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Vitamin E From the U.S. National Institute of Health
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Vitamin E: What is it?
Vitamin E is a fat-soluble vitamin that exists in eight
different forms. Each form has its own biological activity,
which is the measure of potency or functional use in the body [1].
Alpha-tocopherol (α-tocopherol) is the name of the most active
form of vitamin E in humans. It is also a powerful biological
antioxidant [2-3].
Vitamin E in supplements is usually sold as alpha-tocopheryl
acetate, a form that protects its ability to function as an
antioxidant. The synthetic form is labeled "D, L" while the
natural form is labeled "D". The synthetic form is only half as
active as the natural form [4].
Antioxidants such as vitamin E act to protect your cells against
the effects of free radicals, which are potentially damaging
by-products of energy metabolism. Free radicals can damage cells
and may contribute to the development of cardiovascular disease
and cancer. Studies are underway to determine whether vitamin E,
through its ability to limit production of free radicals, might
help prevent or delay the development of those chronic diseases.
Vitamin E has also been shown to play a role in immune function,
in DNA repair, and other metabolic processes [2-3].
What foods provide vitamin E?
Vegetable oils, nuts, green leafy vegetables, and fortified
cereals are common food sources of vitamin E in the United
States (U.S.). Table 1, Selected Food Sources of Vitamin E,
suggests many food sources of vitamin E [4].
Food values are listed in alpha-tocopherol equivalents (ATE) to
account for the variation in biological activity of the
different forms of vitamin E.
Table 1: Selected Food Sources of Vitamin E [4]
| FOOD |
Milligrams (mg)
Alpha-tocopherol
per serving |
Percent
DV* |
| Wheat germ oil, 1 tablespoon |
20.3 |
100 |
| Almonds, dry roasted, 1 ounce |
7.4 |
40 |
| Sunflower seed kernels, dry roasted, 1 ounce |
6.0 |
30 |
| Sunflower oil, over 60% linoleic, 1 tablespoon |
5.6 |
30 |
| Safflower oil, over 70% oleic, 1 tablespoon |
4.6 |
25 |
| Hazelnuts, dry roasted, 1 ounce |
4.3 |
20 |
| Peanut butter, smooth style, vitamin and mineral
fortified, 2 Tablespoons |
4.2 |
20 |
| Peanuts, dry roasted, 1 oz |
2.2 |
10 |
| Corn oil (salad or vegetable oil), 1 tablespoon |
1.9 |
10 |
| Spinach, frozen, chopped, boiled, ˝ cup |
1.6 |
6 |
| Broccoli, frozen, chopped, boiled, ˝ cup |
1.2 |
6 |
| Soybean oil, 1 tablespoon |
1.3 |
6 |
| Kiwi, 1 medium fruit without skin |
1.1 |
6 |
| Mango, raw, without refuse, ˝ cup sliced |
0.9 |
6 |
| Spinach, raw, 1 cup |
0.6 |
4 |
*DV = Daily Value. DVs are reference numbers developed by the
Food and Drug Administration (FDA) to help consumers determine
if a food contains a lot or a little of a specific nutrient. The
DV for vitamin E is 30 International Units (or 20 mg ATE). Most
food labels do not list a food's vitamin E content. The percent
DV (%DV) listed on the table indicates the percentage of the DV
provided in one serving. A food providing 5% of the DV or less
is a low source while a food that provides 10-19% of the DV is a
good source. A food that provides 20% or more of the DV is high
in that nutrient. It is important to remember that foods that
provide lower percentages of the DV also contribute to a
healthful diet. For foods not listed in this table, please refer
to the U.S. Department of Agriculture's Nutrient Database Web
site:
http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.
What is the recommended intake
for vitamin E?
Recommendations for vitamin E are provided in the Dietary
Reference Intakes developed by the Institute of Medicine [5].
