Softgel Capsules
Golden colored, oval shaped soft gelatin capsule, filled with dark amber viscous clear oil.
Clinical Particulars
Deficiency
Vitamin E deficiency causes neurological problems due to poor nerve conduction. These include
neuromuscular problems such as spinocerebellar ataxia and myopathies. Deficiency can also cause
anemia, due to oxidative damage to red blood cells.
Other uses
Age-related macular degeneration (AMD)
Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the
United States and the developed world among people 65 years and older. It has been shown that vitamin E
alone does not attenuate the development or progression of AMD
However, studies focusing on efficacy of Vitamin E combined with other antioxidants, like zinc and
vitamin C, indicate a protective effect against the onset and progression of AMD
Alternative medicine A variety of schools of alternative medicine advocate high intake of dietary or supplementary vitamin E.
A review of a number of randomized controlled trials in the scientific literature by the Cochrane
Collaboration published in JAMA in 2007 also found an increase in mortality, of 4% (Relative Risk 1.04,
95% confidence interval 1.01-1.07) Excessive intake of vitamin E may increase risk of bleeding. A 2005
meta-analysis found that high-dosage vitamin E supplements may increase all-cause mortality."High
dose" vitamin E esters (>400 units/day) were also associated with an increased risk in all-cause mortality
of 39 per 10,000 persons, and a statistically significant relation existed between dose and mortality, with
increased risk at doses exceeding 150 units per day. The Miller study was criticised in the Journal of the
American Nutraceutical Association.
Proponents of megavitamin, orthomolecular, and naturally based therapies have for the last two thirds of a
century advocated and used the natural tocopherols, often mixed tocopherols with an additional 25% -
200% w/w d-beta-, d-gamma-, and d-delta-tocopherol.Studies on vitamin E have largely concentrated on
use of either a synthetic all-racemic ("d, l-") alpha tocopheryl ester (acetate or succinate) or a semisynthetic
d-alpha tocopheryl ester (acetate or succinate).
Alzheimer's disease
Alzheimer's disease is a wasting disease of the brain. As oxidative stress may be involved in the
pathogenesis of Alzheimer's, tocopherols have been tested as both a means of prevention and treatment.
The results of these studies have been mixed, with some research suggesting that high levels of vitamin E
in the diet may reduce the risk of Alzheimer's, while other studies found no such link.[32] Studies on
progression have also been contradictory, with the Alzheimer’s Disease Cooperative Study suggesting that
vitamin E supplementation might be beneficial, but a later trial finding no clinical benefit.Due to this
contradictory and confusing evidence, vitamin E or tocopherol supplements are not currently
recommended for treating or preventing Alzheimer's disease.
Cancer
As of 2009[update], human trials and surveys that have investigated potential association of vitamin E
intake with incidence of cancer remain generally inconclusive. Antioxidants such as vitamin E help
protect against the damaging effects of free radicals, which may contribute to the development of chronic
diseases such as cancer. Vitamin E also may block the formation of nitrosamines, which are carcinogens
formed in the stomach from nitrites consumed in the diet. It also may protect against the development of
cancers by enhancing immune function.
Some evidence associates higher intake of vitamin E with a decreased incidence of prostate cancer (see
ATBC study) and breast cancer. Some studies correlate additional cofactors, such as specific vitamin E
isomers, e.g. gamma-tocopherol, and other nutrients, e.g. selenium, with dramatic risk reductions in
prostate cancer. However, an examination of the effect of dietary factors, including vitamin E, on
incidence of postmenopausal breast cancer in over 18,000 women from New York State did not associate
a greater vitamin E intake with a reduced risk of developing breast cancer. A study of the effect on lung
cancer in smokers also showed no benefit.
Recent studies have found that increased intake of vitamin E, especially among smokers may be
responsible for an increase in the incidence of lung cancer, with one study finding an increase in the
incidence of lung cancer by 7% for each 100 IU of vitamin E taken daily.
A potential confounding factor is the form of Vitamin E used in these studies. As explained earlier,
synthetic, racemic mixtures of Vitamin E isomers are not bioequivalent to natural, non-racemic mixtures,
yet are widely used academically and commercially. The SELECT study for prostate cancer used racemic
alpha-tocopherol, for instance, and has shown no benefit The study, cited above, showing a modest
increase in cancer risk with Vitamin E supplementation, reported that over 90% of its respondents used a
racemic form of Vitamin E (d,l-alpha-tocopherol) A meta-analysis of studies using Vitamin E, sorting
results by the form (racemic vs non-racemic) used, is necessary.
Cataracts
Antioxidants are being studied to determine whether they can help prevent or delay age-related growth of
cataracts, a clouding of the tissue of the lens of the eye. Observational studies have found that lens clarity,
which is used to diagnose cataracts, was better in regular users of vitamin E supplements and in persons
with higher blood levels of vitamin E. A controlled trial of high doses of vitamins C and E and beta
carotene found no effect on the risk of developing cataracts. Similarly, a trial using vitamin E alone found
that vitamin E supplementation produced no change in the risk of developing cataracts or the rate of
progression of existing cataracts.
