when taken by mouth or applied to the skin. Most people do not experience any side effects when taking the recommended daily dose, which is 15 mg.

Vitamin E is POSSIBLY UNSAFE if taken in high doses. If you have a condition such as heart disease or diabetes, don’t take doses of 400 IU/day or more. Some research suggests that high doses might increase the chance of death and possibly cause other serious side effects. The higher the dose, the greater the risk of serious side effects.

There is some concern that vitamin E might increase the chance of having a serious stroke called hemorrhagic stroke, which is bleeding into the brain. Some research shows that taking vitamin E in doses of 300-800 IU each day might increase the chance of this kind of stroke by 22%. However, in contrast, vitamin E might decrease the chance of having a less severe stroke called an ischemic stroke.

There is contradictory information about the effect of vitamin E on the chance of developing prostate cancer. Some research suggests that taking large amounts of a multivitamin plus a separate vitamin E supplement might actually increase the chance of developing prostate cancer in some men.

High doses can also cause nausea, diarrhea, stomach cramps, fatigue, weakness, headache, blurred vision, rash, and bruising and bleeding.

Special Precautions & Warnings:

Pregnancy and breast-feeding: When used in the recommended daily amount, vitamin E is POSSIBLY SAFE for pregnant and breast-feeding women. There has been some concern that taking vitamin E supplements might be harmful to the fetus when taken in early pregnancy. But it is too soon to know if this is an important concern. Until more is known, do no take vitamin E supplements during early pregnancy without talking with your healthcare provider.

Angioplasty, a heart procedure: Avoid taking supplements containing vitamin E or other antioxidant vitamins (beta-carotene, vitamin C) immediately before and following angioplasty without the supervision of a health care professional. These vitamins seem to interfere with proper healing.

Low levels of vitamin K (vitamin K deficiency): Vitamin E might worsen clotting problems in people whose levels of vitamin K are too low.

An eye condition called retinitis pigmentosa: All-rac-alpha-tocopherol (synthetic vitamin E) 400 IU seems to speed vision loss in people with retinitis pigmentosa. However, much lower amounts (3 IU) don’t seem to produce this effect. If you have this condition, it’s best to avoid vitamin E.

Bleeding disorders: Vitamin E might make bleeding disorders worse. If you have a bleeding disorder, avoid taking vitamin E supplements.

Head and neck cancer: Don’t take vitamin E supplements in doses of 400 IU/day or more. Vitamin E might increase the chance that cancer will return.

Prostate cancer: There is concern that taking vitamin E might increase the chance of developing prostate cancer. The effect of vitamin E in men who currently have prostate cancer is not clear. But, in theory, taking vitamin E supplements might worsen prostate cancer in men who already have it.

Surgery: Vitamin E might increase the risk of bleeding during and after surgery. Stop using vitamin E at least 2 weeks before a scheduled surgery.

VITAMIN E Interactions 

Moderate Interaction Be cautious with this combination

• Cyclosporine (Neoral, Sandimmune) interacts with VITAMIN E

Taking large amounts of vitamin E along with cyclosporine (Neoral, Sandimmune) might increase how much cyclosporine (Neoral, Sandimmune) the body absorbs. By increasing how much cyclosporine the body absorbs, vitamin E might increase the effects and side effects of cyclosporine (Neoral, Sandimmune).

• Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with VITAMIN E

Some medications are changed and broken down by the liver. Vitamin E might increase how quickly the liver breaks down some medications. Taking vitamin E along with some medications that are broken down by the liver can decrease the effectiveness of some medications. Before taking vitamin E talk to your healthcare provider if you are taking any medications that are changed by the liver.Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

• Medications for cancer (Chemotherapy) interacts with VITAMIN E

Vitamin E is an antioxidant. There is some concern that antioxidants might decrease the effectiveness of some medications used for cancers. But it is too soon to know if the interaction occurs.

• Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with VITAMIN E

Vitamin E might slow blood clotting. Taking vitamin E along with medications that also slow clotting might increase the chances of bruising and bleeding.Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

• Medications used for lowering cholesterol (Statins) interacts with VITAMIN E

Taking vitamin E, beta-carotene, vitamin C, and selenium together might decrease the effectiveness of some medications used for lowering cholesterol. It is not known if taking vitamin E alone decreases the effectiveness of some medications used for lowering cholesterol.Some medications used for lowering cholesterol include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), and pravastatin (Pravachol).

• Niacin interacts with VITAMIN E

Taking vitamin E along with beta-carotene, vitamin C, and selenium might decrease some of the beneficial effects of niacin. Niacin can increase the good cholesterol. Taking vitamin E along with these other vitamins might decrease the good cholesterol.

• Warfarin (Coumadin) interacts with VITAMIN E

Warfarin (Coumadin) is used to slow blood clotting. Vitamin E can also slow blood clotting. Taking vitamin E along with warfarin (Coumadin) can increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.

VITAMIN E Dosing

The following doses have been studied in scientific research:

BY MOUTH:

• For vitamin E deficiency: a typical dose in adults is RRR-alpha tocopherol (natural vitamin E) 60-75 IU per day.
• For the movement disorder called tardive dyskinesia: RRR-alpha-tocopherol (natural vitamin E) 1600 IU daily.
• For improving male fertility: vitamin E 200-600 IU daily.
• For Alzheimer’s disease: up to 2000 IU daily. Combination therapy of donepezil (Aricept) 5 mg and vitamin E 1000 IU per day has been used for slowing memory decline in people with Alzheimer’s disease.
• For liver disease called non-alcoholic steatohepatitis: 800 IU daily in adults has been used; 400-1200 IU daily has been used in children.
• For early Huntington’s chorea: RRR-alpha-tocopherol (natural vitamin E) 3000 IU.
• For rheumatoid arthritis pain: vitamin E 600 IU twice daily.
• For preventing nerve damage caused by cisplatin: vitamin E (alpha-tocopherol) 300 mg daily with each chemotherapy treatment and for up to 3 months after stopping cisplatin therapy.
• For improving effectiveness of nitrates used for heart disease: vitamin E 200 mg three times daily.
• To reduce protein in the urine of children with a kidney disease called focal segmental glomerulosclerosis: vitamin E 200 IU.
• For G6PD deficiency: vitamin E 800 IU daily.
• For premenstrual syndrome (PMS): RRR-alpha-tocopherol (natural vitamin E) 400 IU daily.
• For painful menstrual periods: vitamin E 200 IU twice or 500 IU daily starting 2 days before the menstrual period and continuing through the first 3 days of bleeding.
• For healing the eyes after a surgery called keratectomy: 230 mg vitamin E (alpha-tocopheryl nicotinate) and vitamin A (retinol palmitate) 25,000 units have been used 3 times daily for 30 days, followed by twice daily for 2 months.
• For fibrosis caused by radiation: vitamin E 1000 IU daily in combination with pentoxifylline 800 mg.
• For beta-thalassemia: vitamin E 750 IU daily.
• For preventing sunburn: RRR-alpha-tocopherol (natural vitamin E) 1000 IU in combination with 2 grams of ascorbic acid.
• For preventing high blood pressure during pregnancy (pre-eclampsia) in high risk women: vitamin E 400 IU with vitamin C 1000 mg daily.

For the most benefit, it’s best to take vitamin E that has been made in a lab (all-rac-alpha-tocopherol) with food.

Dosing for vitamin E can be confusing. Current guidelines show recommended dietary allowance (RDA) and upper tolerable limits (UTL) for vitamin E in milligrams. However, most products are still labeled in International Units (IUs).