Vitamin E

1. Sources
   1. Vegetable Oil
      1. Corn oil
      2. Cottonseed oil
      3. Sunflower oil
      4. Soybean oil
   2. Wheat germ
   3. Fish liver oil
   4. Nuts
2. Mechanism
   1. Vegetable and Seed Oils: gamma-tocopherol
      1. Antioxidant
      2. Usual daily intake 15 IU/day
   2. Supplements: alpha-tocopherol
      1. Blocks antioxidant effect of natural foods
      2. May have pro-oxidant effect
         1. S Christen (1997) Proc Natl Acad Sci 64:3217
3. Adverse Effects: Potential Risks of high Vitamin E doses
   1. Interference with Vitamin K metabolism
   2. Interference with Platelet function
4. Efficacy: Potential Benefits
   1. May delay progression of Alzheimer's Disease
      1. Randomized trial of n=341
         1. Study criticized for methods, analysis
      2. Reference
         1. Sano (1997) N Engl J Med 336: 1216-22
   2. May boost immune response in elderly
      1. Study (DBPCT) of those over age 65 years (n=88)
         1. Measured Antigen produced induration to PPD
         2. Marked increase induration with 200 mg/day
         3. Suggested that US RDA (30 mg) may be too low
      2. References
         1. Meydani (1997) JAMA 277:1380-6
5. Efficacy: Potential Risks or No Benefit
   1. Does not reduce cancer risk
      1. Prostate Cancer risk is increased (1 new case in 625 men taking 400 units/day)
      2. Klein (2011) JAMA 306:1549-56.
   2. Coronary Artery Disease risk
      1. Initial studies suggested possible benefit
      2. PPP Study suggests no benefit
      3. May increase Heart Failure risk
      4. PPP study shows possibly higher CVA risk
      5. Studies show slightly higher all cause mortality
   3. Hemorrhagic Stroke increased risk
      1. Schurks (2010) BMJ 341: c5702
   4. Congestive Heart Failure increased risk
   5. Reference
      1. (2011) Presc Lett 18(12): 68
      2. Stephans (1996) Lancet 347:781
      3. (2001) Lancet 357:89-95
      4. Lonn (2005) JAMA 293:1338-47