Vitamin E

Vitamin E: A Comprehensive Overview of Its Health Benefits

Vitamin E refers to a group of eight compounds that are classified as tocopherols and tocotrienols, and have varying levels of biological activity. These include alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol, which are fat-soluble antioxidants that help to protect cells from oxidative stress and inflammation. Among these forms, alpha-tocopherol is thought to be the most biologically active and the most common form found in fortified foods and nutritional supplements. Vitamin E is a fat-soluble antioxidant that plays a role in immune function and various metabolic processes, including cell signalling and regulation of gene expression.

The serum concentration of alpha-tocopherol is regulated by the liver, which absorbs the nutrient from the small intestine and preferentially resecretes it via the hepatic alpha-tocopherol transfer protein. The liver also metabolises and excretes the other forms of vitamin E, leading to lower blood and cellular concentrations of these forms, which have been the subjects of less research.

Reactive oxygen species (ROS) are molecules that contain unshared electrons and are highly reactive, reacting rapidly with oxygen to form ROS. The body forms ROS endogenously during metabolism, and exposure to environmental sources of free radicals, such as cigarette smoke and UV radiation, can also lead to the production of ROS. ROS can damage cells and may contribute to the development of chronic diseases such as cardiovascular disease and cancer. Antioxidants, including vitamin E, can protect cells from the damaging effects of ROS by reacting with free radicals and limiting their production.

In addition to its role as an antioxidant, vitamin E has been shown to improve the function of blood vessels. Vitamin E-replete endothelial cells, which line the interior surface of blood vessels, are better able to resist the adherence of blood-cell components to this surface. Vitamin E also increases the expression of enzymes that suppress arachidonic acid metabolism, leading to the release of prostacyclin from the endothelium. Prostacyclin dilates blood vessels and inhibits platelet aggregation, which can help to prevent the development of cardiovascular disease.

Overall, the mechanisms by which vitamin E may help to prevent or delay the onset of chronic diseases associated with ROS are not fully understood. However, the available evidence suggests that vitamin E may play a role in protecting cells from the damaging effects of ROS and improving the function of blood vessels, and may have the potential to help prevent or delay the development of certain chronic diseases. While deficiency in vitamin E is uncommon, it is essential to consume an adequate amount of this nutrient to support overall health and prevent or treat various conditions. In spite of this, in comparative dietary analysis it is estimated that more than 90% of Americans adults do not meet the estimated average requirement (EAR) of 12 mg/day of α-tocopherol.

Natural dietary sources of vitamin E

Here are some natural dietary sources of vitamin E:

• Nuts and seeds: Nuts and seeds are good sources of vitamin E, with a quarter-cup of almonds, for example, providing about 7.3 milligrams (mg) of vitamin E.

• Spinach: Spinach is a good source of vitamin E, with a cup of cooked spinach providing about 4 mg of vitamin E.

• Avocados: Avocados are a good source of vitamin E, with one avocado providing about 4 mg of vitamin E.

• Broccoli: Broccoli is a good source of vitamin E, with a cup of cooked broccoli providing about 3 mg of vitamin E.

• Peppers: Peppers are a good source of vitamin E, with a cup of raw red peppers providing about 2 mg of vitamin E.

• Olive oil: Olive oil is a good sources of vitamin E. A tablespoon of olive oil provides about 2 mg of vitamin E.

It is worth noting that the amount of vitamin E you can obtain from food varies based on factors such as the soil in which it was grown, the processing methods used, the form in which it is present, and the presence of other substances that may interfere its absorption.

While dietary intake of vitamin E is important for maintaining adequate levels in the body, it is possible to obtain this nutrient in the bioavailable form of mixed (low-alpha type) tocopherols with vitamin supplements. However, the best way to get the essential nutrients your body needs is to eat a variety of whole, unprocessed, fruits, vegetables, nuts, seeds, and other plant-based foods. These types of food ensure that you are getting a wide range of nutrients, which may include vitamin E, and should not be replaced by vitamin and mineral supplements alone.

Benefits of vitamin E for cardiovascular health

Vitamin E has been shown to have a number of beneficial effects on cardiovascular health. It has been shown to reduce the risk of heart disease and stroke by both lowering levels of low-density lipoprotein (LDL) cholesterol (bad) and importantly inhibiting its oxidation (thought to be a crucial initiating step for atherosclerosis), and raising levels of high-density (HDL) cholesterol (good). Vitamin E has also been found to improve blood flow and reduce the formation of blood clots that can lead to a heart attack or venous thromboembolism. 

