Vitamin E


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Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Vitamin E deficiency
Vitamin E deficiency is rare and may occur in people with diminished fat absorption through the gut (due to surgery, Crohn's disease, or cystic fibrosis), malnutrition, very-low-fat diets, or several specific genetic conditions (abetalipoproteinemia, "ataxia and vitamin E deficiency" [AVED]); in very-low-birthweight premature infants; or infants taking unfortified formulas. Vitamin E supplementation is accepted as an effective therapy for vitamin E deficiency to halt progression of complications. Diagnosis of this condition and its management should be under the care of a physician and nutritionist. 		A
Age-related macular degeneration
Like other antioxidants, vitamin E has been suggested to prevent, slow progression, or improve macular degeneration. The scientific evidence in this area is not conclusive, although there is some suggestion that vitamin E alone, or in combination with beta-carotene, may not be beneficial. Additional research is warranted before a clear conclusion can be drawn. 		C
Allergic rhinitis
Although antioxidants are thought to aid in reducing the nasal symptoms of allergies, vitamin E intake may not be effective. Although this has not been well studied in humans, research has demonstrated the potential use of gamma-tocopherol in allergic rhinosinusitis. However, current evidence is limited, and additional research is warranted. 		C
Altitude sickness
Vitamin E may offer some benefits in exposure to high altitude. Antioxidant supplementation (vitamin E with beta-carotene, vitamin C, selenium, and zinc) may improve ventilatory threshold at high altitudes. However, antioxidants may not reduce inflammation after exercise at high altitudes. Additional research is warranted. 		C
Amyotrophic lateral sclerosis (ALS)
Nutritional interventions have been investigated for the prevention and treatment of neurodegenerative diseases such as ALS. There is unclear evidence with respect to vitamin E for treatment of ALS. Additional research is warranted. 		C
Anemia
Antioxidants have been studied for the prevention and treatment of various types of anemia. Studies of vitamin E supplementation for anemia have yielded mixed results. Additional research is warranted. 		C
Angina
Vitamin E has been suggested and evaluated in patients with angina (chest pain), although its possible benefits remain unclear. Further evidence is necessary before a clear conclusion can be drawn. Patients with known or suspected angina should be evaluated by a physician. 		C
Antioxidant
Vitamin E possesses antioxidant activity, but the clinical effects of antioxidant protection by vitamin E are not clear in humans. The American Heart Association has recommended obtaining antioxidants such as vitamin E by eating a well-balanced diet high in fruits, vegetables, and whole grains, rather than from supplements, until further scientific evidence is available. 		C
Asthma
In schoolchildren, lower levels of vitamin E have been associated with poorly controlled asthma. Maternal intake of vitamin E during pregnancy has been associated with reduced rates of asthma and wheeze in children. However, there is evidence that vitamin E supplementation may not provide benefits in individuals with asthma. Additional research is warranted. 		C
Atherosclerosis
Vitamin E has been proposed to have a role in preventing or reversing atherosclerosis (clogging and hardening of arteries) by inhibiting oxidation of low-density lipoprotein (or "bad") cholesterol. Studies have suggested that a high dietary intake of vitamin E and high blood concentrations of alpha-tocopherol are associated with lower rates of heart disease. This area remains controversial, and further research is required. 		C
Bladder cancer
There is preliminary evidence of possible benefits of long-term vitamin E supplementation to reduce the risk of mortality in bladder cancer patients, although additional research is necessary before a clear conclusion can be reached. 		C
Breast cancer
Vitamin E has been suggested as a possible therapy for the prevention or treatment of breast cancer. Published studies have included measurement of vitamin E levels, laboratory experiments, and population studies. Evidence remains inconclusive, and no clear conclusion can be drawn at this time. 		C
Breast cancer-related hot flashes
A study of oral vitamin E reports a very small reduction in hot flash frequency (approximately one less hot flash daily), but with no preference among patients for vitamin E over placebo. Further research is required. 		C
Cancer prevention (general)
Evidence from a well-conducted randomized controlled trial (the Women's Health Study) reports no reduction in the development of cancer with the use of natural-source vitamin E taken daily. Previously, there have been laboratory, population, and other human trials examining whether vitamin E is beneficial in preventing various types of cancer, including prostate, colon, or stomach cancer. Results of these prior studies have been variable. Additional research is warranted. 		C
Cancer treatment
