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Vitamin E

Uses

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Anemia
60 to 75 IU per day
Supplementing with vitamin E may improve anemia in cases of vitamin E deficiency.

Hemolytic anemia refers to a category of anemia in which red blood cells become fragile and undergo premature death. Vitamin E deficiency, though quite rare, can cause hemolytic anemia because vitamin E protects the red blood cell membrane from oxidative damage. Vitamin E deficiency anemia usually affects only premature infants and children with cystic fibrosis.1 , 2 Preliminary studies have reported that large amounts (typically 800 IU per day) of vitamin E improve hemolytic anemia caused by a genetic deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD)3 , 4 , 5 and anemia caused by kidney dialysis.6 , 7

3 Stars
Anemia (Vitamin E Oral)
800 IU daily
Studies have reported that large amounts of vitamin E improve hemolytic anemia caused by a genetic deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD).

Hemolytic anemia refers to a category of anemia in which red blood cells become fragile and undergo premature death. Vitamin E deficiency, though quite rare, can cause hemolytic anemia because vitamin E protects the red blood cell membrane from oxidative damage. Vitamin E deficiency anemia usually affects only premature infants and children with cystic fibrosis.8 , 9 Preliminary studies have reported that large amounts (typically 800 IU per day) of vitamin E improve hemolytic anemia caused by a genetic deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD)10 , 11 , 12 and anemia caused by kidney dialysis.13 , 14

3 Stars
Epilepsy in Children
400 IU daily
Supplementing with vitamin E can help improve treatment results in children.

Vitamin E has been studied as a possible add-on to conventional drug treatment for epilepsy. A double-blind trial found that adding 400 IU per day of vitamin E reduced seizure frequency in children without side effects.17 Other preliminary trials18 , 19 have reported similar results, and, while some preliminary research suggested this effect might also be achieved in adults,20 a double-blind trial found no effect of vitamin E supplementation on adults with epilepsy.21

3 Stars
Immune Function
200 IU daily
Vitamin E enhances some measures of immune-cell activity in the elderly.

Most,22 , 23 but not all,24 double-blind studies have shown that elderly people have better immune function and reduced infection rates when taking a multiple vitamin-mineral formula. In one double-blind trial, supplements of 100 mcg per day of selenium and 20 mg per day of zinc, with or without additional vitamin C, vitamin E, and beta-carotene, reduced infections in elderly people, though vitamins without minerals had no effect.25 Burn victims have also experienced fewer infections after receiving trace mineral supplements in double-blind research.26 These studies suggest that trace minerals may be the most important micronutrients for enhancing immunity and preventing infections in the elderly.

3 Stars
Intermittent Claudication
400 to 600 IU daily
Taking vitamin E may improve blood flow and increase walking capacity.

Vitamin E supplementation has been shown in controlled trials to increase both walking distance and blood flow through arteries of the lower legs in people with intermittent claudication.27 , 28 Increasing dietary intake of vitamin E was also associated with better blood flow to the legs.29 Some early studies did not find vitamin E useful. Possibly this failure was due to the short duration of the studies,30 as one review article suggested that a minimum of four to six months of vitamin E supplementation may be necessary before significant improvement is seen.31 Most clinical trials of vitamin E and intermittent claudication used 400 to 600 IU per day, although one study used 2,400 IU per day.

3 Stars
Rheumatoid Arthritis
1,200 to 1,800 IU daily
Vitamin E is an important antioxidant, protecting joints against oxidative damage. Supplementing with vitamin E can help ease symptoms, including pain.

People with RA have been reported to have an impaired antioxidant system, making them more susceptible to free radical damage.32 Vitamin E is an important antioxidant, protecting many tissues, including joints, against oxidative damage. Low vitamin E levels in the joint fluid of people with RA have been reported.33 In a double-blind trial, approximately 1,800 IU per day of vitamin E was found to reduce pain from RA.34 Two other double-blind trials (using similar high levels of vitamin E) reported that vitamin E had approximately the same effectiveness in reducing symptoms of RA as anti-inflammatory drugs.35 , 36 In other double-blind trials, 600 IU of vitamin E taken twice daily was significantly more effective than placebo in reducing RA, although laboratory measures of inflammation remained unchanged.37 , 38

3 Stars
Sunburn (Vitamin C)
2,000 to 3,000 mg vitamin C and 1,000 to 2,000 IU vitamin E
Antioxidants may protect the skin from sunburn due to free radical–producing ultraviolet rays. Combinations of vitamin E and C offer protection against ultraviolet rays.

Antioxidants may protect the skin from sunburn due to free radical–producing ultraviolet rays.39 Combinations of 1,000 to 2,000 IU per day of vitamin E and 2,000 to 3,000 mg per day of vitamin C, but neither given alone, have a significant protective effect against ultraviolet rays, according to double-blind studies.40 , 41 , 42

Oral synthetic beta-carotene alone was not found to provide effective protection when given in amounts of 15 mg per day or for only a few weeks’ time in larger amounts of 60 to 90 mg per day, but it has been effective either in very large (180 mg per day) amounts or in smaller amounts (30 mg per day) in combination with topical sunscreen.43 , 44 , 45 , 46 , 47

Natural sources of beta-carotene or other carotenoids have been more consistently shown to protect against sunburn. One controlled study found that taking a supplement of natural carotenoids (almost all of which was beta-carotene) in daily amounts of 30 mg, 60 mg, and 90 mg gave progressively more protection against ultraviolet rays.48 In another controlled study, either 24 mg per day of natural beta-carotene or 24 mg per day of a carotenoid combination of equal amounts beta-carotene, lutein, and lycopene helped protect skin from ultraviolet rays.49 A preliminary study compared synthetic lycopene (10.1 mg per day), a natural tomato extract containing 9.8 mg of lycopene per day plus additional amounts of other carotenoids, and a solubilized tomato drink (designed to increase lycopene absorption) containing 8.2 mg of lycopene plus additional amounts of other carotenoids. After 12 weeks, only the two tomato-based products were shown to give significant protection against burning by ultraviolet light.50

Still other trials have tested combinations of several antioxidants. One preliminary study found that a daily combination of beta-carotene (6 mg), lycopene (6 mg), vitamin E (15 IU), and selenium for seven weeks protected against ultraviolet light.51 However, a double-blind trial of a combination of smaller amounts of several carotenoids, vitamins C and E, selenium, and proanthocyanidins did not find significant UV protection compared with placebo.52 Similarly, in a controlled trial, a combination of selenium, copper, and vitamins was found to be ineffective.53

It should be noted that while oral protection from sunburn has been demonstrated with several types of antioxidants, the degree of protection (typically less than an SPF of 2) is much less than that provided by currently available topical sunscreens. On the other hand, these modest effects will provide some added protection to skin areas where sunscreen is also used and will give a small amount of protection to sun-exposed areas where sunscreen is not applied. However, oral protection from sunburn is not instantaneous; maximum effects are not reached until these antioxidants have been used for about eight to ten weeks.54 , 55

3 Stars
Tardive Dyskinesia
1,600 IU daily
Vitamin E has been shown to reduce the severity of tardive dyskinesia.

Vitamin E has been found in a number of studies to reduce the severity of TD. In a double-blind trial, people with TD were randomly assigned to receive vitamin E (800 IU per day for two weeks and 1,600 IU per day thereafter) or a placebo. Vitamin E was significantly more effective than placebo in reducing involuntary movements.56 An uncontrolled study of 20 people with TD reported that 1,600 IU of vitamin E per day may be the optimal amount;57 this large amount should be supervised by a healthcare practitioner. Other studies have also found that vitamin E supplements reduce the severity of TD.58 , 59 , 60 Two studies failed to show a beneficial effect of vitamin E.61 , 62 However, the people in those studies had been receiving neuroleptics for at least ten years, and research has shown that vitamin E is most effective when started within the first five years of neuroleptic treatment.63 , 64

2 Stars
Alzheimer’s Disease
2,000 IU daily
Antioxidant supplements such as vitamin E have been associated with lower risk of Alzheimer’s disease and improved brain function in middle-aged and older adults.

In a preliminary study, people who used antioxidant supplements (vitamin C or vitamin E) had a lower risk of Alzheimer’s disease compared with people who did not take antioxidants.65 Other preliminary research shows that higher blood levels of vitamin E correlate with better brain functioning in middle-aged and older adults.66 The possible protective effect of antioxidants may be explained by the observation that oxidative damage appears to play a role in the development of dementia.67 Large amounts of supplemental vitamin E may slow the progression of Alzheimer’s disease. A double-blind trial found that 2,000 IU of vitamin E per day for two years extended the length of time people with moderate Alzheimer’s disease were able to continue caring for themselves (e.g., bathing, dressing, and other necessary daily functions), compared with people taking a placebo.68

2 Stars
Anemia and Kidney Dialysis (Vitamin E Oral)
800 IU daily
Studies have reported that large amounts of vitamin E improve anemia caused by kidney dialysis.

People with severe thalassemia who receive regular blood transfusions become overloaded with iron, which increases damaging free radical activity and lowers antioxidant levels in their bodies.69 , 70 , 71 , 72 Some people with milder forms of thalassemia may also have iron overload.73 Iron supplements should be avoided by people with thalassemia unless iron deficiency is diagnosed. Preliminary studies have found that oral supplements of 200 to 600 IU per day of vitamin E reduce free radical damage to red blood cells in thalassemia patients.74 , 75 , 76 However, only injections of vitamin E have reduced the need for blood transfusions caused by thalassemia.77 , 78

2 Stars
Angina
50 IU daily
Low levels of antioxidant vitamins in the blood, particularly vitamin E, are associated with greater rates of angina. In one study supplementing with small amounts of vitamin E had a minor benefit in people with angina.

Low levels of antioxidant vitamins in the blood, particularly vitamin E, are associated with greater rates of angina.79 This is true even when smoking and other risk factors for angina are taken into account. Early short-term studies using 300 IU (International Units) per day of vitamin E could not find a beneficial action on angina.80 A later study supplementing small amounts of vitamin E (50 IU per day) for longer periods of time showed a minor benefit in people suffering angina.81 Those affected by variant angina have been found to have the greatest deficiency of vitamin E compared with other angina patients.82

2 Stars
Athletic Performance, Exercise Recovery, and High-Altitude Exercise Performance
400 IU daily
Antioxidants, including vitamin E, neutralize exercise-related free radicals before they can damage the body, so antioxidants may aid in exercise recovery. Vitamin E has been shown to benefit exercise performance at high altitudes.

