Vitamin E Side Effects - Dosage, Overdose and Deficiency
It's really hard to overdose on vitamin E. It is a much more common problem to take the wrong kind of vitamin E. But there are upper limits to how much you should take of any vitamin E product.
How much vitamin E is too much? While we more often think of vitamin consumption in terms of too little, it is also possible to get too much. Vitamin E is a fat-soluble vitamin. It is stored in your liver and in your fatty tissues and your skin.
Two other fat-soluble vitamins, A and D, can build up to toxic levels in your liver, up to twenty-five times more than the body actually needs. Vitamin E, however, does not build up to toxic levels. If you keep on taking vitamin E, your liver just stops receiving it. The problem is thought to be what excess vitamin E may do to blood cells.
The reason experts are concerned about the effect of vitamin E on clotting factors is that a study back in the 1990's found that smokers who took a low dose of vitamin E (50 IU a day) were slightly, although not significantly, more likely to have hemorrhagic stroke. The magnitude of the effect was small enough that it is possible that it was just a fluke. And studies using up to 3,200 IU of vitamin E a day didn't find any problems of this nature at all.
Still, if you are taking any kind of blood thinning drug, it's a good idea to keep it carefully monitored. You actually have much greater concerns about vitamin K, but you should discuss taking vitamin E with your doctor before you start.
Are there any other side effects of vitamin E? People who take vitamin E capsules sometimes get stomach upset. This is most likely to happen when the product is dl-alpha-tocopheryl acetate suspended in soy oil. It's a very inexpensive product that really doesn't do your body a lot of good, because it's not the form of vitamin E your body absorbs with ease.
The product with these supplements actually isn't the vitamin E. It's the soy oil. Oils eventually go bad, even when they are stored in capsules. If you get stomach upset after taking this kind of vitamin E, throw out the bottle (that probably cost you between US $1.99 and $3.99) and take d-alpha-tocopheryl succinate or, better, a mixture of alpha-tocopherol and vitamin E tocotrienols.
Excess vitamin E is far less of a problem than taking the wrong kind.
Vitamin E Dosage
Vitamin E is not just one single compound. There are actually eight different kinds of vitamin E, and our bodies need all eight of them.
Any vitamin E supplement you take should contain a balance of tocopherols and tocotrienols, such as are found in the palm oil supplement Tocomin®. And if you are in good health and consume a balanced diet, as little as 10 milligrams of a balanced vitamin E may cover your minimum needs. But there are certain situations where you need more:
- If you get less than 15 per cent of your calories from fat, you may benefit from taking more than 10 mg a day of vitamin E. The reason for this is that fat in food dissolves vitamin E and carries it to the liver for distribution to the rest of the body.
- If you consume a foods made with "fake fats," such as Olestra, then you may need more vitamin E. Olestra can dissolve vitamin E, but because the fake fat is not absorbed by your body, the vitamin E is lost. Up to 200 IU of alpha-tocopherol (or alpha-tocopheryl acetate) plus 200 milligrams of tocotrienols per day may help you avoid vitamin E deficiency.
- If you have Crohn's disease or inflammatory bowel syndrome, your gut cannot absorb fat, so it cannot absorb vitamin E. You may benefit from a combination of up 400 IU of alpha-tocopherol (or alpha-tocopheryl acetate) plus 400 milligrams of tocotrienols per day may help you avoid vitamin E deficiency.
- If you have liver disease, then you may benefit from up to 800 IU of alpha-tocopherol (or alpha-tocopheryl acetate) plus 800 milligrams of tocotrienols per day. The reason people who have liver disease need more vitamin E is that an injured liver does not make as much bile. The bile salts are what capture vitamin E in the digestive tract and carry it into the bloodstream.
- And if you are over 50, or you have any kind of neurodegenerative disease, in particular Parkinson's or Alzheimer's, then you may benefit from up to 1200 IU of alpha-tocopherol (or alpha-tocopheryl acetate) plus 1200 milligrams of tocotrienols every day. Be sure to let your doctor know you are taking vitamin E or any other supplements.
Vitamin E supplements have been tested in dosages of up to 3,200 IU a day. At this dosage, there are occasionally problems with stomach upset. This is much more likely to be a problem when the product is old and the carrier oils have gone bad.
Probably much higher doses are OK, but since they have not been clinically tested, and there is a point at which additional vitamin E can't be stored by your body, no one should take more than 3,200 IU a day. That's the equivalent of 1,600 IU of alpha-tocopherol plus 1,600 mg of tocotrienols.
It only takes a little vitamin E to prevent vitamin E deficiency. It can take a whole lot more to support recovery from disease. Here are some minimum levels:
- It takes at least 50 IU a day for cancer prevention.