Dietary Reference Intakes (DRIs) is the general term
for a set of reference values used for planning and assessing
nutrient intake for healthy people. Three important types of
reference values included in the DRIs are Recommended
Dietary Allowances (RDA), Adequate Intakes (AI),
and Tolerable Upper Intake Levels (UL). The RDA
recommends the average daily dietary intake level that is
sufficient to meet the nutrient requirements of nearly all
(97-98%) healthy individuals in each age and gender group [5].
An AI is set when there is insufficient scientific data
available to establish a RDA. AIs meet or exceed the amount
needed to maintain a nutritional state of adequacy in nearly all
members of a specific age and gender group. The UL, on the other
hand, is the maximum daily intake unlikely to result in adverse
health effects [5].
In Table 2, RDAs for vitamin E are listed as Alpha-Tocopherol
Equivalents (ATE) to account for the different biological
activities of the various forms of vitamin E [5-6].
Table 2 also lists RDAs for vitamin E in International Units (IU)
because food and some supplement labels list vitamin E content
in International Units (1 mg ATE vitamin E = 1.5 IU).
Table 2: Recommended Dietary Allowances for Vitamin E
for Children and Adults [5]
Age
(years) |
Children
(mg/day) |
Men
(mg/day) |
Women
(mg/day) |
Pregnancy
(mg/day) |
Lactation
(mg/day) |
| 1-3 |
6 mg
(=9 IU) |
|
|
|
|
| 4-8 |
7 mg
(=10.5 IU) |
|
|
|
|
| 9-13 |
|
11 mg
(=16.5 IU) |
11 mg
(=16.5 IU) |
15 mg
(=22.5 IU) |
19 mg
(=28.5 IU) |
| 14 + |
|
15 mg
(=22.5 IU) |
15 mg
(=22.5 IU) |
15 mg
(=22.5 IU) |
19 mg
(=28.5 IU) |
There is insufficient scientific data on vitamin E to establish
an RDA for infants. An Adequate Intake (AI) has been established
that is based on the amount of vitamin E consumed by healthy
infants who are fed breast milk. Table 2 lists the adequate
intakes for vitamin E for infants in mg ATE and IUs (1 mg ATE
vitamin E = 1.5 IU) [5].
Table 3: Adequate Intake for Vitamin E for Infants [5]
Age
(months) |
Males and Females
(mg/day) |
| 0 to 6 |
4 mg
(=6 IU) |
| 7 to 12 |
5 mg
(=7.5 IU) |
Results of two national surveys, the National Health and
Nutrition Examination Survey (NHANES III 1988-94) [7]
and the Continuing Survey of Food Intakes by Individuals
(1994-96 CSFII) [8]
indicated that diets of most Americans do not provide the
recommended intake for vitamin E. However, an Institute of
Medicine (IOM) report on vitamin E published in 2000 states that
intake estimates of vitamin E may be low because energy and fat
intake are often underreported in national surveys and because
the kind and amount of fat added during cooking is often not
known. The IOM states that most North American adults get enough
vitamin E from their normal diets to meet current
recommendations. However, they do caution that low fat diets can
result in a significant decrease in vitamin E intake. "Low-fat
diets can substantially decrease vitamin E intakes if food
choices are not carefully made to enhance α-tocopherol intakes"
[5].
Who is at risk for vitamin E
deficiency?
Vitamin E deficiency is rare in humans. There are three
specific situations when a vitamin E deficiency is likely to
occur.
- persons who cannot absorb dietary fat due to an
inability to secrete bile or with rare disorders of fat
metabolism are at risk of vitamin E deficiency [9];
- individuals with rare genetic abnormalities in the
alpha-tocopherol transfer protein are at risk of vitamin E
deficiency [10];
and
- premature, very low birth weight infants (birth weights
less than 1500 grams, or 3 pounds, 4 ounces) are at risk of
vitamin E deficiency [3,6].
Blood levels of vitamin E may also be decreased with zinc
deficiency [11].
Vitamin E deficiency is usually characterized by neurological
problems associated with nerve degeneration in hands and feet [5].
These symptoms are also associated with other medical
conditions. A physician can determine if they are the result of
a vitamin E deficiency or are from another cause.
Who may need extra vitamin E
to prevent a deficiency?
