Vitamin E

Vitamin E is a powerful antioxidant. It is fat soluble and is found naturally in some foods and also available as a dietary supplement. Interestingly, vitamin E does not describe one particular biologic molecule, but in fact is used to describe 8 different naturally occurring forms of structurally similar molecules. These molecules can be broken down into 2 major groups that are differentiated by the distribution of their electrons and number of hydrogen elements within the molecules.

Curiously though, given all this variety, humans have a distinct preference for one particular form of vitamin E referred to as alpha tocopherol. After all forms of vitamin E have been absorbed in the small intestine, alpha tocopherol is preferentially selected out in the liver and exported to the rest of the body for usage. 

Vitamin E has numerous biological functions, including its role as a powerful antioxidant and booster of immune cells.

3 Benefits of Vitamin E for Musculoskeletal Health 

The body has natural systems to neutralize free radicals, but sometimes these intrinsic defenses are overwhelmed by the number and virulency of high energy toxins. Oxidative stress occurs when unstable free radicals are left unchecked by the body’s protective systems and damage key proteins, fats, RNA, and DNA.  

Fat anywhere in the body, both on a microscopic and macroscopic level, is at extreme risk for uncontrolled and progressive oxidative damage. We commonly think of excess fat on our belly or butt, but joints also have localized areas of fat. Recent research has suggested that these fat areas play an integral role in unhealthy joints, muscle, and bone. 

Fat is especially sensitive to oxidation. A frequent target of free radicals is the fat in cell walls. Damage to one fat particle rapidly propagates to many other fat particles like a chain reaction, a phenomena referred to as lipid peroxidation. 

This event is catastrophic for the cell and often ends with a massive puncture in the cell wall. The contents of the cell leak out, severely comprising cell function and possibly leading to cell death.

Vitamin E is both a potent antioxidant and fat soluble. Vitamin E easily dissolves into the cell wall and disarms the free radical before it can ignite a devastating chain reaction.  Vitamin E is an invaluable bulwark against lipid peroxidation and crucial component of the body’s overall strategy to prevent oxidative stress.

1. Vitamin E Supports Joint Health

Oxidative stress contributes to unhealthy joints and magnifies unhealthy inflammation.  Markers and end products of oxidative stress have been found to be elevated in individuals with unhealthy joints. Vitamin E curbs some of the negative effects of oxidation and chronic inflammation.  Moreover, some research suggests vitamin E may stimulate the synthesis of proteins that support the joint’s shock absorbing attributes.

 

Thai investigators evaluated the effect of vitamin E supplementation on individuals with unhealthy knees.  The author’s demonstrated that vitamin E reduced markers of oxidative stress and improved symptoms. (Tantavisut et al. Effect of vitamin E on oxidative stress level in blood, synovial fluid, and synovial tissue in severe knee osteoarthritis: a randomized controlled study. BMC Musculoskeletal Disorders (2017) 18:281 DOI 10.1186/s12891-017-1637-7)

 

Multiple population studies have identified an association between low vitamin E intake and osteoarthritis. Researchers in Boston identified vitamin E deficiency in patients with osteoarthritis and a decreased risk of progression in individuals with higher intakes of vitamin E. Enrollees in the highest intake group, 12 mg or greater, had a statistically significant reduction in the progression of osteoarthritis compared to the vitamin E deficient group. (McAlindon TE, Jacques P, Zhang Y, et al. “Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis?” Arthritis Rheum 1996;39:648-56). 

 

To analyze the premise that optimal vitamin E protects against the symptoms of osteoarthritis, German  researchers carried out a multicenter, placebo-controlled, double-blind trial that administered vitamin E 400 IU/day for six weeks to study participants. Compared to the placebo group, the treatment group experienced less pain and improved mobility. (Blankenhorn G. “Clinical effectiveness of Spondivit (vitamin E) in activated arthroses. A multicenter placebo-controlled double-blind study.” Z Orthop Ihre Grenzgeb 1986;124:340–343.)

