“How much vitamin E should I be taking''

Sally, a 75-year-old, asked me this question last week.
Good question. Vitamin E is a fat-soluble vitamin that works as a powerful antioxidant. Antioxidants can protect cells from dangerous compounds called free radicals. We produce free radicals in our bodies during specific cell processes. Free radicals can directly damage your cells in ways that lead to cancer, heart disease, and stroke, the 3 leading causes of death in America.
As an antioxidant, shouldn't taking vitamin E help us stay healthier? Research has been exploring how to reduce free radicals in our bodies and maximize the effects of antioxidant compounds to counteract their damaging effect.
Unfortunately, carefully designed clinical studies have shown that extra vitamin E doesn't consistently improve health. Taking a supplement of 400 IU or more of vitamin E daily can actually INCREASE your risk of death, either by having a stroke caused by bleeding into the brain or developing prostate cancer.
How much vitamin E is enough? The National Institutes for Health (NIH) recommends 22.5 International Units (IU) of vitamin E daily for adults. Most Americans get only about half the recommended daily amount of vitamin E from their diet, but deficiency is rare.
Vitamin E is a fat-soluble vitamin and having some fat in your diet helps your body absorb it. Eating a very low-fat diet or having a disease that interferes with digestion or absorption of fat, such as Crohn's disease or cystic fibrosis, increases your risk of having low vitamin E.
Vitamin E deficiency may cause nerve and muscle damage with numbness in your arms and legs, muscle weakness, vision problems, and reduced effectiveness of your immune system.
There are 8 compounds recognized as being vitamin E: four forms each (alpha, beta, gamma, and delta) of tocopherol and tocotrienol. Alpha-tocopherol exists in higher concentrations in the body than its cousin gamma-tocopherol and, until recently, was assumed responsible for vitamin E’s antioxidant effects.
Many vitamin E supplements contain alpha-tocopherol, while gamma-tocopherol is found in foods rich in vitamin E, such as nuts, seeds, oils, and green leafy vegetables like spinach and broccoli.
Most multivitamins include 30 IU of alpha-tocopherol, considered to be 100% of the daily requirement for adults by the NIH. At the same time, individual vitamin E supplements often contain 400 IU, over 10 times that amount.
Recent research has uncovered evidence that taking excess alpha-tocopherol can decrease the level of gamma-tocopherol in your body. This may interfere with the antioxidant effects of vitamin E.
This may partly explain why taking alpha-tocopherol supplements produced harmful instead of favorable results in several well-designed studies.
More research is showing that vitamin E does not act alone. Other nutrients like vitamin C, zinc, beta-carotene, and selenium can interact with vitamin E, enhancing or interfering with its antioxidant activity. Future research is needed to clarify how these compounds work together.
Alpha-tocopherol is available in its natural form (d-alpha-tocopherol) and synthetic form (dl-alpha-tocopherol). Natural vitamin E (d-alpha-tocopherol) is 1.5 times as potent as its synthetic form (dl-alpha-tocopherol).
Vitamin E supplements with gamma-tocopherol are now available. However, it’s unclear whether they can prevent cancer, stroke, or heart disease.  
Vitamin E supplements CAN help in certain situations, such as age-related macular degeneration (AMD), a common cause of blindness in the elderly. The Age-Related Eye Disease Study (AREDS) looked at the effect of a daily supplement consisting of zinc and copper combined with vitamins A, C, and 400 IU of vitamin E on the progression of AMD over 5 years. The most severely affected study participants showed a 25% decrease in the advancement of macular degeneration. Those with mild or no AMD did not see any benefit from supplementation.
Here Are 4 Final Facts About Vitamin E:
1. Take an AREDS vitamin supplement if you have age-related macular degeneration.
The AREDS formulation is available as PreserVision® AREDS and as Ocuvite®. Ask your eye care professional which would be best for you.
2. AVOID taking supplemental vitamin E if you are taking a blood thinner.
Vitamin E supplementation of 400 IU or more can cause bleeding problems, especially in people taking blood thinners like warfarin (Coumadin®), Eliquis®, Pradaxa®, Xarelto®, aspirin, and clopidogrel (Plavix®).   
3. Eat foods rich in vitamin E.
The best way to get the antioxidant benefits of vitamin E is to eat plenty of nuts (especially almonds), seeds, and green leafy vegetables such as spinach and broccoli.
4. Avoid fat-free diets
Your diet needs fat to help you absorb the fat-soluble vitamins A, E, D, and K.
Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com. ©2022 Louise Achey
 

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