Most research has demonstrated that strenuous exercise increases production of harmful substances called free radicals, which can damage muscle tissue and result in inflammation and muscle soreness. Exercising in cities or smoggy areas also increases exposure to free radicals. Antioxidants, including vitamin C and vitamin E, neutralize free radicals before they can damage the body, so antioxidants may aid in exercise recovery. Regular exercise increases the efficiency of the antioxidant defense system, potentially reducing the amount of supplemental antioxidants that might otherwise be needed for protection. However, at least theoretically, supplements of antioxidant vitamins may be beneficial for older or untrained people or athletes who are undertaking an especially vigorous training protocol or athletic event.83 , 84

Placebo-controlled research, some of it double-blind, has shown that taking 400 to 3,000 mg of vitamin C per day for several days before and after intense exercise may reduce pain and speed up muscle strength recovery.85 , 86 , 87 However, taking vitamin C only after such exercise was not effective in another double-blind study.88 While some research has reported that vitamin E supplementation in the amount of 800 to 1,200 IU per day reduces biochemical measures of free radical activity and muscle damage caused by strenuous exercise,89 , 90 , 91 several studies have not found such benefits,92 , 93 , 94 , 95 and no research has investigated the effect of vitamin E on performance-related measures of strenuous exercise recovery. A combination of 90 mg per day of coenzyme Q10 and a very small amount of vitamin E did not produce any protective effects for marathon runners in one double-blind trial,96 while in another double-blind trial a combination of 50 mg per day of zinc and 3 mg per day of copper significantly reduced evidence of post-exercise free radical activity.97

In most well-controlled studies, exercise performance has not been shown to improve following supplementation with vitamin C, unless a deficiency exists, as might occur in athletes with unhealthy or irrational eating patterns.98 , 99 Similarly, vitamin E has not benefited exercise performance, 100 , 101 except possibly at high altitudes. 102 , 103

2 Stars
Cold Sores
Apply cotton saturated with oil for 15 minutes every three hours on day one, then three times daily on days two and three
Applying vitamin E oil directly to a cold sore appears to accelerate healing.

In a preliminary trial, a piece of cotton saturated with vitamin E oil was applied to newly erupted cold sores and held in place for 15 minutes. The first application was performed in the dentist’s office. Participants were instructed to repeat the procedure every three hours for the rest of that day, and then three times daily for two more days. In nearly all cases, pain disappeared in less than eight hours. Application of vitamin E oil appeared to accelerate healing of the cold sores.104 Similar results were reported in another study.105

2 Stars
Dermatitis Herpetiformis
10 IU daily
Supplementing with selenium and vitamin E has been shown to correct an antioxidant deficiency common in DH.

A deficiency in the selenium-containing antioxidant enzyme known as glutathione peroxidase has been reported in DH.106 , 107 Preliminary108 and double-blind109 trials suggest that supplementation with 10 IU of vitamin E and 200 mcg of selenium per day for six to eight weeks corrected this deficiency but did not lead to symptom improvement in the double-blind trial.

2 Stars
Down’s Syndrome
100 to 400 IU daily
Taking vitamin E may improve antioxidant protection. Ask your doctor before supplementing with this vitamin.

Alzheimer’s disease , cataracts, autoimmune diseases, and a general increase in the pace of aging are all seen in people with Down’s syndrome.110 These associated conditions are similar in that they involve damage to body tissues by free radicals. It is believed that the genetic defect that produces Down’s syndrome increases the need for antioxidants (nutrients that prevent free-radical damage), and several studies of blood and urine biochemistry have shown this to be true.111 , 112 In a preliminary study, vitamin E protected cells of people with Down’s syndrome from the oxidative damage to which they are most susceptible.113 However, blood levels of vitamin C and vitamin E, two antioxidant nutrients, have not been found to be different when compared with those of healthy individuals.114 , 115 The role of vitamin E and other antioxidants in treating Down’s syndrome needs further exploration.

2 Stars
Dysmenorrhea
400 to 600 IU of vitamin E a day for five days, beginning two days before menstruation
Taking vitamin E beginning two days before menstruation may help prevent severe pain.

In a double-blind trial, supplementation with 500 IU of vitamin E per day for two months, beginning two days before menstruation and continuing for three days after the onset of menstruation, was significantly more effective than a placebo at relieving menstrual pain.116 Similar benefits were seen in four-month double-blind trial using 400 IU per day, beginning two days before the expected start of menstruation and continuing through the first three days of bleeding.117

2 Stars
Endometriosis (Vitamin C)
1,000 mg vitamin C and 1,200 IU vitamin E daily
A combination of vitamin C and vitamin E can help lessen the pain of endometriosis.

In a study of women with pelvic pain presumed to be due to endometriosis, supplementation with vitamin E (1,200 IU per day) and vitamin C (1,000 mg per day) for two months resulted in an improvement of pain in 43% of women, whereas none of the women receiving a placebo reported pain relief.118

2 Stars
Hay Fever
800 IU daily
In a study of people with hay fever, adding vitamin E to regular anti-allergy treatment during the pollen season significantly reduced the severity of hay fever symptoms.

In a double-blind trial, supplementation with a specific probiotic strain (Bifidobacterium longum strain BB536) during the pollen season significantly decreased symptoms such as sneezing, runny nose, nasal blockage, compared with a placebo.119

2 Stars
Heart Attack
400 to 800 IU daily
Supplementing with vitamin E, synthetic or natural, may help reduce heart attack risk.


Several studies[REF][REF] including two double-blind trials[REF][REF] have reported that 400 to 800 IU of natural vitamin E reduces the risk of heart attacks. However, other recent double-blind trials have found either limited benefit,[REF] or no benefit at all from supplementation with synthetic vitamin E.[REF] One of the negative trials used 400 IU of natural vitamin E[REF]—a similar amount and form to previous successful trials. In attempting to make sense of these inconsistent findings the following is clear: less than 400 IU of synthetic vitamin E, even when taken for years, does not protect against heart disease. Whether 400 to 800 IU of natural vitamin E is or is not protective remains unclear.

Taking antioxidant supplements may improve the outcome for people who have already had a heart attack. In one double-blind trial, people were given 50,000 IU of vitamin A per day, 1,000 mg of vitamin C per day, 600 IU of vitamin E per day, and approximately 41,500 IU of beta-carotene per day or placebo.120 After 28 days, the infarct size of those receiving antioxidants was significantly smaller than the infarct size of the placebo group.

2 Stars
Hypertension
200 IU daily
In a study of people with high blood pressure, vitamin E was significantly more effective than placebo at reducing both systolic and diastolic blood pressure.

In a double-blind study of people with high blood pressure, 200 IU of vitamin E per day taken for 27 weeks was significantly more effective than a placebo at reducing both systolic and diastolic blood pressure.121 This study was done in Iran, and it is not clear whether the results would apply to individuals consuming a Western diet.

2 Stars
Intermittent Claudication (Alpha-Linolenic Acid, Fish Oil, Folic Acid, Oleic Acid, Vitamin B6)
200 mg of EPA and 130 mg of DHA daily, plus small amounts of vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid
In one study, men with intermittent claudication who drank a milk product fortified with fish oil, vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid could walk further without pain than those who drank regular milk.

Men with intermittent claudication consumed a fortified milk product or regular milk daily for one year. The fortified product provided daily 130 mg of eicosapentaenoic acid and 200 mg of docosahexaenoic acid (EPA and DHA, two fatty acids in fish oil), small amounts of supplemental vitamin E, folic acid, and vitamin B6, and additional amounts of oleic acid and alpha-linolenic acid. Compared with regular milk, the fortified milk product significantly increased the distance the participants could walk before the onset of pain.122

2 Stars
Leukoplakia
800 IU daily
According to a review of clinical trials, the combination of beta-carotene and vitamin E has led to complete or partial remissions in six of eight trials studying people with leukoplakia.

According to a review of clinical trials, the combination of beta-carotene and vitamin E has led to complete or partial remissions in six of eight trials studying people with leukoplakia.123 In one trial, administration of 50,000 IU of beta-carotene, 1 gram of vitamin C, and 800 IU of vitamin E per day for nine months led to improvement in 56% of people with leukoplakia, with stronger effects in those who also stopped using tobacco and alcohol.124 In a double-blind trial, a group of men with leukoplakia was given a combination of vitamin A (100,000 IU per week), beta-carotene approximately 67,000 IU per day), and vitamin E (80 IU per week).125 A 38% decrease in the incidence of leukoplakia was observed after six months of treatment.

Although vitamin E has been used in successful trials in which patients are also given beta-carotene, few trials have investigated the effects of vitamin E when taken by itself. One trial used 400 IU of vitamin E two times per day.126 After 24 weeks, 46% showed some improvement in signs or symptoms of leukoplakia or related conditions and 21% showed microscopic evidence of improvement.

2 Stars
Lung Cancer
200 to 400 IU daily
High vitamin E levels have been associated with a reduced lung cancer risk. In one trial, nonsmokers who took vitamin E had a 45% lower lung cancer risk compared with those who did not take the vitamin.

Relatively high blood levels127 , 128 and dietary levels129 of vitamin E have been associated with a reduced risk of lung cancer. In a preliminary trial, nonsmokers who took vitamin E supplements had a 45% lower risk of lung cancer compared with nonsmokers who did not supplement with vitamin E.130 While a double-blind trial reported that vitamin E supplementation had no effect on lung cancer risk,131 the amount used—approximately 50 IU per day—may have been too low to have a significant effect.

2 Stars
Menopause
Refer to label instructions
Vitamin E may help reduce menopause symptoms. Many doctors suggest that women going through menopause try vitamin E for at least three months to see if symptoms improve.

Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of menopause. Most,132 , 133 , 134 , 135 , 136 but not all,137 studies found vitamin E to be helpful, and the benefit of vitamin E was confirmed more recently in a double-blind trial.138 Many doctors suggest that women going through menopause take 400 to 800 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount may be continued or a lower amount may be tried for maintenance.

2 Stars
Osgood-Schlatter Disease
400 IU a day with 150 mcg a day of selenium
Taking a combination of vitamin E and selenium may help the healing.

Based on the personal experience of a doctor who reported his findings,139 some physicians recommend vitamin E (400 IU per day) and selenium (50 mcg three times per day). One well-known, nutritionally oriented doctor reports anecdotally that he has had considerable success with this regimen and often sees results in two to six weeks.140

2 Stars
Osteoarthritis
400 to 1,600 IU per day
As an antioxidant, vitamin E appears to help protect joints.

People who have osteoarthritis and eat large amounts of antioxidants in food have been reported to exhibit a much slower rate of joint deterioration, particularly in the knees, compared with people eating foods containing lower amounts of antioxidants.141 Of the individual antioxidants, only vitamin E has been studied as a supplement in controlled trials. Vitamin E supplementation has reduced symptoms of osteoarthritis in both single-blind142 and double-blind research.143 , 144 In these trials, 400 to 1,600 IU of vitamin E per day was used. Clinical effects were obtained within several weeks. However, in a six-month double-blind study of patients with osteoarthritis of the knee, 500 IU per day of vitamin E was no more effective than a placebo.145

2 Stars
Pancreatic Insufficiency
270 IU daily
Taking antioxidant supplements, such as vitamin E, may lessen pain and prevent pancreatitis recurrences.
There are few controlled trials of antioxidant supplementation to patients with pancreatitis. One small controlled study of acute pancreatitis patients found that sodium selenite at a dose of 50 micrograms (mcg) daily resulted in decreased levels of a marker of free radical activity, and no patient deaths occurred.146 In a small double-blind trial including recurrent acute and chronic pancreatitis patients, supplements providing daily doses of 600 mcg selenium, 9,000 IU beta-carotene, 540 mg vitamin C, 270 IU vitamin E, and 2,000 mg methionine significantly reduced pain, normalized several blood measure of antioxidant levels and free radical activity, and prevented acute recurrences of pancreatitis.147 These researches later reported that continuing antioxidant treatment in these patients for up to five years or more significantly reduced the total number of days spent in the hospital and resulted in 78% of patients becoming pain-free and 88% returning to work.148
2 Stars
Parkinson’s Disease (Vitamin C)
3,000 mg of vitamin C and 3,200 IU of vitamin E
Supplementing with vitamins C and E may help people with early Parkinson’s disease delay the need for medication.

