Vitamin E
Scientific Names: Alpha-, beta-, delta-, and gamma-tocopherol Other Common Names: N/A Overall Safety: 😊
Therapeutic Efficacy and Considerations:
Used as a general antioxidant, for the prevention and treatment of hyperlipidemia, atherosclerosis and heart disease, peripheral vascular disease, osteoarthritis, PMS symptoms, benign breast disease, prevention of cancer, and skin inflammation. Dosing of vitamin E depends upon the form used, i.e., “natural” or synthetic. Many recommendations are now given in mg of d-alpha-tocopherol equivalents, but most of the vitamin E products available are labeled in IUs. When most evidence for an indication supports a particular form, the form is specified. If that has not been determined, then generally synthetic vitamin E is appropriate.
Daily Recommended Allowance: 15 mg/day (33 IU dl-alpha or 22 IU d-alpha). Upper dose limit for supplementation is 400 IU. Tolerable upper limit is 1100 IU dl-alpha or 1500 IU d-alpha.
Hyperlipidemia: 😊 100-400 IU daily.
Heart Disease: 😊 200-800 IU daily.
Osteoarthritis: 😊 500-600 IU daily.
Rheumatoid Arthritis: 😊 600 IU twice daily.
Tardive Dyskinesia: 😊 1600 IU daily d-alpha tocopherol.
PMS: 😊 400 IU daily d-alpha tocopherol.
Chemistry/Pharmacology: Vitamin E is a fat-soluble vitamin. There are actually eight forms of vitamin E, but the general term refers to alpha-tocopherol. Vitamin E found in foods is in the dextrorotary d-alpha-tocopherol (also known as RRR-alpha-tocopherol) form, while synthetically produced vitamin E is the racemic mixture, dl-alpha-tocopherol. The d-alpha-tocopherol form is better absorbed and utilized. Vitamin E is carried throughout the body by alpha-tocopherol transfer protein (a-TTP), which is produced by the liver. Much is unknown about specific roles for vitamin E; it does serve an antioxidant function and it is in this role that it is believed to have activity for several disease states. For cardiovascular issues, other activities include inhibition of platelet aggregation, decreases in proliferation of vascular smooth muscle production of leukotrienes, possible increases in prostacyclin, and inhibition of protein kinase C.
Drug Interactions: High doses may increase risk of bleeding with warfarin or other anticoagulant or antiplatelet agents; limit use to doses of 400 IU or less in these patients. Orlistat will decrease absorption of vitamin E and other fat-soluble vitamins; therefore, supplementation is necessary. Vitamin E may decrease the effectiveness of some chemotherapies and increase effectiveness of others; specific information for each drug in a regimen must be researched before use.
Contraindications/Precautions: Large doses should be avoided in vitamin K deficiency, due to possible increases in coagulation problems, and anemia of iron deficiency, due to interference of response to iron treatment.
Adverse Effects: Side effects are very rare at normal supplementation doses. With the higher doses (generally >800 IU daily), there is an increased risk of bleeding. At doses of >1000 IU daily, there have been reports of thyroid and other endocrine dysfunction, diarrhea, gynecomastia, nausea, fatigue, headache, and blurry vision.
