International Health News

Vitamin E: Your Heart's Best Friend

by Hans R. Larsen, MSc ChE

If Hans Christian Andersen had been into vitamins he could have written "The Ugly Duckling" about vitamin E and he would have been right on the mark. Although vitamin-E is now a "beautiful swan" it certainly was not born that way.

Hans LarsenDrs. Evan and Wilfrid Shute of London, Ontario, Canada were the first medical doctors to realize that an adequate vitamin E status is vital to the health of the heart. In 1945 they discovered that 200 IU per day of vitamin E was beneficial in reversing heart disease and in treating angina pectoris. By 1954 the Shute brothers had treated over 10,000 heart disease patients with miraculous results(1). Unfortunately, when they tried to publish their findings in medical journals their scientific papers were rejected and the medical establishment continued to ignore their findings for another 40 years. A glimmer of hope occurred in 1959 when the United States Food and Drug Administration (FDA) formally recognized that vitamin E was indeed essential to human health.

RDA Inadequate
In 1959 the average North American diet provided about 20 mg/day of vitamin E, so based on the observation that very few people suffered from any of the more or less obscure vitamin E related deficiency diseases recognized by the medical establishment, the RDA (Recommended Daily Allowance) for vitamin E was set at 30 IU (20 mg) per day. In 1974 this level was lowered to 15 IU/day when the FDA realized that the average diet now only provided 10 IU or less per day(2). In other words, the RDA was adjusted to conform to the inadequate and steadily decreasing level of vitamin E in the American diet. The absurdity of this whole situation can perhaps best be illustrated by the fact that an eminent scientist and member of the RDA panel, who in 1974 supported the contention that a vitamin E intake of 10-30 mg/day would be adequate for an adult, publicly stated in 1991 that he was himself taking 400 IU of vitamin E every second day. To quote "...The knowledge that undesirable products of lipid peroxidation in human tissues can be decreased by taking vitamin E have persuaded me to personally take a 269 mg (400 IU) supplement of d-alpha-tocopherol every other day(3,4)."

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Most Powerful Antioxidant
The hypothesis that vitamin E can prevent lipid peroxidation caused by free radical reactions was first advanced in 1983 and has since been proven correct by numerous, credible, scientific investigations. There is now general agreement that vitamin E is the most powerful antioxidant in the body's lipid (fat) phase and that its ability to protect cell membranes from oxidation is of crucial importance in preventing and reversing many degenerative diseases. Vitamin E also inhibits blood clotting (platelet aggregation and adhesion) and prevents plaque enlargement and rupture(5-13).

The evidence that vitamin E can prevent and reverse heart disease is now incontrovertible. In 1992 researchers at the University of Texas reported that vitamin E protects against atherosclerosis (hardening of the arteries) by preventing oxidation of the low density lipoprotein fraction of blood(14). In 1993 researchers at the Harvard Medical School released a study showing that vitamin E supplementation prevents heart disease. Nurses who took more than 100 IU/day of vitamin E for more than two years reduced their risk of heart disease by 41 per cent. A related study involving almost 40,000 male health professionals showed that men who supplemented with between 100 and 250 IU/day reduced their risk of heart disease by 37 per cent. Vitamin E is also highly beneficial in the treatment of intermittent claudication and recent research has confirmed its ability to prevent and, in some cases, reverse the progression of atherosclerosis(13,15-18).

Vitamin E is also highly effective in warding off a heart attack. Researchers at Cambridge University in England reported in 1996 that patients who had been diagnosed with coronary atherosclerosis could lower their risk of having a heart attack by 77 per cent by supplementing with 400 IU or 800 IU/day of natural source vitamin E(19). Very recently researchers at the Toyama Medical University in Japan reported that patients with unstable angina can reduce their risk of angina attacks by a factor of six by supplementing with vitamin E (300 mg/day of alpha-tocopherol acetate)(20). Supplementation with vitamin E has also been found useful in preventing complications after heart surgery and helps slow the restenosis (reblockage) of arteries subjected to angioplasty(16,17,21).

Protects More Than the Heart
The evidence supporting vitamin E's efficacy in preventing and reversing heart disease is indeed overwhelming. However, vitamin E has many other benefits. Daily supplementation with 400 IU of vitamin E and 600 mg of vitamin C can reduce the risk of developing cataracts by 50 per cent(22). A low intake of vitamin E is a risk factor for the development of diabetes (non-insulin-dependent, Type II) and supplementation has been found to be beneficial for diabetics(23,24). Several studies have shown that vitamin E supplementation improves longevity and may have a protective effect against both Alzheimer's and Parkinson's diseases(25-29).

