Vitamin E is a master antioxidant and the body's most potent fat-soluble antioxidant. Vitamin E is crucial for protecting against free radical damage.
Vitamin E also strengthens and regulates the heartbeat (and is very important in preventing and treating heart disease and cardiac conditions), enables the heart to do more work with less oxygen, promotes wound healing, helps prevent blood clots, improves fertility and some PMS and menopause symptoms, reduces the risk of heart disease, cancer, stroke and cataracts and strengthens the immune system (and effects many other bodily processes).
Vitamin E increases the body's production of CD4 cells, natural killer cells, and certain antibodies, boosting overall immunity without overstimulating the immune system or aggravating autoimmune disorders. Vitamin E can also slow down the mental decline associated with some neurological disorders. Dr Atkins explains that vitamin E supplementation is essential for diabetics and that, ‘When vitamin E levels are low, the risk of acquiring type 2 Diabetes rises by a ratio of four to one.’
What is vitamin E?
Unlike some vitamins, which consist of a single compound, vitamin E consists of eight different compounds, four tocopherols and four tocotrienols (designated as alpha, beta, gamma and delta). Our food contains all eight compounds. Alpha-tocopherol became synonymous with vitamin E for two reasons: (1) It is the most abundant of the eight in our (and in other animals) bodies; (2) It is the most effective of the eight to support reproduction—which we thought was vitamin E’s main function. Are the differences between the eight vitamin E family members a big deal? Yes. These eight members have some similar but other different functions. Where they go in our body varies, especially for alpha-tocopherol versus the others.
Thus it is important when supplementing vitamin E that we take some natural alpha-tocopherol and also some of the other 7 vitamin E compounds. As gamma-tocopherol is far more effective than alpha-tocoperol at reducing nitrogen radicals and reducing inflammation, it is also advisable for those with serious diseases such as M.E. to take some extra gamma-tocopherol. (Gamma-tocopherol is the most prevalent form of vitamin E in nature. Gamma-tocopherol reduces nitrogen dioxide back to NO or reacts with it to form a harmless compound. Very preliminary data also suggests that gamma-tocotrienol may have a similar effect.)
There is some vitamin E in foods (such as nuts and seeds, wheat germ, sweet potato, cauliflower and peas) but this is not enough to provide the benefits shown in vitamin E research, and so vitamin E supplements are necessary.
Natural vs synthetic and esterfied vs unesterfied vitamin E
Unlike most vitamins, with vitamin E there is a real difference between natural and synthetic. It is very important to buy only natural vitamin E. When buying alpha-tocopherol make sure to buy d-alpha tocopherol and NOT dl-alpha tocopherol. (Watch out for that lower case L after the D.) If the bottle does not say if it contains natural or synthetic vitamin E, assume it is a synthetic product.
Make sure to also buy an unesterfied form of alpha-tocopherol. This form of vitamin E is ‘muzzled’ and the body needs to work to ‘demuzzle’ it chemically before it can be used by the body, which may be a problem in serious diseases such as M.E. (particularly in larger doses). The alpha-tocopherol contained in powders and multivitamins will almost always be esterfied, as this makes the product more stable. Esterfied alpha-tocopherol in a multi is fine, but make sure that when buying a stand-alone alpha-tocopherol product that you avoid this form. When you see terms such as ‘succinate’ and ‘acetate’ written after d-alpha-tocopherol, this lets you know that it is an esterfied product.
Note that only alpha-tocopherol is sold in synthetic and esterfied forms. The other 7 vitamin E compounds are only available in natural and unesterfied forms.
IU vs milligrams
The system of measuring vitamin E in ‘International units’ came about when it was thought that alpha-tocopherol was the only important vitamin E compound. But this system only tells part of the story (see The Vitamin E Factor book for more information on the history of vitamin E and the IU system of measurement). Today, very often alpha-tocopherol is measured in IU and the other 7 vitamin E compounds are measured in milligrams. (If a conversion is necessary, however, note that one IU of natural alpha-tocopherol is equal to 0.67 milligrams of natural alpha-tocopherol. Online converters are also available.)
Proper Absorption of Vitamin E
Vitamin E is better at preventing disease than treating it. Andreas M. Papas, Ph.D. states that conditions such as leaky gut syndrome (a condition very often seen in M.E.) can impede the absorption of vitamin E and that,
Vitamin E deficiency can go undetected for a long time. Once damage is found, it is largely irreversible. This is especially so for damage to nerve tissue. For proper absorption of vitamin E, low fat diets can be bad. A healthy person absorbs oils (which include vitamin E) through micelles (tiny spheres), which carry the oil/fat compounds through our intestine wall. The fat is put into these unique tiny spheres (micelles) with a water-loving (hydrophilic) outer layer. There is also a special, unique form of vitamin E labeled TPGS. It is water soluble and forms its own tiny spheres so it can be more easily absorbed by people with diseases like AIDS who need it.
