Symptoms of vitamin E deficiency are rare, but according to at least four national surveys, most Americans consume less than the government’s Recommended Daily Allowance (RDA) of this essential nutrient.1 The authors of an August 2015 study published in PLOS-One call vitamin E a “shortfall nutrient” because over 90% of Americans consume insufficient quantities and because low vitamin E status has been linked to multiple health consequences, including increased total mortality.2 Vitamin E is clearly important, but can the Paleo diet provide adequate levels? After all, some of the most frequently cited “best dietary sources” aren’t Paleo compliant. The RDA for males and females above 14 years of age is 15 mg daily. The following table shows vitamin E values for 100 grams of various foods and their corresponding RDAs. The foods highest in vitamin E are predominantly seeds/nuts and their oils. Seed oils are excluded from the Paleo diet, however, primarily because they contain excessive amounts of polyunsaturated fatty acids (PUFAs).
Almonds, hazelnuts, and sunflower seeds are good Paleo vitamin E sources. Fruits and vegetables are also good, but they contain very low amounts. Those small amounts accumulate, however, so collectively they are indeed significant. Probably the best Paleo vitamin E source is olive oil. One tablespoon packs 1.9 mg, which is 10% of the RDA. You can add a few tablespoons of olive oil on salads or cooked vegetables, or use it for cooking. Olive oil becomes even more attractive when you consider its relatively low levels of PUFAs. We should note that vitamin E functions primarily as an antioxidant, which means it protects against cellular damage by scavenging for free radicals. PUFAs have a high propensity to oxidize and oxidation creates free radicals. Therefore, high levels of PUFAs can negate vitamin E’s benefits. If we refer back to our chart, we see that many foods rich in vitamin E are also PUFA-rich. Back in 1988, Brazilian scientists theorized that total vitamin E content is not the best indicator of vitamin E activity for vegetable oils.
Using high-pressure liquid chromatography, they analyzed various oils for vitamin E activity and determined that high PUFA content offsets vitamin E activity and that oil refinement causes vitamin E losses upwards of 22%, especially during steam deodorization.3 They proposed that for vitamin E, unrefined oils beat their refined counterparts and that the ratio of vitamin E to PUFA better indicates vitamin E potential compared to absolute vitamin E levels. A British Journal of Nutrition study published this month (October 2015) reiterates the same point: “The vitamin E requirement will increase with an increase in PUFA consumption and with the degree of unsaturation of the PUFA in the diet.”4 Another just-published study is also raising interest about vitamin E, particularly for its conclusion that those who have metabolic syndrome (about one-third of the US population) don’t absorb vitamin E as effectively as those who are healthy.5 Lead author of this latter study, Richard Bruno, commented, “Dietary requirements of nutrients are generally defined only in the context of what a healthy person needs
, but considering that two-thirds of Americans are overweight or obese, a healthy person might not be representative of our society. This work tells us that at least one-third of Americans have higher vitamin E requirements than healthy people.” With all this in mind, one might conclude that supplementation is the best way to maintain adequate vitamin E levels. In the 1980s, scientists began to understand how free radicals contribute to atherosclerosis, cancer, vision loss, and various other chronic conditions. This sparked interest in the preventative potential of antioxidant supplements, particularly vitamin E. Several observational studies, including the Nurses’ Health Study, suggested 20 – 40% reductions in heart disease risk among people taking vitamin E supplements.7 Follow-up randomized controlled trials, however, dampened enthusiasm for vitamin E supplements, both for heart disease and cancer prevention. One meta-analysis even concluded that high-dose vitamin E supplementation may increase all-cause mortality and should be avoided.8 For those who are interested, the Harvard School of Public Health has an excellent summary on the history of research on vitamin E supplementation.
In conclusion, supplementation may provide benefits for certain conditions, but food sources of vitamin E are widely considered to be superior. Many of the richest food sources, however, are high-PUFA seed oils. High levels of PUFAs counteract vitamin E’s antioxidant capacity. It’s best to eliminate vegetable seed oils from your diet. The Paleo Diet provides plenty of vitamin E via olive oil, small quantities of seeds and nuts, and large amounts of vegetables. 1. National Institutes of Health, Office of Dietary Supplements. Vitamin E Fact Sheet for Health Professionals. 2. McBurney, M., et al. (August 19, 2015). Suboptimal Serum α-Tocopherol Concentrations Observed among Younger Adults and Those Depending Exclusively upon Food Sources, NHANES 2003-2006. 3. Desai, D., et al. (June 1988). Vitamin E content of crude and refined vegetable oils in Southern Brazil. The Journal of Food Composition and Analysis, 1(3). 4. Raederstorff, D., et al. (October 2015). Vitamin E function and requirements in relation to PUFA.
