vitamin E

What can high-vitamin E foods do for you?

• Protect your skin from ultraviolet light
• Prevent cell damage from free radicals
• Allow your cells to communicate effectively
• Help protect against prostate cancer and Alzheimer's disease

What events can indicate a need for more high-vitamin E foods?

• Digestive system problems, especially malabsorption
• Tingling or loss of sensation in the arms, hands, legs, or feet
• Liver or gallbladder problems

Excellent sources of vitamin E include: mustard greens, chard, sunflower seeds, and turnip greens. Very good sources include almonds and spinach.

For serving size for specific foods, see Nutrient Rating Chart below at the bottom of this page.

Description Function Deficiency Symptoms Toxicity Symptoms Cooking, storage and processing Factors that affect function

Drug-nutrient interaction Nutrient interaction Health conditions Supplements Food Sources Public Recommendations References

Description

What is vitamin E?

Even though its name makes it sound like a single substance, vitamin E is actually a family of fat-soluble vitamins that are active throughout the body. Some members of the vitamin E family are called tocopherols. These members include alpha tocopherol, beta tocopherol, gamma tocopherol, and delta tocopherol.

Other members of the vitamin E family are called tocotrienols. These members include alpha, beta, gamma, and delta tocotrienol. As increasing information has become available about these forms of vitamin E, more and more of them are understood to have unique functions.

How it Functions

What is the function of vitamin E?

Prevention of oxidative stress

Although humans must breathe oxygen to stay alive, oxygen is a risky substance inside the body because it can make molecules overly reactive. When oxygen-containing molecules become too reactive, they can start damaging the cell structures around them. In chemistry, this imbalanced situation involving oxygen is called oxidative stress.

Vitamin E helps prevent oxidative stress by working together with a group of nutrients that prevent oxygen molecules from becoming too reactive. This group of nutrients includes vitamin C, glutathione, selenium, and vitamin B3. Some researchers believe that vitamin E is the most important member of this oxidative stress-preventing group.

Supporting healthy skin

Vitamin E has sometimes been described as the "lightening rod" of the cell, allowing reactive molecules to strike the cell, like lightening, without causing damage. This "lightening rod" function of vitamin E is particularly apparent in the case of the skin, since vitamin E directly protects the skin from ultraviolet radiation (also called UV light). In numerous research studies, vitamin E applied topically to the skin has been shown to prevent UV damage. When the diet contains vitamin E-rich foods, vitamin E can travel to the skin cell membranes and exert this same protective effect.

Protection against Bladder Cancer

One of the benefits of making foods rich in vitamin E-nuts, seeds, spinach, mustard greens, peppers and olive oil-a part of your healthy way of eating is an up to 50% reduction in risk of developing bladder cancer, according to research presented at the annual meeting of the American Association of Cancer Research, Orlando, FL, May 23, 2004.

Bladder cancer, which kills 12,500 Americans annually, is the fourth leading cancer killer among men, and is four times more common in men than women. The study, which included 468 bladder cancer patients and 534 cancer-free controls drawn from residents of Houston, TX, collected data using eating habits questionnaires. Those whose vitamin E intake was in the top 25% had half as much bladder cancer as those in the lowest 25%.

Increasing vitamin E intake to the amount consumed by those in the top group would not be difficult since the actually difference in the amount of vitamin E-rich foods the two extremes consumed was small-the equivalent of a single daily serving of spinach or a handful of almonds.

The research team looked at the two most common forms of vitamin E, alpha- and gamma-tocopherol, and found that only alpha-tocopherol was associated with lower bladder cancer risk. Also, whether study participants got their vitamin E from food alone or from vitamin pills, the reduction in risk was roughly the same. Those with the highest intake of alpha-tocopherol from food had a 42% reduced risk of bladder cancer, and those with a vitamin E rich diet who also took vitamin E supplements had a 44% reduced risk.

Vitamin E from Foods, but not Supplements Offers Protection against Prostate Cancer and Alzheimer's Disease

While the type of vitamin E usually used in supplements is alpha-tocopherol, research published in the December 2004 issue of the Proceedings of the National Academy of Sciences indicates another form of vitamin E, gamma-tocopherol, but not alpha-tocopherol, inhibits prostate cancer cell proliferation, without affecting healthy prostate cells.

Plus, the anti-cancer effect of gamma-tocopherol, when combined with other forms of vitamin E such as delta-tocopherol, appears to be additive.

As noted above, Vitamin E is a generic term for a family of at least eight structurally related molecules. When the first research was conducted on vitamin E by the Shute brothers early in the 19th century, in rats, one fraction of vitamin E, alpha tocopherol, appeared more potent since it was necessary for successful pregnancy and production of offspring. For this reason, the Shutes named the vitamin "tocopherol," from the Greek word meaning "to give birth."

