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Is vitamin e beneficial or harmful? acerbic all through the disorder of another exact opinions - diet


Numerous information have freshly appeared in both the lay and health check press questioning the value of vitamin E supplementation and symptomatic of that there are risks linked with its use even at doses formerly belief to have been "safe". What do we do with the hundreds of studies and broad clinical examination that has been in print in the medicinal prose suggestive of advantage in cardiovascular disease, alzheimers, diabetes and other degenerative diseases? A exploration of the Citizen Collection of Medicine yields over 25,000 citations, many funded or sponsored by the General Institutes of Healthiness (NIH) and other high-status health check and exact organizations.

This month, the authors of an critique in Physical condition News (Health News. 2005 Apr;11(4):12-3) headlined this statement: "High doses of vitamin E may amplify risk of death. Talk to your medical doctor ahead of charming supplements containing more than 200 IUs. " Discussing these questions with your doctor of medicine is very important. The aim of this commentary is to give you with a tool, a supply that you can print out and chat about with your physician.

Negative Clinical Studies:

Increased blight return in patients with head and neck cancer:

Bairati and co-workers (J Natl Corruption Inst. 2005 Apr 6;97(7):481-8. ) found in a multicenter, double-blind, placebo-controlled, randomized chemoprevention trial among 540 patients with head and neck corruption treated by radiation therapy that supplementation with alpha-tocopherol (400 IU/day) fashioned unexpected adverse possessions on the occurrence of be with central cancers and on cancer-free survival.

No add to in corruption risk, but better risk of Heart Bankruptcy in patients with conventional vascular disease or diabetes:

The HOPE Trial Investigators (JAMA. 2005 Mar 16;293(11):1338-47) evaluated whether long-term supplementation with vitamin E (Daily dose of actual basis of 400 IU of vitamin E or matching placebo) decreases the risk of cancer, canker death, and major cardiovascular events. The Hope vitamin E trial was a randomized, double-blind, placebo-controlled intercontinental trial of patients at least 55 years old with vascular disease or diabetes mellitus (9541 patients, in 174 centers) with a mean duration of follow-up of 7. 0 years. The investigators examined canker incidence, corruption deaths, and major cardiovascular procedures (myocardial infarction, stroke, and cardiovascular death), heart failure, unstable angina, and need for cardiac revascularization. Among all HOPE patients, there were no important differences in the basic analysis: for bane incidence, 11. 6% in the vitamin E group vs 12. 3% in the gesture group residential canker (a non-significant cut for vitamin E); for bane deaths, 3. 3% in the vitamin E group vs 3. 7% in panacea (also not significant) and for major cardiovascular events, 21. 5% vs 20. 6%, correspondingly (not significant). Of concern, was that patients in the vitamin E group had a considerably senior risk of heart bankruptcy and hospitalization for heart failure. The authors concluded that in patients with vascular disease or diabetes mellitus, long-term vitamin E supplementation does not check corruption or major cardiovascular dealings and may add to the risk for heart failure.

Increased all-cause mortality:

A meta-analysis of randomized, 19 forbidden clinical trials (135,967 participants) evaluating the dose-response connection connecting vitamin E supplementation and total mortality (Ann Hold Med. 2005 Jan 4;142(1):37-46. Epub 2004 Nov 10. ) Published by Miller and contacts at the Johns Hopkins Instruct of Medicine, found High-dosage (greater than or equal to 400 IU/d) vitamin E supplements may add to all-cause mortality by 5% and ought to be avoided.

Neutral Clinical Studies:

Risk of Coronary heart disease (CHD) in Smokers not effected:

The air of vitamin E on coronary heart disease (CHD) was evaluated in the alpha-tocopherol, beta-carotene bane prevention (ATBC) study (Eur Heart J. 2004 Jul;25(13):1171-8. ). 29,133 male smokers, aged 50-69 years were randomized to collect alpha-tocopherol 50 mg, or beta-carotene 20 mg, or both, or sop daily for 5-8 years. The risk for a first-ever major coronary event was immaterially abridged by 5% among alpha-tocopherol recipients compared with non-recipients, and the risk for non-fatal MI was immaterially abridged by 4%. The authors did not advocate the use of vitamin E supplements due to the weak findings.

Cardiovascular mortality and all cause Mortality not effected:

In a meta assay of eighty-four trials (J Gen Hold Med. 2004 Apr;19(4):380-9. ) probing outcomes of all-cause mortality, cardiovascular mortality, fatal or nonfatal myocardial infarction vitamin E was not found to have neither categorical nor adverse effects. Shekelle and colleagues found that the use of vitamin E supplements irrelevantly bargain the risk of all cause mortality by 4%, immaterially compact cardiovascular mortality by 3% and trended for but did not do a hefty bargain in nonfatal myocardial infarction, falling the last by 28%.