Glaucoma
A 2007 study published in the European Journal of Ophthalmology found that, along with other treatments
for glaucoma, adding alpha-tocopherol appeared to help protect the retina from glaucomatous damage.
Groups receiving 300 mg and 600 mg per day of alpha-tocopherol, delivered orally, showed statistically
significant decreases in the resistivity index in the posterior ciliary arteries and in the pulsatility index in
the ophthalmic arteries, after six and twelve months of therapy. Alpha-tocopherol-treated patients also had
significantly lower differences in mean visual field deviations."
Heart disease
Preliminary research has led to a widely held belief that vitamin E may help prevent or delay coronary
heart disease, but larger controlled studies have not shown any benefit. Many researchers advance the
belief that oxidative modification of LDL-cholesterol (sometimes called "bad" cholesterol) promotes
blockages in coronary arteries that may lead to atherosclerosis and heart attacks.Vitamin E may help
prevent or delay coronary heart disease by limiting the oxidation of LDL-cholesterol. Vitamin E also may
help prevent the formation of blood clots, which could lead to a heart attack. Observational studies have
associated lower rates of heart disease with higher vitamin E intake. A study of approximately 90,000
nurses suggested that the incidence of heart disease was 30% to 40% lower among nurses with the highest
intake of vitamin E from diet and supplements. The range of intakes from both diet and supplements in
this group was 21.6 to 1,000 IU (32 to 1,500 mg), with the median intake being 208 IU (139 mg). A 1994
review of 5,133 Finnish men and women aged 30 – 69 years suggested that increased dietary intake of
vitamin E was associated with decreased mortality (death) from heart disease.
Despite these promising observations, randomized clinical trials have consistently shown lack of benefit to
the role of vitamin E supplements in heart disease. The Heart Outcomes Prevention Evaluation (HOPE)
Study followed almost 10,000 patients for 4.5 years who were at high risk for heart attack or stroke. In this
intervention study the subjects who received 265 mg (400) IU of vitamin E daily did not experience
significantly fewer cardiovascular events or hospitalizations for heart failure or chest pain when compared
to those who received a sugar pill. The researchers suggested that it is unlikely that the vitamin E
supplement provided any protection against cardiovascular disease in the HOPE study. This study is
continuing, to determine whether a longer duration of intervention with vitamin E supplements will
provide any protection against cardiovascular disease.
Furthermore, meta analysis of several trials of antioxidants, including vitamin E, have not shown any
benefit to vitamin E supplementation for preventing coronary heart disease. One study suggested that
Vitamin E (as alpha-tocopherol only) supplementation may increase the risk for heart failure.
Supplementing alpha-tocopherol without gamma-tocopherol is known to lead to reduced serum gammaand
delta-tocopherol concentrations.
A large-scale 10-year study published in 2007 examined the rates of venous thromboembolism (VTE) and
pulmonary embolism in women taking 600 IU of vitamin E on alternate days. The study found a
significant reduction in VTE especially in women who had a history of thrombtic events or a genetic
predispostion.
Parkinson's disease
In May 2005, The Lancet Neurology published a study suggesting that vitamin E may help protect against
Parkinson's disease Individuals with moderate to high intakes of dietary vitamin E were found to have a
lower risk of Parkinson's. No conclusion could be made whether supplemental vitamin E has the same
effect. Other trials have tested whether giving vitamin E supplements reduces the risk of Parkinson's
disease, or if they can slow the progression of the disease. In a 1998 study, vitamin E supplements had no
effect on the rate of progression.
Pregnancy
Recent studies into the use of both vitamin C and the single isomer vitamin E esters as possible aids in
preventing oxidative stress leading to pre-eclampsia has failed to show significant benefits, but did
increase the rate of babies born with a low birthweight in one study.
Preservative
Tocopherols are sometimes used as a food preservative to prevent oils from going rancid.Mixed
Tocopherols are listed as an ingredient in most dry pet foods.
Topical use
Vitamin E is widely used as an inexpensive antioxidant in cosmetics and foods. Vitamin E containing
products are commonly used in the belief that vitamin E is good for the skin; many cosmetics include it,
often labeled as tocopherol acetate, tocopheryl linoleate or tocopheryl nicotinate. Some individuals
experience allergic reactions to some tocopheryl esters or develop a rash and hives that may spread over
the entire body from the use of topical products with alpha tocopheryl esters
Vitamin E is often claimed by manufacturers of skin creams and lotions to play a role in encouraging skin
healing and reducing scarring after injuries such as burns on the basis of limited research, but the weak
evidence of a benefit of silicon gel sheeting with or without added Vitamin E is limited by the poor quality
of the research. One study found that it did not improve or worsen the cosmetic appearance in 90% of
patients, with a third developing contact dermatitis.