Observational studies have shown an association between higher vitamin E intake and lower rates of heart disease. For example, one study involving approximately 90,000 nurses found that the incidence of heart disease was 30% to 40% lower in those with the highest intakes of vitamin E, primarily from supplements. A review of 18 studies published in 2019 found that vitamin E supplements were effective at lowering systolic blood pressure (the top number in a blood pressure reading) compared to placebo treatments, but had no effect on diastolic blood pressure (the bottom number). In addition to these effects on blood pressure, vitamin E has been shown to reduce the risk of hypertension (high blood pressure) and improve the function of the cells lining the blood vessels (endothelial function).

Benefits of vitamin E for cognitive function

Vitamin E has been shown to have a number of beneficial effects on cognitive function, including improving memory and reducing the risk of cognitive decline and dementia. The brain has a high oxygen consumption rate and a high concentration of polyunsaturated fatty acids in neuronal cell membranes, making it vulnerable to oxidative stress. Some researchers believe that the accumulation of free radical damage to neurons over time may contribute to cognitive decline and the development of neurodegenerative diseases, such as Alzheimer's disease. If this is the case, then it is possible that sufficient intake of antioxidants, such as vitamin E, might provide some protective effect by reducing oxidative damage to neurons.

A systematic review and meta-analysis of observational studies found that higher dietary intake and plasma levels of vitamin E were associated with a lower risk of cognitive decline and Alzheimer's disease. Additionally, a study found that vitamin E supplementation improved memory and cognitive function in healthy older adults. Another study investigating the potential benefits of vitamin E supplementation in patients with Alzheimer's disease hypothesized that it might protect against oxidative damage, reduce neuronal damage, and slow the progression of the disease. After conducting a two-year intervention in which study participants received a daily supplement of 2000 IU of vitamin E, researchers observed a slowing of the disease's progression. These findings suggest that vitamin E supplementation may be a promising approach for managing Alzheimer's disease and warrant further investigation.

Benefits of vitamin E for skin health

Vitamin E has been found to have a number of beneficial effects on skin health. It has been used by dermatologists for decades to protect the skin from free radical damage and has been shown to reduce the risk of skin cancer and improve the appearance of scars and stretch marks. Vitamin E has also been found to improve the appearance of aging skin, reducing the appearance of fine lines and wrinkles. Additionally, vitamin E has been shown to reduce the risk of UV-induced skin damage and improve the healing of sunburns.

Benefits of vitamin E for eye health

Macular degeneration (AMD) and cataracts are among the most prevalent age-related eye conditions linked to oxidative stress and free radical damage. Vitamin E, an antioxidant, may be effective in the prevention and treatment of both AMD and cataracts due to its demonstrated beneficial effects on eye health. Evidence suggests that vitamin E supports the repair of the retina, cornea, and uvea, and may reduce the risk of AMD, a leading cause of vision loss in older individuals. Additionally, vitamin E has been shown to improve visual acuity - a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance, and decrease the risk of cataracts, a condition characterised by the clouding of the eye's lens. Another prospective cohort study found that lens clarity, a measure of eye health, was better in participants who took vitamin E supplements and those with higher blood concentration levels of the vitamin.

Benefits of Vitamin E for immune function

Vitamin E has been found to have a number of beneficial effects on immune function. It has been shown to enhance the function of immune cells, such as T cells and natural killer cells, and to reduce the risk of infections. Vitamin E has also been found to reduce the severity of autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis.

Debunking negative and inconclusive science about vitamin E supplementation

A 2005 meta-analysis published in the Annals of Internal Medicine found that high doses of vitamin E (primarily synthetic dl-alpha-tocopherol) were associated with a small but significant increase in all-cause mortality. However, this conclusion has been called into question due to several methodological issues and the use of only a single isomer of vitamin E. Natural vitamin E, which includes mixed tocopherols and tocotrienols, has a robust and rapidly growing body of research indicating its significant therapeutic potential and safety when used as a supplement. In contrast, high doses of synthetic dl-alpha-tocopherol may become pro-oxidant, disrupt detoxification enzymes and immune function, and promote inflammation. Despite this, the media coverage of the 2005 meta-analysis has contributed to ongoing doubts among health professionals and the public at large about the benefits and safety of vitamin E supplementation.

