Vitamin E
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Vitamin E research is mixed with many smaller studies showing benefit but most of the larger studies finding none.  A recent huge study from Harvard of 39,000 women for 10 years found no benefit at all for preventing death (JAMA July 6, 2005, below).  Vitamin E has not lived up to its great hope.  Of even greater concern, a recent research review by Edgar Miller of Johns Hopkins of 19 studies covering 136,000 people reports that those taking 400 IU or more were 10% more likely to die than those taking 200 IU or less (Annals Int Med 11/04).  Vitamin E interferes with the effectiveness of statin cholesterol lowering medications.  I wonder if Miller may be exaggerating the findings since another review of 220,000 found no difference from placebo for heart disease deaths, but he explains the different results in his paper.  In any case, vitamin E is not worth taking as a supplement.  A healthy diet should give you all that you need.  The small amount in a multivitamin is not a concern, but many multivitamins have large amounts of vitamin A which is definitely a concern.

Alcoholic Hepatitis Not Helped in DB: A 52-patient, 3 month DB PC study of vitamin E 1000 IU found no benefit. A randomized placebo controlled trial of vitamin E for alcoholic hepatitis. Mezey E, Potter JJ, Rennie-Tankersley L, Caballeria J, Pares A. J Hepatol. 2004 Jan;40(1):40-6

Alzheimer's: Vitamin E & C Decrease Alzheimer's: 633 elderly over age 65 and disease-free were then followed for 4.3 years. Of those with adequate vitamin intake data, none of 27 with vitamin E and none of 23 with vitamin C had Alzheimer's (p<.04, p<.10) but multivitamins made no diff. MC Morris, Rush U, Alz Dis Assoc Disord ’98 12(3):121-6.

Alzheimer's: Vitamin A, C, E Didn't Decrease Alzheimer's: A four year prospective study of 980 elderly who were free of dementia at the start and of whom 242 developed dementia found no benefit to carotene, vitamins C or vitamin E either by supplement or in the diet. Antioxidant vitamin intake and risk of Alzheimer disease. Luchsinger JA, Tang MX, Shea S, Mayeux R. Arch Neurol. 2003 Feb;60(2):203-8

Alzheimer's: Vitamin E & Selegiline Help Moderate-Severe AD Slow Progression: DB trial with selegiline & placebo, vitamin E progressed 25% less rapidly after 2 years. Selegiline, which also has anti-ox properties, also slowed decline. NEJM ’97 336:1216-22

Arterial Flexibility: Vitamin E Helped: In a very small, 20-healthy adult DB PC 1-month study of 700 IU/day vitamin E, plasma vitamin E levels increased by 123%, which was associated with a 20% increase in carotid artery compliance and a 30-60% increase in baroreflex indices. All these changes regressed 1 month after cessation of vitamin E supplementation. Effect of vitamin E on carotid artery elasticity and baroreflex gain in young, healthy adults. Studinger P, Mersich B, Lenard Z, Somogyi A, Kollai M., Semmelweis University, Budapest, Hungary. Auton Neurosci. 2004 Jun 30;113(1-2):63-70

Asthma Helped: Higher blood levels of vitamin E decreased IgE and also help asthma and lowers skin sensitivity. Lancet 11/4/00

Asthma: Vitamin E No Benefit for Adults in Small Study: Increased dietary vitamin E intake is associated with a reduced incidence of asthma, and combinations of antioxidant supplements including vitamin E are effective in reducing ozone induced bronchoconstriction. In a 6-week DB PC study of 72 atopic adults with asthma, there was no effect of vitamin E supplementation on any other measure of asthma control. Vitamin E supplements in asthma: a parallel group randomised placebo controlled trial. Pearson PJ, Lewis SA, Britton J, Fogarty A. University of Nottingham, UK. Thorax. 2004 Aug;59(8):652-6

Cancer: Vitamin E Didn't Help Cancer or Heart in Huge Study: In the very large DB PC HOPE study of 9541 adults over age 54 with vascular disease or diabetes, 3994 agreed to continue in HOPE-TOO for a total of 7 years taking vitamin E 400 IU/d or placebo. There were no significant differences for cancer (vitamin E 11.6% vs. placebo 12.3%), cancer deaths (156 vs. 176), or major cardiovascular events, 1022 (21.5%) vs 985 (20.6%). Patients in the vitamin E group had a slightly higher risk of heart failure (RR, 1.13; P = .03). Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. Lonn E, Bosch J, et al. McMaster University, Hamilton, Ontario. JAMA. 2005 Mar 16;293(11):1338-47.

