Background

Vitamin E is a fat-soluble vitamin with antioxidant properties. Vitamin E exists in eight different forms: alpha-, beta-, gamma-, and delta-tocopherol; and alpha-, beta-, gamma-, and delta-tocotrienol. Alpha-tocopherol is the most active form in humans.

Dosing for vitamin E is often given in alpha-tocopherol equivalents (ATEs). This accounts for the different activities that the different forms of vitamin E have in the body. One milligram of an ATE is equal to 1.5 international units (IU).

Vitamin E supplements are available in natural or man-made forms. The natural forms are usually labeled with the letter "d" (for example, d-gamma-tocopherol), whereas synthetic forms are labeled "dl" (for example, dl-alpha-tocopherol).

Vitamin E has been studied for the prevention or treatment of many health conditions. However, there is a lack of strong evidence to support its use for any disease at this time, aside from vitamin E deficiency.

Concerns have been raised about the safety of vitamin E supplementation, particularly in high doses. An increased risk of bleeding may occur in people taking blood thinners, or those with vitamin K deficiency. Evidence suggests that regular use of high-dose vitamin E supplements may increase the risk of death from all causes by a small amount, although research is unclear. Caution is advised.

Vitamin E has also been studied for scar prevention. However, there is a lack of evidence to support this use. Because of a risk of allergic skin symptoms, some researchers have advised against the use of this therapy.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

Foods that contain vitamin E include eggs, fortified cereals, fruit, green leafy vegetables (such as spinach), meat, nuts, nut oils, poultry, vegetable oils (corn, cottonseed, safflower, soybean, sunflower), argan oil, olive oil, wheat germ oil, and whole grains. Cooking and storage may destroy some of the vitamin E in foods. Most people in the United States obtain vitamin E from the diet, although people with very low-fat diets or intestine disorders may need supplementation. The recommended daily intake for adults over 14 is 15 milligrams (or 22.5 IU); for pregnant women of any age, it is 15 milligrams (or 22.5 IU), and for breastfeeding women of any age, it is 19 milligrams (or 28.5 IU). For adults older than 18 years, pregnant women, and breastfeeding women, the maximum dose is 1,000 milligrams daily (or 1,500 IU).

For age-related macular degeneration, 30 milligrams to 500-600 IU of vitamin E (alpha-tocopherol) has been taken by mouth daily for 4-8 years.

For amyotrophic lateral sclerosis, 1,000 milligrams of vitamin E has been taken by mouth daily, as either one daily dose or in two divided doses, for up to 48 weeks.

For clogged arteries, 45-3,200 IU has been taken by mouth daily for up to five years.

For atopic eczema, 600 IU of all-rac-alpha-tocopherol has been taken by mouth daily for 60 days.

For breast cancer, 4-20 milligrams has been taken by mouth daily.

For cancer, 4-800 milligrams of vitamin E has been taken by mouth daily for up to 10 years.

For heart disease, 33-3,200 IU has been taken by mouth daily or on alternate days for up to 10 years. Doses of all-rac-alpha-tocopherol ranging from 50-2,000 milligrams and doses of RRR-alpha-tocopherol ranging from 272-800 milligrams have been taken by mouth daily for up to 6.6 years.

For heart disease in people undergoing kidney disease treatment, 800 IU has been taken by mouth daily for 519 days.

For cataract prevention, 300-600 IU of vitamin E has been taken by mouth daily for up to six years, with conflicting results. Doses of 50-300 milligrams have been taken by mouth daily or on alternate days for 3.6-9.7 years.

For chemotherapy side effects, 200-600 milligrams to 1,600-3,200 IU of vitamin E has been taken by mouth daily. A dose of 400 milligrams of vitamin E oil or dressing has been applied to the skin. A dose of 200 milligrams of alpha-tocopherol has been injected into the muscle.

For colorectal cancer prevention, 30-600 milligrams of vitamin E has been taken by mouth daily or every other day for 1-12 years.

For dementia/Alzheimer's disease, 800-2,000 IU of Vitamin E has been taken by mouth 1-2 times daily for 2-3 years, with mixed results.