Out of 120 primary research studies published from 1973-2007 that examined the effects of vitamin E (alpha-tocopherol) on lipid structures such as lipoproteins and cell membranes, 25% used natural d-alpha-tocopherol, 25% used synthetic (all-racemic) dl-alpha-tocopherol, and the form used was not identified in the remaining 50% of studies. None of the studies used natural vitamin E, which includes a full complement of tocopherols and tocotrienols.

Synthetic dl-alpha-tocopherol is a mixture of 8 stereoisomers, which are molecules with the same molecular formula and bond sequence but different spatial arrangements. Only one of these stereoisomers has the same spatial arrangement as naturally occurring alpha-tocopherol. The other seven stereoisomers, which make up 87.5% of synthetic dl-alpha-tocopherol, are not found in any food and are not biologically active. In contrast, natural alpha-tocopherol is biologically active and found in food sources. Moreover synthetic dl-alpha-tocopherol requires a higher dose to increase blood serum levels compared to natural alpha-tocopherol, but a lower dose to increase the risk of bleeding and serious bleeding in the brain (known as hemorrhagic stroke).

y-Tocopherol (gamma) is a more potent anti-inflammatory agent than α-tocopherol (alpha). This is because it is more effective at trapping reactive nitrogen species, lowering C-reactive protein concentrations in hemodialysis patients, and inhibiting cyclooxygenase and lipoxygenase, enzymes involved in the formation of pro-inflammatory substances. In addition, γ-tocopherol has a stronger influence on eicosanoid synthesis and increases PPARγ mRNA levels to a greater extent than α-tocopherol. However, supplementing with α-tocopherol alone can actually decrease γ-tocopherol levels, potentially increasing inflammation.

In several of the studies analysed that indicated small but significant increase in all-cause mortality, subjects were given a high dose of synthetic dl-alpha-tocopherol in combination with other supplements, including vitamin C, beta-carotene, zinc, and copper. This regimen included a dose of zinc that was twice the recommended safety limit and used synthetic beta-carotene, which is not structurally the same as naturally occurring beta-carotene and has been shown to have negative effects. When the risk of mortality in relation to vitamin E dose was analysed, it was found that the increased risk of death was only statistically significant at a dose of 2,000 IU/day, which according to Australian Regulatory Guidelines is 4.5 times higher than the recommended daily upper intake level for adults. The highest recommended dose of alpha-tocopherol is 300 mg/day, which is very unlikely to cause haemorrhaging in most adults.

What are the symptoms of vitamin E deficiency?

Vitamin E is an essential nutrient that plays a role in maintaining healthy skin and eyes, as well as supporting the immune system. A deficiency in vitamin E can lead to a variety of health problems. Symptoms of vitamin E deficiency may include:

• Weakness: Vitamin E is necessary for muscle function, so a deficiency can cause muscle weakness and a general feeling of malaise.

• Impaired wound healing: Vitamin E is necessary for the healing process, so a deficiency can cause wounds to heal slowly.

• Dry skin: Vitamin E plays a role in maintaining healthy skin, so a deficiency can cause dry, flaky skin.

• Dry and itchy eyes: Vitamin E is important for eye health, so a deficiency can cause dry and itchy eyes.

• Impaired vision: A deficiency in vitamin E can cause impaired vision know as retinopathy, including difficulty seeing at night.

• Unusual taste sensations: Some people with a deficiency in vitamin E may experience unusual taste sensations.

If you are experiencing symptoms of vitamin E deficiency, it is important to speak with a health professional. They can help diagnose the cause of your symptoms and recommend appropriate treatment.

It is important to note that while vitamin E deficiency is relatively rare in healthy individuals who follow a balanced diet, approximately 92% of men and 96% of women in the United States do not consume enough vitamin E on a daily basis according to nutrition surveys. Moreover, individuals with metabolic syndrome or fat-malabsorption disorders may be at greater risk of deficiency. These disorders, such as Crohn's disease, cystic fibrosis, or impaired bile secretion, can disrupt the absorption of fat and may lead to additional symptoms such as greasy stools or chronic diarrhea. “Research showed that people with metabolic syndrome need about 30-50 percent more vitamin E than those who are generally healthy,” says Maret Traber, Professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute. These findings have been supported by the National Dairy Council, DSM Nutrition and the National Institutes of Health. These individuals may require larger amounts of vitamin E supplementation or may benefit from using water-soluble forms of the nutrient.