Cataracts Not Prevented in DB: A 4-year, 1193 patients DB PC study of 500 IU of vitamin E found no protective value. Vitamin E supplementation and cataract: randomized controlled trial. McNeil JJ, Robman L, Tikellis G, Sinclair MI, McCarty CA, Taylor HR. 4/2004

Hay Fever: Vitamin E Fails to Help: In a DB PC study of 112 hay fever patients, vitamin E 800 mg/d was no better than placebo when both were added to their regular medications. Effect of vitamin E supplementation on the regular treatment of seasonal allergic rhinitis. Effect of vitamin E supplementation on the regular treatment of seasonal allergic rhinitis. Shahar E, Hassoun G, Pollack S. Haifa, Israel. 7/04

Heart Disease, Stroke, Cancer: Vitamin E No Help and Increased Heart Failure: In the 7-year HOPE-TOO DB PC study of over 9,000 adults with cardiovascular disease or diabetes, those taking 400 IU/day of vitamin E developed 13% more heart failure (14 extra cases per 1,000 participants on vitamin E). E Lonn et al. J Amer Med Assoc 293:1338, 2005 

Heart Disease Decreased: U Minn ’96 NEJM 35,000 post-menopausal female 7 yr f/u. Those highest in vitamin E in diets such as nuts had 62% lower heart disease.

Heart Disease Not Helped by Vitamin E in Meta-Analysis: Cleveland Clinic Foundation, analyzed the pooled results from 15 key studies involving nearly 220,000 people. Death rates with vitamin E from heart disease and other diseases no lower than placebo. Beta-carotene associated with 0.3% increased heart death and 0.4% increased death overall. Lancet 6/12/03

Heart: Vitamin E No Help in Advanced Heart Failure: DB 56 pt 12 weeks increased blood levels but no impact on a host of clinical parameters. Amer J Clin Nutr 2/01;219

Heart: Vitamin E & C Protects Heart Transplants in Very Small Study: DB 40 pt placebo controlled vs. E 400IU & C 500mg BID. No intimal increase with vitamins but 8% with placebo. Lancet 3/30/02, Harvard

Heart: Vitamin E Supplements Lower Risk a Liitle for Cardiovasc: Those taking for two or more years. EB Rimm, NEJM 328:1450 ’93; MJ Stampfer NEJM 328:144 ’93. High dose of vitamin E in a questionnaire study were associated with a lower risk death CHD. Kushi NEJM 334:1156 ’96. In a DB study of vitamin E 400-800 IU/day for 510 days, it reduced non-fatal heart attacks but not overall death. NG Stephens Lancet 347:781 ’96. 1996 The CHOAS Study (Cambridge Heart Antioxidant Study) of 2002 found 77% decrease in nonfatal heart attacks. In a DB study of Finnish smokers, there was little difference in CHD but lower prostate cancer death. Virtamo Anch Intern Med 158:668 3/23/98, Heinonen J Natl Cancer Inst 90:440 ’98.

Menstruation: Vitamin E Helped Painful Periods in Girls: In a 4-month DB PC study of 278 girls ages 15-17 with primary dysmenorrhea (painful periods), vitamin E 200 IU twice a day starting 2 days before expected onset of menstruation and for the first three days lowered pain at two months (median VAS score 3 vs 5, P > 0.001) and four months (0.5 vs 6, P > 0.001), and blood loss assessed by PBLAC score was lower at two months (54 [31] vs 70 [40], P > 0.0001) and at four months (46 [28] vs 70 [37], P > 0.0001). A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. Ziaei S, Zakeri M, et al. Tarbiat Modarres University, Tehran, Iran. BJOG. 2005 Apr;112(4):466-9.

Mortality: Vitamin E No Benefit in Huge 10-Year U.S. DB Study: In a 10.1-year DB PC study of 39,876 healthy US women over age 44, those on 600 IU of natural-source vitamin E on alternate days had a nonsignificant 7% risk reduction (RR = 0.93; P = .26). There were no significant effects on the incidences of myocardial infarction (RR, 1.01) or stroke (RR, 0.98; P = .82), as well as ischemic or hemorrhagic stroke. For cardiovascular death, there was a significant 24% reduction (RR, 0.76; P = .03). There was no significant effect on the incidences of total cancer (RR, 1.01) or breast (RR, 1.005), lung (RR, 1.09), or colon cancers (RR, 1.00). Cancer deaths also did not differ significantly between groups. There was no significant effect of vitamin E on total mortality (RR, 1.04). Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. Lee IM, et al. Brigham and Women's Hospital-Harvard. JAMA. 2005 Jul 6;294(1):56-65. Ed: This study is so huge that it should lay to rest any possibility that taking vitamin E will help you live longer. I do not recommend taking vitamin E as a supplement. 