Some preliminary studies have indicated that high dietary intakes of antioxidant nutrients, especially vitamin E, are associated with a low risk of Parkinson’s disease,149 , 150 even though Parkinson’s patients are not deficient in vitamin E.151 , 152 The correlation between protection from Parkinson’s and dietary vitamin E may be not be due to the vitamin E itself, however. Legumes (beans and peas) contain relatively high amounts of vitamin E. Independent of their vitamin E content, consumption of legumes has been associated with low risk of Parkinson’s disease.153 In other words, high vitamin E intake may be a marker for diets high in legumes, and legumes may protect against Parkinson’s disease for reasons unrelated to their vitamin E content.

Interest in the relationship between antioxidants and Parkinson’s disease led to a preliminary trial using high amounts of vitamin C and vitamin E in early Parkinson’s disease154 and to a large ten-year controlled trial of high amounts of vitamin E combined with the drug deprenyl.155 In the trial combining vitamins C and E, people with early Parkinson’s disease given 750 mg of vitamin C and 800 IU of vitamin E four times each day (totaling 3,000 mg of vitamin C and 3,200 IU of vitamin E per day) were able to delay the need for drug therapy (i.e., L-dopa or selegiline) by an average of about two and a half years, compared with those not taking the vitamins.156 The ten-year controlled trial used 2,000 IU of vitamin E per day found no benefit in slowing or improving the disease.157 The difference in the outcomes between these two trials might be due to the inclusion of vitamin C and/or the higher amount of vitamin E used in the successful trial. However, the difference might also be due to a better study design in the trial that found vitamin E to be ineffective.

The amounts of vitamin E used in the above trials were very high, because raising antioxidant levels in brain tissue is quite difficult to achieve.158 In fact, some researchers have found that even extremely high intakes of vitamin E (4,000 IU per day) failed to increase brain vitamin E levels.159 The difficulty in increasing brain vitamin E levels may explain the poor results of the large, controlled trial.

2 Stars
Preeclampsia (Vitamin C)
1,000 mg daily vitamin C with 400 IU vitamin E
2 Stars
Premenstrual Syndrome
300 IU daily
Vitamin E may decrease PMS symptoms, according to one study.

Although women with PMS do not appear to be deficient in vitamin E,160 a double-blind trial reported that 300 IU of vitamin E per day may decrease symptoms of PMS.161

2 Stars
Prostate Cancer
50 IU daily
Supplementing with vitamin E as mixed tocopherols may help lower prostate cancer risk, especially in smokers.

Relatively high blood levels of vitamin E have been associated with relatively low levels of hormones linked to prostate cancer.162 In a double-blind trial studying smokers, vitamin E supplementation (50 IU per day for an average of six years) led to a 32% decrease in prostate cancer incidence and a 41% decrease in prostate cancer deaths.163 Both findings were statistically significant.164 However, in a double-blind study of 35,533 healthy men, supplementing with 400 IU per day of vitamin E for an average of 5.5 years (with a total follow-up period of 7 years) significantly increased the incidence of prostate cancer by 17%.165 The effects of vitamin E have yet to be studied in men already diagnosed with prostate cancer.

The conflicting results in these studies may be due to the fact that all of the studies used pure alpha-tocopherol, which is only one of the four different forms of vitamin E that occur naturally in food (alpha-, beta-, gamma-, and delta-tocopherol). Treatment with large doses of alpha-tocopherol by itself (such as 400 IU per day or more) has been shown to deplete gamma-tocopherol, potentially upsetting the natural balance of the different forms of vitamin E in the body. "Mixed tocopherols," on the other hand, a supplement that contains all four types of vitamin E, would not be expected to cause such an imbalance.

Both alpha-tocopherol and gamma-tocopherol have been found to inhibit the growth of human prostate cancer cells in a test tube, but gamma-tocopherol was the more potent of the two.166 In another study, higher blood levels of alpha-tocopherol and gamma-tocopherol were each associated a lower risk of developing prostate cancer, but the protective effect of gamma-tocopherol was greater than that of alpha-tocopherol.167 These observations raise the possibility that both alpha- and gamma-tocopherol have a protective effect against prostate cancer. However, when alpha-tocopherol is given by itself in large doses (such as 400 IU per day or more), it depletes gamma-tocopherol, which could more than negate any beneficial effect that alpha-tocopherol might have. If that is the case, then taking vitamin E as mixed tocopherols would not be expected to increase prostate cancer risk, and might even help prevent prostate cancer. Further research is needed to examine that possibility.

2 Stars
Retinopathy and Retrolental Fibroplasia in Premature Infants
Consult a qualified healthcare practitioner
Large amounts of vitamin E have been shown to reduce the incidence of severe retinopathy in premature infants.

Free radicals have been implicated in the development and progression of several forms of retinopathy.168 Retrolental fibroplasia, a retinopathy that occurs in some premature infants who have been exposed to high levels of oxygen, is an example of free radical-induced damage to the retina. In an analysis of the best published trials, large amounts of vitamin E were found to reduce the incidence of severe retinopathy in premature infants by over 50%.169 , 170 Some of the evidence supporting the use of vitamin E in the prevention of retrolental fibroplasia comes from trials that have used 100 IU of vitamin E per 2.2 pounds of body weight in the form of oral supplementation.171 Use of large amounts of vitamin E in the prevention of retrolental fibroplasia requires the supervision of a pediatrician.

Vitamin E has also been found to prevent retinopathy in people with a rare genetic disease known as abetalipoproteinemia.172 People with this disorder lack a protein that transports fat-soluble nutrients, and can therefore develop deficiencies of vitamin E and other nutrients.

In one trial, vitamin E failed to improve vision in people with diabetic retinopathy,173 although in a double-blind trial, people with type 1 diabetes given very high amounts of vitamin E were reported to show a normalization of blood flow to the retina.174 This finding has made researchers hopeful that vitamin E might help prevent diabetic retinopathy. However, no long-term trials have yet been conducted with vitamin E in the actual prevention of diabetic retinopathy.

Because oxidation damage is believed to play a role in the development of retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.175 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

2 Stars
Skin Ulcers (Vitamin E Oral)
400 IU daily
Antioxidants, such as vitamin E, are depleted in healing skin tissue. Studies have shown that vitamin E taken orally to be effective at preventing skin ulcers and promoting healing.

Antioxidants such as vitamin C, vitamin E, and glutathione are depleted in healing skin tissue.176 One animal study found that vitamin E (alpha-tocopherol) applied to the skin shortened the healing time of skin ulcers.177 Another animal study reported that administration of oral vitamin E before skin lesions were introduced into the skin prevented some of the tissue damage associated with the development of pressure ulcers.178 A controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft surgery for chronic venous ulcers.179 No further research has investigated the potential benefit of vitamin E for skin ulcers.

2 Stars
Sunburn (Vitamin C)
Apply a formula containing 2% vitamin E and 5% vitamin C before sun exposure
Studies have found sunscreen-like effects from topical application of the vitamin C and vitamin E combination.

Antioxidants have been studied as topical agents for protection against sunburn. Animal studies have found sunscreen-like effects from topical application of a vitamin C and vitamin E combination, and a controlled human study reported ultraviolet protection from the use of a lotion containing 0.02% to 0.05% of the selenium-containing amino acid known as selenomethionine.180 , 181 The topical use of the hormone melatonin has been shown to protect human skin against ultraviolet rays in double-blind research.182 , 183 A double-blind human trial tested topical vitamins C and E and melatonin, alone and in combinations, and found the highest degrees of protection from combination formulations containing 2% vitamin E, 5% vitamin C, and 1% to 2.5% melatonin.184 Other studies in which topical antioxidants were applied after ultraviolet exposure have found no benefits.185 , 186

2 Stars
Thalassemia (Vitamin E Injection)
Refer to label instructions
Studies have found that vitamin E supplements reduce free radical damage to red blood cells in thalassemia patients. Vitamin E injections have reduced the need for blood transfusions caused by thalassemia.

People with severe thalassemia who receive regular blood transfusions become overloaded with iron, which increases damaging free radical activity and lowers antioxidant levels in their bodies.187 , 188 , 189 , 190 Some people with milder forms of thalassemia may also have iron overload.191 Iron supplements should be avoided by people with thalassemia unless iron deficiency is diagnosed. Preliminary studies have found that oral supplements of 200 to 600 IU per day of vitamin E reduce free radical damage to red blood cells in thalassemia patients.192 , 193 , 194 However, only injections of vitamin E have reduced the need for blood transfusions caused by thalassemia.195 , 196

2 Stars
Type 1 Diabetes and Diabetic Nephropathy
900 to 1,800 IU daily
Vitamin E supplementation may protect against diabetic neuropathy.
People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many, although not all, studies of people with type 1 diabetes.
2 Stars
Type 1 Diabetes and Diabetic Retinopathy
1800 IU daily
Supplementing with vitamin E may combat free radicals associated with diabetic retinopathy.
People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many, although not all, studies of people with type 1 diabetes.
2 Stars
Type 2 Diabetes and Diabetic Neuropathy
900 IU daily
Vitamin E supplementation may protect against neuropathy.

People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes.197 , 198 Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most,199 , 200 , 201 but not all,202 double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.203 , 204 Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent.

In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months.205 Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy,206 , 207 serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.

Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,208 , 209 , 210 , 211 , 212 although not all,213 , 214 , 215 studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.216 The reason for the discrepancy between reports is not known.

Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of vitamin E (50 IU per day).217

2 Stars
Type 2 Diabetes and Diabetic Retinopathy
1800 IU daily
Vitamin E supplementation may protect against diabetic retinopathy.

People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes.218 , 219 Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most,220 , 221 , 222 but not all,223 double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.224 , 225 Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent.

In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months.226 Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy,227 , 228 serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.

Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,229 , 230 , 231 , 232 , 233 although not all,234 , 235 , 236 studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.237 The reason for the discrepancy between reports is not known.

Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of vitamin E (50 IU per day).238

2 Stars
Wound Healing
400 IU daily
Supplementing with vitamin E may enhance healing and prevent adhesion formation after surgery, applied topically, the vitamin may help prevent scarring.

Animal studies have shown that supplementing with vitamin E can decrease the formation of unwanted adhesions following a surgical wound. In addition, wound healing was more rapid in animals fed a vitamin E-rich diet than in those fed a standard diet.239 In another study, however, wound healing was inhibited by supplementation with a massive amount of vitamin E (equivalent to about 35,000 IU).240 This adverse effect of vitamin E was prevented by supplementation with vitamin A. Although the relevance of these studies to humans is not clear, many doctors recommend supplementing with both vitamins A and E in order to enhance wound healing and prevent adhesion formation. Typical amounts recommended are 25,000 IU of vitamin A per day and 400 IU of vitamin E per day, beginning two weeks prior to surgery and continuing for four weeks after surgery.

Topical application of vitamin E is sometimes recommended for preventing or treating post-injury scars, although only three controlled studies have been reported. Two of these trials found no effect on scar prevention after surgery,241 , 242 and one trial found vitamin E improved the effect of silicon bandages on large scars called keloids.243

2 Stars
Yellow Nail Syndrome
800 IU daily
Vitamin E has been used successfully with people who have yellow nail syndrome in several preliminary reports.

Supplementation with vitamin E has been used successfully with people who have yellow nail syndrome in several preliminary reports.244 , 245 , 246 Although topical use of the vitamin has also been reported to be effective,247 taking vitamin E supplements is much easier and less messy. A typical amount is 800 IU per day, with results beginning to appear after several months.