More recent research has revealed that, in humans, other vitamin E fractions may be even more beneficial. Gamma-tocopherol has been found to exhibit anti-inflammatory effects, which has led researchers to think this fraction may be more cardioprotective than the alpha-tocopherol found in most supplements. Not only is gamma-tocopherol anti-inflammatory, but it is also highly attracted to the nucleus in cells-the site where mutations in the genetic code can promote the development of cancer.

When Dr. Jiang and his team investigated the anti-carcinogenic potential of various forms of vitamin E, they found that gamma-tocopherol, particularly in combination with other forms of vitamin E such as delta-tocopherol, induced apoptosis (cell death) in androgen-sensitive prostate cancer cells within 3 days of treatment. Alpha-tocopherol alone did not have this effect.

The gamma and delta E fractions appear to induce apoptosis by interrupting the synthesis of sphingolipid, a fatty molecule in cell membranes that acts as a signaling messenger to modulate events inside the cell. In the cell membranes of human prostate cancer cells, the interruption of sphingolipid's synthesis by gamma and delta tocopherols causes the cancerous cells to self-destruct, while leaving healthy cells unaffected. Both fractions, as well as alpha tocopherol, are naturally present in foods rich in vitamin E, which include a number of greens (mustard greens, turnip greens, spinach, collard greens, and kale), sunflower seeds and almonds.

A high intake of vitamin E from food, but not from supplements (which usually contain just alpha-tocopherol) is also inversely associated with Alzheimer's disease. Rush University's Martha Clare Morris, Sc.D., lead nutrition researcher for CHAP, the Chicago Health and Aging Project, found a 67% lower risk of Alzheimer's in subjects with the highest intakes of vitamin E from food and concluded: "various tocopherol forms rather than alpha-tocopherol alone may be important in the vitamin E protective association with Alzheimer's disease."

Other roles for vitamin E

While most of the research on vitamin E has focused on its role in prevention of oxidative stress, a variety of new roles have recently been suggested. Most of these new roles involve the transfer of chemical information from one cell to another, or across different structures inside of a cell. This transfer of chemical information is referred to as "cell signaling," and many researchers believe that cell signaling cannot accurately take place without the help of vitamin E.

Deficiency Symptoms

What are deficiency symptoms for vitamin E?

Deficiency symptoms for vitamin E are difficult to pinpoint and controversial in the research literature. The area of broadest agreement involves malabsorption. In many research studies, low levels of vitamin E are associated with digestive system problems where nutrients are poorly absorbed from the digestive tract. These problems include pancreatic disease, gallbladder disease, liver disease, and celiac disease.

A second area of focus for vitamin E deficiency symptoms is called peripheral neuropathy. This area focuses on nervous system problems in the arms, hands, legs, and feet. Pain, tingling, and loss of sensation in these extremities have been associated with vitamin E deficiency. Although many healthcare practitioners report that skin problems appear closely linked to vitamin E deficiency, there are limited human research studies to support this view.

Toxicity Symptoms

What are toxicity symptoms for vitamin E?

When obtained from food sources alone, vitamin E has no documented research of toxicity. Vitamin E supplements, when taken in very high doses of 3000 IU or more, have been shown to have toxic effects. These effects include intestinal cramps and diarrhea, fatigue, double vision, and muscle weakness. Below the 3000 IU level, the research on vitamin E toxicity is inconsistent, but the majority of studies do not demonstrate toxic effects.

An exception to the generally low risk of toxicity associated with vitamin E involves simultaneous vitamin K deficiency. For persons with vitamin K deficiency, high intake of vitamin E can prolong bleeding time and interfere with clotting. In 2000, the National Academy of Sciences set a Tolerable Upper Intake Level (UL) for vitamin E of 1,000mg (or 1,500 IU of vitamin E in the form of alpha-tocopherol). This daily limit applies to supplemental vitamin E only, and is intended to apply to all individuals age 19 and older.

Impact of Cooking, Storage and Processing

How do cooking, storage, or processing affect vitamin E?

Exposure to air and factory processing can be particularly damaging to the vitamin E content of food. In wheat, for example, where most of the vitamin E is found in the germ layer, commercial processing removes 50-90% of the food's vitamin E. In 60% extraction wheat flour - the kind that is used to make over 90% of all breads, baked goods, and pastas sold in the U.S., the alpha tocopherol content drops almost 90%, and the beta tocopherol content drops 43%. (Alpha and beta tocopherol are two forms of vitamin E.)

To help protect their vitamin E content, vegetables oils like olive oil, sunflower seed oil, and peanut oil should be kept in tightly capped containers to avoid unnecessary exposure to air.

Factors that Affect Function

What factors might contribute to a deficiency of vitamin E?

