Vitamin E Safety Controversy

Published on April 19, 2012 by Dr. George Templeton

For my first post, I thought I’d take on a topic that has been in and out of the media for the past few years, vitamin E.

Initially, vitamin E was thought to have a lot of potential for general health, from heart to prostate health.  Smaller studies and in vitro work showed promise, but then some big studies over the last year had conclusions that were disappointing: “vitamin E did not affect the overall risk of HF[heart failure]”1 or scary: “Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men”2

How did this happen?  How did we go from ‘vitamin E for all’ to ‘vitamin E: useless and/or dangerous’?  The answer is pretty simple: people are taking the wrong vitamin E.

All of these large scale clinical trials use alpha-tocopherol, one of the eight forms of vitamin E.  Some of them even use synthetic versions of alpha-tocopherol, which is widely accepted to have less than half the potency of natural alpha-tocopherol (due to shortcomings in the synthesis process).

So why is that a problem?  Well, research going back more than a decade has shown that supplementing pure alpha-tocopherol actually reduces the amounts of the gamma-, beta- and delta-tocopherols in the blood.  It turns out that these other tocopherols are actually pretty important, and are stronger antioxidants than the alpha form.  There have even been studies that show that gamma-tocopherol, but not alpha-tocopherol, levels are reduced in men that develop prostate cancer3.

Wait, that sounds familiar, doesn’t it?  So alpha-tocopherol supplementation decreases blood levels of gamma-tocopherol, and low gamma-tocopherol is linked to prostate cancer.  Why are we then surprised to see that alpha-tocopherol supplementation is linked to prostate cancer?

How did AOR put those pieces together a decade ago to determine that vitamin E supplements should have a balanced blend of tocopherols and tocotrienols (didn’t even get a chance to talk about those, but guess what, also really important), but major clinical trials can’t get their act together?  In the meantime, millions of people have been scared away from taking vitamin E supplements, when complete vitamin E supplements have been shown in clinical trials to improve cholesterol status, increase levels of multiple types of vitamin E in the blood (without decreasing any), reduce overall oxidative stress, boost immune function, and decrease arterial stiffness, just to name a few.  High blood levels of all vitamin E forms have also been linked to reduced risk of Alzheimer’s disease4, and animal model experiments have demonstrated that gamma- and delta-tocopherol, but not alpha-tocopherol, have strong anti-cancer effects5.

So if you are taking just alpha-tocopherol, consider switching to a more complete vitamin E, and if you’re already taking something like Total E, don’t worry about the scary headlines, those studies won’t apply.

You may also be interested in: "3 Reasons to Think About Vitamin E This Summer"

Image by © 2015 psphotography via Dollarphotoclub

1 Chae UC et al. (2012) Vitamin E Supplementation and the Risk of Heart Failure in Women. Circ Heart Fail. 5(2):176-82.

2 Klein EA et al. (2011) Vitamin E and the Risk of Prostate Cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 306(14):1549-56.

3 Helzlsouer KJ et al. (2000) Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer. J Natl Cancer Inst. 92:2018-2023.

4 Mangialasche F et al. (2010) High plasma levels of vitamin E forms and reduced Alzheimer’s disease risk in advanced age. J Alzheimers Dis. 20(4):1029-37.

5 Yang CS et al. (2012) Does Vitamin E Prevent or Promote Cancer? Cancer Prev Res. Epub ahead of print April 13.

  • Smith

    I heard about those studies and considered stopping my Total E.  Glad I didn't, thanks for clearing that up!

  • Andrew Ward

    Based on the research on tocotrienols I always take them seperately from the tocopherols (supposedly it should be at least 8 hours). This comes from the research of Dr Barrie Tan. Do you have any thoughts on mixed vitamin E formulas if this is the case? Dr Tan suggested that mixing the two types nullifies their effectiveness.
    Thank you.

    • George Templeton

      Hi Andrew,
      Thanks for a great question!
      I'm aware of the opinions of Dr. Tan.  This is a derivative of the well supported theory that high dose alpha-tocopherol consumption reduces levels of the other seven vitamers of vitamin E.  It is important to note that this is a systemic reaction to having too much alpha-tocopherol, and you can't correct it by taking small amounts of tocotrienols with or away from your alpha-tocopherol dose. 
      Even with the above being true, there is no clinical data that supports the idea that any amount of tocopherols, no matter how small, restricts effectiveness of supplemented tocotrienols.  In fact, most clinical trials showing benefits to tocotrienol supplementation use a tocotrienol rich fraction (TRF), which has about 1 part alpha-tocopherol for every 4 parts tocotrienols.
      The biggest problem I have with the idea of supplementing nearly pure delta-tocotrienol (as espoused by Dr. Tam) is that it seems that you'd be making the same mistake that was made by supplementing pure alpha-tocopherol.  There are 8 vitamers of vitamin E in your body for a reason, taking massive amounts of a single version is going to upset your natural ratios.  I will also say that, for as bad a rap as alpha-tocopherol gets, it is the actual "vitamin", that is, the one that your body requires to live, so it is possible that reducing it too much can cause just as many problems as taking too much.
      Until real clinical data is available for tocopherol-free blends of tocotrienols, I'd suggest to maintain balance in your vitamin E supplements.

      • Andrew Ward

        Dear Dr Templeton,
        Thank you for your thoughtful reply. What you have suggested makes perfect sense and highlights the danger of relying on one study as a definitive answer. Typically, I like to see the same information gleaned by several studies before I make a decision, so I have let myself down on this one :)
        Again, I very much appreciate your thoughts on this and I will continue with a balanced vitamin E approach in future. Best wishes, Andrew.

  • Joseph

    Dr. Nibber, I have been taking two (700mg) capsules of ACTIVE GREEN TEA per day and ave. 5 mugs of medium strength WHITE TEA per day. I am now informed that the amount of FLUORIDE SHOULD BE OF CONCERN! Can you shed some light on this dilemma for me? What amount is in a (ave) cup of WHITE TEA and in one 700mg cap of the ACTIVE GREEN TEA . How is the extra fluoride pass from the body, or does it accumulate and cause problems . thank you, joseph


      Hi Joseph,

      Fluoride is a concern with tea intake, but only at extreme intake levels. Numerous studies have shown that fluoride intakes above 20 mg/day for extended periods (10+ years) are required before starting to see skeletal fluorosis, but to be safe, the American Dental Association suggest no more than 10 mg/day for adults. Normal intake through food, drinking water and toothpaste is around 2-3 mg per day (depending on if you drink fluoridated water or not). Three capsules of Active Green Tea provides approximately 0.5 mg of fluoride per day. This is a far lower dose than you would get from the equivalent amount of green tea, as the purification process for the EGCG removes much of the fluoride. As fluoride accumulates as the tea leaves grow older, white tea is lower in fluoride than green or black tea. Essentially, with your regimen, assuming your white tea intake is approximately 1 L/day and you don't drink fluoridated water, you should be well under the 10 mg/day limit for fluoride, and should have no side effects as a result.

      Thanks for a great question!