Positive Clinical Studies:

Reduced Risk of Congestive Heart Breakdown and Myocardial Infarction

In two large clinical studies conducted by Stampfer et al470 and Rimm et al,471 vitamin E supplements were coupled with a compact risk of congestive heart failure. In an examination of just about 45,000 men in the Physical condition Certified Follow-up Study catalog by Ascherio and associates,823 the use of vitamin E, or multi-vitamin supplements, was linked with a a lot decreased risk of myocardial infarction. These fallout bring to mind that senior supplemental doses of vitamin E may be beneficial in patients with CAD, above all those on diets high in polyunsaturated fatty acids.

Reduction in Risk for Cardiovascular Disease and Myocardial Infarction (Heart Attack):

The Nurses' Fitness Study, a study of 121,700 women connecting the ages of 34 and 59 which was conducted by Manson and co-workers,69,805 used food frequency questionnaires to determine a connection connecting dietetic intakes of foods rich in vitamin E and beta carotene, and the cutback in the risk of cardiovascular disease.

A hot assay of the same data by Stampfer et al470 exposed that the defensive achieve of vitamin E was attributable to supplemental vitamin E at pharmacological levels exceeding 100 IU per day. Since dietetic intakes of alpha tocopherol in the United States typically range from 4 to 16 IU per day, the past level of intake would be enormously challenging to complete from diet alone. 804 Those women who took 100 mg. vitamin E supplements (in accumulation to 15mg of beta carotene daily) skilled a 36% bargain in myocardial infarction, and women with the main relating to diet vitamin E intake, and who consumed vitamin E supplements daily for two years, had a 41% cutback in risk (multivariant risk 0. 59).

The Physical condition Professionals Follow-up Study,471 connecting 51,529 male shape professionals, demonstrated comparable cardiovascular payback of a diet rich in antioxidants. As in the Nurses' Physical condition Study, these male participants' antioxidant vitamin intake was assessed by a dietetic questionnaire, and coronary heart disease was assessed by health check album review. After calculating for age and coronary risk factors, advanced relating to diet vitamin E intake levels were coupled with a drastically lower risk for CAD. For men consuming more than 60 IU (an quantity commonly requiring vitamin supplementation), the risk of myocardial infarction or cardiac death was 36% less (multivariant risk 0. 64) than in those men consuming 7. 5 I. U. per day. CAD risk was buck for the men with the peak food vitamin E intake who additionally took at least 100 IU of vitamin E supplements daily for two years.

Low serum Vitamin E may be a superior risk aspect for myocardial infarction than also high blood anxiety or high-minded serum cholesterol alone, according to examination sponsored by the World Fitness Organization, and reported by Gey et al67 in the Conglomerate Monitoring Assignment of Trends and Determinants of Cardiovascular Disease (MONICA) study. In the MONICA study, Gey and co-workers67 compared plasma antioxidant levels among 16 atypical groups of 100 men each from regions with a six-fold alteration in CAD mortality and reported a beefy inverse correlation (p=0. 002) amid plasma vitamin E and mortality from ischemic heart disease which was all-embracing of lipid levels.

This inverse connection for CAD mortality was strongest for vitamin E. Low serum vitamin E alone was an perfect analyst for fatal myocardial infarction in 60% of cases studied. Death from Acute Myocardial Infarction was accurately predicted in 80% of patients with both low serum vitamin E and high-minded serum cholesterol; and fatal outcomes were accurately predicted in 90% of patients with low serum levels of both vitamin E and A in conjunction with high serum cholesterol, and grand blood pressure. These findings were constant with at an earlier time erudition available by Gey. 580


Cavarocchi and associates681 found that pretreatment of coronary bypass patients with 2,000 IU of vitamin E appreciably inhibited the age bracket of destructive oxygen free radicals all through surgery, and DeMaio and co-workers583 found that vitamin E supplementation cheap the incidence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).


Rimersma and co-workers469,643 found an inverse affiliation concerning the risk of angina pectoris and vitamin E levels. Folks with serum vitamin E levels in the lowly quintile (28. 2 µM/L). Similarly, Byers870 reported that an bigger nutritional intake of vitamin E compact death from myocardial infarction.


A prospective study of antioxidant vitamins and the incidence of CAD in women, which was conducted by Manson et al,805 used food frequency questionnaires to assess relating to diet intake of vitamin E, and found that the incidence of CAD was buck among women with the main intake of alpha tocopherol.