For diabetes, 400-600 IU vitamin E has been taken by mouth once daily for 1.5-8 years.

For leg pain due to clogged arteries, 300-1,600 milligrams of Vitamin E has been taken by mouth daily for up to 18 months.

For liver disease (non-alcoholic fatty liver disease), 30-1,000 IU of vitamin E has been taken by mouth 1-2 times daily for two months to five years.

For lung cancer, 50 milligrams or 400-600 milligrams of alpha-tocopherol has been taken by mouth 1-2 times daily or every other day for 2-8 years.

For reducing risk of death, 16.5-5,500 IU of Vitamin E has been taken by mouth daily or every other day for up to 10 years, without benefit. A dose of 100 milligrams of vitamin E (d-alpha-tocopheryl acetate) or 200 IU vitamin E (dl-alpha-tocopherol) has been taken daily for 1-6 years.

For Parkinson's disease, 2,000-3,200 IU has been taken by mouth daily, without benefit.

For prostate cancer prevention, 50 milligrams or 400 IU of vitamin E has been taken by mouth daily or every other day for a follow-up of 5-8 years.

For stroke prevention, 50-800 milligrams of Vitamin E has been taken by mouth daily for greater than 10 years, without benefit.

For tardive dyskinesia, 400-1,600 IU of Vitamin E has been taken by mouth daily for up to one year.

Treatment of vitamin E deficiency should be under medical supervision. If the cause is due to poor nutrition, taking a dose by mouth that is 2-5 times greater than the RDA may be considered. If the cause is stomach or intestine problems, then injections of vitamin E may be needed.

For scar prevention, vitamin E has been applied to the skin, without benefit.

Children (under 18 years old)

Common formulas used in children are alpha-tocopherol, alpha-tocopherol acetate, and tocofersolan. The recommended intakes are as follows: for healthy breastfeeding infants 0-6 months old, 4 milligrams daily (6 IU); for infants 7-12 months old, 5 milligrams daily (7.5 IU); for children 1-3 years old, 6 milligrams daily (9 IU); for those 4-8 years old, 7 milligrams daily (10.5 IU); for those 9-13 years old, 11 milligrams daily (16.5 IU); for those over 14 or pregnant women of any age, 15 milligrams daily (22.5 IU); and for breastfeeding women of any age, 19 milligrams daily (28.5 IU).

For kidney disease, 400 IU (if weight was less than 30 kilograms) or 800 IU (if weight was more than 30 kilograms) has been taken by mouth for two years.

For liver disease, 17-200 milligrams per kilogram of d-alpha-tocopherol has been taken by mouth daily.

For supplementation in preterm and very low birth weight infants, 10-25 milligrams per kilogram have been injected into the muscle daily starting within 8-24 hours of birth and continued up to 30 days after. These doses have been accompanied by doses of 15-20 milligrams per kilogram injected into the vein, sometimes followed by 15-200 milligrams taken by mouth daily started after at least three days of life.

Treatment of vitamin E deficiency should be under medical supervision. Vitamin E absorption may improve if given with meals and in small doses.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Vitamin E deficiency

Vitamin E deficiency is rare and may occur in people with reduced fat absorption through the gut (due to surgery, Crohn's disease, or cystic fibrosis), malnutrition, very low-fat diets, or genetic disorders. It may also occur in very low-birthweight, premature infants or infants taking unfortified formulas. Vitamin E supplementation is considered an effective therapy for vitamin E deficiency. Diagnosis and management should be under the care of a medical professional.

B

Diabetes

Vitamin E has been proposed for the prevention of type 1 or 2 diabetes, blood sugar control, clotting problems or clogged arteries in diabetes, vitamin E deficiency in diabetic people, and for the prevention of diabetic complications. Vitamin E deficiency has been seen in people with diabetic foot ulcers. Further evidence is needed.

B

Liver disease

A daily dose of 800 IU of vitamin E is recommended by experts for non-diabetic people with non-alcoholic fatty liver disease. There is some evidence that vitamin E may also benefit children with liver disease. More evidence is needed.