There is a lack of reliable scientific evidence that vitamin E is effective as a treatment for any specific type of cancer. Caution is merited in people undergoing treatment with chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anticancer effects of these therapies. This remains an area of controversy, and studies have produced variable results. High doses of vitamin E may also cause harm in cancer patients. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. 		C
Cardiovascular disease in dialysis patients
It has been suggested that hemodialysis patients may be under increased oxidative stress and therefore may benefit from the chronic use of antioxidants (particularly for the reduction of risk of heart disease). There is some research on the use of high-dose chronic vitamin E in dialysis patients for heart disease prevention, although its benefits or risks remain unclear in this population. Recent concern has been raised that regular use of high-dose vitamin E supplements may actually increase the risk of death from all causes by a small amount, although this remains an area of controversy and active investigation. Additional research is warranted. 		C
Cataract prevention
There is conflicting evidence regarding the use of vitamin E to prevent cataracts. Although some studies across populations have suggested some protective effects (which may take up to 10 years to yield benefits), other studies in humans have reported a lack of benefits when used either alone or in combination with other antioxidants. Additional research is warranted. 		C
Chemotherapy-induced neuropathy
Like other antioxidants, vitamin E has been suggested as a therapy to prevent complications due to chemotherapy, such as neuropathy (nerve damage). There is some evidence of benefit, for example, when it is used with cisplatin. However, caution is merited, because it is not known if the use of high-dose antioxidants during chemotherapy may actually reduce the anticancer effects of some chemotherapy agents or radiation therapy. This remains an area of controversy. Patients interested in using antioxidants during chemotherapy should discuss this decision with their oncologist. 		C
Colon cancer prevention
Sufficient scientific evidence is lacking to determine if vitamin E prevents colon cancer. In patients with previous colon cancer, a combination of vitamins A, C, and E has been reported to reduce the risk of developing a new colon cancer, while this effect was not observed in another trial. Preventive benefits have also been suggested in those with no prior colon cancer when vitamin E is used in a multivitamin, but not when used alone. Recent results of the Women's Health Study have reported no overall reduction in cancer risk with daily use of vitamin E, although this study was not large enough to look at colon cancer specifically. Additional research is warranted. 		C
Dementia / Alzheimer's disease
Vitamin E has been proposed and evaluated for the prevention or slowing of dementia (including the Alzheimer's type), based on antioxidant properties and findings of low vitamin E levels in some individuals with Alzheimer's disease. There is some evidence that all-rac-alpha-tocopherol (synthetic vitamin E) is similar in efficacy to selegiline (Eldepryl®) and superior to placebo for slowing cognitive function decline in patients with moderately severe Alzheimer's disease, but no additive effect was observed when used in combination with selegiline. Retrospective data suggest that long-term combination therapy with donepezil (Aricept®) may help slow cognitive decline in patients with Alzheimer's disease. Other research suggests that vitamin E from dietary sources or supplements does not affect the risk of developing Alzheimer's disease or vascular dementia. Overall, the evidence remains inconclusive in his area. 		C
Diabetes mellitus
Vitamin E has been proposed for the prevention of type 1 or 2 diabetes; for the improvement of abnormal sugar control in diabetes; for prevention of platelet dysfunction and atherosclerosis in diabetes; for the correction of vitamin E deficiency in diabetic patients; and for the prevention of diabetic neuropathy, retinopathy, and nephropathy (complications of the eye, kidneys, and nervous system). Vitamin E deficiency has been observed in patients with diabetic foot ulcers. It is not clear that vitamin E is beneficial in any of these areas. Further evidence is warranted before a clear conclusion can be drawn. 		C
Diabetic retinopathy
Micronutrients have been studied for improvement in diabetic retinopathy, and vitamin E has been proposed to reduce oxidative stress related to diabetic complications. However, the evidence of benefit is lacking, and additional research is warranted. 		C
Dysmenorrhea
There is preliminary evidence of possible benefits of vitamin E supplementation to reduce chronic menstrual pain, although additional research is warranted in this area before a firm conclusion can be reached. 		C
G6PD deficiency
Vitamin E supplementation has been studied for the inherited disorder G6PD deficiency, with conflicting evidence. Additional research is warranted before a clear conclusion can be drawn. 		C
Glomerulosclerosis (kidney disease)
It has been suggested that proteinuria (protein in the urine) may be reduced with the use of vitamin E in patients with focal segmental glomerulosclerosis, which is resistant to standard medical management. However, further research is warranted before a clear conclusion can be drawn. 		C
