Amount of Evidence: Very High Potential Benefits: Low Safety: Reasonable
TABLE OF CONTENTS
What is vitamin E?
Vitamin E is a fat-soluble vitamin with antioxidant properties. It consists of 8 compounds, 4 tocopherols and 4 tocotrienols. While vitamin E supplements are most useful for fixing a deficiency, they may be of benefit even if you are not deficient in the nutrient. However, the supplements also have some potential for harm. In this article, we will look at vitamin E’s main benefits, potential side effects, and how to use it the right way.
Potential benefits
It is important to note that all of the potential benefits mentioned below are dose-dependent. In general, the higher the dose you take, the more pronounced the effects will be. However, they do reach a plateau at a certain point. We will discuss the best dosing protocol later in this article.
Major benefits
Correcting a vitamin E deficiency – A deficiency in vitamin E can have a terrible impact on health and overall quality of life. The main symptom of vitamin E deficiency is neurological problems. This is because the brain is very oily and uses a lot of energy, which generates oxidants in the process. The neurological problems involve loss of coordination, difficulty walking, visual problems resulting from damage to the retina, and pain, weakness, numbness, or tingling in the hands and feet. Vitamin E deficiency can also result in hemolytic anemia, a form of anemia where red blood cells get destroyed because their membranes fall apart. Fortunately, a severe deficiency is not as common as a deficiency of many other nutrients. A moderate deficiency is way more common and can lead to vulnerability to thyroid disorders and infections, damage or poor healing in the gut, skin, and lungs, increasing the risk of most chronic, degenerative diseases, such as heart disease and cancer, and more. If you experience some of these signs of deficiency or you know your vitamin E levels are too low, fixing a deficiency is the main benefit of the supplement.
Minor benefits
Reduced cardiovascular disease mortality – A mild decrease in cardiovascular disease mortality has been observed in people who take 600 IU of alpha-tocopherol every other day. It is important to note that there does not seem to be any reduction in the development of the disease states or incidences. In other words, the supplement does not decrease your risk for cardiovascular disease but it can decrease the mortality associated with it.
Reduced symptoms of Alzheimer’s – 2,000 IU of alpha-tocopherol a day appears to reduce the rate of cognitive decline in persons with moderate to severe Alzheimer’s Disease with a potency comparable to selegiline. The supplement does not work for reducing cognitive decline not associated with Alzheimer’s.
Reduced liver damage – This effect has been observed in people with inflammatory liver damage.
Lowered arterial stiffness – While the evidence is mixed, the supplement does seem to improve arterial stiffness to a minor degree. This effect may be responsible for the decrease in cardiovascular disease mortality.
Hair regrowth – Mixed tocopherols can improve hair regrowth in people with alopecia at doses of 100 mg.
Reduced oxidative damage in the body – Vitamin E prevents oxidative damage to cellular membranes and other cellular components. Put simply, when an oxidant damages a fatty acid, the fatty acid itself becomes an oxidant and can damage other fatty acids. Vitamin E can stop this chain reaction of oxidation. This is why the vitamin is known as a “chain-breaking antioxidant.” It is important to note that supplementing with vitamin E requires doses of over 500 mg or more of alpha-tocopherol to achieve a mild reduction in oxidation and this effect may not apply to healthy people with low levels of oxidation even at doses this high.
Improved immunity – The supplement increases T-cell mediated immunity in older people. This effect does not apply to young individuals.
Reduced oxidation of PUFAs – Polyunsaturated fatty acids (omega 3 and 6) are more vulnerable to oxidation than monounsaturated or saturated fatty acids. Vitamin E’s main (and perhaps only) well-established function in the body is to stop PUFAs from oxidizing inside and outside of the body. This means that the more PUFAs you consume, the more vitamin E you need.
Reduced risk for prostate cancer – While a reduced risk was noted in smokers taking a low dose (50 mg of alpha-tocopherol), an increased risk was noted in healthy older people who took 400 IU daily. So low doses may reduce the risk for prostate cancer but only if you have a high level of oxidation in your body. High doses would likely do more harm than good when it comes to prostate cancer and other types of cancer.
Reduced risk of thromboembolism – Those who take 600 IU every other day have a 27% risk of thromboembolism. For those who already went through such an event in the past, the reduction is as high as 44%.
Reduced liver fat – This benefit only applies to those with steatohepatitis, at least it has never been noted in healthy individuals.