Like other antioxidants, vitamin E has been suggested to prevent, slow progression of, or improve macular degeneration. The scientific evidence in this area is unclear, although there is some suggestion that vitamin E alone, or in combination with beta-carotene, may not have benefit. More research is needed.

C

Allergies

Although antioxidants are thought to reduce allergy symptoms, vitamin E intake may not be effective. However, current evidence is limited, and more research is needed.

C

Altitude sickness

Vitamin E may benefit altitude sickness. Antioxidant supplementation (vitamin E with beta-carotene, vitamin C, selenium, and zinc) may improve breathing at high altitudes. However, antioxidants may not reduce inflammation after exercise at high altitudes. More research is needed.

C

Amyotrophic lateral sclerosis (disease of nerve cells in the brain)

Vitamin E has been studied for the prevention and treatment of diseases such as ALS. There is unclear evidence with respect to vitamin E for treatment of ALS. More research is needed.

C

Anemia

Antioxidants have been studied for the prevention and treatment of various types of anemia. Studies of vitamin E supplementation for anemia have found mixed results. More research is needed.

C

Antioxidant

The antioxidant effects of vitamin E are unclear in humans. The American Heart Association recommends the intake of antioxidants such as vitamin E by eating a well-balanced diet high in fruits, vegetables, and whole grains, rather than from supplements, until further evidence is available.

C

Asthma

In children, lower levels of vitamin E have been linked to poorly controlled asthma. Vitamin E intake during pregnancy may reduce rates of asthma in children. However, there is evidence that vitamin E supplementation may not benefit people with asthma. More research is needed.

C

Atopic eczema (disorder causing skin itching)

Vitamin E has been applied to the skin to prevent scars. However, because of a risk of allergic skin reaction, some researchers have advised against the use of this therapy. Further studies are needed.

C

Bladder cancer

There is early evidence that long-term vitamin E supplementation may reduce the risk of death in people with bladder cancer. Further study is needed.

C

Breast cancer

Vitamin E has been suggested as a possible therapy for the prevention or treatment of breast cancer. Evidence remains unclear. More research is needed.

C

Breast cancer-related hot flashes

Vitamin E taken by mouth may help reduce hot flash frequency associated with breast cancer. Further research is required.

C

Cancer prevention (general)

Evidence suggests that vitamin E may lack effect on the development of cancer. Vitamin E has been studied for various types of cancer, including prostate, colon, or stomach cancer. More research is needed.

C

Cancer treatment

There is a lack of evidence that vitamin E is effective as a treatment for any specific type of cancer. Caution is advised in people undergoing treatment with chemotherapy or radiation. High doses of vitamin E may cause harm in people with cancer, and should be discussed with a medical professional.

C

Cataract prevention

There is conflicting evidence on the use of vitamin E to prevent cataracts. Some studies suggest some protective effects, while others have reported a lack of benefit. More research is needed.

C

Chemotherapy side effects

Vitamin E has been suggested as a therapy to prevent complications due to chemotherapy, such as nerve pain. There is some evidence of benefit when it is used with cisplatin. However, caution is needed, because it is not known if the use of high-dose antioxidants during chemotherapy may reduce therapy effectiveness. This should be discussed with a medical professional.

C

Chest pain

Vitamin E has been studied in people with chest pain, although possible benefits remain unclear. Further evidence is necessary before a clear conclusion can be made.

C

Claudication (leg pain from clogged arteries)

Multiple studies have looked at the use of vitamin E in people with leg pain from clogged arteries. It remains unclear if vitamin E is beneficial in this condition.

C

Clogged arteries

Vitamin E may help prevent or treat clogged arteries. Studies have suggested that a high dietary intake of vitamin E may be linked to lower rates of heart disease. More research is needed.

C

Colon cancer prevention

Evidence is lacking to determine if vitamin E prevents colon cancer. A combination of vitamins A, C, and E has been reported to reduce the risk of developing colon cancer, but there are conflicting results. More research is needed.

C

Coordination disorders

Diet changes and vitamin E supplementation have been studied for improvement in developmental coordination disorder in children. However, more research is needed.

C

Cystic fibrosis (mucus build-up in lungs)

Vitamin E supplementation has been studied in people with cystic fibrosis. Further research is needed.