Individuals who cannot absorb fat require a vitamin E
supplement because some dietary fat is needed for the absorption
of vitamin E from the gastrointestinal tract. Intestinal
disorders that often result in malabsorption of vitamin E and
may require vitamin E supplementation include [3]:
- Crohn's Disease is an inflammatory bowel disease that
affects the small intestines. People with Crohn's disease
often experience diarrhea and nutrient malabsorption.
- Cystic Fibrosis is an inherited disease that effects the
lungs, gastrointestinal tract, pancreas, and liver. Cystic
fibrosis can interfere with normal digestion and absorption
of nutrients, especially of fat soluble vitamins including
vitamin E.
People who cannot absorb fat often pass greasy stools or have
chronic diarrhea. People with an inability to secrete bile, a
substance that helps fat digestion, may need a special
water-soluble form of vitamin E.
Abetalipoproteinemia is a rare inherited disorder of fat
metabolism that results in poor absorption of dietary fat and
vitamin E [9]. The
vitamin E deficiency associated with this disease causes
problems such as poor transmission of nerve impulses, muscle
weakness, and degeneration of the retina that can cause
blindness. Individuals with abetalipoproteinemia may be
prescribed special vitamin E supplements by a physician to treat
this disorder [12].
Ataxia and vitamin E deficiency (AVED) is also a rare inherited
disorder. It is caused by a genetic defect in a liver protein
that is responsible for maintaining normal alpha-tocopherol
concentrations in the blood. These individuals have such severe
vitamin E deficiency that without supplements they are unable to
walk (ataxia) [10].
Very low birth weight infants may be deficient in vitamin E [3,6].
Necrotizing enterocolitits, a condition sometimes seen in very
low birth weight infants that is characterized by inflammation
of the lining of the intestines, may lead to a vitamin E
deficiency [4].
These infants are usually under the care of a neonatologist, a
pediatrician specializing in the care of newborns who evaluates
and treats the exact nutritional needs of premature infants.
What are some current issues
and controversies about vitamin E?
Vitamin E and heart disease
Preliminary research has led to a widely held belief that
vitamin E may help prevent or delay coronary heart disease [13].
Researchers have reported that oxidative changes to LDL-cholesterol
(sometimes called "bad" cholesterol) promote blockages
(atherosclerosis) in coronary arteries that may lead to heart
attacks. Vitamin E may help prevent or delay coronary heart
disease by limiting the oxidation of LDL-cholesterol [14].
Vitamin E also may help prevent the formation of blood clots,
which could lead to a heart attack. Observational studies have
associated lower rates of heart disease with higher vitamin E
intake. A study of approximately 90,000 nurses suggested that
the incidence of heart disease was 30% to 40% lower among nurses
with the highest intake of vitamin E from diet and supplements.
Researchers found that the apparent benefit was mainly
associated with intake of vitamin E from dietary supplements.
High vitamin E intake from food was not associated with
significant cardiac risk reduction [15].
A 1994 review of 5,133 Finnish men and women aged 30-69 years
also suggested that increased dietary intake of vitamin E was
associated with decreased mortality (death) from heart disease [16].
Even though these observations are promising, randomized
clinical trials raise questions about the efficacy of vitamin E
supplements in the prevention of heart disease. The Heart
Outcomes Prevention Evaluation (HOPE) Study followed almost
10,000 patients for 4.5 years who were at high risk for heart
attack or stroke [17].
In this intervention study the subjects who received 265 mg (400
IU) of vitamin E daily did not experience significantly fewer
cardiovascular events or hospitalizations for heart failure or
chest pain when compared to those who received a placebo (sugar
pill). The researchers suggested that it is unlikely that the
vitamin E supplement provided any protection against
cardiovascular disease in the HOPE study. This study is
continuing, with the goal of determining whether a longer
duration of intervention with vitamin E supplements will provide
any protection against cardiovascular disease.