1 Star
Abnormal Pap Smear
Refer to label instructions
Women with cervical dysplasia may have lower blood levels of vitamin E compared with healthy women.

Women with cervical dysplasia may have lower blood levels of beta-carotene and vitamin E248 , 249 compared to healthy women.

1 Star
Age-Related Cognitive Decline
Refer to label instructions
Use of vitamin E, alone or with vitamin C, has been associated with better cognitive function and a reduced risk of certain forms of dementia (but not Alzheimer’s disease).

Use of vitamin C or vitamin E supplements, or both, has been associated with better cognitive function and a reduced risk of certain forms of dementia (not including Alzheimer’s disease).250 Clinical trials of these antioxidants are needed to confirm the possible benefits suggested by this study.

1 Star
Alcohol Withdrawal
Refer to label instructions
Alcohol-related anxiety may be improved by a combination of vitamin E, vitamin B6, niacin, and vitamin C, though the high amounts of niacin and vitamin B6 used in the study need a doctor’s supervision.

The daily combination of 3 grams of vitamin C, 3 grams of niacin, 600 mg of vitamin B6, and 600 IU of vitamin E has been used by researchers from the University of Mississippi Medical Center in an attempt to reduce anxiety and depression in alcoholics.251 Although the effect of vitamin supplementation was no better than placebo in treating alcohol-associated depression, the vitamins did result in a significant drop in anxiety within three weeks of use. Because of possible side effects, anyone taking such high amounts of niacin and vitamin B6 must do so only under the care of a doctor.

Although the incidence of B-complex deficiencies is known to be high in alcoholics, the incidence of other vitamin deficiencies remains less clear.252 Nonetheless, deficiencies of vitamin A, vitamin D, vitamin E, and vitamin C are seen in many alcoholics. While some reports have suggested it may be safer for alcoholics to supplement with beta-carotene instead of vitamin A,253 potential problems accompany the use of either vitamin A or beta-carotene in correcting the deficiency induced by alcoholism.254 These problems result in part because the combinations of alcohol and vitamin A or alcohol and beta-carotene appear to increase potential damage to the liver. Thus, vitamin A-depleted alcoholics require a doctor’s intervention, including supplementation with vitamin A and beta-carotene accompanied by assessment of liver function. Supplementing with vitamin C, on the other hand, appears to help the body rid itself of alcohol.255 Some doctors recommend 1 to 3 grams per day of vitamin C.

1 Star
Asthma (Vitamin C, Selenium)
Refer to label instructions
There is some evidence that a combination of antioxidants vitamin E, vitamin C, and selenium may help prevent asthma thought to be caused by air pollution.

There is some evidence that combinations of antioxidants such as vitamin E, vitamin C, and selenium may help improve symptoms of asthma throught to be caused by air pollution.256 In one double-blind study, 46 Dutch bicyclists were randomly assigned to receive a placebo or 100 mg of vitamin E and 500 mg of vitamin C daily for 15 weeks.257 Lung function was measured before and after each training session on 380 different occasions, and ambient ozone concentrations were measured during each training session. After analysis, researchers concluded that bicyclists with the vitamins C and E blunted the adverse effects of ozone on measures of lung function. In another double-blind study, 17 adults (18 to 39 years old) were randomly assigned to receive either 400 IU per day of vitamin E and 500 mg per day of vitamin C or a placebo for five weeks.258 Tests showing improved measures of lung function led researchers to conclude that supplementation with vitamins C and E inhibited the decline in pulmonary function induced in asthmatics by exposure to air pollutants. Also using a double-blind design, another study of 158 children with asthma living in Mexico City were randomly assigned to receive, a daily supplement containing 50 mg of vitamin E and 250 mg of vitamin C or a placebo.259 Tests results suggested that supplementing with vitamins C and E may reduce the adverse effect of ozone exposure on lung function of children with moderate to severe asthma.

1 Star
Atherosclerosis
100 to 200 IU daily
Vitamin E is an antioxidant that protects LDL cholesterol from oxidative damage and has been linked to heart disease prevention. Many doctors recommend supplementing with vitamin E to lower the risk of atherosclerosis and heart attacks.

Vitamin E is an antioxidant that serves to protect LDL from oxidative damage260 and has been linked to prevention of heart disease in double-blind research.261 Many doctors recommend 400–800 IU of vitamin E per day to lower the risk of atherosclerosis and heart attacks. However, some leading researchers suggest taking only 100–200 IU per day, as studies that have explored the long-term effects of different supplemental levels suggest no further benefit beyond that amount, and research reporting positive effects with 400–800 IU per day have not investigated the effects of lower intakes.262 In a double-blind trial, people with high cholesterol who took 136 IU of natural vitamin E per day for three years had 10% less progression of atherosclerosis compared with those taking placebo.263

1 Star
Bronchitis
Refer to label instructions
Vitamin E appears to help keep the lungs healthy and prevent damage from environmental pollution and cigarette smoke exposure.

Vitamin C and vitamin E may prevent oxidative damage to the lung lipids by environmental pollution and cigarette smoke exposure. It has been suggested that amounts in excess of the RDA (recommended dietary allowance) are necessary to protect against the air pollution levels currently present in North America,264 although it is not known how much vitamin E is needed to produce that protective effect.

1 Star
Burns
Refer to label instructions
Using the antioxidant vitamin E topically on minor burns is a popular remedy. If applying vitamin E topically, use the tocopherol form.

Despite a lack of research on the subject, using vitamin E topically on minor burns is a popular remedy. This makes sense, because some of the damage done to the skin is oxidative, and vitamin E is an antioxidant. Some doctors suggest simply breaking open a capsule of vitamin E and applying it to the affected area two or three times per day. Vitamin E forms are listed as either “tocopherol” or “tocopheryl” followed by the name of what is attached to it, as in “tocopheryl acetate.” While both forms are active when taken by mouth, the skin utilizes the tocopheryl forms very slowly.265 , 266 Therefore, those planning to apply vitamin E to the skin should buy the tocopherol form.

1 Star
Cataracts
Refer to label instructions
Low blood levels of vitamin E have been linked to increased risk of forming cataracts. Vitamin E supplements have been reported to protect against cataracts.

People with low blood levels of antioxidants and those who eat few antioxidant-rich fruits and vegetables have been reported to be at high risk for cataracts.267 , 268

Low blood levels of vitamin E have been linked to increased risk of forming cataracts.269 , 270 Dietary vitamin E intake has not been consistently associated with protection from cataracts.271 , 272 Vitamin E supplements have been reported to protect against cataracts in animals273 and people,274 though the evidence remains inconsistent.275 In one trial, people who took vitamin E supplements had less than half the risk of developing cataracts, compared with others in the five-year study.276 Doctors typically recommend 400 IU of vitamin E per day as prevention. Smaller amounts (approximately 50 IU per day) have been proven in double-blind research to provide no protection.277

1 Star
Childhood Diseases
Refer to label instructions
Healthy immune function requires adequate amounts of vitamin E. Animal studies have shown that vitamin E increases immune cell activity and reduces virus activity.

Healthy immune function also requires adequate amounts of vitamin E. Vitamin E deficiency is associated with increased severity of viral infections in mice.278 , 279 , 280 Supplementation with vitamin E during viral infections has been shown to increase immune cell activity281 and reduce virus activity282 in mice. Research into the effects of vitamin E supplementation on childhood exanthems has not been done.

1 Star
Colon Cancer
Refer to label instructions
In most preliminary reports, vitamin E appears to protect against cancer.
In most,283 , 284 but not all, preliminary reports, people who take vitamin E supplements were found to have decreased risks of precancerous colon polyps and colon cancer, compared with those who do not take vitamin E.285 Although a double-blind study of male smokers reported that those receiving low amounts of vitamin E (equivalent to approximately 50 IU per day) had a higher incidence of precancerous colon polyps than those assigned to placebo,286 the same trial found a trend toward lower risk of colon cancer in the vitamin E group.287 Insufficient information exists for making recommendations regarding the use of vitamin E in connection with the prevention of colon cancer.
1 Star
Cystic Fibrosis
Refer to label instructions
The fat malabsorption associated with cystic fibrosis often leads to a deficiency of fat-soluble vitamins, such as vitamin E. Supplementation can help counteract the deficiency.

The fat malabsorption associated with CF often leads to a deficiency of fat-soluble vitamins. Oral supplementation of these nutrients is considered crucial to maintaining good nutritional status.288 Current recommendations for supplementation are as follows: vitamin A, 5,000 to 10,000 IU/day; vitamin D, 1,000 to 2,000 IU/day; vitamin E, 100 to 300 IU/day; and vitamin K, 5 mg every three days. Of the water-soluble vitamins, only vitamin B12 is poorly absorbed in cystic fibrosis,289 and taking pancreatic enzymes helps prevent B12 deficiencies.290

1 Star
Dupuytren’s Contracture
Refer to label instructions
Supplementing with vitamin E may improve Dupuytren’s contracture, although research on the topic has been conflicting.

Many decades ago, researchers investigated the effects of taking vitamin E to treat Dupuytren’s contracture. Several studies reported that taking 200–2,000 IU of vitamin E per day for several months was helpful.291 Other studies, however, did not find it useful.292 Overall, there are more positive trials than negative ones,293 although none of the published research is recent. Nonetheless, some doctors believe that a three-month trial using very high amounts of vitamin E (2,000 IU per day) is helpful in some cases.

1 Star
Epilepsy in Adults
Refer to label instructions
Supplementing with vitamin E has been shown to improve treatment results in children, and similar effects may be seen in adults.

Vitamin E has been studied as a possible add-on to conventional drug treatment for epilepsy. A double-blind trial found that adding 400 IU per day of vitamin E reduced seizure frequency in children without side effects.294 Other preliminary trials295 , 296 have reported similar results, and, while some preliminary research suggested this effect might also be achieved in adults,297 a double-blind trial found no effect of vitamin E supplementation on adults with epilepsy.298

1 Star
Female Infertility
Refer to label instructions
In one study, infertile couples given vitamin E showed significantly improved fertility.

Vitamin E deficiency in animals leads to infertility.299 In a preliminary human trial, infertile couples given vitamin E (200 IU per day for the female and 100 IU per day for the male) showed a significant increase in fertility.300

1 Star
Fibrocystic Breast Disease
Refer to label instructions
Some studies have reported that vitamin E reduces symptoms of FBS, many women try it for three months to see if it helps.

While several studies report that 200–600 IU of vitamin E per day, taken for several months, reduces symptoms of FBD,301 , 302 most double-blind trials have found that vitamin E does not relieve FBD symptoms.303 , 304 Nonetheless, many women take 400 IU of vitamin E for three months to see if it helps.

1 Star
Fibromyalgia
Refer to label instructions
Vitamin E was used in one early study with beneficial and sometimes dramatic results.

One early preliminary study described the use of vitamin E supplements in the treatment of “fibrositis”—the rough equivalent of what is today called fibromyalgia. Several dozen individuals were treated with vitamin E using amounts ranging from 100–300 IU per day. The results were positive and sometimes dramatic.305 Double-blind trials are needed to confirm these preliminary observations.

1 Star
Gingivitis
Refer to label instructions
Vitamin E is often recommended by doctors to help prevent and treat periodontitis.