C

Dementia / Alzheimer's disease

Vitamin E has been studied for preventing or slowing dementia (including the Alzheimer's type). There is some evidence that all-rac-alpha-tocopherol (man-made vitamin E) is as effective as selegiline (Eldepryl®) for slowing cognitive function decline in people with moderately severe Alzheimer's disease. Long-term combination therapy with donepezil (Aricept®) may also help slow cognitive decline in people with Alzheimer's disease. Other research suggests that vitamin E from diet or supplements may not affect the risk of developing Alzheimer's disease or dementia. Overall, the evidence remains unclear in his area.

C

Diabetic eye disease

Micronutrients have been studied for improvement in diabetic eye disease, and vitamin E has been proposed to reduce oxidative stress related to diabetic complications. However, evidence of benefit is lacking, and more research is needed.

C

G6PD deficiency

Vitamin E supplementation has been studied for G6PD deficiency, a genetic disorder in which red blood cells break down when the body is exposed to drugs or infection. More research is needed before a clear conclusion can be made.

C

Glomerulosclerosis (kidney disease)

It has been suggested that protein in the urine may be reduced with the use of vitamin E in people with kidney disease. However, further research is needed before a clear conclusion can be made.

C

Healing after photorefractive keratectomy (laser eye surgery)

High-dose vitamin E plus vitamin A taken by mouth may improve eye healing and vision after laser surgery for vision correction. Research suggests that applying vitamin E to the eye may also be helpful. More research is needed.

C

Heart disease

Many vitamins, including vitamin E, have been studied for heart disease, with mixed results. Numerous studies suggest a lack of benefit of vitamin E, and high doses may be harmful. Further research is required.

C

Heart disease (in people with undergoing kidney disease treatment)

People undergoing dialysis (a treatment for kidney disease) may benefit from antioxidant use, which may lower the risk of heart disease. Results are unclear as to whether high-dose, long-term vitamin E use may benefit this population. More research is needed.

C

Hepatitis (hepatitis C)

In people with hepatitis C on antiviral therapy, vitamin E has been proposed to prevent inflammation. More research is needed to examine the effects of vitamin E in chronic hepatitis.

C

High blood pressure associated with pregnancy

Vitamin E has been studied for the prevention of high blood pressure in pregnant women. However, most studies have been in combination with vitamin C or other micronutrients. Evidence on vitamin E alone is lacking, and further research is needed.

C

High cholesterol

The effects of vitamin E on cholesterol levels and clogged arteries have been studied. It remains unclear whether it may have benefits, and it is not known what the effects of vitamin E are compared to (or in combination with) other cholesterol-lowering agents. Further research is needed before a clear conclusion can be made.

C

H. pylori infection

Vitamin E combined with vitamin C has been studied for H. pylori infection. Further study is needed to determine the effects of vitamin E alone.

C

Immune system function

Studies of the effects of vitamin E supplementation on immune system function have found mixed results. More research is needed.

C

Kidney disease

Vitamin E has been studied in various types and stages of kidney disease with mixed results. Further study is warranted.

C

Kidney disease (IgA nephropathy)

Vitamin E has been studied for IgA nephropathy, a type of kidney disease in which an antibody causes inflammation that may lead to kidney dysfunction. Limited study has looked at the effects of vitamin E supplementation in long-term kidney disease with mixed results. Further study is needed.

C

Kwashiorkor

Kwashiorkor is a poor nutrition disorder caused by a lack of protein in the diet. Treatment involves increasing calorie and protein intake as well as supplementation with vitamins and minerals. It is not clear if vitamin E supplementation is effective in the prevention of kwashiorkor. Further research is needed.

C

Lung cancer

Studies have looked at the effects of vitamin E for preventing various types of cancer, including prostate, colon, or stomach cancer. Results have been mixed for lung cancer. More research is needed.

C

Menstrual cramps

There is early evidence of possible benefits of vitamin E supplementation to reduce menstrual pain, although more research is needed in this area before a firm conclusion can be reached.