Muscle Damage Not Prevented: Vitamin E in a 3-week DB PC didn’t help prevent muscle damage after repeated exercise bouts. J Strength Cond Res. 2003 Nov;17(4):801-9

Respiratory Infection: Vitamin E Little Benefit for Respiratory Infection Prevention: In a 1-year DB PC study of 617 elderly, vitamin E 200 IU/day had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, slightly fewer acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; and 65% vs 74%; RR, 0.88), or upper respiratory tract infections (44% vs 52%; RR, 0.84; and 50% vs 62%; RR, 0.81). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83). Vitamin E had no significant effect on antibiotic use. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Tufts University. JAMA. 2004 Aug 18;292(7):828-36. Ed: These are very minimal benefits at best.

Vit E 100mg, C Protect Lungs: DB PC 38 Dutch cyclists Vit E 100 mg, C 500mg/d confered partial protection against acute effects of ozone on FEV-1. Grievink, Am J Epid 2/99;149:306

Vit E 75mg Protects Lungs in Mexico City: Street workers DB PC Vit E 75mg, Vit C 650, beta-carot 15mg/d 47 workers 5 months. Romieu, Am J Resp Crit Car Med ’98;158:226

Vit E Protects Against Oxidized LDL: DB PC 4 months 29 smokers or hyperchol smokers. only hyperchol smokers benefited in endothelial relaxation of forearm resistance vessels. Heitzer, Germany, J Am Coll Cardiol 2/99;33:499

Vit E Helps Defective DM Nerv Conduction: DB PC 21 type 2 DM 6 months Vit E 900mg/d found definite improvement in median and tibial motor nerves. Tutuncu, Turkey, Diabetes Care 11/98;21:1915

Low Dose Vit E 50mg, Beta-Carotene No Effect Smoker Cataracts, Maculopathy, Stomach CA, CHD, Lung CA, Angina: Finnish DB PC 28934 male smokers 5.3 yr Vit E 50mg/d, Beta-carotene 20mg/d, both, or placebo. No difference in cataract surgery. Vit E RR 0.91. Maculopathy results reports in Acta Opthalmol Scand ’98;76:224; Gastric changes in Scand J Gastroentero ’98;33:294; Heart disease deaths increased on beta-carotene and no decrease with Vit E (nonsignif incr) Lancet ’97;349:1715; Lung CA NEJM ’94;330:1029; Angina= DB PC 4.3yr Vit E 50mg/d, beta-car 20mg/d 1795 pts. Rapola, Finland, Heart ’98;79:454

Vit E No Help Epilepsy: DB PC 3 mo study as an add on rx. India, Epilepsia ’94;35:378

Vit E no Benefit Myotonic Dystrophy: 27 pts DB PC. Sweden, J Intern Med 94;235:205

Vit E Helps Prostate CA: 29133 DB PC smoking men 9.3yr f/u suggests Vit E some protective benefit with highest intake quartile RR 0.52 vs. lowest. Vit A no benefit. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. Heinonen OP, Albanes D, Virtamo J, Taylor PR, Huttunen JK, Hartman AM, Haapakoski J, Malila N, Rautalahti M, Ripatti S, Maenpaa H, Teerenhovi L, Koss L, Virolainen M, Edwards BK. J Natl Cancer Inst 1998 Mar 18;90(6):440-6

and Cancer Epid Biomarkers Prev ’98;7:335

Vit E Decr Prost CA, beta-car Incr Prost CA: Helsinki study 32% decr incidence 41% decr death vs 23% incr incidence 15% incr death with beta-carotene. J Natl Cancer Inst ’98;90:440

Vit E Helps Bladder CA: Taking Vit E supplements for 10 or more years Bladder CA RR 0.60 tho no impact from shorter use or from Vit C. 991,522 US adults in CA Prevention Study II. Am J Epid '‘2;156:1002.