Since vitamin E is a fat-soluble vitamin, poor absorption of fat in the digestive tract can contribute to vitamin E deficiency. Some specific health conditions that can cause fat malabsorption include pancreatic disease, celiac disease, and gallbladder disease. Premature birth has also been shown to increase risk of vitamin E deficiency in infants.

Drug-Nutrient Interactions

What medications affect vitamin E?

Use of the following medications can reduce the body's supply of vitamin E: Anticonvulsant drugs (like Dilantin ™) and cholesterol-lowering drugs (like probucol, cholestyramine, clofibrate, colestipol, and gemfibrozil) can significantly reduce the body's supply of vitamin E.

Long-term, regular use of mineral oil (for example, as non-prescription laxative) can also compromise the body's supply of vitamin E.

Nutrient Interactions

How do other nutrients interact with vitamin E?

The recycling of vitamin E in the body is intricately connected to four other nutrients: vitamin C, glutathione, selenium, and vitamin B3.

Vitamin C is required to keep vitamin E in its metabolically active form; glutathione (a very small protein molecule called a tripeptide and consisting of three amino acid building blocks) is required to keep vitamin C in its active form; and selenium (a micromineral) and vitamin B3 (in a special form called NADPH) are required to keep glutathione in its active form.

The fact that vitamin E is so heavily dependent on vitamin C, vitamin B3, selenium, and glutathione means that a diet high in vitamin E cannot have its optimal effect unless it is also rich in foods that provide these other nutrients.

At moderately high levels of 1,000 milligrams or more, vitamin E can interfere with the bodily activities of vitamin K. The potential injury to vitamin K metabolism was largely the reason why the National Academy of Sciences, in the year 2000, set a Tolerable Upper Limit (UL) of 1,000 milligrams per day for vitamin E.

Health Conditions

What health conditions require special emphasis on vitamin E?

Vitamin E may play a role in the prevention and/or treatment of the following health conditions:

• Acne
• Alzheimer's disease
• Angina pectoris
• Asthma
• Atherosclerosis
• Breast cancer
• Diabetes
• Epilepsy
• Fibrocystic breast disease
• Gout
• Graves' disease
• Infertility (male)
• Inflammatory bowel disease
• Macular degeneration
• Menopause
• Migraine
• Multiple sclerosis
• Oral cancers
• Osteoarthritis
• Parkinson's disease
• Peptic ulcers
• Peripheral vascular disease
• PMS
• Pregnancy-induced hypetension
• Psoriasis
• Rheumatoid arthritis
• Senile cataracts
• Squamous cancer
• Stroke
• Tardive dyskinesia
• Vaginitis

Form in Dietary Supplements

What forms of vitamin E are found in dietary supplements?

The vast majority of vitamin E supplements contain a single form of the vitamin, alpha-tocopherol. More specifically, most supplements contain a natural form of alpha-tocopherol, called d-alpha tocopherol (or d-alpha tocopheryl acetate). Practitioners often prefer this form of the vitamin over a synthetic version called l-alpha tocopherol.

However, because vitamin E is actually a family of vitamins involving many tocopherols and many tocotrienols, some practitioners recommend vitamin E supplements containing not only d-alpha tocopherol, but other tocopherol and tocotrienol forms of vitamin E.

Supplements containing this wide variety of vitamin E forms are typically referred to as "mixed tocopherol" or "mixed tocotrienol" supplements. Human research studies comparing the effects of different types of vitamin E supplements are too limited to allow definite conclusions, but recent research suggests dietary vitamin E is preferable to supplements containing only one fraction of this nutrient.

Food Sources

What foods provide vitamin E?

Excellent sources of vitamin E include mustard greens, turnip greens, chard, and sunflower seeds.

Very good sources of vitamin E include almonds and spinach.

Good sources of vitamin E include collard greens, parsley, kale, papaya, olives, bell pepper, brussels sprouts, kiwifruit, tomato, blueberries, and broccoli.

 

Introduction to Nutrient Rating System Chart

In order to better help you identify foods that feature a high concentration of nutrients for the calories they contain, we created a Food Rating System. This system allows us to highlight the foods that are especially rich in particular nutrients. The following chart shows the World's Healthiest Foods that are either an excellent, very good, or good source of vitamin E. Next to each food name, you'll find the serving size we used to calculate the food's nutrient composition, the calories contained in the serving, the amount of vitamin E contained in one serving size of the food, the percent Daily Value (DV%) that this amount represents, the nutrient density that we calculated for this food and nutrient, and the rating we established in our rating system. For most of our nutrient ratings, we adopted the government standards for food labeling that are found in the U.S. Food and Drug Administration's "Reference Values for Nutrition Labeling." Read more background information and details of our rating system.