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),306 vitamin E, selenium, zinc, coenzyme Q10, and folic acid.307 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.308

1 Star
Goiter
0.5 to 8 grams daily
Vitamin E levels are lower in people with goiter than in those without. Supplementing with vitamin E prevented goiter formation in iodine-deficient conditions in some research.

Blood levels of vitamin A are lower in people with goiter than in similar people without goiter.309 , 310 The same relationship has been found for vitamin E and goiter.311 Animal research has found that, in iodine-deficient conditions, a supplement combination of vitamin C, vitamin E, and beta-carotene prevented goiter formation (though hypothyroidism was not improved), and vitamin E alone had a similar effect.312 No studies have been done to investigate this benefit in humans.

1 Star
Halitosis
Refer to label instructions
Vitamin E is often recommended by doctors to help prevent and treat periodontitis.

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),313 vitamin E, selenium, zinc, coenzyme Q10, and folic acid.314 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.315

1 Star
Hepatitis
900 to 2,700 mg per day
Some trials have shown vitamin E to be helpful in treating hepatitis B and to reduce liver damage in people with hepatitis C.

Vitamin E levels have been shown to be low in people with hepatitis,316 as well as in those who later develop liver cancer from long-standing hepatitis.317 Vitamin E levels in the liver may also be decreased in some people with hepatitis.318 In a controlled trial of individuals with hepatitis B, 600 IU of vitamin E per day for nine months resulted in all signs of hepatitis disappearing in five of twelve people.319 In a preliminary trial of adults with hepatitis C, administering 1,200 IU per day of vitamin E for eight weeks appeared to reduce liver damage to some extent.320 In a preliminary trial of people with hepatitis C, 544 IU of vitamin E per day for 24 weeks improved the response to interferon/antioxidant therapy, although the results did not reach statistical significance.321 However, in children with viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any benefit.322

1 Star
High Cholesterol
Refer to label instructions
In one trial, supplementing with vitamin E increased levels of protective HDL cholesterol.
In one double-blind trial,323 vitamin E increased protective HDL cholesterol, but several other trials,324 , 325 , 326 found no effect of vitamin E. However, vitamin E is known to protect LDL cholesterol from damage.327 Most cardiologists believe that only damaged LDL increases the risk of heart disease. Studies of the ability of vitamin E supplements to prevent heart disease have produced conflicting results,328 but many doctors continue to recommend that everyone supplement 400 IU of vitamin E per day to lessen the risk of having a heart attack.
1 Star
HIV and AIDS Support
Refer to label instructions
In test-tube studies, vitamin E improved the effectiveness of the anti-HIV drug zidovudine (AZT) while reducing its toxicity.

In test-tube studies, vitamin E improved the effectiveness of the anti-HIV drug zidovudine (AZT) while reducing its toxicity.329Similarly, animal research suggests that zinc and NAC supplementation may protect against AZT toxicity.330 It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.

1 Star
Hypoglycemia
Refer to label instructions
Vitamin E helps control blood sugar levels in diabetics, and since there are similarities in the way the body regulates high and low blood sugar levels, it might be helpful for hypoglycemia as well.

Research has shown that supplementing with chromium (200 mcg per day)331 or magnesium (340 mg per day)332 can prevent blood sugar levels from falling excessively in people with hypoglycemia. Niacinamide (vitamin B3) has also been found to be helpful for hypoglycemic people.333 Other nutrients, including vitamin C, vitamin E, zinc, copper, manganese, and vitamin B6, may help control blood sugar levels in diabetics.334 Since there are similarities in the way the body regulates high and low blood sugar levels, these nutrients might be helpful for hypoglycemia as well, although the amounts needed for that purpose are not known.

1 Star
Insulin Resistance Syndrome
Refer to label instructions
Vitamin E has been shown to increase insulin sensitivity in both healthy and hypertensive people and may have a similar effect on people with IRS.

Vitamin E , 800–1,350 IU per day, has been shown to increase insulin sensitivity in both healthy335 and hypertensive336 people in double-blind studies. Research is needed to investigate this effect in people with IRS.

1 Star
Kidney Stones
Refer to label instructions
In one study, supplementing with synthetic vitamin E was found to reduce several risk factors for kidney stone formation in people with elevated levels of urinary oxalate.

In a double-blind trial, supplementation with 200 IU of synthetic vitamin E per day was found to reduce several risk factors for kidney stone formation in people with elevated levels of urinary oxalate.337

1 Star
Liver Cirrhosis
Refer to label instructions
Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.

Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.338 However, a study reported that supplementation of 500 IU per day of vitamin E for one year failed to influence laboratory tests, liver function, survival or hospitalization rates in people with alcoholic cirrhosis.339 Further clinical trials are needed to determine if any benefits may be expected from vitamin E supplementation in people with liver cirrhosis.

1 Star
Macular Degeneration
Refer to label instructions
Sunlight triggers oxidative damage in the eye, which in turn can cause macular degeneration. Vitamin E protects against oxidative damage and may reduce macular degeneration risk.

Sunlight triggers oxidative damage in the eye, which in turn can cause macular degeneration.340 Animals given antioxidants—which protect against oxidative damage—have a lower risk of this vision problem.341 People with high blood levels of antioxidants also have a lower risk.342 Those with the highest levels (top 20th percentile) of the antioxidants selenium, vitamin C, and vitamin E may have a 70% lower risk of developing macular degeneration, compared with people with the lowest levels of these nutrients (bottom 20th percentile).343 People who eat fruits and vegetables high in beta-carotene, another antioxidant, are also at low risk.344 Some doctors recommend antioxidant supplements to reduce the risk of macular degeneration; reasonable adult levels include 200 mcg of selenium, 1,000 mg of vitamin C, 400 IU of vitamin E, and 25,000 IU of natural beta-carotene per day. However, a preliminary study found no association between age-related macular degeneration and intake of antioxidants, either from the diet, from supplements, or from both combined.345 Moreover, in a double-blind study of male cigarette smokers, supplementing with vitamin E (50 IU per day), synthetic beta-carotene (about 33,000 IU per day), or both did not reduce the incidence of age-related macular degeneration.346 Another double-blind trial found that supplementing with 600 IU of vitamin E every other day did not reduce the incidence of age-related macular degeneration in healthy women.347

1 Star
Male Infertility
Refer to label instructions
Vitamin E supplementation appears to enhance fertility, possibly by decreasing free-radical damage to sperm cells.

Vitamin E deficiency in animals leads to infertility.348 In a preliminary human trial, 100–200 IU of vitamin E given daily to both partners of infertile couples led to a significant increase in fertility.349 Vitamin E supplementation may enhance fertility by decreasing free-radical damage to sperm cells. In another preliminary study, men with low fertilization rates in previous attempts at in vitro fertilization were given 200 IU of vitamin E per day for three months.350 After one month of supplementation, fertilization rates increased significantly, and the amount of oxidative stress on sperm cells decreased. However, the evidence in favor of vitamin E remains preliminary. A review of research on vitamin E for male infertility concluded that there is no justification for its use in treating this condition.351 Controlled trials are needed to validate these promising preliminary findings.

1 Star
Menorrhagia
Refer to label instructions
In a study of women with menorrhagia associated with the use of an intrauterine device (IUD), supplementing with vitamin E corrected the problem in all cases within ten weeks.

In a study of women with menorrhagia associated with the use of an intrauterine device (IUD) for birth control, supplementing with 100 IU of vitamin E every other day corrected the problem in all cases within ten weeks (63% responded within four weeks).352 The cause of IUD-induced menstrual blood loss is different from that of other types of menorrhagia; therefore, it’s possible that vitamin E supplements might not help with menorrhagia not associated with IUD use.

1 Star
Pre- and Post-Surgery Health
Refer to label instructions
Some studies have found that vitamin E levels decrease after surgery, supplementation may correct a deficiency. Vitamin E may also prevent scarring when used topically after surgery.

Some studies of surgery patients,353 , 354 though not all, 355 have found that blood levels of vitamin E decrease during and after surgery. Animal research suggests that vitamin E may prevent skin scarring when used topically after surgery,356 but a human study reported disappointing results.357 Vitamin E taken by mouth may interfere with blood clotting358; therefore, use of vitamin E before surgery should be discussed with the surgeon. No research on either the usefulness or hazards of vitamin E supplementation around surgery has been done.

1 Star
Restless Legs Syndrome
Refer to label instructions
In one study, supplementing with vitamin E produced complete relief in seven out of nine people with restless leg syndrome.

In a group of nine people with RLS, 300 IU of vitamin E per day produced complete relief in seven.359 Doctors who give vitamin E to people with RLS generally recommend at least 400 IU of vitamin E per day, and the full benefits may not become apparent for three months.360

1 Star
Retinopathy
Refer to label instructions
Vitamin E has been found to prevent retinopathy in people with a rare genetic disease known as abetalipoproteinemia.

Free radicals have been implicated in the development and progression of several forms of retinopathy.361 Retrolental fibroplasia, a retinopathy that occurs in some premature infants who have been exposed to high levels of oxygen, is an example of free radical-induced damage to the retina. In an analysis of the best published trials, large amounts of vitamin E were found to reduce the incidence of severe retinopathy in premature infants by over 50%.362 , 363 Some of the evidence supporting the use of vitamin E in the prevention of retrolental fibroplasia comes from trials that have used 100 IU of vitamin E per 2.2 pounds of body weight in the form of oral supplementation.364 Use of large amounts of vitamin E in the prevention of retrolental fibroplasia requires the supervision of a pediatrician.

Vitamin E has also been found to prevent retinopathy in people with a rare genetic disease known as abetalipoproteinemia.365 People with this disorder lack a protein that transports fat-soluble nutrients, and can therefore develop deficiencies of vitamin E and other nutrients.

In one trial, vitamin E failed to improve vision in people with diabetic retinopathy,366 although in a double-blind trial, people with type 1 diabetes given very high amounts of vitamin E were reported to show a normalization of blood flow to the retina.367 This finding has made researchers hopeful that vitamin E might help prevent diabetic retinopathy. However, no long-term trials have yet been conducted with vitamin E in the actual prevention of diabetic retinopathy.

Because oxidation damage is believed to play a role in the development of retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.368 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

1 Star
Shingles and Postherpetic Neuralgia
Refer to label instructions
Some doctors have found vitamin E supplements to be effective for people with postherpetic neuralgia. Vitamin E oil can also be applied to the skin.

Some doctors have found vitamin E to be effective for people with postherpetic neuralgia—even those who have had the problem for many years.369 , 370 The recommended amount of vitamin E by mouth is 1,200–1,600 IU per day. In addition, vitamin E oil (30 IU per gram) can be applied to the skin. Several months of continuous vitamin E use may be needed in order to see an improvement. Not all studies have found a beneficial effect of vitamin E;371 however, in the study that produced negative results, vitamin E may not have been used for a long enough period of time.

1 Star
Sickle Cell Anemia
Refer to label instructions
Low vitamin E levels have been associated with higher numbers of diseased cells in children and with greater symptom frequency in adults. Supplementing with the vitamin can help restore levels.

Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.372 , 373 , 374 , 375 , 376 , 377 Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children378 and with greater frequency of symptoms in adults.379 A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.380

In another preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.381

Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.382 This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.383

1 Star
Skin Ulcers (Vitamin E Topical)
Refer to label instructions
Antioxidants such as vitamin E, are depleted in healing skin tissue. One study found that topically applied vitamin E shortened the healing time of skin ulcers.

