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YOUR RESOURCE FOR BETTER HEALTH | JANUARY 2009
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Vitamin E

Vitamin E is an antioxidant that protects cell membranes and other fat-soluble parts of the body, such as low-density lipoprotein (LDL; “bad” cholesterol) cholesterol, from damage.

Several studies, including two double-blind trials, have reported that 400 to 800 IU of natural vitamin E per day reduces the risk of heart attacks. Other recent double-blind trials have found either limited benefit or no benefit at all from supplementation with synthetic vitamin E. One of the negative trials used 400 IU of natural vitamin E—a similar amount and form to previous successful trials. In attempting to make sense of these apparently inconsistent findings, the following is clear: less than 400 IU of synthetic vitamin E, even when taken for years, does not protect against heart disease. Whether 400 to 800 IU of natural vitamin E is, or is not, protective remains unclear.

Which form is best?
The names of all types of Vitamin E begin with either “d” or “dl,” which refer to differences in chemical structure. The “d” form is natural and “dl” is synthetic. The natural form is more active and better absorbed. Little is known about how the “unnatural” “l” portion of the synthetic “dl” form affects the body.

After the “d” or “dl” designation, often the Greek letter “alpha” appears, which also describes the structure. Synthetic “dl” vitamin E is found only in the alpha form—as in “dl-alpha tocopherol.” Natural vitamin E may be found either as alpha—as in “d-alpha tocopherol”—or in combination with beta, gamma, and delta, labeled “mixed”—as in mixed natural tocopherols.

Little is known about the importance of the beta and delta forms of vitamin E, but a debate has arisen concerning gamma tocopherol. In a test tube study, gamma tocopherol was found to be more effective than alpha tocopherol in protecting against certain specific types of oxidative damage.

Vitamin E forms are listed as either plain “tocopherol” or tocopheryl followed by the name of what is attached to it, as in “tocopheryl acetate.” Plain tocopherol may be absorbed a little better, while tocopheryl attached forms have a slightly better shelf life. Both forms are active when taken by mouth. However, the skin utilizes the tocopheryl forms very slowly, so those planning to apply vitamin E to the skin should buy tocopherol. The most common forms of vitamin E are d-alpha tocopherol and d-alpha tocopheryl acetate or succinate. Both of these d (natural) alpha forms are frequently recommended by doctors.

How much is usually taken?
The recommended dietary allowance for Vitamin E is low, just 15 mg or approximately 22 International Units (IU) per day. The most commonly recommended amount of supplemental vitamin E for adults is 400 to 800 IU per day. However, some leading researchers suggest taking only 100 to 200 IU per day, since trials that have explored the long-term effects of different supplemental levels suggest no further benefit beyond that amount. In addition, research reporting positive effects with 400 to 800 IU per day has not investigated the effects of lower intakes. For tardive dyskinesia, the best results have been achieved from 1,600 IU per day, a large amount that should be supervised by a healthcare practitioner.

A diet high in unsaturated fat increases vitamin E requirements. Vitamin E and selenium work together to protect fat-soluble parts of the body.

Are there any side effects or interactions?
Vitamin E toxicity is very rare and supplements are widely considered to be safe. The National Academy of Sciences has established the daily tolerable upper intake level for adults to be 1,000 mg of vitamin E, which is equivalent to 1,500 IU of natural vitamin E or 1,100 IU of synthetic vitamin E. Individuals with heart disease or diabetes should consult their doctor before taking vitamin E.

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