What are the potential side effects of taking vitamin E supplements?

Vitamin E supplements are generally well tolerated and have a low risk of side effects when taken in recommended amounts. However, taking excessive amounts of vitamin E can cause side effects, including:

• Nausea: Consuming large amounts of vitamin E can cause digestive symptoms, such as nausea.

• Diarrhea: Vitamin E supplements may cause diarrhea in some people.

• Headache: Some people may experience headaches after taking high doses of vitamin E.

• Blurred vision: Consuming large amounts of vitamin E may cause blurred vision.

• Rash: Taking high doses of vitamin E may cause a rash to develop on the skin.

• Fatigue: Large amounts of vitamin E may cause weakness and fatigue.

• Blood thinning: Vitamin E can thin the blood, so taking high doses of vitamin E may increase the risk of bleeding.

It is important to note that these side effects are typically associated with taking large amounts of vitamin E, well above the recommended daily intake. It is important to speak with a health professional before taking vitamin E supplements to ensure that you are taking the appropriate amount.

Vitamin E supplements are generally safe when taken in recommended amounts. However, as with any supplement, it is important to speak with a health professional before starting to ensure that they are safe and appropriate for you.

Can vitamin E supplements interact with other medications or supplements?

Yes, vitamin E supplements can interact with certain medications and supplements. Some medications and supplements that may interact with vitamin E include:

• Blood thinners: Vitamin E can thin the blood, so taking it with blood thinners, such as warfarin or aspirin, may increase the risk of bleeding.

• Statins: Some research suggests that vitamin E may interfere with the effectiveness of statins, which are medications used to lower cholesterol levels.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Vitamin E may interact with NSAIDs, such as ibuprofen and naproxen, and increase the risk of bleeding.

• Other supplements: Some supplements, such as large doses of vitamin K, may interact with vitamin E. It is important to speak with a healthcare professional about potential interactions between vitamin E and any other supplements you are taking.

It is important to speak with a health professional before taking vitamin E supplements to ensure that they are safe and appropriate for you. They can help you understand any potential interactions with other medications or supplements you are taking.

Is it safe to take vitamin E supplements if I have a particular health condition?

Vitamin E supplements are generally safe and well tolerated when taken in recommended amounts. However, if you have a particular health condition, it is important to speak with a health professional before taking vitamin E supplements to ensure that they are safe and appropriate for you. Some conditions that may be affected by vitamin E supplements include:

• Bleeding disorders: Vitamin E can thin the blood, so taking it may increase the risk of bleeding if you have a bleeding disorder.

• Diabetes: Vitamin E supplements may affect blood sugar levels in people with diabetes. It is important to speak with a healthcare professional about the appropriate amount of vitamin E to take if you have diabetes.

• High blood pressure: Some research suggests that high doses of vitamin E may increase the risk of high blood pressure. It is important to speak with a healthcare professional about the appropriate amount of vitamin E to take if you have high blood pressure.

• Medications: Vitamin E supplements may interact with certain medications, such as blood thinners and statins. It is important to speak with a healthcare professional about potential interactions between vitamin E and any medications you are taking.

It is always important to speak with a health professional before starting any new supplement to ensure that it is safe and appropriate for you. They can help you understand any potential risks or interactions with your specific health condition and any medications or supplements you are taking.

Conclusion

In conclusion, vitamin E is a vital nutrient that plays a crucial role in the maintenance of overall health. It has been shown to have a number of beneficial effects on cardiovascular, cognitive, skin, eye, and immune health. To ensure adequate intake of vitamin E, it is recommended to include a variety of vitamin E-rich foods in the diet, such as nuts, seeds, and olive oil and to consider supplementation under the guidance of a health professional.

It is worth noting that vitamin E supplements may interact with certain medications or supplements, and it may have side effects in some people. If you are currently taking any medications or supplements, or if you have any underlying medical conditions, you should speak to your health professional before taking vitamin E or any other nutritional supplement. Your health professional can help you determine if vitamin E is safe and appropriate for you, based on your individual circumstances and medical history.

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