Drs. Evan and Wilfrid Shute of London, Ontario, Canada were the first medical doctors to realize that an adequate vitamin E status is vital to the health of the heart. In 1945 they discovered that 200 IU per day of vitamin E was beneficial in reversing heart disease and in treating angina pectoris. By 1954 the Shute brothers had treated over 10,000 heart disease patients with miraculous results(1). Unfortunately, when they tried to publish their findings in medical journals their scientific papers were rejected and the medical establishment continued to ignore their findings for another 40 years. A glimmer of hope occurred in 1959 when the United States Food and Drug Administration (FDA) formally recognized that vitamin E was indeed essential to human health.

RDA Inadequate
In 1959 the average North American diet provided about 20 mg/day of vitamin E, so based on the observation that very few people suffered from any of the more or less obscure vitamin E related deficiency diseases recognized by the medical establishment, the RDA (Recommended Daily Allowance) for vitamin E was set at 30 IU (20 mg) per day. In 1974 this level was lowered to 15 IU/day when the FDA realized that the average diet now only provided 10 IU or less per day(2). In other words, the RDA was adjusted to conform to the inadequate and steadily decreasing level of vitamin E in the American diet. The absurdity of this whole situation can perhaps best be illustrated by the fact that an eminent scientist and member of the RDA panel, who in 1974 supported the contention that a vitamin E intake of 10-30 mg/day would be adequate for an adult, publicly stated in 1991 that he was himself taking 400 IU of vitamin E every second day. To quote "...The knowledge that undesirable products of lipid peroxidation in human tissues can be decreased by taking vitamin E have persuaded me to personally take a 269 mg (400 IU) supplement of d-alpha- tocopherol every other day(3,4)."

Most Powerful Antioxidant
The hypothesis that vitamin E can prevent lipid peroxidation caused by free radical reactions was first advanced in 1983 and has since been proven correct by numerous, credible, scientific investigations. There is now general agreement that vitamin E is the most powerful antioxidant in the body's lipid (fat) phase and that its ability to protect cell membranes from oxidation is of crucial importance in preventing and reversing many degenerative diseases. Vitamin E also inhibits blood clotting (platelet aggregation and adhesion) and prevents plaque enlargement and rupture(5-13).

The evidence that vitamin E can prevent and reverse heart disease is now incontrovertible. In 1992 researchers at the University of Texas reported that vitamin E protects against atherosclerosis (hardening of the arteries) by preventing oxidation of the low density lipoprotein fraction of blood(14). In 1993 researchers at the Harvard Medical School released a study showing that vitamin E supplementation prevents heart disease. Nurses who took more than 100 IU/day of vitamin E for more than two years reduced their risk of heart disease by 41 per cent. A related study involving almost 40,000 male health professionals showed that men who supplemented with between 100 and 250 IU/day reduced their risk of heart disease by 37 per cent. Vitamin E is also highly beneficial in the treatment of intermittent claudication and recent research has confirmed its ability to prevent and, in some cases, reverse the progression of atherosclerosis(13,15-18).

Vitamin E is also highly effective in warding off a heart attack. Researchers at Cambridge University in England reported in 1996 that patients who had been diagnosed with coronary atherosclerosis could lower their risk of having a heart attack by 77 per cent by supplementing with 400 IU or 800 IU/day of natural source vitamin E(19). Very recently researchers at the Toyama Medical University in Japan reported that patients with unstable angina can reduce their risk of angina attacks by a factor of six by supplementing with vitamin E (300 mg/day of alpha-tocopherol acetate)(20). Supplementation with vitamin E has also been found useful in preventing complications after heart surgery and helps slow the restenosis (reblockage) of arteries subjected to angioplasty(16,17,21).

Protects More Than the Heart
The evidence supporting vitamin E's efficacy in preventing and reversing heart disease is indeed overwhelming. However, vitamin E has many other benefits. Daily supplementation with 400 IU of vitamin E and 600 mg of vitamin C can reduce the risk of developing cataracts by 50 per cent(22). A low intake of vitamin E is a risk factor for the development of diabetes (non-insulin- dependent, Type II) and supplementation has been found to be beneficial for diabetics(23,24). Several studies have shown that vitamin E supplementation improves longevity and may have a protective effect against both Alzheimer's and Parkinson's diseases(25-29).

Vitamin E supplementation (400 IU/day) improves the immune system response in both young and older people, is helpful in the treatment of cystic fibrosis and arthritis, and applied topically has even been found to cure dermatitis(21,30-32). Vitamin E is also helpful in cancer prevention. Scientists at the National Cancer Institute found that supplementation with vitamin E cuts the risk of oral cancer by 50 per cent. Non-smokers can reduce their risk of developing lung cancer by taking vitamin E and men can reduce their risk of colon cancer by 65 per cent by increasing their intake of vitamin E(33-36).

Optimum Intake
It is clear that vitamin E is an extremely important factor in human health. Most studies involving vitamin E supplementation have used amounts between 100 IU/day and 800 IU/day and 400 IU/day is now considered to be a basic, safe and adequate dosage for an average, healthy person(37-41). The optimum intake for an individual, however, depends on many factors including the intake of polyunsaturated fatty acids and the degree of exposure to air pollution and toxic chemicals. Higher dosages may be indicated for women suffering from premenstrual or menopausal problems, for smokers, for people engaging in heavy, outdoor exercise, and for people having a family history of cancer. A large intake of fish or fish oils has been shown to increase the requirement for vitamin E quite significantly(2,21,39-43).

Large, well-controlled studies of vitamin E supplementation have shown the vitamin to be non-toxic in intakes as high as 3200 IU/day(40,44). However, most researchers caution against daily intakes higher than 800-1200 IU/day for extended periods(37,38,41). It is also recommended that the progression to a daily dose of 400 IU be gradual as should any decrease in intake. Some very recent research has shown that vitamin E in dosages higher than 1600 IU/day may have a prooxidative effect. However, this effect can be avoided by always taking adequate amounts of vitamin C when supplementing with vitamin E(45,46).

There are some cases in which high dosages (more than 30 IU/day) of vitamin E are contraindicated. Medical advice concerning dosage should be sought by individuals having high blood pressure, those taking anticoagulant drugs (Coumadin, warfarin) or having a tendency to prolonged bleeding, those having a vitamin K deficiency, and those suffering from rheumatic heart disease, an overactive thyroid or diabetes(21,37,40).

Inorganic iron (ferrous sulphate) destroys vitamin E and birth control pills deactivate it to some degree. So vitamin E should be taken with the main meal (to optimize absorption) and at least six hours before or after taking an iron supplement or a birth control pill.

Supplementation is Essential
Natural vitamin E comes in several forms; d-alpha-tocopherol (100 mg=149 IU), d-alpha-tocopherol acetate (100 mg=136 IU), and d-alpha-tocopherol succinate are the most common. The "d" designation in front indicates that the products are derived from natural sources such as vegetable oils or wheat germ. A prefix of "dl", such as dl-alpha-tocopherol, shows that the vitamin has been synthesized from a petroleum base. Synthetic vitamin E is far less effective than natural vitamin E. Recent research has also shown that expensive water- soluble forms of vitamin E are no more effective than the regular fat-soluble forms(21,30,47-49).

REFERENCES

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