2.  Vitamin E Supports Bone Health

Chronic free radical attack on bone contributes to age related bone loss. Vitamin E is  a potent free radical scavenger. Vitamin E may neutralize free radicals before they can damage healthy bone tissue. Additionally, some research suggests vitamin E contributes to an alkaline environment that promotes calcium storage in bone.

 

Swedish researchers investigated the association between vitamin E and the rate of  fracture in elderly women and men. Analysis of the data suggested low intakes and low serum concentrations of α-tocopherol are associated with an increased rate of fracture in elderly women and men. (Michaëlsson, K.; Wolk, A.; Byberg, L.; Ärnlöv, J.; Melhus, H. Intake and serum concentrations of α-tocopherol in relation to fractures in elderly women and men: 2 cohort studies. Am. J. Clin. Nutr. 2014, 99, 107–114.)

3. Vitamin E Supports Muscle Health

Normal muscle aging and byproducts of rigorous exercise generate free radicals. Muscle’s increased exposure to high loads of highly unstable molecules makes muscle vulnerable to destructive oxidative damage. Vitamin E’s antioxidant properties stabilizes free radicals and  supports muscle health.

 

American researchers sought to determine whether a low serum concentration of Vitamin E was associated with subsequent decline in physical function in an elderly population. The author’s concluded a low serum concentration of vitamin E is associated with subsequent decline in physical function among community-living older adults. (Bartali, B.; Frongillo, E.A.; Guralnik, J.M.; Stipanuk, M.H.; Allore, H.G.; Cherubini, A.; Bandinelli, S.; Ferrucci, L.; Gill, T.M. Serum micronutrient concentrations and decline in physical function among older persons. JAMA 2008, 299, 308–315.)

Other Health Benefits 

There are other conditions that vitamin E may assist, although more research is needed and for some conditions results to date have been mixed. Those include:

  • Promotes heart health
  • Important for breast health
  • Key for bladder health
  • Supports eye health
  • Promotes brain health

 

Excellent Sources

Nuts and seeds are among the richest sources of alpha-tocopherol, and significant amounts are available in green leafy vegetables.


Recommended Dietary Allowance (RDA)

The Food and Nutrition Board has developed a table of recommended daily allowances (RDAs) of vitamin E, based on age and gender. The values are:

Recommended Dietary Allowances (RDAs) for Vitamin E (Alpha-Tocopherol):

Age

Males

Females

Pregnancy

Lactation

0 to 6 months*

6 IU – 4 mg

6 IU – 4 mg

 

 

7 to 12 months*

7.5 IU – 5 mg

7.5 IU – 5 mg

 

 

1 to 3 years

9 IU – 6 mg

9 IU – 6 mg

 

 

4 to 8 years

10.4 IU – 7 mg

10.4 IU – 7 mg

 

 

9 to 13 years

16.4 IU – 11 mg

16.4 IU – 11 mg

 

 

14+ years

22.4 IU – 15 mg

22.4 IU – 15 mg

22.4 IU – 15 mg

28.4 IU – 19 mg

*Adequate Intake (AI)

Precautions

Vitamin E from natural foods is generally well tolerated. RDA amounts can usually be obtained from a balanced, healthful diet.

An upper limit for vitamin E has been set at 1000 mg/day and 1490 IU/day. High doses of vitamin E supplements can interrupt normal blood clotting and increase risk of bleeding.

Additionally, vitamin E interacts with certain prescription blood thinners and any consideration of supplementation should be discussed with a qualified health professional familiar with your unique medical history. 