Reduced Risk of Cancer:

An inverse bond concerning serum vitamin E levels and blight has been found in seven epidemiologic studies,580,669,670,679,685,686,687 and vitamin E supplementation has been shown to suppress indexes of lipid peroxidation in the blood of both smokers and non-smokers, not including finishing plasma lipoprotein concentrations. 899 Since low density lipoprotein is one of the main transports for vitamin E and cholesterol in the blood stream, pharmacologic and a number of nutritional interventions ensuing in reductions in LDL and serum cholesterol may condense serum vitamin E in persons whose diets are not supplemented. 488,490 Hypolipidemic drug therapy may act as a vitamin E enemy and cut down serum vitamin E. 844


Regular use of vitamin E supplements was allied with up to a 62% lower risk of dying of ALS in a study of 957,740 those 30 years of age or older participating in the American Canker Society's Corruption Prevention Study II. (Ann Neurol. 2005 Jan;57(1):104-10. )

The Balanced Approach:

Perhaps a all right accost would be a three-tiered effort:

  • To moderately become more intense vitamin E levels with good for you dietetic sources of the vitamin (which may allow for an comparable level of 15-45 IUs per day from optimizing diet)
  • The add-on of MODERATE levels of supplementation with Biological (d-isomer) mixed tocopherols (which are nearer to the mix seen in diet) and
  • Use of least amount levels of vitamin E that have shown beneficial bring about (100 IU or greater) and not exceeding levels which have been connected with risk (greater than 400 IU) and definitely not bigger than 1,600 IUs where better risk seems to be more openly distinct in some studies.
This is in line with contemporary recommendations made this month by Hancock and co-workers who analyzed a large file of many clinical studies, (Am J Clin Nutr. 2005 Apr;81(4):736-45) and inscription for the Board for Dependable Diet (CRN) in Washington, DC declared: "? nutritional supplements of vitamins E and C are safe for the common population?. Many clinical trials with these vitamins have caught up subjects with a choice of diseases, and no constant archetype of adverse possessions has occurred at any intake? Thus, we conclude from clinical trial confirmation that vitamin E supplements arrive on the scene safe for most adults in amounts less than or equal to 1,600 IU ?. "

Additionally, this is in concord with recommendations of Denton Harmon, M. D. Ph. D. , the priest of the Free-Radical Guess of Aging (D. Harmon, J. Gerontol. 11, 298-300 (1956). ) who recommends 400 IU of vitamin E daily (Life Addition Magazine, Interview, January 1998).

DISCUSSION: What is Vitamin E?

Vitamin E is a fat-soluble antioxidant vitamin that is caught up in the metabolism of all cells. Vitamin E protects vitamin A and basic fatty acids from corrosion in the body cells and prevents breakdown of body tissues. Vitamin E is extensively established to be the core physiological antioxidant in man. 472,488,844,845,846

Vitamin E exists in eight altered forms, each with its own biological action and functional use in the body(Traber MG and Packer L. Vitamin E: Ahead of antioxidant function. Am J Clin Nutr 1995;62:1501S-9S). Alpha-tocopherol is the name of the most energetic form of vitamin E in humans. It is also a able biological antioxidant (Traber MG. Vitamin E. In: Shils ME, Olson JA, Shike M, Ross AC, ed. Contemporary Diet in Healthiness and Disease. 10th ed. Baltimore: Williams & Wilkins, 1999:347-62). Vitamin E in supplements is customarily sold as alpha-tocopheryl acetate, a form that protects its capability to act as an antioxidant. The copied form is labeled "D, L" while the biological form is labeled "D". The fake form is only half as energetic as the biological form (U. S. Area of Agriculture, Agricultural Examine Service. 2004. USDA Countrywide Nutrient Catalog for Accepted Reference, Announcement 16-1).

Epidemiology A propos Vitamin E:

Pacht and colleagues498 found flawed levels of vitamin E in frequent cigarette smokers. Similarly, Riemersma and associates469 found low vitamin E levels among angina patients who were smokers, and Brown et al899 found that smokers sustained an better free radical load (characterized by augmented indices of lipid peroxidation) for the reason that of their exposure to large quantities of immediate free radicals in the gas and tar phases of cigarette smoke. The researchers dogged that this bigger lipid peroxidation was bargain in vitro next vitamin E supplementation. These findings are in accordance with other clinical examine which suggests that smoking reduces plasma vitamin E levels, and increases oxidative stress. 590,591

Excessive alcohol eating may have an adverse appearance on serum antioxidant levels which is all-embracing of dietetic status. Disproportionate drinking of alcohol has been coupled with low serum vitamin E levels,499,889 malondialdehyde (MDA) markers of oxidative stress and free radical activity. 889 Frequent studies have shown that alcoholics have lower serum beta carotene,901 alpha tocopherol,889 selenium,889 and ascorbic acid889 concentrations than check subjects who drink moderately.