Quinine, Not Vit E Helps Nocturnal Leg Cramps: DB PC. Arch Int Med ’92;152:1877

Vit E 80mg Helps Hepatitis C: DB PC 23 pts refractory to interferon rx Vit E 40mg/BID with 40% decr ALT after 12 wk rx with quick relapse off Vit E and recovery when rx reinstituted. Heinrich Heine Univ, Free Rad Res ’97;27:599

Vit E 200mg No Help Colds: DB study 652 Germans over 60yo no benefit and actually longer illness 19 vs 14 days if developed a cold. JAMA 2002 Aug 14;288(6):715-21

Vit E 600mg, C Help Prevent Nitrate Tolerance: DB PC pts on NTG. Vit E 200mg TID helped. Watanabe, Japan, J Cardiol ’98;31:173; Vit C in Circ, ’98;97:886

Vit E 600mg Some Help Rheum Arth: DB PC 42pts 12wk Vit E 600mg/d no benefit lab or clin measures but signif decr pain. Benefit additive to NSAID. London, Ann Rheum Dis ’97;56:649

Vit E Improved Sperm Mobility: 52 pt DB PC with impregnation in 21% & better than placebo. J Androl ’96;17:530; also see Fertil Steril ’95;64:825

Vit E-C-beta-carotene & zinc Decr BP: 38 HBP pts DB crossover 6 wk. Leeds, Clin Sci (Colch)’97;92:361

Vit E 400 IU Slows Cognitive Decline: 2889 elderly with cog testing and 3 yr f/u. Highest Vit E from food or supplements had smallest decline, 36% less than smallest (7 IU. 18-22 IU recommended). Vit C and A not assoc with cognitive decline. Morris, Arch Neuro 02;59:1125, Rush

Vit E 400 IU May Worsen Retinitis Pig & Vit A Help: DB PC Vit A 15000 and/or Vit E 400 IU. 601 pts 5 yr. Arch Opth ’93;111:761

Vit E 400IU-C 2000mg-B6-Zn-beta Decr Bladder CA Recurrence: DB PC with B6 100mg, Vit A 40000, Vit C 2000, Vit E 400 IU, Zn 90mg/d with 80% recur with placebo and 40% with megavit 5 yr. Lamm, Uwest Va, J Urol ’94;151:21

No Benefit DB Vit E 400 IU: 4.5 yr Canadian study with 9500 males and females 55 or older found no benefit Vit E 400 IU in preventing MI, stroke, CVD, or related death. : N Engl J Med 2000 Jan 20;342(3):154-60

Vit E 400 IU + Vit C 500mg or NRT No Benefit Heart: In postmenopausal women with coronary disease, neither HRT nor antioxidant vitamin supplements provide cardiovascular benefit. Instead, a potential for harm was suggested with each treatment. 423 women with coronary stenosis DB PC 2 year. JAMA 2002 Nov 20;288(19):2432-40

Vit E 500 IU No Help Macular Degeneration: DB, 1000 pt, BMJ 7/6/01.

Vit E 500 IU No Benefit Osteoarthritis: 77 pt DB 6 months. Ann Rheum Dis 2001 Oct;60(10):946-9

Vit E 500 IU No Benefit Knee Cartilage: J Rheumatol 2002 Dec;29(12):2585-91, DB PC 2 years 136 subjects with knee OA. Dietary levels of antioxidants (vitamin C, beta carotene, retinol equivalents) had no effect on cartilage volume loss.

Vit E 400 IU, Vit C 500mg No Benefit Cataract Prevention: 4767 pt with one opacity. AREDS study DB 6.3 yr f/u A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Age-Related Eye Disease Study Research Group. Arch Ophthalmol 2001 Oct;119(10):1439-52

Vit E 400 IU, Vit C 500mg, + Zinc 80mg Helps Cataract Prevention: DB PC found only with the added zinc was prevention effective. Zinc by itself not as good as combo. RR 0.66. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Age-Related Eye Disease Study Research Group. Arch Ophthalmol 2001 Oct;119(10):1417-36

Vit E 600 IU May Help Prevent EPS: DB 39 schiz 2 weeks found less neuroleptic induced parkinsonism although p<.08. Eur Neuropsychopharmacol 1999 Dec;9(6):475-7. The effect of vitamin E addition to acute neuroleptic treatment on the emergence of extrapyramidal side effects in schizophrenic patients: an open label study. Dorfman-Etrog P, Hermesh H, Prilipko L, Weizman A, Munitz H.