Reduced muscle damage – This effect has been shown in athletes who experienced a reduction in lipid peroxidation from vitamin E supplementation.
Reduced oxidation of LDL – It is important to note that this effect only applies to high doses of vitamin E.
Reduced respiratory tract infections – This effect has only been observed when it comes to upper respiratory tract infections, not lower respiratory tract infections. Also, it only applies to the elderly and is relatively minor.
Dysmenorrhea – 400-500 IU taken daily can lead to an improvement.
Unproven benefits
The effect of vitamin E on these parameters is either not sufficiently researched or the science shows little to no efficacy in these areas.
All-cause mortality – Doses over 400IU of alpha-tocopherol have been shown to slightly increase mortality in unhealthy individuals. Doses below this amount appear to slightly decrease all-cause mortality in those people. We don’t yet know how vitamin E supplements affect the lifespan of healthy individuals.
Blood flow – Vitamin E supplements have been shown to both increase and reduce blood flow, depending on whether the vitamin is acting as a prooxidant or an antioxidant.
Blood pressure – The same said about blood flow also applies to blood pressure.
Insulin sensitivity – Vitamin E supplementation doesn’t directly influence insulin sensitivity and blood glucose levels. No effect has ever been noted in healthy individuals or people with type I or type II diabetes.
Breast cancer risk – The supplement does not appear to increase nor decrease the risk for breast cancer.
Colon cancer risk – Vitamin E supplements do not affect colon cancer rates.
CRP (C-reactive protein) – No influence on CRP has ever been noted.
DNA protection – Vitamin E has never been shown by human studies to protect DNA from oxidation. If anything, high doses may actually damage the DNA.
Triglycerides – No significant influence has ever been noted.
Cholesterol – The vitamin does not directly influence HDL or LDL cholesterol levels.
Cognitive decline – The only two instances where the vitamin can help slow down cognitive decline is if you are deficient or if you suffer from Alzheimer’s disease.
VO2 max – The supplement does not directly improve your VO2 max. It has been shown to have no reasonable effect on aerobic exercise.
Risk of stroke – Relative to placebo, vitamin E has never been shown to reduce the risk of stroke.
Serum T3 and T4 – There is no significant interaction between vitamin E and serum T3 and T4.
Well-being – Vitamin E supplements do not reduce rates of depression. It also doesn’t appear to increase subjective well-being in any way.
Weight – The supplement does not lead to weight loss or weight gain.
Strength – Vitamin E supplements do not help you gain strength or muscle mass faster.
Asthma – The supplement has never been shown to help with asthma. At least one study shows there is no benefit of vitamin E supplements as far as asthma goes.
Cancer mortality – The only type of cancer that can be reduced by the supplement is prostate cancer and the effect has only been noted in smokers.
Power output – Vitamin E does not influence power output during cardio or resistance training. It does not impact endurance either.
Kidney function – Biomarkers of kidney function are not significantly altered with supplementation of vitamin E relative to placebo.
Sleep quality – The supplement does not appear to increase sleep quality. It also does not affect sleep duration.
Stress and anxiety – Only one study found a reduction in PMS-associated depression and anxiety with 100 mg of vitamin E daily. This effect does not seem to apply to other groups of people. Vitamin E supplements do not directly impact cortisol levels.
Metabolic rate – The supplement does not speed up your metabolism, nor does it slow it down.
Possible side effects
These side effects are dose-dependent and the risk for them increases (most often linearly but sometimes exponentially) as you increase the dose. Some of the side effects are only relevant to very high doses.
Lowered life expectancy – Vitamin E supplements at high doses (400+ IU) have been associated with an increase in all-cause mortality. While this effect has only been noted so far in people with impaired health, it likely applies to healthy people as well.
Increased risk for prostate cancer – While a reduced risk was noted in smokers taking a low dose (50 mg of alpha-tocopherol), an increased risk was noted in healthy older people who took 400 IU daily. So low doses may reduce the risk for prostate cancer but only if you have a high level of oxidation in your body. High doses would likely do more harm than good when it comes to prostate cancer and other types of cancer.
Increased risk of heart failure – While the supplements do not significantly increase overall cardiovascular mortality and may actually lower it in some cases, 400 IU a day has been shown to increase the risk of heart failure in older people with preexisting medical conditions. The study showing this effect lasted for 7 years and in that time, 443 participants who took the placebo experienced heart failure while 519 who took vitamin E did.