A water-soluble source of vitamin E, such as Aqua-E, allows for improved absorption in patients with diseases of malabsorption that affect the liver, pancreas, or intestines. Aqua-E forms its own micelles—small spheres that have a water-loving exterior to allow the vitamin E to make contact with the lining of the gut—and contains all eight members of the vitamin E family.
(Note that vitamin E expert Andreas M. Papas PhD is a founding member of Yasoo, the producer of ‘Aqua-E.’) Several different companies manufacture water soluble vitamin E. Look for tocopheryl succinate polyethylene glycol 1000 (TPGS) or do a search for ‘water soluble vitamin E.’
Loose stools that appear to have lots of fat in them and extreme weight loss may be a sign of severe problems absorbing fat from the diet. Most often patients with absorption problems will have decreased absorption levels however, rather than a complete inability to take in any vitamin E at all (this is quite rare). Thus if one cannot afford expensive water soluble vitamin E products, taking a reasonable dose of standard vitamin E (all 8 types) will still allow some vitamin E to be absorbed. Andreas M. Papas’s book on vitamin E gives more information on the need for water soluble vitamin E, and how this product can be combined with other fat soluble vitamins to also improve their absorption.
A biochemical antioxidant profile test may be useful if problems absorbing vitamin E are suspected as this test measures the levels of beta carotene, vitamin A and vitamin E in the blood.
Toxicity and vitamin E
Andreas M. Papas, Ph.D. explains that, ‘Unlike other fat-soluble vitamins, toxicity of vitamin E is very low probably because it is not stored in the liver.’ While mild gastrointestinal upset may occur at very high doses, daily doses of 1600 IU or more have been given for significant periods of time with no toxicity.
Vitamin E precautions
Vitamin E thins the blood, as so should be discontinued before surgery. More vitamin E may be needed if large doses of vitamin A or fish oil are taken (while CoQ10 recycles vitamin E).
Topical use of vitamin E
Andreas M. Papas, Ph.D. explains that esterfied forms of alpha-tocopherol are not appropriate or effective for use in topical oils and creams (as the skin can’t break them down properly) and that the only useful form for topical application is unesterfied natural vitamin E. Vitamin E oils can improve healing and be useful in treating burns and various types of sores. A few drops from a vitamin E capsule or oil may treat problems with earwax even better than olive oil.
The correct dosage and types of vitamin E
Dosages typically given for alpha-tocopherol vary from 400 – 800 IU or sometimes up to 1200 IU, however, this ignores the evidence which suggests that taking this one form of vitamin E alone isn’t as effective or as safe as taking all 8 at once. Andreas M. Papas, Ph.D. recommends in his book on vitamin E that those with serious neurological diseases take 400 IU (or approximately 270 mg) of alpha-tocopherol daily, plus 400 mg of mixed tocopherols and tocotrienols. This gives a total of 670 mg of vitamin E daily.
(He also recommends that over the age of forty that this dosage be doubled. Note however that the first dosage recommendation given is still quite high, and so doubling it gives a very high dose that may or may not be necessary for all patients.)
Recent studies have shown that taking alpha-tocopherol alone can lead to a depletion of gamma and delta-tocopherol which is problematic as more and more studies are showing the benefits of gamma-tocopherol in particular.
At this time, experts suggest that this problem is best solved by making sure that one takes at least twice as much gamma-tocopherol as alpha-tocopherol as well as some of each of the other 6 types of vitamin E in the proper proportions. While the issue of alpha- vs. gamma-tocopherol requires more research before it can be fully understood, Lyle MacWilliam from the LEF explains that,
Although less is known about gamma tocopherol than about alpha tocopherol, recent evidence suggests that the gamma form is an important weapon in defending against cardiovascular disease. Several investigations confirm that higher tissue concentrations of gamma tocopherol are associated with lower rates of illness and death due to cardiovascular events. Numerous studies suggest that gamma tocopherol may provide powerful protection for the heart. While both forms of vitamin E have disease-preventive actions that reflect their individual chemistries, it is their combination that likely accounts for the powerful preventive effects observed in epidemiological, retrospective, and laboratory studies. Consequently, to highlight one form and exclude the other is to sell both forms short.
So if one wanted to stay with Papas’s recommendation of taking 670 mg of vitamin E daily (made up of some of each of the 8 types of vitamin E) and also take into account the new research recommending that twice as much gamma-tocopherol as alpha-tocopherol be taken, then one may decide on a daily vitamin E intake as follows:
Approximately 170 mg (250 IU) of alpha-tocopherol
Approximately 345 mg of gamma-tocopherol, 115 mg of delta-tocopherol and 8 mg of beta-tocopherol
50 mg of mixed tocotrienols
This gives a daily total of approximately 688 mg.