Vitamin E supplementation (400 IU/day) improves the immune system response in both young and older people, is helpful in the treatment of cystic fibrosis and arthritis, and applied topically has even been found to cure dermatitis(21,30-32). Vitamin E is also helpful in cancer prevention. Scientists at the National Cancer Institute found that supplementation with vitamin E cuts the risk of oral cancer by 50 per cent. Non-smokers can reduce their risk of developing lung cancer by taking vitamin E and men can reduce their risk of colon cancer by 65 per cent by increasing their intake of vitamin E(33-36).

Optimum Intake
It is clear that vitamin E is an extremely important factor in human health. Most studies involving vitamin E supplementation have used amounts between 100 IU/day and 800 IU/day and 400 IU/day is now considered to be a basic, safe and adequate dosage for an average, healthy person(37-41). The optimum intake for an individual, however, depends on many factors including the intake of polyunsaturated fatty acids and the degree of exposure to air pollution and toxic chemicals. Higher dosages may be indicated for women suffering from premenstrual or menopausal problems, for smokers, for people engaging in heavy, outdoor exercise, and for people having a family history of cancer. A large intake of fish or fish oils has been shown to increase the requirement for vitamin E quite significantly(2,21,39-43).

Large, well-controlled studies of vitamin E supplementation have shown the vitamin to be non-toxic in intakes as high as 3200 IU/day(40,44). However, most researchers caution against daily intakes higher than 800-1200 IU/day for extended periods(37,38,41). It is also recommended that the progression to a daily dose of 400 IU be gradual as should any decrease in intake. Some very recent research has shown that vitamin E in dosages higher than 1600 IU/day may have a prooxidative effect. However, this effect can be avoided by always taking adequate amounts of vitamin C when supplementing with vitamin E(45,46).

There are some cases in which high dosages (more than 30 IU/day) of vitamin E are contraindicated. Medical advice concerning dosage should be sought by individuals having high blood pressure, those taking anticoagulant drugs (Coumadin, warfarin) or having a tendency to prolonged bleeding, those having a vitamin K deficiency, and those suffering from rheumatic heart disease, an overactive thyroid or diabetes(21,37,40).

Inorganic iron (ferrous sulphate) destroys vitamin E and birth control pills deactivate it to some degree. So vitamin E should be taken with the main meal (to optimize absorption) and at least six hours before or after taking an iron supplement or a birth control pill.

Supplementation is Essential
Natural vitamin E comes in several forms; d-alpha-tocopherol (100 mg=149 IU), d-alpha-tocopherol acetate (100 mg=136 IU), and d-alpha-tocopherol succinate are the most common. The "d" designation in front indicates that the products are derived from natural sources such as vegetable oils or wheat germ. A prefix of "dl", such as dl-alpha-tocopherol, shows that the vitamin has been synthesized from a petroleum base. Synthetic vitamin E is far less effective than natural vitamin E. Recent research has also shown that expensive water-soluble forms of vitamin E are no more effective than the regular fat-soluble forms(21,30,47-49).

The benefits of an adequate vitamin E intake cannot be over-emphasized. Unfortunately, it is quite impossible to get enough vitamin E from even the most well-balanced diet. To obtain a daily vitamin E intake of 400 IU it would be necessary to consume 200 cups of brown rice, 10 cups of almonds, 80 cups of cooked spinach or 12 tablespoons of unrefined, fresh wheat germ oil every day. Supplementation is clearly necessary. A daily intake of 400 IU/day of natural vitamin E combined with 250-1000 mg/day of vitamin C will help protect you against heart disease, cancer, and many other degenerative diseases.