Reddening of the skin – This potential side effect only applies to topical alpha-tocopherol.
Prooxidant qualities – Even though vitamin E is an anti-oxidant, it can act as a prooxidant, especially when taken at high doses.
Imbalance in fat-soluble vitamins – Vitamins A, D, E, and K get broken down in the body by the same mechanism. Since they share the same breakdown pathways, consuming lots of one vitamin may increase the breakdown of the others. So if you take too much vitamin E, your body may turn on this pathway and break down more of the other vitamins as well. Put simply, megadosing one of those fat-soluble vitamins is not the best idea unless you also increase your intake of the other ones. Also, taking one isolated part of vitamin E (such as alpha-tocopherol) may deplete you of the other tocopherols and tocotrienols. This is why mixed tocopherol or mixed tocotrienol supplements are probably safer than isolated alpha-tocopherol or other parts of vitamin E.
Who should not take vitamin E?
You should probably avoid taking the vitamin if you:
already get a lot of vitamin E from food
only eat a low amount of PUFAs (polyunsaturated fatty acids – omega 3 and 6)
are healthy and have low levels of oxidation in the body
are deficient in vitamin K
take warfarin (the supplement can lead to an adverse interaction with warfarin)
are at risk of pulmonary embolism or thrombophlebitis
have impaired coagulation
Who will benefit the most?
You should consider taking the vitamin if you:
experience symptoms of vitamin E deficiency
consume high amounts of PUFAs (either from foods or from omega 3/6 supplements)
suffer from Alzheimer’s disease (vitamin E can slow down the cognitive decline related to Alzheimer’s, especially in later stages of the disease)
Forms of vitamin E
There are 8 components (vitaminers) of vitamin E:
α-tocopherol (alpha-tocopherol) – This is the form occurring in most supplements. While it appears to be the most biologically active form, all the other tocopherols and tocotrienols are biologically active as well. Alpha-tocopherol can either be synthetic (all-rac) or natural (D-alpha-tocopherol). The synthetic form is more problematic and should be avoided. D-alpha-tocopherol appears to be much safer but mixed tocopherol or mixed tocotrienol supplements still appear to be superior
β-tocopherol (beta-tocopherol)
γ-tocopherol (gamma-tocopherol) – This is the 2nd most common tocopherol found in supplements and also the 2nd most researched. This is because it can be found in high amounts in vegetable oils, which are the main source of vitamin E in many western countries.
δ-tocopherol (delta-tocopherol)
α-tocotrienol (alpha-tocotrienol)
β-tocotrienol (beta-tocotrienol)
γ-tocotrienol (gamma-tocotrienol)
δ-tocotrienol (delta-tocotrienol)
It is important to note that vitamin E found in food is up to 2 times more bioavailable than any of the synthetic forms. Natural food sources also contain a full spectrum of tocopherols and tocotrienols.
There is a case to be made that tocotrienols may be safer and more effective at helping stop the spread of cancerous cells. That is because they are more bioactive and you need a lower dose to get the same effect.
Tocotrienols also accumulate in tissues and tumors rather than in the blood, which is another indication they may be superior to tocopherols.
However, this is just a hypothesis and whether or not tocotrienols are superior to tocopherols is still unknown.
Since getting too much of one form may flush out the other forms, it is safe to say that either mixed tocotrienols or mixed tocopherols is the best supplement form to take.
Signs of vitamin E deficiency
The most common symptoms of deficiency include:
loss of coordination
difficulty walking
vision problems resulting from damage to the retina
pain, weakness, numbness, or tingling in the hands and feet
hemolytic anemia
loss of body movement control
muscle weakness
Keep in mind that these signs are just indications of deficiency. The fact that you experience some of them does not necessarily mean that you need more vitamin E. On the other hand, some people may have a deficiency even though they are completely asymptomatic.
With that said, if you experience many or most of these symptoms, there is a high chance you are not getting enough of the vitamin. The more of these symptoms you experience and the more severe they are, the more likely you are deficient.
How much vitamin E should you take?
While the recommended daily intake is 15 mg (22.4 IU) for both men and women, the RDA has been set in the year 2000 and is based on a single study that is not very reliable. Even those who created the RDA later admitted that it is unreliable.
We most likely need much less vitamin E than 15 mg a day. However, our need for the vitamin goes up as we increase our intake of PUFAs (polyunsaturated fatty acids). So how much vitamin E you should consume depends primarily on how much PUFAs you are consuming.