In a study sponsored by the National Heart, Lung, and Blood
Institute (NHLBI) of the National Institutes of Health,
postmenopausal women with heart disease who took supplements
providing 400 IU vitamin E and 500 mg vitamin C twice a day,
either alone or in combination with hormones, did not have fewer
heart attacks or deaths. There was also no change in progression
of their coronary disease. This study, The Women's Angiographic
Vitamin and Estrogen (WAVE) trial, studied 423 postmenopausal
women at seven clinical centers in the U.S. and Canada. In
postmenopausal women with coronary disease enrolled in this
trial, neither hormone replacement therapy nor antioxidant
vitamin supplements provided cardiovascular benefit [18].
Results of the Women's Health Study, the Women's Antioxidant and
Cardiovascular Study and the SuVIMAX study, all of which are
investigating the effects of vitamin supplements on the
progression of coronary heart disease, are due in 2005 and will
provide additional information on the association between
vitamin E supplements and cardiovascular disease.
Vitamin E and cancer
Antioxidants such as vitamin E are believed to help protect cell
membranes against the damaging effects of free radicals, which
may contribute to the development of chronic diseases such as
cancer [4].
Vitamin E also may block the formation of nitrosamines, which
are carcinogens formed in the stomach from nitrites consumed in
the diet. It also may protect against the development of cancers
by enhancing immune function [19].
Unfortunately, human trials and surveys that have tried to
associate vitamin E intake with incidence of cancer have been
generally inconclusive.
Some evidence associates higher intake of vitamin E with a
decreased incidence of prostate cancer and breast cancer [20].
However, an examination of the effect of dietary factors,
including vitamin E, on incidence of postmenopausal breast
cancer in over 18,000 women from New York State did not
associate a greater vitamin E intake with a reduced risk of
developing breast cancer [21].
A study of women in Iowa provides evidence that an increased
dietary intake of vitamin E may decrease the risk of colon
cancer, especially in women under 65 years of age [22].
On the other hand, a study of 87,998 females from the Nurses'
Health Study and 47,344 males from the Health Professionals
Follow-up Study failed to support the theory that an increased
dietary intake of vitamin E may decrease the risk of colon
cancer [23].
The American Cancer society recently released the results of a
long-term study that evaluated the effect of regular use of
vitamin C and vitamin E supplements on bladder cancer mortality
in almost 1,000,000 adults in the U.S. The study, conducted
between the years 1982 to 1998, found that subjects who
regularly consumed a vitamin E supplement for longer than 10
years had a reduced risk of death from bladder cancer. No
benefit was seen from vitamin C supplements [24].
At this time researchers cannot confidently recommend vitamin E
supplements for the prevention of cancer because the evidence on
this issue is inconsistent and limited.
Vitamin E and cataracts
Cataracts are abnormal growths in the lens of the eye. These
growths cloud vision. They also increase the risk of disability
and blindness in aging adults. Antioxidants are being studied to
determine whether they can help prevent or delay cataract
growth. Observational studies have found that lens clarity,
which is used to diagnose cataracts, was better in regular users
of vitamin E supplements and in persons with higher blood levels
of vitamin E [25].
A study of middle-aged male smokers, however, did not
demonstrate any effect from vitamin E supplements on the
incidence of cataract formation [26].
The effects of smoking, a major risk factor for developing
cataracts, may have overridden any potential benefit from the
vitamin E, but the conflicting results also indicate a need for
further studies before researchers can confidently recommend
extra vitamin E for the prevention of cataracts.
What is the health risk of too
much vitamin E?
Most studies of the safety of vitamin E supplementation have
lasted for several months or less, so there is little evidence
for the long-term safety of vitamin E supplementation.
| ODS is working on updating
this section of the vitamin E fact sheet to
include the results of meta-analyses and
clinical trials that have been published
recently. A new version will be posted shortly. |
|
The Food and Nutrition Board of the Institute of Medicine has
set an upper tolerable intake level (UL) for vitamin E at 1,000
mg (1,500 IU) for any form of supplementary alpha-tocopherol per
day. Based for the most part on the result of animal studies,
the Board decided that because vitamin E can act as an
anticoagulant and may increase the risk of bleeding problems
this UL is the highest dose unlikely to result in bleeding
problems.