REFERENCES

  1. Shute, Evan The current status of alpha tocopherol in cardiovascular disease. Vitamin E - Your Key to a Healthy Heart by Herbert Bailey, ARC Books, NY, 1959
  2. Horwitt, M.K. Interpretations of requirements of thiamin, riboflavin, niacin-tryptophan, and vitamin E plus comments on balance studies and vitamin B-6. American Journal of Clinical Nutrition, Vol. 44, 1986, pp. 973-85
  3. Horwitt, M.K. Status of human requirements for vitamin E. American Journal of Clinical Nutrition, Vol. 27, 1974, pp. 1182-93
  4. Horwitt, M.K. Data supporting supplementation of humans with vitamin E. Journal of Nutrition, Vol. 121, 1991, pp. 424-29
  5. Ames, B.N. Dietary carcinogens and anticarcinogens. Science, Vol. 221, 1983, pp. 1256-64
  6. Burton, G.W. and Ingold, K.U. Vitamin E as an in vitro and in vivo antioxidant. Annals of the New York Academy of Sciences, Vol. 570, 1989, pp. 7-22
  7. Niki, Etsuo, et al. Inhibition of oxidation of biomembranes by tocopherol. Annals of the New York Academy of Sciences, Vol. 570, 1989, pp. 23-31
  8. Cross, C.E., et al. Oxygen radicals and human disease. Annals of Internal Medicine, Vol. 107, 1987, pp. 526-45
  9. Packer, L. Protective role of vitamin E in biological systems. American Journal of Clinical Nutrition, Vol. 53, 1991, pp. 1050S-55S
  10. Halliwell, Barry. Oxidation of low-density lipoproteins: questions of initiation, propagation, and the effect of antioxidants. American Journal of Clinical Nutrition, Vol. 61, No. 3, March 1995, pp. 670S-77S
  11. Sies, Helmut and Stahl, Wilhelm. Vitamins E and C, beta-carotene, and other carotenoids as antioxidants. American Journal of Clinical Nutrition, Vol. 62, December 1995, pp. 1315S-21S
  12. Freedman, Jane E., et al. Alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C-dependent mechanism. Circulation, Vol. 94, No. 10, November 15, 1996, pp. 2434-40
  13. Azen, Stanley P., et al. Effect of supplementary antioxidant vitamin intake on carotid aterial wall intima-media thickness in a controlled clinical trial of cholesterol lowering. Circulation, Vol. 94, No. 10, November 15, 1996, pp. 2369-72
  14. Jialal, Ishwarlal and Grundy, Scott M. Effect of dietary supplementation with alpha-tocopherol on the oxidative modification of low density lipoprotein. Journal of Lipid Research, Vol. 33, June 1992, pp. 899-906
  15. Stampfer, Meir J., et al. Vitamin E consumption and the risk of coronary disease in women and men. New England Journal of Medicine, Vol. 328, No. 20, May 20, 1993, pp. 1444-56
  16. Stampfer, Meir J. and Rimm, Eric B. Epidemiologic evidence for vitamin E in prevention of cardiovascular disease. American Journal of Clinical Nutrition, Vol. 62, December 1995, pp. 1365S-69S
  17. Hodis, Howard N., et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. Journal of the American Medical Association, Vol. 273, No. 23, June 21, 1995, pp. 1849-54
  18. Paolisso, Giuseppe, et al. Chronic intake of pharmacological doses of vitamin E might be useful in the therapy of elderly patients with coronary heart disease. American Journal of Clinical Nutrition, Vol. 61, 1995, pp. 848-52
  19. Stephens, Nigel G., et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). The Lancet, Vol. 347, March 23, 1996, pp. 781-86
  20. Miwa, Kunihisa, et al. Vitamin E deficiency in variant angina. Circulation, Vol. 94, No. 1, July 1, 1996, pp. 14-18
  21. Meydani, Mohsen. Vitamin E. The Lancet, Vol. 345, January 21, 1995, pp. 170-75
  22. Robertson, J.M., et al. Vitamin E intake and risk of cataracts in humans. Annals of the New York Academy of Sciences, Vol. 570, 1989, pp. 372-82
  23. Salonen, Jukka T., et al. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. British Medical Journal, Vol. 311, October 28, 1995, pp. 1124-27
  24. Paolisso, Giuseppe, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin-dependent diabetic patients. American Journal of Clinical Nutrition, Vol. 57, May 1993, pp. 650-56
  25. Golbe, Lawrence I., et al. Case-control study of early life dietary factors in Parkinson's disease. Archives of Neurology, Vol. 45, No. 12, December 1988, pp. 1350-53