How much vitamin E you should consume per mg of omega 3 or 6 is not yet clear. However, there are a few guidelines that will help you get a good ratio of these:
1) Avoid vegetable oils – Even though these oils are the main source of vitamin E for most people living in the west, they are also the main source of PUFAs in the west. Oils like extra virgin olive oil are much safer in this regard and much better for health in general. 2) Avoid grain-fed and factory-farmed meat and animal products – These foods typically have terrible ratios of vitamin E to PUFAs, as well as omega 3:6 ratios. 3) Limit fatty fish intake to twice a week – Fish have a high PUFA content and low vitamin E content. This is because they usually live in cold water and have low body temperatures so the fatty acids are not too prone to oxidation. What is good about omega 3 supplements, such as algae and fish oil, is that they almost always contain vitamin E. However, the dose they put into the supplements may not be enough to protect the omega 3 fatty acids from oxidation. 4) Eat at least some amount of vegetables rich in vitamin E – The richest vegetables in vitamin E are kale, spinach, and many other leafy green vegetables.
As long as you stick to these, you probably do not need to take vitamin E. If you are not following one or more of these rules, taking a low dose may be of help. Specifically, 15 mg (or around 22.4 IU) of alpha-tocopherol from mixed tocopherols or mixed tocotrienols seems to be the best dose to take.
Unless you are trying to fix a severe vitamin E deficiency, taking more than that is probably not a good idea and may cause more harm than good.
Food sources of vitamin E
Again, it is not about how much vitamin E you are consuming, it is about the vitamin E to PUFA ratio.
Rather than consuming foods that are the highest in vitamin E, look for foods that have a good vitamin E to PUFA ratio. The more vitamin E per mg of omega 3 and omega 6, the better.
The ratios can vary from food to food. To simplify this section and make it practical, there are a few guidelines that will help optimize the ratio.
So again, the guidelines that will help you get a good ratio of vitamin E to PUFAs are:
1) Avoid vegetable oils – Even though these oils are the main source of vitamin E for most people living in the west, they are also the main source of PUFAs in the west. Oils like extra virgin olive oil are much safer in this regard and much better for health in general. 2) Avoid grain-fed and factory-farmed meat and animal products – These foods typically have terrible ratios of vitamin E to PUFAs, as well as omega 3:6 ratios. 3) Limit fatty fish intake to twice a week – Fish have a high PUFA content and low vitamin E content. This is because they usually live in cold water and have low body temperatures so the fatty acids are not too prone to oxidation. What is good about omega 3 supplements, such as algae and fish oil, is that they almost always contain vitamin E. However, the dose they put into the supplements may not be enough to protect the omega 3 fatty acids from oxidation. 4) Eat at least some amount of vegetables rich in vitamin E – The richest vegetables in vitamin E are kale, spinach, and many other leafy green vegetables.
The easiest way to find out how much vitamin E and PUFAs (omega 3 and 6) you are getting in your diet is with Cronometer.com – the app is free and allows you to track all vitamins, minerals, and more.
Best time to take vitamin E
Since this vitamin is fat-soluble, you need to take it with a source of fat if you wish to maximize the absorption.
More fat will lead to better absorption than less fat in the case of vitamin E so you want to take the vitamin with the meal highest in fat.
Whether you take the supplement in the morning or the evening doesn’t really matter.
You also do not have to take the vitamin every day. There is not a big difference (if any) between taking 20 mg every day and taking 70 mg twice a week.
Interactions with other supplements
Vitamin D Vitamins A, D, E, and K get broken down in the body by the same mechanism. Since they share the same breakdown pathways, consuming lots of one of these fat-soluble vitamins may increase the breakdown of the others. So if you take too much vitamin E, your body may turn on this pathway and break down more of the other vitamins as well. Put simply, megadosing one of those fat-soluble vitamins is not the best idea unless you also increase your intake of the other ones.
Vitamin A The same said about vitamin D also applies to vitamin A.
Vitamin K The same said about vitamin D and A also applies to vitamin K.
Omega 3 Vitamin E protects omega 3 fatty acids (ALA, EPA, and DHA) from oxidizing, both inside and outside the body. It is important to note that if omega 3 fatty acids have already oxidized, vitamin E cannot fix them back to normal. Taking vitamin E with rancid fish oil will not make it beneficial or non-harmful. With that said, the more omega 3 fatty acids you take, the more vitamin E you will need.