Antioxidants such as vitamin C, vitamin E, and glutathione are depleted in healing skin tissue.384 One animal study found that vitamin E (alpha-tocopherol) applied to the skin shortened the healing time of skin ulcers.385 Another animal study reported that administration of oral vitamin E before skin lesions were introduced into the skin prevented some of the tissue damage associated with the development of pressure ulcers.386 A controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft surgery for chronic venous ulcers.387 No further research has investigated the potential benefit of vitamin E for skin ulcers.

1 Star
Sprains and Strains and Exercise-Related Muscle Injury
Refer to label instructions
Antioxidant supplements, including vitamin E, may help prevent exercise-related muscle injuries by neutralizing free radicals produced during strenuous activities.

Antioxidant supplements, including vitamin C and vitamin E, may help prevent exercise-related muscle injuries by neutralizing free radicals produced during strenuous activities.388 Controlled research, some of it double-blind, has shown that 400–3,000 mg per day of vitamin C may reduce pain and speed up muscle strength recovery after intense exercise.389 , 390 Reductions in blood indicators of muscle damage and free radical activity have also been reported for supplementation with 400–1,200 IU per day of vitamin E in most studies,391 , 392 , 393 but no measurable benefits in exercise recovery have been reported.394 A combination of 90 mg per day of coenzyme Q10 and a very small amount of vitamin E did not produce any protective effects in one double-blind trial.395

1 Star
Stroke
Refer to label instructions
Studies have found that people who eat foods high in antioxidants such vitamin E have less carotid stenosis, a risk factor for stroke. Vitamin E plus aspirin has also been shown to be effective in reducing stroke risk.

Narrowing of the neck arteries (carotid stenosis) caused by atherosclerosis is a risk factor for stroke. Preliminary diet studies have found that people who eat foods high in antioxidants such as vitamin C and vitamin E have less carotid stenosis.396 , 397

In a double-blind trial, people with atherosclerosis in the carotid arteries were given a palm oil extract containing 160–240 mg of tocotrienols (a vitamin E-like supplement) and approximately 100–150 IU vitamin E per day. After 18 months, they had significantly less atherosclerosis or less progression of atherosclerosis compared to a group receiving placebo.398 Vitamin E plus aspirin, has been more effective in reducing the risk of strokes and other related events than has aspirin, alone.399 However, most preliminary trials have shown no protective effects from antioxidant supplementation.400 , 401 , 402 , 403 , 404 , 405 A large Finnish trial concluded that supplementation with either vitamin E or beta-carotene conferred no protection against stroke in male smokers,406 although a later review of the study found that those smokers who have either hypertension (high blood pressure) or diabetes do appear to have a reduced risk of stroke when taking vitamin E.407

People with high risk for stroke, such as those who have had TIAs or who have a heart condition known as atrial fibrillation,408 are often given aspirin or anticoagulant medication to reduce blood clotting tendencies. Some natural inhibitors of blood clotting such as garlic,409 , 410 , 411 fish oil,412 and vitamin E,413 , 414 may have protective effects, but even large amounts of fish oil are known to be less potent than aspirin.415 Whether any of these substances is an adequate substitute to control risk of stroke in high-risk people is unknown, and anyone taking anticoagulant medication should advise their prescribing doctor before beginning use of these natural substances.

1 Star
Type 1 Diabetes (Selenium, Vitamin A, Vitamin C)
Refer to label instructions
A combination of the antioxidants selenium, vitamin A, vitamin C, and vitamin E has been shown to improve diabetic retinopathy.
Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.416 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.
1 Star
Type 1 Diabetes and Diabetic Retinopathy (Selenium, Vitamin A, Vitamin C)
Refer to label instructions
Antioxidant nutrients including selenium, vitamin A, vitamin C, and vitamin E may combat free radicals associated with diabetic retinopathy.
Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.417 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.
1 Star
Type 2 Diabetes and Diabetic Neuropathy (Selenium, Vitamin A, Vitamin C)
Refer to label instructions
A combination of the antioxidants selenium, vitamin A, vitamin C, and vitamin E has been shown to improve diabetic retinopathy.
Because oxidation damage is believed to play a role in the development of diabetic retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.418 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.
1 Star
Vaginitis
Refer to label instructions
Some doctors recommend vitamin E (taken orally, topically, or vaginally) for certain types of vaginitis.

Some doctors recommend vitamin E (taken orally, topically, or vaginally) for certain types of vaginitis. Vitamin E as a suppository in the vagina or vitamin E oil can be used once or twice per day for 3 to 14 days to soothe the mucous membranes of the vagina and vulva. Some doctors recommend vaginal administration of vitamin A to improve the integrity of the vaginal tissue and to enhance the function of local immune cells. Vitamin A can be administered vaginally by inserting a vitamin A capsule or using a prepared vitamin A suppository. Vitamin A used this way can be irritating to local tissue, so it should not be used more than once per day for up to seven consecutive days.

0 Stars
Sunburn (Vitamin A)
Refer to label instructions

Antioxidants may protect the skin from sunburn due to free radical–producing ultraviolet rays.419 Combinations of 1,000 to 2,000 IU per day of vitamin E and 2,000 to 3,000 mg per day of vitamin C, but neither given alone, have a significant protective effect against ultraviolet rays, according to double-blind studies.420 , 421 , 422

Oral synthetic beta-carotene alone was not found to provide effective protection when given in amounts of 15 mg per day or for only a few weeks’ time in larger amounts of 60 to 90 mg per day, but it has been effective either in very large (180 mg per day) amounts or in smaller amounts (30 mg per day) in combination with topical sunscreen.423 , 424 , 425 , 426 , 427

Natural sources of beta-carotene or other carotenoids have been more consistently shown to protect against sunburn. One controlled study found that taking a supplement of natural carotenoids (almost all of which was beta-carotene) in daily amounts of 30 mg, 60 mg, and 90 mg gave progressively more protection against ultraviolet rays.428 In another controlled study, either 24 mg per day of natural beta-carotene or 24 mg per day of a carotenoid combination of equal amounts beta-carotene, lutein, and lycopene helped protect skin from ultraviolet rays.429 A preliminary study compared synthetic lycopene (10.1 mg per day), a natural tomato extract containing 9.8 mg of lycopene per day plus additional amounts of other carotenoids, and a solubilized tomato drink (designed to increase lycopene absorption) containing 8.2 mg of lycopene plus additional amounts of other carotenoids. After 12 weeks, only the two tomato-based products were shown to give significant protection against burning by ultraviolet light.430

Still other trials have tested combinations of several antioxidants. One preliminary study found that a daily combination of beta-carotene (6 mg), lycopene (6 mg), vitamin E (15 IU), and selenium for seven weeks protected against ultraviolet light.431 However, a double-blind trial of a combination of smaller amounts of several carotenoids, vitamins C and E, selenium, and proanthocyanidins did not find significant UV protection compared with placebo.432 Similarly, in a controlled trial, a combination of selenium, copper, and vitamins was found to be ineffective.433

It should be noted that while oral protection from sunburn has been demonstrated with several types of antioxidants, the degree of protection (typically less than an SPF of 2) is much less than that provided by currently available topical sunscreens. On the other hand, these modest effects will provide some added protection to skin areas where sunscreen is also used and will give a small amount of protection to sun-exposed areas where sunscreen is not applied. However, oral protection from sunburn is not instantaneous; maximum effects are not reached until these antioxidants have been used for about eight to ten weeks.434 , 435

How It Works

How to Use It

The recommended dietary allowance for vitamin E is low, just 15 mg or approximately 22 International Units (IU) per day. The most commonly recommended amount of supplemental vitamin E for adults is 400 to 800 IU per day. However, some leading researchers suggest taking only 100 to 200 IU per day, since trials that have explored the long-term effects of different supplemental levels suggest no further benefit beyond that amount. In addition, research reporting positive effects with 400 to 800 IU per day has not investigated the effects of lower intakes.436 For tardive dyskinesia, the best results have been achieved from 1,600 IU per day,437 a large amount that should be supervised by a healthcare practitioner.

Where to Find It

Wheat germ oil, nuts and seeds, whole grains, egg yolks, and leafy green vegetables all contain vitamin E. Certain vegetable oils should contain significant amounts of vitamin E. However, many of the vegetable oils sold in supermarkets have had the vitamin E removed in processing. The high amounts found in supplements, often 100 to 800 IU per day, are not obtainable from eating food.

Possible Deficiencies

Severe vitamin E deficiencies are rare. People with a genetic defect in a vitamin E transfer protein have severe vitamin E deficiency, characterized by low blood and tissue levels of vitamin E and progressive nerve abnormalities.438 , 439

Low vitamin E status has been associated with an increased risk of rheumatoid arthritis440 and major depression.441 Women with preeclampsia have been found to have lower blood levels of vitamin E than women without the condition.442

Very old people with type 2 diabetes have shown a significant age-related decline in blood levels of vitamin E, irrespective of their dietary intake.443

Best Form to Take

The names of all types of vitamin E begin with either “d” or “dl,” which refer to differences in chemical structure. The “d” form is natural (also known as RRR-alpha tocopherol) and “dl” is synthetic (more correctly known as all-rac-alpha tocopherol). The natural form is more active and better absorbed. Little is known about how the “unnatural” “l” portion of the synthetic “dl” form affects the body, though no clear toxicity has been discovered.

In theory, when a vitamin E supplement is labeled “400 IU” it should have the same level of activity regardless of its source. This is purportedly achieved by using more synthetic vitamin E to reach the same potency as a lesser amount of natural vitamin E. For example, 100 IU of vitamin E requires about 67 mg of the natural form but closer to 100 mg of the synthetic. However, a recent review of the scientific evidence suggests that natural vitamin E probably has greater activity in the body than indicated on the label.444 Natural vitamin E may be as much as twice as bioavailable as synthetic vitamin E, not 1.36 times as is generally accepted.445 Many doctors advise people to use only the natural, the “d” form, of vitamin E.

After the “d” or “dl” designation, often the Greek letter “alpha” appears, which also describes the structure. Synthetic “dl” vitamin E is found only in the alpha form—as in “dl-alpha tocopherol.” Natural vitamin E may be found either as alpha—as in “d-alpha tocopherol”—or in combination with beta, gamma, and delta, labeled “mixed”—as in mixed natural tocopherols.

Little is known about the importance of the beta and delta forms of vitamin E, but a debate has arisen concerning gamma tocopherol. In a test tube study, gamma tocopherol was found to be more effective than alpha tocopherol in protecting against certain specific types of oxidative damage.446 In addition, some research has shown that supplementation with large amounts of alpha tocopherol (such as 1,200 IU per day) increases the breakdown, and decreases blood levels, of gamma tocopherol.447

Human trials with vitamin E have almost always been done with the alpha (not gamma) form. Historically the synthetic “dl” form was used in most trials, but some trials are now using the natural form. The issue of alpha vs. gamma form requires more research before it can be fully understood.

Almost all vitamin E research shows that, when positive results are obtained, hundreds of units per day are required—an amount easily obtained with supplements but impossible with food. Therefore, switching to food sources, as suggested by some researchers, is impractical. On the other hand, the vitamin E occurring naturally in food contains gamma tocopherol and other tocopherols. Thus, it possibly may turn out to be more effective than the vitamin E taken in supplement form. Additional research is needed in this area.

