Vitamin E has been the subject of keen interest since its discovery 100 years ago. Yet, despite its recognition as an essential vitamin and an ingredient in all multivitamins, vitamin E is suffering from an identity crisis.
Safety concerns simmer, and sales as a stand-alone supplement have sagged in recent years. But here’s why I believe vitamin E deserves a second look.
What Does Vitamin E Do in the Body?
As the body’s most abundant fat-soluble antioxidant, vitamin E protects lipids (fats) against free radical damage. It is especially active in cell membranes, the lipid-rich barrier that surrounds each cell. By interrupting the chain reaction of oxidative damage, vitamin E helps protect the integrity of your cells.
Another lipid that benefits from vitamin E’s antioxidant actions is LDL cholesterol (low-density lipoproteins), which transports cholesterol from the liver to tissues throughout the body. Oxidized LDL cholesterol has been linked with arterial damage and cardiovascular disease.
This vitamin also plays vital roles in gene expression, immunity, cell signaling, and inflammation, so it is obviously important for overall health. But what about higher doses?
Vitamin E for Eyes
There is no question that vitamin E is important for eye health. Several studies show it slows the development of cataracts, but it really shines in the prevention of advanced age-related macular degeneration (AMD), the leading cause of vision loss in individuals over age 50.
The large, government-funded Age-Related Eye Disease Study (AREDS) was a randomized, placebo-controlled clinical trial involving people at high risk of advanced AMD. Study results revealed that participants who took supplements containing 400 IU vitamin E, 15 mg beta-carotene, 500 mg vitamin C, 80 mg zinc, and 2 mg copper were 25% less likely to progress to advanced AMD over the five-year study period.
A follow-up study, AREDS2, had a slightly different formula—beta-carotene was replaced with 10 mg lutein and 2 mg zeaxanthin. But results were similar, and many doctors recommend this nutrient combo for older people concerned about preserving their vision.
Protection for Your Liver
The benefits of vitamin E for the liver are particularly apparent in non-alcoholic fatty liver disease, which is now the most common liver disease, rising in tandem with our dramatic increase in obesity and diabetes.
As the name implies, it begins with fatty deposits in the liver. As fatty infiltration increases, it may progress to nonalcoholic steatohepatitis (NASH) and cirrhosis, which are marked by inflammation, cell damage and death, scarring, and in end-stage disease, liver failure.
A study published in the New England Journal of Medicine compared the effects of daily doses of 800 IU of vitamin E, the diabetes drug Actos, and a placebo in patients with NASH. When participants were reevaluated after nearly two years, the group taking vitamin E had the greatest improvements in liver enzymes and fatty deposits.
Does Vitamin E Help Skin?
Vitamin E is delivered to the skin via the sebaceous glands, which secrete an oily substance that prevents the skin from drying out. This fat-soluble antioxidant protects against oxidative damage, reduces inflammation, and supports wound healing.
Supplemental vitamin E is a proven treatment for eczema/atopic dermatitis, a common condition that causes patches of inflamed, rough, and/or itchy skin. A 2019 meta-analysis of studies examining the effects of various vitamin combinations found that vitamin E 400–600 IU per day improved moderate to severe atopic dermatitis.
Some people use vitamin E oil for eczema, and others swear by vitamin E for wounds, scars, and stretch marks. Although there isn’t a lot of scientific support for this, topical vitamin E may provide some protection against UV-generated free radicals and inflammation. Nevertheless, for therapeutic purposes vitamin E is best taken orally.
Other areas in which supplemental vitamin E can help include:
- Immune dysfunction: Vitamin E enhances immune function, especially in older people with a compromised immune system.
- Cardiovascular disease: A significant reduction in thromboembolism (blockage of a blood vessel by a blood clot) has been reported with vitamin E 600 IU every other day, along with a reduction in death from cardiovascular disease.
- Alzheimer’s disease: Very high-dose vitamin E, 2,000 IU, has been shown to slow the progression of Alzheimer's disease.
- Male/female concerns: I have been asked about the sexual benefits of vitamin E because of its reputation as an aphrodisiac. Although this vitamin does play a role in reproduction, and a handful of small studies suggest a reduction in menstrual cramps and PMS, I can find no evidence that it increases libido or sexual function.
Types of Vitamin E
Vitamin E is actually a family of eight related natural tocopherol and tocotrienol compounds. Although all these forms are found in foods—especially in nuts, seeds, and oils—the type of vitamin E that is most active in the body and the only form present in most supplements is alpha-tocopherol.
Some studies suggest other types of vitamin E, especially gamma- and delta-tocopherol and tocotrienols, may be superior or at least equal to alpha-tocopherol. Therefore, there are advantages to using a supplement that also includes other tocopherols and mixed tocotrienols.
The most important thing, however, is to take natural vitamin E as D-alpha-tocopherol (or tocopheryl). Synthetic vitamin E (listed as DL- rather than D-) is only half as active as the natural form.
Is Vitamin E Safe?
Can you take too much vitamin E? Sure, you can take too much of anything, including water. The National Academy of Medicine set an upper limit of 1,000 mg (1,500 IU)* because of a potential risk of bleeding and recommend that people on Coumadin or related blood thinners do not exceed 400 IU per day. However, no significant vitamin E toxicity symptoms were reported in studies using daily doses up to 2,000 IU.
You may be aware of controversies concerning vitamin E and prostate cancer. One clinical trial examining the effects of selenium and synthetic vitamin E found that neither supplement protected against prostate cancer, but there was a 17% increased risk in those taking 400 IU vitamin E alone. The men who took both selenium and vitamin E had no increased risk—and other studies have linked supplemental vitamin E with significant reductions in the risk of developing prostate cancer.
Safety is always a priority, but some conventional doctors seem to want to throw out the baby with the bathwater and steer people away from vitamin E altogether. After looking at the research from every angle, I am convinced of the safety of above-RDA, yet prudent doses of this essential nutrient.
How Much Should You Take?
The current RDA is 15 mg (22.5 IU).* Yet, studies suggest 90% of Americans fail to get even half of that much from their food. Considering the benefits of this vitamin and the sad state of the average American diet, my general recommendation is a safe and protective daily dose of 150–300 mg (100–200 IU) in the forms noted above.
Additional recommendations include:
- Take only natural vitamin E; avoid synthetic.
- Take it with adequate amounts of other antioxidants and essential nutrients—as you would get in a comprehensive daily multivitamin—to ensure a balanced intake of vitamin and minerals essential for health; ideally, this would include mixed tocotrienols.
- Take more robust therapeutic doses for specific health concerns, if appropriate.
* The FDA now requires supplement labels to list vitamin E in mg rather than IU. I understand this is confusing, since IUs were used for decades and most of the studies list vitamin E doses as IU. But from here on out, you will be seeing vitamin E in mg.
Natural vitamin E conversions:
- From mg to IU: mg x 1.5 = IU
- From IU to mg: IU x 0.67 = mg
Examples for current RDA:
- 15 mg x 1.5 = 22.5 IU
- 22.5 IU x 0.67 = 15 mg
Note: Synthetic vitamin E conversion is different.