There are several ways to go about getting these specific amounts and types of vitamin E.
One could take one 200 IU softgel of natural alpha-tocopherol daily, plus around 50 IU of extra natural alpha-tocopherol used as an antioxidant in various other supplements such as fish oil and ubiquinol, plus eight ‘gamma-E’ softgels EACH WEEK each containing 300 mg of gamma-tocopherol (and also roughly 100 mg of delta-tocopherol and 7 mg of beta-tocopherol), plus a 50 mg mixed tocotrienols product once daily.
One could take a multivitamin that contains 200 IU of natural (though probably esterfied) alpha-tocopherol, plus around 50 IU of extra natural alpha-tocopherol used as an antioxidant in various other supplements such as fish oil and ubiquinol, plus eight ‘gamma-E’ softgels EACH WEEK each containing 300 mg of gamma-tocopherol (and also roughly 100 mg of delta-tocopherol and 7 mg of beta-tocopherol), plus a 50 mg mixed tocotrienols product once daily.
One could take a multivitamin that contains 250 IU of natural (though probably esterfied) alpha-tocopherol, plus eight ‘gamma-E’ softgels EACH WEEK each containing 300 mg of gamma-tocopherol (and also roughly 100 mg of delta-tocopherol and 7 mg of beta-tocopherol), plus a 50 mg mixed tocotrienols product once daily.
One could take a daily multivitamin that contains 50 IU of natural (though probably esterfied) alpha-tocopherol, plus a 400 IU alpha-tocopherol softgel every second day, plus eight ‘gamma-E’ softgels EACH WEEK each containing 300 mg of gamma-tocopherol (and also roughly 100 mg of delta-tocopherol and 7 mg of beta-tocopherol), plus a 100 mg mixed tocotrienols product every second day.
If a lower level of vitamin E supplementation is desired, due to financial or other reasons, then the daily dosages given above can be halved. (This lower level of supplementation can also be halved again, if necessary. It is far better to take a smaller amount of vitamin E than none at all.)
If the total amount of alpha-tocopherol in a daily multivitamin and other supplements is slightly higher than 250 IU, it may be necessary to up the gamma-E intake to 9 weekly instead of 8 to keep the ratios the same. If daily alpha-tocopherol intake were only 200 IU, then perhaps gamma-E intake could be taken down to 7 weekly instead of 8, to again keep the ratios the same.
At least 50 mg of mixed tocotrienols daily is ideal (or 50 mg every second or third day, if financial restraints are an issue). If financial restraints are less of an issue, it may also be worthwhile considering a high-dose tocotrienol complex of up to 200 mg daily, as this has been shown to be helpful for those with various types of heart disease.
The 'Unique E' vitamin E products made by the A.C. Grace company are also specifically recommended by some practitioners and are a high quality choice. These products are wheat, soy, corn, additive and filler-free. The company makes a basic Unique E product and also a separate Tocotrienol product which they recommend to be taken a different times of the day from each other for better absorption.
Prices vary considerably, so some research of different brands is necessary. Perhaps companies such as Carlson Labs, Jarrow and LEF which offer several good vitamin E products are a good place to start. Looks for brands, like these three, which list all the individual amounts of each compound and don’t just say ‘mixed’ tocopherols or tocotrienols, as such products very often give you more of the cheaper compounds (such as the alphas) and less of the more expensive and more beneficial ones. Look at the products from these brands to see what the proper percentages of each tocopherol and tocotrienol should be (percentages similar to those found in nature).
Expect to wait at least 3 months to see an effect from vitamin E supplementation, as vitamin E is fat soluble and takes a while to build up in the body (particularly in the brain). Vitamin E is well tolerated by M.E. patients generally, but it is highly recommended that the dose be raised gradually and that the final desired daily dose is worked up to over at least 2 months.
What Makes Gamma Tocopherol Superior to Alpha Tocopherol by Lyle MacWilliam MSc FP on LEF
Get the Straight Facts on Vitamin E Tocopherols by Smart Publications
The Vita-Nutrient Solution by Dr Atkins
"Vitamin E is Nature’s master antioxidant" Scientific American, March/April, 1994
‘The nerves in the brain are the most susceptible to damage from free radicals. Vitamin E is the best antioxidant to fight free radicals, which attack the membranes of nerve cells.’ The Vitamin E Factor—Summary and Review
‘Although alpha tocopherol has been shown to be a better antioxidant than gamma tocopherol, gamma tocopherol is a better anti-inflammatory. It is very good at controlling chronic inflammation-related diseases including arthritis, cancer, cardiovascular disease, and neurodegenerative disorders such as Alzheimer's disease. Recent evidence indicates that gamma-tocopherol may be a more powerful chemopreventive than alpha-tocopherol, and that it is better at inhibiting cancer cell proliferation.’ Get the Straight Facts on Vitamin E Tocopherols
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