Supporting the hypothesis that heme iron acts as a pro-oxidant in vivo, and validating preceding clinical research, Ascherio et al823 found that a high intake of antioxidant vitamin E may foil the adverse cardiovascular possessions of extra heme iron consumption,830,831,832,833 and concluded that oxidative stress ensuing from smoking837 and hyperglycemia allied with diabetes834,835,836 may enhance it.

Nutritional recommendations:

According to many nutritionists who have evaluated this data, 150 to 200 IUs a day is almost certainly beneficial and safe for most folks deficient to supplement their diet. That is more than three times what citizens can get from a good for you diet (good sources include: nuts, cooking oil, sweet potatoes, mayonnaise, wheat-germ oil, fish, eggs, carrying weapons cereals) and low-dose multivitamins. Almonds may help to augment vitamin E in the blood and cut lipid levels (J Am Diet Assoc. 2005 Mar;105(3):449-54). Kiwi fruit confine high amounts of vitamin E and may be cardioprotective (Platelets. 2004 Aug;15(5):287-92).

Good Sources of Vitamin E
Food Allocation Size Milligrams % RDA
Egg, whole, fresh 1 large 0. 88 5. 8
Almond oil 1 tablespoon 5. 3 35. 3
Corn oil 1 tablespoon 1. 9 12. 6
Corn oil (Mazola) 1 tablespoon 3 5
Cottonseed oil 1 tablespoon 4. 8 32
Olive oil 1 tablespoon 1. 6 10. 6
Palm oil 1 tablespoon 2. 6 17. 3
Peanut oil 1 tablespoon 1. 6 10. 6
Safflower oil 1 tablespoon 4. 6 30. 6
Soybean oil 1 tablespoon 1. 5 10
Sunflower oil 1 tablespoon 6. 1 40. 6
Vegetable-oil spray 2. 5 back spray 0. 51 3. 4
Wheat-germ oil 1 tablespoon 20. 3 135. 3
Tomato juice 6 fluid ounces 0. 4 2. 6
Apple with skin 1 channel 0. 81 5. 4
Mango, raw 1 channel 2. 32 15. 4
Macaroni pasta, enriched 1 cup 1. 03 6. 8
Spaghetti pasta, enriched 1 cup 1. 03 6. 8
Almonds, dried 1 ounce 6. 72 44. 8
Hazelnuts, dried 1 ounce 6. 7 44. 6
Peanut butter (Skippy) 1 tablespoon 3 5
Peanuts, dried 1 ounce 2. 56 17
Pistachio nuts, dried 1 ounce 1. 46 9. 7
Walnuts, English 1 ounce 0. 73 4. 8
Margarine (Mazola) 1 tablespoon 8 53. 3
Margarine (Parkay, diet) 1 tablespoon 0. 4 2. 6
Mayonnaise (Hellmann's) 1 tablespoon 11 73. 3
Miracle Whip (Kraft) 1 tablespoon 0. 5 3. 3
Avocado, raw 1 avenue 2. 32 15. 4
Asparagus, frozen 4 spears 1. 15 7. 6
Spinach, raw 1/2 cup 0. 53 3. 5
Sweet potato 1 average 5. 93 39. 5
Tomato, red, raw 1 tomato 0. 42 2. 8
Turnip greens, raw 1/2 cup chopped 0. 63 4. 2

Source: Ohio State Academe Additional room Fact Sheet

Web MD Interview of Dr. Petrosino A propos Vitamin E (Sept. 26, 2000)

Vitamin E wellbeing is posted in its entirety (with annotated footnotes) on www. nutritionadvisor. com

Other Reviews on dietetic Supplements by Dr. Petrosino

Dr. Petrosino customary his Baccalaureate grade from Penn State Academe in 1975, pursued his Masters extent with honors at Penn State in 1978, and graduated Summa Cum Laude with a Doctorate in Sustenance from Lasalle Academia (Mandeville) in 1995. His doctoral dissertation examined the belongings of race and poverty on cardiovascular health. He was an Accessory Professor of Sustenance at LaSalle Academia (1995-1999); a affiliate of the Inhabitant Institutes of Physical condition (NIH) Consensus Change Board on Cardiovascular Disease; a Certified Associate and Charter Associate of the American Heart Company Methodical Association on Epidemiology and Prevention of Cardiovascular Disease; a Expert Appendage and Charter Component of the American Heart Company Exact Association on Nutrition, Corporal Bustle and Metabolism; a Expert Associate of the American Heart Connection Interdisciplinary Effective Group on Functional Genomics and Translational Biology; an Combined Healthiness Care Practitioner appendage of the. . . .


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