Although the researchers conclude that, "overall, vitamin E supplementation did not affect all-cause mortality", they do suggest that high doses of vitamin E (greater than 400 IU/day) are associated with an increased all-cause mortality. In the trials using supplement dosages higher than 400 IU/day they observed a 0.34% higher mortality in patients taking vitamin E than in those not doing so. On the other hand, in trials using vitamin E doses of 400 IU/day or less, there was a decrease in all-cause mortality of 0.33%.

The researchers caution that all the trials testing high dosage vitamin E involved patients with chronic diseases and that some trials involved other vitamins (notably beta-carotene) as well. They also point out that their results may not be applicable to healthy individuals. They speculate that their findings could be explained by a pro-oxidant activity of alpha-tocopherol, the displacement of gamma-tocopherol by alpha- tocopherol, or an increased risk of hemorrhagic stroke. The researchers conclude that supplementation with 400 IU/day or more of vitamin E should be discouraged.
Miller, ER, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine www.annals.org November 10, 2004 (to be published in January 2005)

Editor's comment: The primary purpose of this study would seem to be to discourage people from supplementing in order to protect their health and well-being. As I have, on numerous occasions, pointed out the primary benefit of antioxidant supplementation is to PREVENT disease. It seems that whenever the medico-pharmaceutical establishment wishes to discredit an antioxidant they totally ignore this basic fact and gleefully report that it does not stop seriously ill patients from dying.

All chronic diseases have a certain lag time before they become clinically manifest. Cardiovascular disease, breast cancer, prostate cancer, Alzheimer's disease, diabetes, etc. do not happen all of a sudden from one day to the next – they develop slowly over a long period of time (the latency period). What antioxidants do is that they prolong this latency period very significantly, in many cases, providing complete protection from disease during a person's lifetime.

I am much less convinced that the antioxidant property of vitamin C, vitamin E, etc. plays a major role in slowing down or reversing already serious manifest disease, although there is some indication that very large intravenous doses of vitamin C may be helpful in slowing the progression of certain cancers, and that large doses of vitamin E may help slow down Alzheimer's and Parkinson's disease.

So, should you continue to supplement with vitamin E to protect your health? – ABSOLUTELY!! Two very large studies involving over 100,000 female nurses and male health professionals found that supplementation with 100 IU/day or more of vitamin E is associated with a 40% reduction in the risk of developing heart disease. Vitamin E has also been found to protect against heart attacks (400 or 800 IU/day) and has been found helpful in preventing diabetes, cataracts, Alzheimer's disease, and several other conditions (see www.yourhealthbase.com/vitamin_E.htm)

Recent research has shown that it is important to take vitamin E as a combination of gamma- and alpha- tocopherol (about a 3:1 ratio) and with adjuvant amounts of other tocopherols and tocotrienols. In such a complete formulation 100 to 200 IU/day of alpha-tocopherol would likely be quite sufficient. Vitamin E should always be taken in combination with vitamin-C, and preferably with alpha-lipoic acid and selenium as well in order to maximize its beneficial effect and prevent any pro-oxidant effect. The optimum daily intake for an individual 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.

There are some cases in which high dosages of vitamin E are contraindicated. Medical advice concerning dosages 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.

Inorganic iron (ferrous sulphate) destroys vitamin E and oral contraceptives deactivate it to some degree. So vitamin E should be taken with the main meal to optimize absorption and at least 6 hours before or after taking an iron supplement or a birth control pill. Vitamin E remains in the body for a long time, so it can be taken once a day or once every second day as convenient.