Healing after photorefractive keratectomy
High-dose vitamin E plus vitamin A (taken by mouth) may improve healing of the cornea and improve visual acuity (sharpness) following laser surgery for vision correction. Although this has not been well studied in humans, research suggests that topical vitamin E on the eye may be helpful. Additional research is warranted. 		C
Heart disease prevention
Numerous studies of vitamin E (taken by mouth) have suggested a lack of benefit in the prevention of cardiovascular disease. Also, there is recent evidence to suggest that regular use of high-dose vitamin E increases the risk of death from all causes by a small amount. These conclusions have been criticized by some experts, and it has been suggested to conduct trials in more selective target populations. The Women's Health Study reported a reduction in cardiovascular deaths in women taking vitamin E daily (with 10-year follow-up), but there was no change in total death rate or number of heart attacks or strokes. Further research is required. 		C
Hepatitis (hepatitis C)
In patients with hepatitis C on antiviral therapy, vitamin E has been proposed to prevent inflammation. Additional research is warranted to examine the effects of vitamin E in chronic hepatitis. 		C
Hyperlipidemia
The effects of vitamin E on cholesterol levels and atherosclerosis have been studied in numerous laboratory, population, and clinical trials. It remains unclear if there are clinically meaningful benefits, and it is not known what the effects of vitamin E are compared to (or in combination with) other agents that have been clearly demonstrated as beneficial for lowering lipids. Further research is warranted before a clear conclusion can be drawn. 		C
Immune system function
Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Additional research is warranted. 		C
Intermittent claudication
Multiple studies have evaluated the use of vitamin E in patients with peripheral vascular disease, to improve exercise tolerance and intermittent claudication (pain in the legs with walking due to cholesterol buildup in blood vessels). It remains unclear if vitamin E is beneficial in this condition. 		C
Kwashiorkor
Kwashiorkor is a malnutrition disorder caused by a lack of protein in the diet. Treatment involves increasing caloric and protein intake as well as supplementation with vitamins and minerals. It is not clear if vitamin E supplementation is effective in the prevention of kwashiorkor. Further research is warranted. 		C
Liver disease
There is some evidence suggesting possible benefits of vitamin E in the management of steatohepatitis (fatty liver) and nonalcoholic fatty liver disease in children. Further evidence is warranted before a clear conclusion may be drawn. 		C
Mortality reduction
Evidence suggests that regular use of high-dose vitamin E supplements may increase the risk of death from all causes by a small amount, although a different study found no effects on mortality in women who took vitamin E daily. Overall, the results have not shown an association between vitamin E intake and decreased mortality. Further research is warranted in this area. 		C
Oral mucositis
Oral mucositis is a common adverse effect associated with chemotherapy. The effect of vitamin E on oral mucositis is unclear. Further research is warranted. 		C
Osteoarthritis
Oxidative stress is thought to play a role in osteoarthritis. Vitamin E has shown mixed results in reducing symptoms or preventing cartilage loss in osteoarthritis. Additional research is warranted. 		C
Parkinson's disease
Vitamin E has been studied for the prevention or treatment of neurodegenerative disorders such as Parkinson's disease, with mixed results. The scientific evidence is inconclusive in this area, and further research is warranted. 		C
Pre-eclampsia prevention
Vitamin E has been studied for the prevention of pre-eclampsia in pregnant women. However, most studies have been in combination with vitamin C or other micronutrients. Evidence of the efficacy of vitamin E alone is lacking, and further research is warranted. 		C
Premenstrual syndrome (PMS)
Several natural products have been studied for the improvement of premenstrual syndrome symptoms, with mixed results. The scientific evidence for vitamin E is inconclusive in this area, and further research is warranted. 		C
Prostate cancer prevention
The role of vitamin E supplementation for the prevention of prostate cancer is controversial. There are numerous laboratory studies that support possible anticancer properties. However, the results of population research and human research have been mixed. 		C
Respiratory infection prevention
Supplementation with oral vitamin E has shown mixed effects on the incidence, duration, or severity of pneumonia in elderly nursing home residents, and it did not alter patterns of antibiotic use, although there may be a protective effect against colds. Additional research is warranted. 		C
Rheumatoid arthritis
Vitamin E, taken by mouth, does not appear to reduce the risk of developing rheumatoid arthritis in women. Additional research is warranted. 		C
Seizure disorder
Vitamin E has been evaluated as an addition to other drugs used to prevent seizures, particularly in refractory epilepsy. This evidence is inconclusive, and further study is warranted. The management of seizure disorder should be under medical supervision. 		C
