Mixed tocopherols · supplement
Evidence tier: insufficient
A foundational antioxidant for skin, liver, and reproductive health. Mixed tocopherols are best.
A fat soluble chain breaking antioxidant that sits in cell membranes and stops the chain reaction of lipid peroxidation. It also inhibits platelet aggregation and affects protein kinase C signalling. That same membrane and platelet activity is what explains BOTH its antioxidant role and its bleeding risk at high dose, which is why the mechanism does not translate into a benefit claim.
SAFETY IS THIS INGREDIENT'S STORY, NOT EFFICACY. Do not grade vitamin E highly just because it is a well known vitamin. The score is low not because the evidence is missing but because the large trials were NULL OR HARMFUL. Per the NIH Office of Dietary Supplements: heart disease, no benefit (HOPE, HOPE-TOO, Physicians' Health Study II and the Women's Health Study found no reduction in serious cardiovascular events, and in some trials all cause mortality was higher on the supplement); cancer, no benefit and a harm signal; cognition, not supported; eyes, only as part of the multi ingredient AREDS/AREDS2 formulation, which is a formulation result and not a case for vitamin E alone, and vitamin E did nothing for cataracts. Deficiency is rare and mostly occurs with fat malabsorption (cystic fibrosis, Crohn's) or a rare genetic disorder, not on a normal diet. So the efficacy evidence for supplementation in healthy people is weak to insufficient. THE HARM SIGNALS ARE REPLICATED AND SERIOUS. Bleeding: vitamin E inhibits platelet aggregation and antagonises vitamin K dependent clotting factors, so high doses can cause haemorrhage; in the Physicians' Health Study II (male physicians on 400 IU every other day for 8 years, most also on aspirin) vitamin E RAISED HAEMORRHAGIC STROKE RISK, hazard ratio 1.74 (95 percent CI 1.04 to 2.91) (PMID 18997197). Prostate cancer: in SELECT, 35,533 HEALTHY MEN taking 400 IU a day had a SIGNIFICANTLY INCREASED RISK OF PROSTATE CANCER, hazard ratio 1.17 (99 percent CI 1.004 to 1.36), an extra 1.6 cases per 1,000 person years; the trial's own conclusion was that dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men (PMID 21990298). All cause mortality: a dose response meta analysis of 135,967 people across 19 trials found high dosage vitamin E (at or above 400 IU a day) carried a pooled excess of 39 deaths per 10,000 persons (95 percent CI 3 to 74), with risk climbing above 150 IU a day, and concluded high dosage vitamin E may increase all cause mortality and should be avoided (PMID 15537682); a second large meta analysis agreed in its low bias trials, relative risk 1.04 (95 percent CI 1.01 to 1.07) (PMID 17327526). The fair counterweight, recorded honestly: NIH ODS notes the mortality trials mostly enrolled older people with chronic disease and that a review of the healthy primary prevention subset found no convincing evidence of increased mortality, so the mortality point is debated. But the bleeding and prostate cancer signals are not debated, and none of it argues for taking more. The liver is NOT the risk here: LiverTox rates vitamin E likelihood score E, unlikely to cause liver injury.
The amount that matters is small. The RDA is just 15 mg a day for anyone aged 14 and older (about 22.4 IU of the natural form), rising to 19 mg while breastfeeding. The tolerable upper limit for adults is 1,000 mg a day of supplemental alpha-tocopherol (1,500 IU natural or 1,100 IU synthetic), and 800 mg a day for ages 14 to 18. THAT UPPER LIMIT EXISTS SPECIFICALLY BECAUSE OF THE RISK OF HAEMORRHAGE. Many high strength vitamin E products sit at 400 IU or more, which is exactly the dose range tied to harm in the trials.
200 to 400 IU mixed tocopherols daily with fat containing meal.
High dose synthetic alpha-tocopherol may slightly increase bleeding and prostate cancer risk, use natural mixed forms.
Pregnancy: caution
Breastfeeding: caution
Active compounds: alpha-tocopherol (the only form that meets human requirements), beta-tocopherol, gamma-tocopherol, delta-tocopherol, alpha-tocotrienol, beta-tocotrienol, gamma-tocotrienol, delta-tocotrienol
Remedies using Vitamin E · Browse by body system · Check it against what you take
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.