  26. Stamler, Jonathan S. A radical vascular connection. Nature, Vol. 380, March 14, 1996, pp. 108-11
  27. Thomas, Tom, et al. Beta-amyloid-mediated vasoactivity and vascular endothelial damage. Nature, Vol. 380, March 14, 1996, pp. 168-71
  28. Malik, Nageena S. and Meek, Keith M. Vitamins and analgesics in the prevention of collagen ageing. Age and Ageing, Vol. 25, No. 4, July 1996, pp. 279-84
  29. Losonczy, Katalin G., et al. Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: The Established Populations for Epidemiologic Studies of the Elderly. American Journal of Clinical Nutrition, Vol. 64, August 1996, pp. 190-96
  30. Nasr, Samya Z., et al. Correction of vitamin E deficiency with fat-soluble versus water-miscible preparations of vitamin E in patients with cystic fibrosis. Journal of Pediatrics, Vol. 122, May 1993, pp. 810-12
  31. Packer, L. and Landvik, S. Vitamin E: introduction to biochemisty and health benefits. Annals of the New York Academy of Sciences, Vol. 570, 1989, pp. 1-6
  32. Olson, Patrick E., et al. Oral vitamin E for refractory hand dermatitis. The Lancet, Vol. 343, March 12, 1994, pp. 672-73
  33. Knekt, Paul, et al. Vitamin E and cancer prevention. American Journal of Clinical Nutrition, Vol. 53, 1991, pp. 283S-86S
  34. Smigel, Kara. Vitamin E moves on stage in cancer prevention studies. Journal of the National Cancer Institute, Vol. 84, July 1, 1992, pp. 996-97
  35. Mayne, Susan Taylor, et al. Dietary beta carotene and lung cancer risk in U.S. nonsmokers. Journal of the National Cancer Institute, Vol. 86, No. 1, January 5, 1994, pp. 33-8
  36. Tseng, Marilyn, et al. Micronutrients and the risk of colorectal adenomas. American Journal of Epidemiology, Vol. 144, No. 11, December 1, 1996, pp. 1005-14
  37. Mindell, Earl. Earl Mindell's Vitamin Bible. Warner Books, NY, 1991, pp. 51-53
  38. Berger, Stuart M. How To Be Your Own Nutritionist. Avon Books, NY, 1988, pp. 192
  39. Murray, Michael T. Encyclopedia of Nutritional Supplements. Prima Publishing, Rocklin, CA, 1996, pp. 44-53
  40. Diplock, Anthony T. Safety of antioxidant vitamins and beta-carotene. American Journal of Clinical Nutrition, Vol. 62, December 1995, pp. 1510S-16S
  41. Giller, M.G. and Matthews, K. Medical Makeover. Beech Tree Books (William Morrow), NY, 1986, p. 162
  42. Sanders, T.A.B. and Hinds, Alison. The influence of a fish oil high in docosahexaenoic acid on plasma lipoprotein and vitamin E concentrations and haemostatic function in healthy male volunteers. British Journal of Nutrition, Vol. 68, July 1992, pp. 163-73
  43. Nair, Padmanabhan P., et al. Dietary fish oil-induced changes in the distribution of alpha-tocopherol, retinol, and beta-carotene in plasma, red blood cells, and platelets: modulation by vitamin E. American Journal of Clinical Nutrition, Vol. 58, July 1993, pp. 98-102
  44. Bendich, A. and Machlin, L.J. Safety of oral intake of vitamin E. American Journal of Clinical Nutrition, Vol. 48, 1988, pp. 612-19
  45. Kontush, Anatol, et al. Antioxidant and prooxidant activity of alpha-tocopherol in human plasma and low density lipoprotein. Journal of Lipid Research, Vol. 37, No. 7, July 1996, pp. 1436-48
  46. Brown, Katrina M., et al. Erythrocyte vitamin E and plasma ascorbate concentrations in relation to erythrocyte peroxidation in smokers and nonsmokers: dose response to vitamin E supplementation. American Journal of Clinical Nutrition, Vol. 65, February 1997, pp. 496-502
  47. Kayden, Herbert J. and Traber, Maret G. Absorption, lipoprotein transport, and regulation of plasma concentrations of vitamin E in humans. Journal of Lipid Research, Vol. 34, March 1993, pp. 343-58
  48. Dimitrov, Nikolay V., et al. Plasma alpha-tocopherol concentrations after supplementation with water- and fat-soluble vitamin E. American Journal of Clinical Nutrition, Vol. 64, September 1996, pp. 329-35
  49. Kiyose, Chikako, et al. Biodiscrimination of alpha-tocopherol stereoisomers in humans after oral administration. American Journal of Clinical Nutrition, Vol. 65, March 1997, pp. 785-89

This article was first published in the May 1997 issue of International Health News

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