C

Mortality reduction

Evidence suggests that regular use of high-dose vitamin E supplements may increase the risk of death from all causes by a small amount. However, some research found a lack of effect on risk of death. Overall, the results have not shown a strong link between vitamin E intake and decreased risk of death. Further research is needed in this area.

C

Mouth sores

Mouth sores are a common side effect of chemotherapy. The effect of vitamin E on this condition is unclear. Further research is needed.

C

Osteoarthritis

Oxidative stress is thought to play a role in osteoarthritis. Vitamin E has shown mixed results in reducing symptoms or preventing cartilage loss in osteoarthritis. More research is needed.

C

Parkinson's disease

Vitamin E has been studied for the prevention or treatment of Parkinson's disease, with mixed results. Further research is needed.

C

Premenstrual syndrome (PMS)

Vitamin E has been studied for the improvement of PMS symptoms, with mixed results. Further research is needed.

C

Prostate cancer prevention

The role of vitamin E supplementation for the prevention of prostate cancer is controversial. There are numerous laboratory studies that support possible anticancer properties. However, the results of population research and human research have been mixed.

C

Respiratory infection prevention

Supplementation with vitamin E has shown mixed effects on the length and severity of pneumonia in elderly nursing home residents. There may be a protective effect against colds. More research is needed.

C

Rheumatoid arthritis

Vitamin E, taken by mouth, does not appear to reduce the risk of developing rheumatoid arthritis in women. More research is needed.

C

Seizure disorder

Vitamin E has been studied as an addition to other drugs used to prevent seizures. This evidence is unclear and further study is needed. The management of seizure disorder should be under medical supervision.

C

Stomach cancer (prevention)

Vitamin supplementation has been studied for stomach cancer. However, there is some evidence suggesting that vitamin E lacks effect. More research is needed to examine whether vitamin E has any effects on stomach cancer.

C

Supplementation in preterm and very low birthweight infants

Premature infants are at risk of vitamin E deficiency, particularly when they are born with very low birth weight. Numerous studies have looked at the use of vitamin E to help prevent serious complications. However, evidence is unclear. Premature infants should be under strict medical supervision. Decisions should be made with the infant's physician.

C

Tardive dyskinesia (disorder causing uncontrolled movements)

Vitamin E has been studied in the management of tardive dyskinesia. Vitamin E may be more effective in higher doses and in people who have had tardive dyskinesia for less than five years. Further research is required.

C

Uveitis (eye inflammation)

Antioxidants have been studied for uveitis. Four-month supplementation with vitamin E taken by mouth was found to lack benefit in one study. More research is needed before a clear conclusion can be made.

C

Vein clots

Data suggest that supplementation with vitamin E may reduce the risk of vein clots in women. Those with a history or higher risk may benefit the most. Further research is needed.

D

Peyronie's disease (connective tissue disorder)

Vitamin E has been studied for Peyronie's disease, with evidence of lack of benefit. Until further evidence is available, vitamin E may not be advisable in this condition.

D

Retinal protection

Vitamin E taken by mouth does not appear to slow vision loss in people with damage to the retina of the eye. Until further evidence is available, vitamin E may not be advisable in this condition. Therapy decisions should be under medical supervision.

D

Scar prevention

Vitamin E applied to the skin does not appear to reduce surgical wound scarring. Because of a risk of allergic skin reaction, some researchers have advised against the use of this therapy.

D

Stroke prevention

Recent evidence suggests that daily vitamin E supplementation does not reduce the risk of stroke. At this time, based on the best available evidence and recent safety concerns, vitamin E is not advised for this use.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Interactions

Interactions with Drugs

Vitamin E may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Vitamin E may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Interactions with Herbs and Dietary Supplements

Vitamin E may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Vitamin E may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may be altered in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with known allergy or sensitivity to products that contain vitamin E. Skin reactions, including inflammation or itching, have been reported with vitamin E applied to the skin.

Side Effects and Warnings

Vitamin E is likely safe when used in healthy adults at doses commonly found in food, and in healthy people over 65 at doses up to 800 IU taken by mouth daily for up to four months.

Vitamin E is possibly safe in people with diabetes or those using agents that lower blood sugar.

Selected references

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am.J.Gastroenterol. 2012;107(6):811-826.

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