World's Healthiest Foods ranked as quality sources of: vitamin E
Food	Serving Size	Cals	Amount (mg)	DV (%)	Nutrient Density	World's Healthiest Foods Rating
Mustard greens, boiled	1 cup	21.0	2.81	14.1	12.0	excellent
Swiss chard, boiled	1 cup	35.0	3.31	16.6	8.5	excellent
Spinach, boiled	1 cup	41.4	3.74	18.7	8.1	excellent
Sunflower seeds, raw	0.25 cup	205.2	18.10	90.5	7.9	excellent
Turnip greens, cooked	1 cup	28.8	2.48	12.4	7.8	excellent
Almonds, dry roasted	0.25 cup	206.0	8.97	44.9	3.9	very good
Collard greens, boiled	1 cup	49.4	1.67	8.3	3.0	good
Kale, boiled	1 cup	36.4	1.11	5.6	2.7	good
Papaya	1 each	118.6	3.40	17.0	2.6	good
Olives	1 cup	154.6	4.03	20.1	2.3	good
Bell peppers, red, raw, slices	1 cup	24.8	0.63	3.1	2.3	good
Brussel sprouts, boiled	1 cup	60.8	1.33	6.7	2.0	good
Kiwifruit	1 each	46.4	0.85	4.3	1.7	good
Tomato, ripe	1 cup	37.8	0.68	3.4	1.6	good
Blueberries	1 cup	81.2	1.46	7.3	1.6	good
Broccoli, steamed	1 cup	43.7	0.75	3.8	1.5	good

World's Healthiest Foods Rating	Rule
excellent	DV>=75%	OR	Density>=7.6	AND	DV>=10%
very good	DV>=50%	OR	Density>=3.4	AND	DV>=5%
good	DV>=25%	OR	Density>=1.5	AND	DV>=2.5%

Public Health Recommendations

What are current public health recommendations for vitamin E?

In 2000, the National Academy of Sciences established the following Adequate Intake (AI) levels for vitamin E:

• Males and females, 0-6 months: 4 milligrams
• Males and females, 6-12 months: 5 milligrams

In 2000, the National Academy of Sciences established the following Recommended Dietary Allowances (RDAs) for vitamin E:

• Males and females, 1-3 years: 6 milligrams
• Males and females, 4-8 years: 7 milligrams
• Males and females, 9-13 years: 11 milligrams
• Males and females, 14 years and older: 15 milligrams
• Pregnant females, 18 years and older: 15 milligrams
• Lactating females, 18 years and older : 19 milligrams

References

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• Bendich A, Machlin LJ. Safety of oral intake of vitamin E. Am J Clin Nutr 1988;48:612-619 1988.
• Cooney RV, Franke AA, Harwood PJ et al. Gamma-tocopherol detoxification of nitrogen dioxide:superiority to alpha-tocopherol. Proc Natl Acad Sci USA 1993 Mar 1;90(5):1771-5 1993.
• Darr D, Dunston S, Faust HH, et al. Effectiveness of antioxidants (vitamin C and E) with and without sunscreens as topical photoprotectants. Acta Derm Venerol 1996;76:264-268 1996.
• Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995 1995.
• Jiang Q, Wong J, Fyrst H, Saba JD, Ames BN. gamma-Tocopherol or combinations of vitamin E forms induce cell death in human prostate cancer cells by interrupting sphingolipid synthesis. Proc Natl Acad Sci U S A. 2004 Dec 21;101(51):17825-30. 2004. PMID:15596715.
• Mascio PD, Murphy ME, Sies H. Antioxidant defense systems: the role of Carotenoids, tocopherols, and thiols. Am J Clin Nutr 1991;53:194S-200S 1991.
• Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS, Aggarwal NT, Scherr PA. Relation of the tocoperol forms to incident Alzheimer disease and to cognitive change. Am J Clin Nutr. 2005 Feb;81(2):508-14. 2005. PMID:15699242.
• Packer L. Vitamin E is nature's master antioxidant. Sci Amer 1994;Mar-Apr:54-63 1994.
• Packer L, Weber SU, Rimbach G. Molecular aspects of alpha-tocotrienol antioxidant action and cell signaling. J Nutr 2001;131(2):369S-73S 2001.
• Schwenke DC. Does lack of tocopherols and tocotrienols put women at increased risk of breast cancer. J Nutr Biochem 2002 Jan;13(1):2-20 2002.
• Sokol RJ. Vitamin E deficiency in adults. Ann Int Med 1984;100:769 1984.
• Wu X, Radcliffe J. Papers on alpha-tocopherol intake and bladder cancer risk. presented at the annual meeting of the American Association of Cancer Research, held in Orlando, FL, May 23, 2004. 2004.

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