Omega 6 Everything said about the interaction between vitamin E and omega 3 also applies to omega 6 fatty acids.
Grape seed extract Vitamin E appears to be synergistic with procyanidins from grape seed extract in exerting antioxidant effects on cell membranes.
Selenium The nutrients can act together to alleviate oxidative stress in certain tissues.
CoQ10 One study has found that very high doses of alpha-tocopherol (1,200 mg) can reverse the exercise-induced reduction in serum CoQ10 by protecting it from oxidation (from a 39% reduction to an 8.5% increase.
ALA Alpha-lipoic acid can recycle vitamin E. The supplements may also be synergistic for preventing blood clots.
Sesamin Sesamin, a lignan compound found in sesame seeds, appears to inhibit the breakdown of vitamin E, keeping your levels higher for longer. However, the effect appears to be rather small.
Warfarin Taking the vitamin and warfarin together can lead to adverse reactions.
Where to buy vitamin E
Amazon seems to be the best option for ordering vitamin E supplements in most countries. They offer some very affordable products that are backed by many positive reviews. Also, you can choose from a wide range of brands there without having to spend time searching through other markets on the internet.
One thing you should pay attention to is that some brands display the dosage per serving and not per pill or capsule. Therefore, you may accidentally buy something that is less potent than you intended. Do not fall for this marketing trick.
FAQ
The supplement can be taken daily and does not need to be cycled.
Yes. The vitamin doesn’t impact your sleep in any negative way.
Vitamin E supplements rarely go bad but they can lose potency over time.
Keep your vitamin E supplements in a cold, dark, and dry place and they will remain just as potent for many years.
It doesn’t directly reduce acne, unfortunately.
Definitely. While vitamin E toxicity is rare, too much vitamin E in the system can cause multiple problems. For example, it can cause an imbalance in fat-soluble vitamin ratios.
Vitamins A, D, E and K get broken down in the body by the same mechanism. Since they share the same breakdown pathways, consuming lots of one vitamin may increase the breakdown of the others. So if you take too much vitamin E, for example, your body may turn on this pathway and break down more of the other vitamins as well. Put simply, megadosing one of those fat-soluble vitamins is not the best idea unless you also increase your intake of the other ones.
So as a general rule, you want to stay below 30 mg or around 40 IU of vitamin E.
Certainly not synthetic alpha-tocopherol, which is, unfortunately, the most popular form in vitamin E supplements.
D-alpha-tocopherol (the natural form) appears to be much safer than synthetic. However, this form still is not the best since it may deplete you of other tocopherols and tocotrienols.
So either mixed tocopherols or mixed tocotrienols are a way to go. Which form is superior is still a question.
There is a case to be made that tocotrienols may be safer and more effective at helping stop the spread of cancerous cells. That is because they are more bioactive and you need a lower dose to get the same effect.
Tocotrienols also accumulate in tissues and tumors rather than in the blood, which is another indication they may be superior to tocopherols.
However, this is just a hypothesis and whether or not tocotrienols are superior to tocopherols is still unknown.
The most common reason people become deficient is that they consume too many polyunsaturated fatty acids (PUFAs) and too little vitamin E. Therefore, foods that people commonly eat that are the most likely to cause a deficiency are vegetable oils, fatty fish, grain-fed meat and animal products, and certain types of nuts and seeds in high quantities. Any intestinal disorders that hurt the digestion and absorption of fat can also cause vitamin E deficiency.
You probably need more of the vitamin if you: – experience signs of deficiency – eat vegetable oils – eat grain-fed meat and animal products – eat fatty fish more than twice a week – megadose with other fat-soluble vitamins: A, D, and K
Yes, most vitamin E supplements on the market are vegan-friendly.
Since these vitamins are fat-soluble, you need to consume dietary fat with them to absorb them properly. Taking these vitamins or consuming them from low-fat food sources without adding extra dietary fat can make some of them up to 10 times less bioavailable. Fortunately, as little as 20 grams of fat should be enough to absorb these vitamins well.
References
Most of the information provided in this guide is based on scientific research that can be found and verified in the PubMed medical library. We excluded from consideration studies that are either confounded or have a high conflict of interest.
Anecdotal evidence (from reports on Reddit, YouTube, and other sources) is also taken into account unless it contradicts scientific research.