Stomach cancer (prevention)
Vitamin supplementation has been proposed to reduce the rate of gastric (stomach) cancer. However, there is some evidence suggesting that vitamin E does not reduce the rates of gastric cancer or precancerous gastric lesions. Additional research is warranted to examine whether vitamin E has any effects on gastric cancer. 		C
Supplementation in preterm and very low birthweight infants
Premature infants are at risk of vitamin E deficiency, particularly when they are born with very low birthweight. There are numerous studies of vitamin E given to premature infants to try to prevent potentially serious complications, such as intraventricular hemorrhage (bleeding into the brain), retinopathy (eye damage), or death. The quality of published research is variable and is not clearly conclusive. Premature infants should be under strict medical supervision. Decisions regarding vitamin supplementation should be made with the infant's physician. 		C
Tardive dyskinesia
Vitamin E has been studied in the management of tardive dyskinesia (involuntary movements) and has been reported to significantly improve abnormal involuntary movements, although the results of existing studies are inconclusive. Vitamin E may be more effective in higher doses and in people who have had tardive dyskinesia for less than five years. Further research is required. 		C
Uveitis
Antioxidants have been studied for uveitis (inflammation of the eye). Four-month oral supplementation with vitamin E had no apparent effect on uveitis-associated macular edema or visual acuity in one small study. Additional research is warranted before a clear conclusion can be drawn. 		C
Venous thromboembolism (VTE)
Data suggest that supplementation with vitamin E may reduce the risk of VTE in women. Those with a prior history or genetic predisposition may particularly benefit. Further research is warranted. 		C
Peyronie's disease
One study did not show significant improvement in pain, curvature, or plaque size in patients with Peyronie's disease (PD) treated with vitamin E, propionyl-L-carnitine, or vitamin E plus propionyl-L-carnitine compared with those treated with placebo. Another trial lacked a difference between vitamin E plus colchicine vs. colchicine alone. Evidence of efficacy for this condition is lacking. 		D
Retinitis pigmentosa
Oral vitamin E does not appear to slow visual decline in people with retinitis pigmentosa and may be associated with more rapid loss of visual acuity, although the validity of this finding has been questioned. Until further evidence is available, vitamin E may not be advisable in this condition. Therapy decisions should be under medical supervision. 		D
Scar prevention
Application of topical vitamin E alone does not appear to reduce surgical wound scarring. Because of a risk of contact dermatitis, some researchers have advised against the use of this therapy. 		D
Stroke prevention
Recent evidence from the Women's Health Study suggests that daily vitamin E supplementation does not reduce the risk of stroke. Prior evidence was indeterminate for stroke prevention or stroke recovery. At this time, based on the best available scientific evidence and recent safety concerns, vitamin E cannot be recommended for this use. 		D

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Abortifacient, acne, air pollution protection, allergies, alopecia, amiodarone pulmonary toxicity prevention, anti-aging, anticoagulation, athletic performance enhancement, bee stings, benign prostate hyperplasia, beta-thalassemia, blood disorders (porphyria), breast pain/inflammation (mastitis), bronchopulmonary dysplasia in premature infants, bursitis, cardiomyopathy, celiac disease, childhood growth promotion, chorea, congestive heart failure, Crohn's disease, cystic fibrosis, dermatitis, diabetic foot ulcers, diaper rash, digestive enzyme/pancreatic insufficiency, doxorubicin hair loss prevention, Duchenne muscular dystrophy, dyspraxia, energy enhancement, exercise recovery, extravasation, fibrocystic breast disease, frostbite, gastric ulcer, granuloma annulare (topical vitamin E), hair loss, heart attack, hematopoiesis, hereditary spherocytosis, human immunodeficiency virus (HIV), Huntington's chorea/disease, hypertension, impaired glucose tolerance, impotence, infertility (habitual abortion), labor pain, leg cramps, liver spots, lung cancer prevention, male fertility, menopausal symptoms, menstrual disorders, miscarriage, muscle strength, myopathy, myotonic dystrophy, neuromuscular disorders, nitrate tolerance, oral leukoplakia, pancreatitis, peptic ulcers, photoprotection, physical endurance, post-operative recovery (postangioplasty restenosis prevention), postural stability (poor posture), radiation injuries (induced fibrosis), reperfusion injury protection during heart surgery, restless leg syndrome, sexual performance, sickle cell disease, skin aging, skin damage caused by the sun, skin disorders (epidermolysis bullosa), sperm motility, stretch marks, sunburn, thrombophlebitis, transplant rejection prevention (heart), ulcerative colitis, water retention, wound and burn healing.

Dosing Related terms
NS_patient-vitamine Portions of this document last updated: Sept. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

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