Table 4 lists the Tolerable Upper Intake Levels (UL) of vitamin
E in mg ATE and IUs for children and adults (1 mg ATE vitamin E
= 1.5 IU). A UL for vitamin E for infants up to 12 months of age
has not been established.
Table 4: Tolerable Upper Intake Levels (UL) of vitamin E
for Children and Adults [5]
| Age (years) |
Males
(mg/day) |
Females
(mg/day) |
Pregnancy
(mg/day) |
Lactation
(mg/day) |
| 1-3 |
200
(=300 IU) |
200
(=300 IU) |
N/A |
N/A |
| 4-8 |
300
(=450 IU) |
300
(=450 IU) |
N/A |
N/A |
| 9-13 |
600
(=900 IU) |
600
(=900 IU) |
N/A |
N/A |
| 14-18 |
800
(=1,200 IU) |
800
(=1,200 IU) |
800
(=1,200 IU) |
800
(=1,200 IU) |
| 19-70 |
1,000
(=1,500 IU) |
1,000
(=1,500 IU) |
1,000
(=1,500 IU) |
1,000
(=1,500 IU) |
| > 70 |
1,000
(=1,500 IU) |
1,000
(=1,500 IU) |
N/A
(=1,500 IU) |
N/A
(=1,500 IU) |
Selecting a Healthful Diet
As the 2000 Dietary Guidelines for Americans state,
"Different foods contain different nutrients and other healthful
substances. No single food can supply all the nutrients in the
amounts you need" [29].
Many people are concerned about their fat intake today. Your
overall diet should be moderate in fat, but it is important to
include some healthful sources of fat, including those oils and
nuts that provide vitamin E. Including these foods in your diet
will help you meet your daily need for vitamin E. Meats, grain
products, dairy products, and most fruits and vegetables are
generally not good sources of vitamin E.
For more information about building a healthful diet, refer to
the Dietary Guidelines for Americans
http://www.health.gov/dietaryguidelines [29]
and the US Department of Agriculture's Food Guide Pyramid
http://www.usda.gov/cnpp/pyramid2.htm [30].
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|

Reasonable care has been taken in preparing this document and
the information provided herein is believed to be accurate.
However, this information is not intended to constitute an
"authoritative statement" under Food and Drug Administration
rules and regulations. |

The mission of the Office of Dietary Supplements (ODS) is to
strengthen knowledge and understanding of dietary supplements by
evaluating scientific information, stimulating and supporting
research, disseminating research results, and educating the
public to foster an enhanced quality of life and health for the
U.S. population.
The NIH Clinical Center is the clinical research hospital for
NIH. Through clinical research, physicians and scientist
translate laboratory discoveries into better treatments,
therapies and interventions to improve the nation's health. |

Health professionals and consumers need credible information to
make thoughtful decisions about eating a healthful diet and
using vitamin and mineral supplements. To help guide those
decisions, registered dietitians at the NIH Clinical Center
developed a series of Fact Sheets in conjunction with ODS. These
Fact Sheets provide responsible information about the role of
vitamins and minerals in health and disease. Each Fact Sheet in
this series received extensive review by recognized experts from
the academic and research communities.
The information is not intended to be a substitute for
professional medical advice. It is important to seek the advice
of a physician about any medical condition or symptom. It is
also important to seek the advice of a physician, registered
dietitian, pharmacist, or other qualified health professional
about the appropriateness of taking dietary supplements and
their potential interactions with medications.
|

The Clinical Nutrition Service and the ODS thank the expert
scientific reviewers for their role in ensuring the scientific
accuracy of the information discussed in these fact sheets:
Charles Hennekens, M.D., Dr. P.H., (retired) Brigham and Women’s
Hospital, Boston
Paul LaChance, Ph.D., Rutgers University
Roger McDonald, Ph.D., University of California-Davis Richard S.
Rivlin, M.D., Institute for Cancer revention, New York, New York
Maret Traber, Ph.D., Linus Pauling Institute, Oregon State
University |
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