~ Vitamin E Controversy: Cause or Correlation?

By Shereen Jegtvig, Your Guide to Nutrition

The Safety Of Vitamin E Is Questioned

A recent study published in the Annals of Internal Medicine states that high doses of vitamin E are dangerous and should be avoided. This study considered doses in excess of 400 IU per day to be high and doses less than 400 IU per day to be low. How valid is this conclusion that high doses of vitamin E are dangerous?

Vitamin E

Vitamin E is an oil soluble vitamin that is found in oils, nuts, and seeds. It is considered to be an anti-oxidant vitamin, although a specific metabolic function of vitamin E hasn't been determined yet. Large doses will act as an anti-coagulant or blood thinner. The Recommended Daily Allowance for vitamin E is about 20 International Units/day.

There are different forms of vitamin E including gamma-tocopherol and the better-known alpha tocopherol.

The RDA was set for alpha tocopherol. Artificial dl-alpha tocopherol is considered to be half as active as natural vitamin E. The gamma-tocopherol form of vitamin E may have potential physiological benefits and warrants further study.

Protective Nutrient or Therapeutic Natural Medicine?

Vitamin E is an anti-coagulant, or "blood-thinner" and could possibly be used to prevent and dissolves blood clots. Vitamin E has also been used by doctors to relieve leg cramps, celiac disease, cystic fibrosis, and to reduce angina pain. There are observational studies that suggest a correlation between vitamin E supplement use and the risk of coronary disease in both men and women. Some observational studies suggest a correlation between vitamin E supplement use and the risk of coronary disease in both men and women.

Vitamin E Studies

There are several studies on the use of vitamin E, however according to these studies, there has been no conclusive evidence that vitamin E will reduce the risk of heart disease and other chronic diseases. The recent study Dr. E Miller1 is an analysis of death rates in study populations gleaned from 19 different research projects that included vitamin E use. The studies included vitamin E as a potential treatment for, or prevention of various diseases such as heart disease, Alzheimer's Disease, and cataracts. In order for the research populations to be included in this study, each project had to have patients take vitamin E for at least one year, and each study had to have at least ten deaths during or after the time of the study.

The results, according to Dr. Miller, show that lower doses of vitamin E may be slightly protective for death, but that higher doses may slightly increase the patients risk of death. He concluded that vitamin E used in high doses is dangerous.

Potential Problems with the Study

This was an analysis of several studies involving the use of vitamin E for various diseases. It did not include some observational studies which have shown a correlation between vitamin E used and a reduced risk of coronary disease. Some potential problems that could confound the results of this study include the following:
  • Vitamin E was often used in combination with pharmaceutical drugs being studied; the effects of these combinations were not discussed in the research.

  • The populations being studied mostly consisted of elderly people with chronic diseases. The paper recognizes this as a possible confounder, because elderly, sick people are more likely to be taking high doses of vitamin E. It would not be possible to generalize the findings to a young and healthy population.

  • The study looked at different types of research studies that used different protocols and procedures such as different doses of vitamin E taken for different lengths of time.

  • The original studies didn't necessarily differentiate between natural and synthetic vitamin E.

  • Some of the results of the original studies have been questioned.
How Much Vitamin E to Take

The study claims to find a relative risk of 1.05. A relative risk of 1.05 is not really significant for an association between death of any kind and high dose vitamin E consumption, since a relative risk of 1.0 is neutral. Due to the conditions of this study, warnings that claim vitamin E consumption is dangerous are premature. The slight increase of risk may be due to some of the problems noted. Patients currently undertaking high dose vitamin E therapy need not panic, however it is understandable that these people might like to discuss their current therapy with their doctor or nutritionist, but this latest study is not conclusive. Most experts agree that vitamin E is safe.

If you want to take vitamin E to help maintain your good health, it is perfectly safe and beneficial to add vitamin E as a vitamin supplement.

If you eat a low fat diet, Vitamin E could easily be deficient.

If you are considering taking higher doses of vitamin E for therapeutic benefit, consult a health professional first to discuss the side effects of vitamin E, and to help determine a dosage of vitamin E that will benefit you.

References:
  1. Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E., Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality, Ann Intern Med. 2004 Nov 10.
  2. Traber, Maret G., Which Form of Vitamin E, Alpha- or Gamma-Tocopherol, is Better?,Linus Pauling Institute Report.
  3. Cathcart, III, M.D, Robert F., Vitamin E and Leg Cramps,JAMA, Jan. 10, 1972, Vol. 219, No. 2.
  4. Aslam A, Misbah SA, Talbot K, Chapel H, Vitamin E deficiency induced neurological disease in common variable immunodeficiency: two cases and a review of the literature of vitamin E deficiency., Clin Immunol. 2004 Jul;112(1):24-9.
  5. Gray SL, Hanlon JT, Fillenbaum GG, Wall WE Jr, Bales, Predictors of nutritional supplement use by the elderly., Pharmacotherapy. 1996 Jul-Aug;16(4):715-20.
  6. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC, Vitamin E consumption and the risk of coronary disease in women., N Engl J Med. 1993 May 20;328(20):1444-9.
  7. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC, Vitamin E consumption and the risk of coronary heart disease in men., N Engl J Med. 1993 May 20;328(20):1450-6.
  8. Position Statement, Council for Responsible Nutrition, November 19, 2002.
  9. Kofman O. S., Shoulson I, Protective Effect or Symptomatic Effect of Deprenyl, N Engl J Med 1993; 328:1715, Jun 10, 1993. Correspondence.


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