Vitamin E forms are listed as either plain “tocopherol” or tocopheryl followed by the name of what is attached to it, as in “tocopheryl acetate.” The two forms are not greatly different. However, plain tocopherol may be absorbed a little better, while tocopheryl attached forms have a slightly better shelf life. Both forms are active when taken by mouth. However, the skin utilizes the tocopheryl forms very slowly,448 , 449 so those planning to apply vitamin E to the skin should buy plain tocopherol. In health food stores, the most common forms of vitamin E are d-alpha tocopherol and d-alpha tocopheryl acetate or succinate. Both of these d (natural) alpha forms are frequently recommended by doctors. Although the succinate form is slightly weaker than the acetate form, more milligrams of the succinate form are added to supplements to compensate for this small difference in potency. Therefore, 400 IU of either form should have equivalent potency.

 Dry powder vitamin E supplements (as alpha tocopheryl succinate or acetate) are sometimes used because they are dispersible in cold water. They may be efficiently absorbed even when taken on an empty stomach or with a low-fat meal. The oil forms of vitamin E may be poorly absorbed unless taken with several grams of fats or oils.

Interactions

Interactions with Supplements, Foods, & Other Compounds

Patients on kidney dialysis who are given injections of iron frequently experience “oxidative stress.” This is because iron is a pro-oxidant, meaning that it interacts with oxygen molecules in ways that may damage tissues. These adverse effects of iron therapy may be counteracted by supplementation with vitamin E.450

A diet high in unsaturated fat increases vitamin E requirements. Vitamin E and selenium work together to protect fat-soluble parts of the body.

Interactions with Medicines

Certain medicines interact with this supplement.

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Carbamazepine

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.460 , 461 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Cholestyramine

    Bile acid sequestrants may prevent absorption of folic acid and the fat-soluble vitamins A, D, E, and K.469 , 470 Other medications and vitamin supplements should be taken one hour before or four to six hours after bile acid sequestrants for optimal absorption.471 Animal studies suggest calcium and zinc may also be depleted by taking cholestyramine.472

  • Colesevelam

    Bile acid sequestrants may prevent absorption of folic acid and the fat-soluble vitamins A, D, E, and K.487 , 488 Other medications and vitamin supplements should be taken one hour before or four to six hours after bile acid sequestrants for optimal absorption.489 Animal studies suggest calcium and zinc may also be depleted by taking cholestyramine.490

  • Colestipol

    Bile acid sequestrants, including colestipol, may prevent absorption of folic acid and the fat-soluble vitamins A, D, E, K.491 , 492 People taking colestipol should consult with their doctor about vitamin malabsorption and supplementation. People should take other drugs and vitamin supplements one hour before or four to six hours after colestipol to improve absorption.493

    Animal studies suggest calcium and zinc may be depleted by taking cholestyramine, another bile acid sequestrant. 494 Whether these same interactions would occur with colestipol is not known.

  • Felbamate

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.522 , 523 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Gemfibrozil

    In a randomized study of 21 men with combined hyperlipidemia, ten to twelve weeks of gemfibrozil therapy reduced alpha- and gamma-tocopherol blood levels to the levels seen in healthy men.540 The clinical significance of this finding is unknown and may reflect a normal physiological response to a reduction in serum cholesterol levels.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Isoniazid

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin), vitamin B12, vitamin D, and vitamin E, folic acid, calcium, and magnesium.559 , 560 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.561 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Levetiracetam

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.563 , 564 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Mineral Oil

    Mineral oil has interfered with the absorption of many nutrients, including beta-carotene, calcium, phosphorus, potassium, and vitamins A, D, K, and E in some,579 but not all,580 research. Taking mineral oil on an empty stomach may reduce this interference. It makes sense to take a daily multivitamin-mineral supplement two hours before or after mineral oil. It is important to read labels, because many multivitamins do not contain vitamin K or contain inadequate (less than 100 mcg per day) amounts.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Orlistat

    Taking orlistat dramatically reduces the absorption of vitamin E,581 which might result in deficiency symptoms. Therefore, people taking orlistat for long periods of time should supplement with vitamin E.

  • Oxcarbazepine

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.582 , 583 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Phenytoin

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.591 , 592 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs should probably supplement with 100 to 200 IU of vitamin E daily to prevent a deficiency.

  • Primidone

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.600 , 601 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Topiramate

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.612 , 613 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

  • Zonisamide

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.614 , 615 Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs might supplement with 100 to 200 IU of vitamin E daily to help prevent a deficiency.

Reduce Side Effects

  • Amiodarone

    Test tube research on human lung tissue suggests that vitamin E might reduce lung toxicity caused by amiodarone.451 More research is needed to further investigate this possibility.

  • Anthralin

    Anthralin can cause inflammation of the skin. A preliminary study found that topical use of vitamin E was able to protect against this side effect.452 This report used a tocopherol form of the vitamin rather than tocopheryl. This makes sense, as there is no conclusive proof that the tocopheryl forms (which require an enzyme to split vitamin E from the fatty acid to which it is attached) have any activity on the skin.

  • Capecitabine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.453 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.454 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.455 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,456 and not all studies have found vitamin E to be effective.457 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).458 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.459

  • Carboplatin

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.462 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.463 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.464 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,465 and not all studies have found vitamin E to be effective.466 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).467 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.468

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Cisplatin

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.473 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.474 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.475 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,476 and not all studies have found vitamin E to be effective.477 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).478 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.479

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Cladribine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.480 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.481 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.482 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,483 and not all studies have found vitamin E to be effective.484 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).485 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.486

  • Cyclophosphamide

    Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.495 However, most scientific research does not support this supposition.

    Cyclophosphamide requires activation by the liver through a process called oxidation. In theory, antioxidant nutrients (vitamin A, vitamin E, beta-carotene and others) might interfere with the activation of cyclophosphamide. There is no published research linking antioxidant vitamins to reduced cyclophosphamide effectiveness in cancer treatment. In a study of mice with vitamin A deficiency, vitamin A supplementation enhanced the anticancer action of cyclophosphamide.496 Another animal research report indicated that vitamin C may increase the effectiveness of cyclophosphamide without producing new side effects.497 Preliminary human research found that adding antioxidants (beta-carotene, vitamin A, and vitamin E) to cyclophosphamide therapy increased the survival of people with small-cell lung cancer treated with cyclophosphamide.498 It is too early to know if adding antioxidants to cyclophosphamide for cancer treatment is better than cyclophosphamide alone. Vitamin A can be toxic in high amounts.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Cytarabine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.500 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.501 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.502 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,503 and not all studies have found vitamin E to be effective.504 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).505 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.506

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Dapsone

    In large amounts, dapsone causes oxidative damage to red blood cells. This damage may be reduced by using lower amounts of dapsone. Fifteen people who took dapsone for dermatitis herpetiformis were given 800 IU of vitamin E per day for four weeks, followed by four weeks with 1,000 mg of vitamin C per day, followed by four weeks of vitamin E and vitamin C together.507 The authors reported only vitamin E therapy offered some protection against dapsone-induced hemolysis.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Doxorubicin

    Animal studies show that the antioxidant activity of vitamin E protects against doxorubicin-induced cardiotoxicity.508 , 509 Test tube evidence suggests that vitamin E might also enhance the anticancer action of the drug.510 Human trials exploring the cardioprotective action of vitamin E in people taking doxorubicin remain inconclusive; however, some evidence suggests that vitamin E may allow for higher drug doses without increasing toxicity.511

    Anecdotal reports indicate that very high (1,600 IU) amounts of vitamin E may reduce the amount of hair loss accompanying use of doxorubicin.512 However, while protection against hair loss was confirmed in a rabbit study, human research has not found this to be true.513

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Erlotinib

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.514 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.515 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.516 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,517 and not all studies have found vitamin E to be effective.518 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).519 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.520

  • Erythromycin-Benzoyl Peroxide

    Animal studies show that benzoyl peroxide promotes tumor growth, yet the significance of this finding in humans is unknown. A test tube study showed that when exposed to vitamin E, human skin cells were more resistant to damage caused by benzoyl peroxide.521 Controlled research is needed to determine whether use of benzoyl peroxide products by humans promotes tumor growth and whether vitamin E might prevent this damage.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Fenofibrate

    Several studies have shown that fenofibrate enhances the toxic effect of ultraviolet (UV) radiation from the sun, which might result in side effects such as skin rashes. One controlled study showed that taking 2 grams of vitamin C and 1,000 IU of vitamin E prior to ultraviolet exposure dramatically blocked UV-fenofibrate damage to red blood cells.524 though further controlled studies are needed, people taking fenofibrate should probably supplement with vitamins C and E until more information is available.

  • Floxuridine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.525 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.526 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.527 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,528 and not all studies have found vitamin E to be effective.529 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).530 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.531

    The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.532

  • Fludarabine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.533 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.534 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.535 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,536 and not all studies have found vitamin E to be effective.537 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).538 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.539

  • Haloperidol

    Haloperidol and related antipsychotic drugs can cause a movement disorder called tardive dyskinesia. Several double-blind studies suggest that vitamin E may be beneficial for treatment of tardive dyskinesia.543 Taking the large amount of 1,600 IU per day of vitamin E simultaneously with antipsychotic drugs has also been shown to lessen symptoms of tardive dyskinesia.544 It is unknown if combining vitamin E with haloperidol could prevent tardive dyskinesia.

  • Hydroxyurea

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.545 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.546 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.547 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,548 and not all studies have found vitamin E to be effective.549 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).550 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.551

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Irinotecan

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.552 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.553 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.554 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,555 and not all studies have found vitamin E to be effective.556 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).557 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.558

  • Isotretinoin

    Preliminary research has found that combined administration of isotretinoin and vitamin E (alpha-tocopherol) substantially reduces the initial toxicity of high-dose isotretinoin without reducing drug efficacy.562 Additional research is needed to further clarify this potentially beneficial interaction.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Lindane

    Test tube studies reveal that vitamin E protects white blood cells from damage caused by lindane.565 Lindane is known to promote the formation of tumors,566 and more research is needed to determine whether vitamin E, when applied at the same time as lindane, can prevent this adverse effect.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Mercaptopurine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.567 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.568 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.569 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,570 and not all studies have found vitamin E to be effective.571 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).572 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.573

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Methotrexate

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.574 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.575 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.576 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,577 and not all studies have found vitamin E to be effective.578 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

  • Paclitaxel

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.584 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.585 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.586 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,587 and not all studies have found vitamin E to be effective.588 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form. In another study, supplementation with vitamin E orally (600 IU per day) reduced the incidence of paclitaxel-induced nerve damage.589

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Polifeprosan 20 with Carmustine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.593 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.594 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.595 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,596 and not all studies have found vitamin E to be effective.597 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).598 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.599

  • Risperidone

    Vitamin E along with vitamin B6 was used to treat a side effect of risperidone called neuroleptic malignant syndrome in a 74-year-old woman, and results were encouraging.602 However, whether vitamin E and vitamin B6 supplementation might help prevent this condition in people taking risperidone is unknown.

  • Sorafenib
    One of the side effects of sorafenib is a severe skin reaction (hand-foot skin syndrome) that often ends treatment. In a preliminary study, supplementing with 300 IU per day of vitamin E produced marked improvement in sorafenib-induced hand-foot skin syndrome within 10 to 12 days, even though the patients continued to take the sorafenib.604
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Thioguanine

    Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.605 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.

    In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.606 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.607 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,608 and not all studies have found vitamin E to be effective.609 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.