Vit E 650 IU, Vit C 750mg Slight Benefit Cataracts: REACT study 3 yr 297 pt DB found benefit in U.S. group but not in Brit group. Harvard, Ophthalmic Epidemiol 2002 Feb;9(1):49-80

Vit E 650, C 250mg No Heart Benefit Although Simvastin Was: Oxford Heart Study of 20500 5 yr. : Int J Clin Pract 2002 Jan-Feb;56(1):53-6

Vit E 680, C 1250 Reduce Albuminuria in DM: Double-blind, randomised study of the effect of combined treatment with vitamin C and E on albuminuria in Type 2 diabetic patients. Gaede P, Poulsen HE, Parving HH, Pedersen O. Diabet Med 2001 Sep;18(9):756-60

Vit E 400-800 IU Decreased MI but not Death: 2002 pts s/p angiography rx DB PC 1 yr 400-800 IU. Big 77% decr in non-fatal MI but no decr in cardiovasc death. Cambridge, Lancet ’96;347:781

Vit E 800 IU no Harm: DB PC study up to 800 IU (727mg) found no harmful effects in 65yos after measuring many parameters of the serum. Meydani, Am J Clin Nutr 8/98;68:311

Vit E 800 IU, Vit C 1000mg+ HRT No Benefit CVD: DB PC 423 post-menopausal women 2.8yr. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, Ouyang P, Thompson P, Tardif JC, Higginson L, Bittner V, Steffes M, Gordon DJ, Proschan M, Younes N, Verter JI. JAMA 2002 Nov 20;288(19):2432-40

Vit E 1000 mg-C 2000 mg Reduce Sunburn: DB PC Vit C 2g/d & Vit E 1000mg/d 8 days. Germany, J Am Acad Derm 1/98;38:45

Vit E 1200 mg Helps Polyarthritis: DB PC vs diclofenac 43 pt Vit E 400mg TID found improved grip, decr AM stiffness, decr pain, and joint index. Similar benefit both drugs (diclofenac non-signif better). Wittenborg, Germany, Z Rheum ’98;57:215

Vit E 1200 IU, Vit C 1500 Helps Radiation Proctitis: Before and after 1 yr f/u of 20pts found benefit. Am J Gastroenterol 2001 Apr;96(4):1080-4

Vit E 1200 IU Protects Against Chronic Infection: U Tx Southwestern studied 47 AODM and 25 healthy adults 1200 IU/d 3 mo. Half of AODM with major complications, e.g. kid failure and had higher CRP (C-reactive Protein), marker of inflam). CRP down dramatically in all 3 groups. Interleukin-6 (this cytokine tells liver make CRP) levels after WBC stimulation only one-third as high. Free Radical Biol 10/23/00. DM WBC’s secrete 3 substances that foster atheroscl and Vit E dramatically reduced all three. Circ 7/11/00.

Vit E 1600 IU Said Helps TD: Controlled but no blind study of 20 patients said benefit of 600IU faded and required increase to 1600 IU/d, but sustained benefit at that level. Int Clin Psychopharmacol 1998 Jul;13(4):147-55. Vitamin E in the treatment of tardive dyskinesia: a preliminary study over 7 months at different doses. Sajjad SH.

Vit E 1600 IU Helped TD Long-Term: 36 week DB 40 patient. Biol Psychiatry 1998 Jun 15;43(12):868-72. Long-term treatment effects of vitamin E for tardive dyskinesia. Adler LA, Edson R, Lavori P, Peselow E, Duncan E, Rosenthal M, Rotrosen J.; Same outcome in DB 35 pt 9 week study at 1600 IU. J Clin Psychiatry 1996 Apr;57(4):167-73; Same with 28 patient. Am J Psychiatry 1993 Sep;150(9):1405-7

High Dose 1800 IU Helps DM retinopathy & nephropathy: 1800 IU x 4 mo in DB helped increase retinal blood flow and normalize creatinine levels which signal kidney damage. Diabetes Care 1999 Aug;22(8):1245-51

Vit E 2000 IU Given in Parkinson’s: Experiment at U Minn. No outcome mentioned except higher CNS levels. Neurol ’98;50:1900; Vit E and deprenyl no impact on mortality in DB study of early Park with mortality about average for population without Park. Ann Neurol ’98;43:318

Vit E 2400 IU, Vit C 1500mg Help Dialysis Cramps: six divided doses per day in DB 97% vs 7% placebo reduction in cramps. Vit E and Vit C didn’t do as well as combo. Nephrol Dial Transplant 2001 Jul;16(7):1448-51

Vit E & Selenium Good for Quail: dietary vitamin E and selenium have synergistic effects and that supplementing a combination of dietary vitamin E (250 mg/kg of diet) and selenium (0.2 mg/kg of diet) offers a good management practice to reduce heat stress-related depression in performance of Japanese quails. Biol Trace Elem Res 2002 Jan;85(1):59-70