British Journal of Nutrition, 114(8). 5. Mah, E., et al. (October 7, 2015). α-Tocopherol bioavailability is lower in adults with metabolic syndrome regardless of dairy fat co-ingestion: a randomized, double-blind, crossover trial. American Journal of Clinical Nutrition [epub ahead of print]. 6. Caldwell, E. (October 7, 2015). Metabolic syndrome leads 1 in 3 Americans to need more vitamin E. Ohio State University (Press Release). 7. Institute of Medicine. (2000). Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. 8. Miller, ER., et al. (January 4, 2005). Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine, 142(1). Generic Name: vitamin E (VYE ta min E)Brand Names: Aqua-E, Aquasol E, Aquavite-E, Aqueous Vitamin E, E-400 Clear Vitamin E is an antioxidant that occurs naturally in foods such as nuts, seeds, and leafy green vegetables. Vitamin E is a fat-soluble vitamin important for many processes in the body.
Vitamin E is used to treat or prevent vitamin E deficiency. People with certain diseases may need extra vitamin E. Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. The Dangers Of DVT: Don't Ignore The Signs Ask a doctor or pharmacist if it is safe for you to use vitamin E if you have other medical conditions, especially: anemia (low red blood cells); a bleeding or blood clotting disorder such as hemophilia; an eye disorder called retinitis pigmentosa; high cholesterol or triglycerides (a type of fat in the blood); a history of stroke or blood clot; if you need surgery, or have recently had surgery. FDA pregnancy category C. It is not known whether vitamin E will harm an unborn baby. Do not use this medicine without a doctor's advice if you are pregnant.See also: Pregnancy and breastfeeding warnings (in more detail)
It is not known whether vitamin E passes into breast milk or if it could harm a nursing baby. Do not use this medicine without a doctor's advice if you are breast-feeding a baby. Your dose needs may be different during pregnancy or while you are nursing. Use vitamin E products exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Vitamin E works best if you take it with food. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Artificially sweetened liquid medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU). The recommended dietary allowance of vitamin E increases with age. Follow your healthcare provider's instructions. You may also consult the Office of Dietary Supplements of the National Institutes of Health, or the U.S. Department of Agriculture (USDA) Nutrient Database (formerly "Recommended Daily Allowances") listings for more information.
If you need surgery or a medical procedure, tell the surgeon ahead of time that you are using vitamin E. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat. See also: Dosage Information (in more detail) Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include stomach pain, nausea, diarrhea, dizziness, headache, tiredness, blurred vision, or tiredness. Avoid taking other vitamins, mineral supplements, or nutritional products without your doctor's advice. If you also take orlistat (alli, Xenical), do not take it within 2 hours before or 2 hours after you take vitamin E. Get emergency medical help if you have any of these signs of an allergic reaction to vitamin E: hives;
swelling of your face, lips, tongue, or throat. Stop taking vitamin E and call your doctor at once if you have: headache, dizziness, vision changes; a light-headed feeling, like you might pass out; unusual weakness or tired feeling; easy bruising or bleeding (nosebleeds, bleeding gums). Common vitamin E side effects may include: This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. See also: Side effects (in more detail) Usual Adult Dose for Vitamin E Deficiency: Treatment: 60 to 75 units orally once daily. Prevention: 30 units orally once daily. Usual Adult Dose for Tardive Dyskinesia: 600 to 1600 units orally per day. Usual Adult Dose for Sickle Cell Anemia: 450 units orally per day. Usual Adult Dose for Alzheimer's Disease: 1000 units orally twice daily. Usual Adult Dose for Dietary Supplement:
Oral liquid formulation (AQUA-E): 200 units (10 mL) orally once daily. Usual Pediatric Dose for Vitamin E Deficiency: 1 unit/kg/day orally of water-miscible vitamin E. Usual Pediatric Dose for Retinopathy Prophylaxis: Prevention of retinopathy of prematurity or Bronchopulmonary dysplasia (BPD) secondary to oxygen therapy: 15 to 30 units/kg/day to maintain plasma levels between 1.5 to 2 mcg/mL (may need as high as 100 units/kg/day). Note: AAP considers this use investigational and routine use is not recommended. Usual Pediatric Dose for Cystic Fibrosis: 100 to 400 units/day orally. Usual Pediatric Dose for Dietary Supplement: Dosing: 1 unit vitamin E = 1 mg dl-alpha-tocopherol acetate. 1 to less than 6 months: 4 units daily 6 to less than 12 months: 5 units daily Recommended Daily Allowance (RDA): 1 to 3 years: 6 units daily 4 to 8 years: 7 units daily 9 to 13 years: 11 units daily 13 years and Older: 15 units daily
Tell your doctor about all medicines you use, and those you start or stop using during your treatment, especially: This list is not complete. Other drugs may interact with vitamin E, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this product only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.