    In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).610 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.611

Support Medicine

  • Cyclosporine

    Twenty-six liver transplant patients (both adults and children) unable to achieve or maintain therapeutic cyclosporine blood levels during the early post-transplant period were given water-soluble vitamin E in the amount of 6.25 IU/2.2 pounds of body weight two times per day.499 Addition of vitamin E in the early post-transplant period reduced the required amount of cyclosporine and the cost of cyclosporine therapy by 26%. These results imply that the addition of vitamin E to established cyclosporine therapy allows for a decrease in the amount of cyclosporine. Combining vitamin E and cyclosporine requires medical supervision to avoid cyclosporine toxicity.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Griseofulvin

    Adding 50 IU of vitamin E per day was reported to increase blood levels of this drug within four weeks in children, allowing the drug dose to be cut in half. Reducing the amount of griseofulvin should decrease the likelihood of side effects. This evidence is preliminary, so people taking griseofulvin should not supplement vitamin E on their own but may wish to discuss this matter with their doctor.541

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Pentoxifylline

    The combination of vitamin E and pentoxifylline has been used successfully to reduce damage to normal tissues caused by radiation therapy.590

  • Sodium Fluoride

    Vitamin E increases the resistance of tooth enamel to acids that cause cavities, and test tube studies show that fluoride, when added to vitamin E, enhances this effect.603 Controlled research is needed to determine whether people might develop fewer cavities when taking vitamin E and fluoride together.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Aspirin

    Although vitamin E is thought to act like a blood thinner, very little research has supported this idea. In fact, a double-blind trial found that very high amounts of vitamin E do not increase the effects of the powerful blood-thinning drug warfarin.616 Nonetheless, a double-blind study of smokers found the combination of aspirin plus 50 IU per day of vitamin E led to a statistically significant increase in bleeding gums compared with taking aspirin alone (affecting one person in three versus one in four with just aspirin).617 The authors concluded that vitamin E might, especially if combined with aspirin, increase the risk of bleedings.

Explanation Required

  • AZT

    Animal studies suggest that vitamin E may improve the efficacy of AZT.618 The practical importance of this finding remains unclear.

  • Lovastatin

    Oxidative damage to LDL (“bad”) cholesterol is widely believed to contribute to heart disease. In a double-blind trial, lovastatin was found to increase oxidative damage to LDL cholesterol and vitamin E was reported to protect against such damage, though not to completely overcome the negative effect of lovastatin.619 This study suggests that people taking lovastatin might benefit from supplemental vitamin E.

  • Simvastatin

    In a study of seven patients with hypercholesterolemia, eight weeks of simvastatin plus vitamin E 300 IU improved markers of blood vessel elasticity more than simvastatin alone.620

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Valproate

    Two studies showed that individuals taking phenytoin and phenobarbital had lower blood vitamin E levels than those who received no treatment for seizures.621 , 622 It is not known whether this same interaction occurs with valproic acid. Though the consequences of lower blood levels of vitamin E are unknown, people taking multiple anticonvulsant drugs should probably supplement with 100 to 200 IU of vitamin E daily to prevent a deficiency.

    On the basis of the biochemical actions of valproic acid, it has been suggested that people taking valproic acid should make sure they have adequate intakes of vitamin E and selenium.623 The importance of supplementation with either nutrient has not yet been tested, however.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Side Effects

Vitamin E toxicity is very rare and supplements are widely considered to be safe. The National Academy of Sciences has established the daily tolerable upper intake level for adults to be 1,000 mg of vitamin E, which is equivalent to 1,500 IU of natural vitamin E or 1,100 IU of synthetic vitamin E.624

In a double-blind study of healthy elderly people, supplementation with 200 IU of vitamin E per day for 15 months had no effect in the incidence of respiratory infections, but increased the severity of those infections that did occur.625 For elderly individuals, the risks and benefits of taking this vitamin should be assessed with the help of a doctor or nutritionist.

In contrast to trials suggesting vitamin E improves glucose tolerance in people with diabetes, one trial reported that 600 IU per day of vitamin E led to impairment in glucose tolerance in obese people with diabetes.626 The reason for the discrepancy between reports is not known.

In a double-blind study of people with established heart disease or diabetes, participants who took 400 IU of vitamin E per day for an average of 4.5 years developed heart failure significantly more often than did those taking a placebo.627 Hospitalizations for heart failure occurred in 5.8% of those in the vitamin E group, compared with 4.2% of those in the placebo group, a 38.1% increase. Considering that some other studies have shown a beneficial effect of vitamin E against heart disease, the results of this study are difficult to interpret. Nevertheless, individuals with heart disease or diabetes should consult their doctor before taking vitamin E.

A review of 19 clinical trials of vitamin E supplementation concluded that long-term use of large amounts of vitamin E (400 IU per day or more) was associated with a small (4%) but statistically significant increase in risk of death.628 Long-term use of less than 400 IU per day was associated with a small and statistically nonsignificant reduction in death rates. This research has been criticized because many of the studies on which it was based used a combination of nutritional supplements, not just vitamin E. For example, the adverse effects reported in some of the studies may have been due to the use of large amounts of zinc or synthetic beta-carotene, and may have had nothing to do with vitamin E. It is also possible that long-term use of large amounts of pure alpha-tocopherol may lead to a deficiency of gamma-tocopherol, with potential negative consequences. For that reason, some doctors recommend that people who need to take large amounts of vitamin E take at least part of it in the form of mixed tocopherols.

References

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188. Loebstein R, Lehotay DC, Luo X, et al. Diabetic nephropathy in hypertransfused patients with beta-thalassemia. The role of oxidative stress. Diabetes Care 1998;21:1306–9.

189. Livrea MA, Tesoriere L, Maggio A, et al. Oxidative modification of low-density lipoprotein and atherogenetic risk in beta-thalassemia. Blood 1998;92:3936–42.

190. De Luca C, Filosa A, Grandinetti M, et al. Blood antioxidant status and urinary levels of catecholamine metabolites in beta-thalassemia. Free Radic Res 1999;30:453–62.

191. Da Fonseca SF, Kimura EY, Kerbauy J. Assessment of iron status in individuals with heterozygotic beta-thalassemia. Rev Assoc Med Bras 1995;41:203–6 [in Portuguese].

192. Miniero R, Canducci E, Ghigo D, et al. Vitamin E in beta-thalassemia. Acta Vitaminol Enzymol 1982;4:21–5.

193. Giardini O, Cantani A, Donfrancesco A, et al. Biochemical and clinical effects of vitamin E administration in homozygous beta-thalassemia. Acta Vitaminol Enzymol 1985;7:55–60.

194. Suthutvoravut U, Hathirat P, Sirichakwal P, et al. Vitamin E status, glutathione peroxidase activity and the effect of vitamin E supplementation in children with thalassemia. J Med Assoc Thai 1993;76 Suppl 2:146–52.

195. Giardini O, Cantani A, Donfrancesco A, et al. Biochemical and clinical effects of vitamin E administration in homozygous beta-thalassemia. Acta Vitaminol Enzymol 1985;7:55–60.

196. Miniero R, Canducci E, Ghigo D, et al. Vitamin E in beta-thalassemia. Acta Vitaminol Enzymol 1982;4:21–5.

197. Knekt P, Reunanen A, Marniumi J, et al. Low vitamin E status is a potential risk factor for insulin-dependent diabetes mellitus. J Intern Med 1999;245:99–102.

198. Salonen JT, Nyssonen K, Tuomainen T-P, et al. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. BMJ 1995;311:1124–7.

199. Bierenbaum ML, Noonan FJ, Machlin LJ, et al. The effect of supplemental vitamin E on serum parameters in diabetics, post coronary and normal subjects. Nutr Rep Int 1985;31:1171–80.

200. Paolisso G, D’Amore A, Giugliano D, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin dependent diabetic patients. Am J Clin Nutr 1993;57:650–6.

201. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

202. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

203. Paolisso G, Di Maro G, Galzerano D, et al. Pharmacological doses of vitamin E and insulin action in elderly subjects. Am J Clin Nutr 1994;59:1291–6.

204. Paolisso G, Gambardella A, Galzerano D, et al. Antioxidants in adipose tissue and risk of myocardial infarction. Lancet 1994;343:596 [letter].

205. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

206. Ross WM, Creighton MO, Stewart-DeHaan PJ, et al. Modelling cortical cataractogenesis: 3. In vivo effects of vitamin E on cataractogenesis in diabetic rats. Can J Ophthalmol 1982;17:61.

207. Bursell SE, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245–51.

208. Ceriello A, Giugliano D, Quatraro A, et al. Vitamin E reduction of protein glycosylation in diabetes. Diabetes Care 1991;14:68–72.

209. Duntas L, Kemmer TP, Vorberg B, Scherbaum W. Administration of d-alpha-tocopherol in patients with insulin-dependent diabetes mellitus. Curr Ther Res 1996;57:682–90.

210. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

211. Jain SK, McVie R, Jaramillo JJ, et al. Effect of modest vitamin E supplementation on blood glycated hemoglobin and triglyceride levels and red cell indices in type I diabetic patients. J Am Coll Nutr 1996;15:458–61.

212. Jain SK, McVie R, Smith T. Vitamin E supplementation restores glutathione and malondialdehyde to normal concentrations in erythrocytes of type 1 diabetic children. Diabetes Care 2000;23:1389–94.

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214. Bursell S-E, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatineine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245–51.

215. Fuller CJ, Chandalia M, Garg A, et al. RRR-alpha-tocopheryl acetate supplementation at pharmacologic doses decreases low-density-lipoprotein oxidative susceptibility but not protein glycation in patients with diabetes mellitus. Am J Clin Nutr 1996;63:753–9.

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218. Knekt P, Reunanen A, Marniumi J, et al. Low vitamin E status is a potential risk factor for insulin-dependent diabetes mellitus. J Intern Med 1999;245:99–102.

219. Salonen JT, Nyssonen K, Tuomainen T-P, et al. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. BMJ 1995;311:1124–7.

220. Bierenbaum ML, Noonan FJ, Machlin LJ, et al. The effect of supplemental vitamin E on serum parameters in diabetics, post coronary and normal subjects. Nutr Rep Int 1985;31:1171–80.

221. Paolisso G, D’Amore A, Giugliano D, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin dependent diabetic patients. Am J Clin Nutr 1993;57:650–6.

222. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

223. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

224. Paolisso G, Di Maro G, Galzerano D, et al. Pharmacological doses of vitamin E and insulin action in elderly subjects. Am J Clin Nutr 1994;59:1291–6.

225. Paolisso G, Gambardella A, Galzerano D, et al. Antioxidants in adipose tissue and risk of myocardial infarction. Lancet 1994;343:596 [letter].

226. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

227. Ross WM, Creighton MO, Stewart-DeHaan PJ, et al. Modelling cortical cataractogenesis: 3. In vivo effects of vitamin E on cataractogenesis in diabetic rats. Can J Ophthalmol 1982;17:61.

228. Bursell SE, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245–51.

229. Ceriello A, Giugliano D, Quatraro A, et al. Vitamin E reduction of protein glycosylation in diabetes. Diabetes Care 1991;14:68–72.

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548. Lopez I, Goudou C, Ribrag V, et al. Traitement des mucites par la vitamine E lors de l’administration d’anti-neoplasiques neutropeniants. Ann Med Interne 1994;145:405–8.

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596. Lopez I, Goudou C, Ribrag V, et al. Traitement des mucites par la vitamine E lors de l’administration d’anti-neoplasiques neutropeniants. Ann Med Interne 1994;145:405–8.

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