References

(2015). USDA National Nutrient Database for Standard: Vitamin E. The National Agricultural Library. Retrieved from https://www.ars.usda.gov/northeast-area/beltsville-md/beltsvillehuman-nutrition-research-center/nutrient-data-laboratory/docs/usda-national-nutrientdatabase-for-standard-reference/

(2016). Vitamin E fact sheet for health professionals. National Institutes of Health. Retrieved from https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/

(2017). Vitamin E. Micronutrient Information Center. Retrieved from http://lpi.oregonstate.edu/mic/vitamins/vitamin-E

(2017). Vitamin E. The World’s Healthiest Foods. Retrieved from http://www.whfoods.com/genpage.php?tname=nutrient&dbid=111

Brand, C., Snaddon, J., Bailey, M., & Cicuttini, F. (2001). Vitamin E is ineffective for symptomatic relief of knee osteoarthritis: A six month double blind, randomised, placebo controlled study. Annals of the Rheumatic Diseases, 60(10), 946. doi:http://dx.doi.org/10.1136/ard.60.10.946

Canter, P. H., Wider, B., & Ernst, E. (2007). The antioxidant vitamins A, C, E and selenium in the treatment of arthritis: A systematic review of randomized clinical trials. Rheumatology, 46, 1223–1233. doi:10.1093/rheumatology/kem116

Otten, J. J., Hellwig, J. P., & Meyers, L. D. (Eds.). (2006). Dietary reference intakes: The essential guide to nutrient requirements. Washington D.C.: National Academy of Sciences.

Rhouma, M., De Oliveira El Warrak, A., Troncy, E., Beaudry, F., & Chorfi, Y. (2013). Antiinflammatory response of dietary vitamin E and its effects on pain and joint structures during early stages of surgically induced osteoarthritis in dogs. The Canadian Journal of Veterinary Research, 77, 191–198.

Surapaneni, K. M., & Venkataramana, G. (2007). Status of lipid peroxidation, glutathione, ascorbic acid, vitamin E and antioxidant enzymes in patients with osteoarthritis. Indian Journal of Medical Sciences, 61(1), 9-14.

Thomas, R. G. & Gebhardt, S. E. (n. d.). Nuts and seeds as sources of alpha and gamma tocopherols. USDA. Retrieved from https://www.ars.usda.gov/ARSUserFiles/80400525/articles/aicr06_nutseed.pdf

Tiku, M. L., Shah, R., & Allison, G. T. (2000). Evidence linking chondrocyte lipid peroxidation to cartilage matrix protein degradation. Possible role in cartilage aging and the pathogenesis of osteoarthritis. J Biol Chem, 275(26), 20069-76. doi:10.1074/jbc.M907604199

Wluka, A. E., Stuckey, S., Brand, C., & Cicuttini, F. M. (2002). Supplementary vitamin E does not affect the loss of cartilage volume in knee osteoarthritis: A 2 year double blind randomized placebo controlled study. J Rheumatol, 29(12), 2585-91. 

Mecocci P, Fano G, Fulle S, et al. Age-dependent increases in oxidative damage to DNA, lipids, and proteins in human skeletal muscle. Free Radic Biol Med 1999;26(34):303–308. [PubMed: 9895220]

Cadenas E, Davies KJ. Mitochondrial free radical generation, oxidative stress, and aging. Free Radic Biol Med 2000;29(34):222–230. [PubMed: 11035250]

Traber MG, Sies H. Vitamin E in humans: demand and delivery. Annu Rev Nutr 1996;16:321–347. [PubMed: 8839930]

 McAlindon TE, Jacques P, Zhang Y, Hannan MT, Aliabadi P, Weissman B, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648–56

Suantawee T, Tantavisut S, Adisakwattana S, Tanavalee A, Yuktanandana P, Anomasiri W, et al. Oxidative stress, vitamin E, and antioxidant capacity in knee osteoarthritis. J Clin Diagn Res. 2013;7:1855–9

Vasanthi B, Komathi J, Arun KD. Therapeutic effect of vitamin E in patients with primary osteoarthritis. Int J Recent Adv Pharm Res. 2012;2:46–50.

Cerullo, F.; Gambassi, G.; Cesari, M. Rationale for antioxidant supplementation in sarcopenia. J. Aging Res. 2012, 2012, 316943. 

Meng, S.J.; Yu, L.J. Oxidative stress, molecular inflammation and sarcopenia. Int. J. Mol. Sci 2010, 11, 1509–1526. 

 Lucas J. Bader MD

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