- It takes at least 100 IU a day for prevention of heart disease.
- It takes at least 400 IU a day to prevent hardening of the arteries.
- It takes at least 1,200 IU a day to slow the progression of neurological diseases associated with aging.
You will always benefit most from a product that contains a combination of alpha-tocopherol and the other forms of vitamin E. You will always benefit most from natural vitamin E. Here is how you recognize natural vitamin E:
- If it says d-alpha-tocopherol, it's natural.
- If it says dl-alpha-tocopherol (or d-alpha-tocopheryl), it's synthetic.
- If it doesn't say d or dl, then assume it's synthetic.
Why should you care?
Synthetic vitamin E contains eight different chemicals, only one of which can be absorbed by the human body. Natural vitamin E also contains eight different chemicals, but all of them are absorbed and used by the body. And if the label mentions beta-, gamma-, delta-tocopherol, or any kind of tocotrienol, you can be assured it's natural vitamin E. Alpha-tocopherol is the only kind of vitamin E that can be synthesized.
If it's natural, it works harder, and you can benefit from less. If it's synthetic, you can take more without getting all the benefits you need.
Why would anybody take synthetic vitamin E?
The simple fact is, there's not enough real vitamin E being produced to go around. Until more food manufacturers are willing to divert at least little more of their organic plant oils to vitamin production, there will always be a demand for the artificial vitamin. But in the meantime you can rely on products by the best manufacturers, such as Life Extension and Xtend Life.
Vitamin E Overdose
You've probably heard the expression "too much of a good thing." Even though chances are you need a lot more vitamin E than the recommended daily intake, it's still possible to take too much vitamin E. Here's the main thing you need to know about the right dose of vitamin E.
There is a very wide gap from the amount of vitamin E you need to prevent deficiency and the amount of vitamin E that might cause vitamin E overdose symptoms.
You absolutely must get at least 12 to 15 units of vitamin E a day from food or supplements. You absolutely must not get more than about 5,000 units of vitamin E a day from supplements.
From 12 to 1200 units of vitamin E a day, there is no risk of interaction with any medications. From 1200 to 3200 units of vitamin E a day there is a possibility of problems if you take certain prescription blood thinners such as Coumadin (warfarin) or clopidrogel for your heart or for circulation to your hands and feet.
Like vitamin A and vitamin D, vitamin E is a fat-soluble vitamin. Unlike vitamin A and vitamin D, there is very little risk of a vitamin E overdose. The reason for this is:
Your liver can keep on storing more and more vitamin A and vitamin D in the liver until they build up to toxic levels. The liver can't store an indefinitely large amount of vitamin E.
Eating too many vitamin A- or vitamin D-rich foods can increase tissue stores of these vitamins by 2500% and liver stores of these vitamins by 10,000%. But you just can't increase your body's stockpiles of vitamin E by more than about 500%.
Laboratory studies have found that there is no dosage of vitamin E that damages DNA and that animals can be fed 1,000 times the recommended daily intake of vitamin E and live. Of course, you don't want just to survive taking vitamin E! You want to have better health as a result of taking vitamin E.
Clinical studies have tracked the effects of taking 50 to 3,200 IU of vitamin E a day. Here are the results:
- The Finnish Alpha-Tocopherol, Beta-Carotene study gave 50 IU of vitamin E a day to 16,000 male smokers.
- The Women's Health Study has been tracking the effects of 400 IU of vitamin E a day on 49,000 women.
- Two studies involving people with Alzheimer's or Parkinson's disease have given participants 2,000 IU a day, and
- One study gave thirty-six people with angina 3,200 IU of vitamin E every day for six weeks.
- Dr. Sambath Parthasarathy, a professor of medicine at Emery University in Atlanta, Georgia, in the USA, has written extensively on the use of vitamin E as a tool for preventing the oxidation of cholesterol that turns into a form that clog arteries. For several years he took 10,000 IU a day with no problems, but now he only takes 1,000 IU a day.
The only study that found there might be a connection between vitamin E and any health problem was the study that used the smallest dosage of the supplement. The Finnish Alpha-Tocopherol, Beta-Carotene study found that 16,000 smokers who took vitamin E every day had a slightly higher risk of a rare form of stroke called hemorrhagic stroke, basically a kind of bleeding in the brain. They had significantly lower risk of the more common ischemic stroke, prostate cancer, and colon cancer.
But the fact that these effects have not been seen in the 49,000 women who took eight times as much vitamin E suggests that the results may have been a fluke. And Dr. Parthasarathy has not encounted any of these kinds of problems, either.
