Vitamin E, long reputed to be the leader of the pack of health-promoting antioxidants -- those fighters of destructive free radicals -- has fallen on hard times. While some researchers question the value of vitamin E in quantities greater than the standard supplementation of 400 International Units (IU) a day, a number of doctors now are saying that any vitamin E supplementation is too much. The most recent study findings are contrary to large amounts of past research findings as well as guidelines from the Institute of Medicine (IOM), an independent scientific adviser on the nation's health that sets dietary guidelines in America. (The IOM has put the upper limit of vitamin E intake at 1,000 IU.) What's the truth?
Edgar R. Miller, MD, associate professor of medicine at Johns Hopkins University, presented findings at the American Heart Association's 2004 scientific meeting of his analysis of 19 studies involving patients over age 60 who had preexisting conditions, such as cancer, heart disease, Alzheimer's disease and kidney disease. Dr. Miller's research revealed that large dosages of vitamin E (400 IU or more) were linked to an increase in death, although no deaths were reported in association with levels of up to 150 IU.
I couldn't let it go without further investigation, so I called internist and dietician Michael Hirt, MD, RD, director of the Center for Integrative Medicine in Tarzana, California. Dr. Hirt's immediate response was that it's not correct to say that vitamin E, or any other vitamin for that matter, is all good or all bad -- the picture is more complicated. He looks at the many studies on the effects of vitamin E, sorting them by quality. He places the Johns Hopkins study into the lower-quality bin because it is a meta-analysis study, the kind that allows researchers to pick and choose from the data.
NOT ALL E IS CREATED EQUAL
But this doesn't mean he lets vitamin E off the hook entirely. Dr. Hirt has a serious caveat about the vitamin. Although he continues to support vitamin E supplementation, he explains that most people are taking a type of the vitamin that is not beneficial or may even be harmful. He thinks that so many people taking the wrong kind of vitamin E may contribute to negative findings in some studies. Vitamin E is not one simple vitamin -- it is made up of a family of four compounds called tocopherols -- each with a different variation of use and activity. But the vitamin E family also has other members that even fewer people know about called tocotrienols -- four compounds that help lower cholesterol and reduce plaque, among other benefits. Both tocopherols and tocotrienols are made up of units referred to as alpha, beta, gamma and delta. Critical to understanding is that you need all members of the vitamin E family, not just parts. People who pick up a bottle of vitamin E from a supermarket shelf, and even a health-food store, are nearly always purchasing a synthetic form of vitamin E that contains only alpha-tocopherol. While a synthetic-based alpha will not hurt you when used in moderation, Dr. Hirt says that its presence in the body makes it impossible for the natural vitamin E family found in the food you consume to do its job. The reason: Synthetic alpha E fills the body's vitamin E receptors, eliminating the space that would otherwise be used by the natural family of E. So by taking this synthetic tocopherol, you are not getting any of the other compounds, and you have excluded the benefits you would otherwise gain from natural dietary vitamin E.
THE RIGHT E
How, then, should people get their vitamin E? Dr. Hirt agrees that food-based vitamin E is valuable, such as that found in almonds, peanuts, vegetable and seed oils, whole grains and fortified cereals. But to get the 400 IU he recommends a day, you would have to eat two pounds of nuts or consume eight cups of olive oil! Obviously, this is out of the question for most of us, which takes us back to the supplement shelf. The right kind of vitamin E is more costly, but the expense pays for itself in improved health. Look for a natural form of vitamin E that contains alpha-, beta-, gamma- and delta-tocopherols and tocotrienols. This is often marketed as a "mixed natural tocopherol/tocotrienol blend" and is available through high-end suppliers via naturopathic physicians and supplement shops. As a final cautionary note, Dr. Hirt reminds everyone that even the finest vitamin E is still a supplement and not a replacement for a healthy lifestyle. Although 400 IU of the right vitamin E can replace two pounds of nuts and eight cups of olive oil, there are no pills in the world that can eliminate the need for eating a balanced diet that includes fruits, vegetables, quality proteins, healthful fats and whole grains. If you are interested in supplementing your E, do it with professional guidance to be sure you have the right daily dose.