Vitamin E is number three of the four fat soluble vitamins. It has eight isoforms, four tocotrienols and four tocopherols for our system to utilize.

The main function of vitamin E is to be an antioxidant. This means that it plays a role in cleaning up reactive oxygen species that are DNA damaging in high volume. Many things promote excessive amounts of reactive oxygen species (ROS) formation including exogenously ingested chemicals like smoke, toxins, drugs, as well as inflammatory food. We naturally make ROS during day to day cellular metabolism, intense exercise or to kill microbes.

ROS are chemically reactive molecules that have an unpaired electron. In the normal state, most electrons are paired off to keep them stable in the oxygen molecule. When they are unpaired they are unstable, dangerous and looking for an electron to steal. Dr. Chris Nagy has a great analogy for ROS. Imagine a amoral single guy being invited to a couple’s party. He meanders around the crowd and doesn’t care with whom he hooks up with as long as he does.

In the cellular world the unpaired electron will attack any cell stealing its electron causing stress and damage. Cells suffer DNA and protein dysfunction, which in turn causes the cell to not perform properly or flat out die.

Vitamin E is your best friend watching your amoral guest meander around the party eyeing your wife or your friend’s wife. Once he sees his true intent is damage, he grabs him by the arm and goes Bruce Lee on him taking him out of circulation.

Vitamin E is especially good at preventing fat cell damage or what is called lipid peroxidation. LDL particles are the infamous low density lipoprotein particles that are associated with heart attacks. When excessive amounts of ROS are in a human soup of excessive sugar and thus fat, lipid (LDL) peroxidation occurs making the oxidized LDL particle a target for immune macrophage cell ingestion. The end result is a foam cell and the first stage of atherosclerosis.

Vitamin C, another antioxidant, is necessary to regenerate the cleaning capacity of vitamin E via a chemical called glutathione. Maintaining adequate volumes of vitamin C is critical.

Vitamin E defiency is rare and usually due to serious GI malabsorption issues and severe malnutrition. Symptoms are mostly neurological with peripheral sensory nerve damage, coordination issues, visual damage and muscle weakness.

Chronic vitamin E insufficiency associated diseases are mainly related to poor antioxidant repair. Cancer and heart disease are the two most common and dangerous diseases associated with poor vitamin E status. Macular degeneration of the eye, type 2 diabetes, dementia and sugar induced fatty liver disease are all worsened by an insufficient vitamin E status.

Food sources of Vitamin E are nuts, nut butters, seeds, certain fish, avocados and fortified foods like cereals.

Most adults need 22.5 IU/day. Incrementally less for kids. This nutrient is easily obtained by a healthy anti inflammatory diet.

Pregnancy and infancy are times of increased vitamin E needs. We highly stress the need for adequate vitamin E stores for all females of child bearing age. Max dosing of vitamin E for all adults appears to be 1100 IU per day before toxicity develops.

Over consumption of vitamin E can be toxic as it is fat soluble and can accumulate in our fat cells in large supplemented doses. Symptoms and findings of toxicity include bleeding issues.

People at risk for insufficiency or deficiency have: issues with intestinal fat malabsorption (vitamin E is a fat soluble vitamin like A/D/K), intestinal dysbiosis, inflammatory bowel disease, eating disorders, celiac disease and disorders of bile production or pancreatic enzyme production and older age.

Vitamin E can interact with vitamin K dependent enzymes increasing the risk of bleeding in patients taking blood thinners like warfarin.

Anticonvulsant drugs may interfere with vitamin E.

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at  newsletter@salisburypediatrics.com