There are anecdotal reports of other problems with vitamin E supplements that may not be caused by the vitamin E itself. The carrier oil for a poorly manufactured vitamin E supplement can go bad if the product is exposed to heat or light or allowed to sit on a shelf for literally years at a time.
You are highly unlikely to encounter these problems if you buy vitamin E from a high-quality supplier who sells over the Internet. You are only likely to encounter this problem if you are buying vitamin E that some retailer who doesn't sell many vitamins has found on a warehouse and suddenly puts on sale at a very low price. And if you do, the most likely result is stomach upset-from a rancid carrier oil.
It's also theoretically possible that you could take so much vitamin E that it would start acting as a pro-oxidant, that is, a kind of anti-antioxidant. This would only happen if you took an enormous amount of vitamin E (over 5,000 IU per day) and you were deficient in vitamin C and you took a statin drug for cholesterol that had the side effect of depleting your body's coenzyme Q10. It's not likely, but it could happen.
If you take 400 to 1,200 IU of a mixture of alpha-tocopherol with other forms of vitamin E every day, however, no problems have ever been reported. Speak with your doctor before taking vitamin E if you are taking any medication to thin your blood.
What about Vitamin E Deficiency Risks
Vitamin E deficiency is a relatively rare condition, but when it occurs, it is devastating. The most common form of vitamin E deficiency is the hereditary disease cystic fibrosis, also known as CF.
Twelve year-old Jason had been diagnosed with CF in infancy. His parents were advised by a "naturopath" that vitamin supplements might be a cure-all, but the family doctor warned that they were probably a scam.
CF results from the lack of a protein that transports chloride ions out of the cells that make mucus. The result is chronic production of thick, sticky mucus not just in the lungs and throat but also in the digestive tract. In particular, mucus blocks the flow of enzymes made by the pancreas.
When the pancreas cannot release esterases, nutrients that are bound into a chemical group known as an ester cannot be broken down for entry into the bloodstream. All of the artificial forms of vitamin E that have chemical names that end in -ate are esters.
Children and adults who have CF get no benefit from d-alpha-tocopheryl acetate, d-alpha-tocopheryl succinate, d-alpha-tocopheryl linoleinate, or d-alpha-tocopheryl nicotinate supplements. These vitamin E supplements are less than useful, because they require valuable enzymes even to break the capsule or break down the pill.
Fortunately, there is a kind of vitamin E that doesn't need these enzymes to be used by the body, and that can "swim" through the thick mucus that blocks nutrient absorption in people who have CF. This is a product with the hard-to-remember name d-alpha-tocopheryl polyethylene glycol 1000 succinate.
If the name sounds like the product is entirely unnatural, it is. But this form of vitamin E is a formm that the body of a child or adult with CF can absorb. It's the only recommended vitamin E supplement for CF.
Raymond had a bad bout of gallstones. At one point, his liver had become so congested with pigment that his skin turned green. An emergency gallbladder operation removed the stones, but just a few months later, even though years of checkups had found no trace of heart disease, hehad a heart attack. And a few months after that, he was diagnosed with dementia.
CF is a relatively rare condition. Gallbladder disease, on the other hand, is relatively common. Every year, just in the United States alone, over three million women and 1.5 million men are treated for gallstones, but millions more do not know that they have them. At one time or another, nearly 50 per cent of all adults will have a gallbladder problem, and the conditions that create gallstones also interfere with the absorption of vitamin E.
The function of the gallbladder is to transport bile from the liver to the intestine. Bile dissolves fats. It gathers them into microscopic bubbles known as micelles, so they can flow into the watery bloodstream. Fats and water don't mix without formation of micelles, so the gallbladder is essential for the absorption of fat-soluble vitamins such as A, D, E, and K.
Both children and adults who have untreated gallbladder disease are at risk for developing serious, even life-threatening neurological conditions. Adults who have gallbladder disease are at increased risk of heart attack. But with this condition, the underlying problem is not a lack of the enzymes needed to process the forms of vitamin E used to make supplements. The problem is not getting enough vitamin E.
If you have gallbladder disease, you should consider a vitamin E supplement in an oil base. That is, you should take a capsule, not a pill. Taking at least 200 IU of alpha-tocopherol or alpha-tocopherol-succinate along with 200 mg of tocotrienols, in two divided doses taken at different times of day, can help compensate for the difficulty your body has absorbing vitamin E.
You also may benefit from mixed carotenoids as a source of vitamin A, and encapsulated, oil-based formulas for vitamins D and K.
Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?. Curr Gastroenterol Rep. May 2005;7(2):132-40.
Schwesinger WH, Diehl AK.Changing indications for laparoscopic cholecystectomy. Stones without symptoms and symptoms without stones. Surg Clin North Am. Jun 1996;76(3):493-504.