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Why is it essential?
Vitamin E is used by most of the tissues of the body. It protects vitamins A and C from destruction and aids the formation of red blood cells, muscles, and other tissues. It plays a crucial role in promoting overall health and immunity by protecting cell membranes. And, by protecting fats and fatty cholesterol compounds in the blood (e.g., LDL cholesterol) from oxidation by free radicals, vitamin E plays a major role in preventing arteriosclerosis, or hardening of the arteries.

Benefits and uses:
Two major studies showed that both men and women who supplement with at least 100 IU of vitamin E per day for at least two years have a 37 to 41 percent drop in the risk of heart disease. Even more impressive is the 77 percent drop in non-fatal heart attacks reported in the double-blind CHAOS study, in which people were given 400 to 800 IU vitamin E per day. Vitamin E may also boost immunity, enhance athletic performance, reduce excess exercise-induced muscle damage, and promote virility. (By itself, vitamin E cannot treat impotency.)

Supplements may play a supportive role in the prevention or treatment of diabetes, eczema, fibrocystic breast disease, and conditions related to menopause and premenstrual syndrome. Studies suggest that oral doses of vitamin E can help eliminate exercise cramps and night time leg cramps, perhaps by aiding the release of sugar in muscles. Vitamin E oil applied to the skin nourishes the tissue and benefits a range of skin conditions, such as canker sores, burns, and diaper rashes. Vitamin E applied to a closed wound helps to prevent scars from forming.

Daily requirement:
The U.S. RDA for vitamin E is 30 IU.

Deficiency risk factors:
A diet high in unsaturated fat increases vitamin E requirements. Vitamin E and selenium work together to protect fat-soluble parts of the body. Severe vitamin E deficiencies are rare.

Optimal intake:
Almost all vitamin E research shows that positive results require hundreds of international units per day, an amount easily obtained with supplements but very difficult with food. An optimal supplement level is 400 to 600 IU daily, a safe and nontoxic dosage for long-term consumption. In elderly persons, intake of 200 IU per day produces substantial increases in immunity to infection.

Food sources: The highest levels of vitamin E are found in vegetable oils, including safflower and wheat germ. Among the better food sources are dark green leafy vegetables, egg yolks, whole grains, wheat germ, nuts, seeds, and legumes. Meat and dairy products usually have low amounts.

Recent findings:
A review article that looked at how high of a dose of vitamin E is needed to prevent atherosclerosis concluded that about 400 IU per day is probably sufficient to reduce an individual’s risk of heart disease. Other new studies suggest that vitamin E protects the retina from the damaging effects of free radicals and that vitamin E therapy is a cost-effective strategy for promoting heart health.

Safety: Some people experience may experience dizziness, elevated blood pressure, decreased blood coagulation, or other side effects at daily dosages of 1,200 to 1,600 IU. Vitamin E toxicity is very rare; supplements are widely considered to be safe. A recent well-designed clinical trial determined that four months of supplementation with 60 to 800 IU of vitamin E per day had no adverse effects.

What types of vitamin E products are available?
Vitamin E supplements most commonly are oil-filled capsules, softgels, or gelcaps. There are also dry capsules and tablets, sublingual forms, and liquids in 2- to 12-ounce containers. Potencies range from 100 to 1,500 IU, with 400 IU being the most common. Vitamin E is sometimes formulated with other nutrients such as selenium and aloe. Vitamin E is also a major ingredient in a variety of hand and body lotions and other bodycare products.

Most supplements provide the naturally occurring forms of vitamin E, designated "d-" (as in d-alpha tocopherol). These are somewhat more active and absorbable than the synthetic, "dl-" forms (dl-alpha tocopherol) of the vitamin, which may actually reduce absorption of the natural vitamin E in foods. Natural vitamin E can be found either as alpha-tocopherol (which also describes the structure) or in combination with beta-, gamma-, and delta-tocopherol—a combination labeled "mixed" tocopherols. Synthetic vitamin E is found only in the alpha form.

References:

• Rimm, E.B., et al., "Vitamin E consumption and the risk of coronary heart disease in men," N Engl J Med (1993), 328:1450–56
• Stampfer, M.J., et al., "Vitamin E consumption and the risk of coronary heart disease in women," N Engl J Med (1993), 328:1444–49
• Stephens, N.G., et al., "Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS)," Lancet (1996), 347:781–86
• Suzukawa, M., et al., "Effect of supplementation with vitamin E on LDL oxidizability and prevention of atherosclerosis," Biofactors (1998), 7(1–2):51–54
• Siu, A.W., et al., "The efficacy of vitamin E and melatonin as antioxidants against lipid peroxidation in rat retinal homogenates," J Pineal Res (1998), 24(4):239–44
• Davey, P.J., et al., "Cost-effectiveness of vitamin E therapy in the treatment of patients with angiographically proven coronary narrowing (CHAOS) trial. Cambridge Heart Antioxidant Study," Am J Cardiol (1998), 82(4):414–17
• Meydani, S.N., et al., "Assessment of the safety of supplementation with different amounts of vitamin E in healthy older adults," Am J Clin Nutr (1998), 68(2):311–18

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