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Overview of vitamin E

Sassan Pazirandeh, MD
David L Burns, MD
Section Editors
Timothy O Lipman, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD


Vitamins are a number of chemically unrelated families of organic substances that cannot be synthesized by humans but need to be ingested in the diet in small quantities to prevent disorders of metabolism. They are divided into water-soluble and fat-soluble vitamins (table 1).

In 1922, Evans and Bishop discovered a substance that was deficient in rats fed a diet that contained lard and that resulted in infertility [1]. The deficiency was corrected when a lipid extract of cereals was added to the diet; this was termed the "anti-sterility factor" [2]. In 1925, vitamin E was officially recognized as the fifth vitamin. A few years later the name tocopherol from the Greek word of "toc" (child) and "phero" (to bring forth) was coined to describe its role as an essential dietary substance in normal fetal and childhood development [3]. In 1969, the FDA formally recognized vitamin E as an essential nutrient for humans. Vitamin E is a fat-soluble compound and an antioxidant and protects cell membranes from oxidation and destruction.

This topic review will focus on vitamin E. Overviews of the other fat-soluble vitamins, minerals and water-soluble vitamins are available elsewhere. (See "Overview of vitamin A" and "Overview of vitamin D" and "Overview of vitamin K" and "Overview of dietary trace minerals" and "Overview of water-soluble vitamins" and "Vitamin supplementation in disease prevention".)


Vitamin E is found in a variety of foods including oils, meat, eggs, and leafy vegetables. The form that is best known for its role in human health is alpha-tocopherol, which is abundant in olive and sunflower oils, and is the predominant form in the European diet. Gamma-tocopherol is another form, which is abundant in soybean and corn oil, and is common in the American diet.


The primary bioactive form of vitamin E is alpha-tocopherol. Alpha-tocopherol has eight isomers, but only four of these (RRR-, RSR-, RRS-, and RSS- alpha-tocopherol) are efficiently maintained in human plasma, and these are the forms to which the dietary reference intakes apply [4]. Furthermore, the RRR-isomer (formerly and incorrectly called D-alpha-tocopherol) is the only form found in foods; it is sometimes known as "natural source" vitamin E.

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Literature review current through: Sep 2017. | This topic last updated: Oct 03, 2016.
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  1. Traber MG. Vitamin E. In: Modern Nutrition in Health and Disease, Shils M, Olson J, Shike M, et al (Eds), Lippincott, Philadelphia 2000.
  2. Evans HM. The pioneer history of vitamin E. Vitam Horm 1963; 20:379.
  3. Mason, KE. The first two decades of vitamin E history. In: Vitamin E: A Comprehensive Treatise, Machlin, LJ (Eds), Marcel Dekker, New York 1980. p.1.
  4. Food and Nutrition Board of the Institute of Medicine. DRI Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. National Academies Press, Washington DC, 2000. p. 186. Available at: http://books.nap.edu/catalog.php?record_id=9810#toc (Accessed on August 06, 2014).
  5. Wolf G. How an increased intake of alpha-tocopherol can suppress the bioavailability of gamma-tocopherol. Nutr Rev 2006; 64:295.
  6. Huang HY, Appel LJ. Supplementation of diets with alpha-tocopherol reduces serum concentrations of gamma- and delta-tocopherol in humans. J Nutr 2003; 133:3137.
  7. Burton GW, Joyce A, Ingold KU. Is vitamin E the only lipid-soluble, chain-breaking antioxidant in human blood plasma and erythrocyte membranes? Arch Biochem Biophys 1983; 221:281.
  8. Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993; 328:1450.
  9. Jialal I, Fuller CJ, Huet BA. The effect of alpha-tocopherol supplementation on LDL oxidation. A dose-response study. Arterioscler Thromb Vasc Biol 1995; 15:190.
  10. Hodis HN, Mack WJ, LaBree L, et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. JAMA 1995; 273:1849.
  11. Stampfer MJ, Rimm EB. Epidemiologic evidence for vitamin E in prevention of cardiovascular disease. Am J Clin Nutr 1995; 62:1365S.
  12. Marchese ME, Kumar R, Colangelo LA, et al. The vitamin E isoforms α-tocopherol and γ-tocopherol have opposite associations with spirometric parameters: the CARDIA study. Respir Res 2014; 15:31.
  13. Abdala-Valencia H, Berdnikovs S, Cook-Mills JM. Vitamin E isoforms as modulators of lung inflammation. Nutrients 2013; 5:4347.
  14. Jiang Q, Elson-Schwab I, Courtemanche C, Ames BN. gamma-tocopherol and its major metabolite, in contrast to alpha-tocopherol, inhibit cyclooxygenase activity in macrophages and epithelial cells. Proc Natl Acad Sci U S A 2000; 97:11494.
  15. Hernandez ML, Wagner JG, Kala A, et al. Vitamin E, γ-tocopherol, reduces airway neutrophil recruitment after inhaled endotoxin challenge in rats and in healthy volunteers. Free Radic Biol Med 2013; 60:56.
  16. Zingg JM, Azzi A. Non-antioxidant activities of vitamin E. Curr Med Chem 2004; 11:1113.
  17. Traber MG, Goldberg I, Davidson E, et al. Vitamin E uptake by human intestinal cells during lipolysis in vitro. Gastroenterology 1990; 98:96.
  18. Nakamura T, Aoyama Y, Fujita T, Katsui G. Studies on tocopherol derivatives: V. Intestinal absorption of several d,1-3,4-3H2-alpha-tocopheryl esters in the rat. Lipids 1975; 10:627.
  19. Cohn JS, McNamara JR, Cohn SD, et al. Postprandial plasma lipoprotein changes in human subjects of different ages. J Lipid Res 1988; 29:469.
  20. Cohn W, Loechleiter F, Weber F. Alpha-tocopherol is secreted from rat liver in very low density lipoproteins. J Lipid Res 1988; 29:1359.
  21. Yoshida H, Yusin M, Ren I, et al. Identification, purification, and immunochemical characterization of a tocopherol-binding protein in rat liver cytosol. J Lipid Res 1992; 33:343.
  22. Traber MG, Kayden HJ, Green JB, Green MH. Absorption of water-miscible forms of vitamin E in a patient with cholestasis and in thoracic duct-cannulated rats. Am J Clin Nutr 1986; 44:914.
  23. Soltani-Frisk S, Gronowitz E, Andersson H, Strandvik B. Water-miscible tocopherol is not superior to fat-soluble preparation for vitamin E absorption in cystic fibrosis. Acta Paediatr 2001; 90:1112.
  24. Winklhofer-Roob BM, van't Hof MA, Shmerling DH. Long-term oral vitamin E supplementation in cystic fibrosis patients: RRR-alpha-tocopherol compared with all-rac-alpha-tocopheryl acetate preparations. Am J Clin Nutr 1996; 63:722.
  25. Feranchak AP, Sokol RJ. Medical and nutritional management of cholestasis in infants and children. In: Liver disease in children, 3rd ed, Suchy FJ, Sokol RJ, Balistreri WF (Eds), Cambridge University Press, New York 2007. p.213.
  26. Sokol RJ, Butler-Simon N, Conner C, et al. Multicenter trial of d-alpha-tocopheryl polyethylene glycol 1000 succinate for treatment of vitamin E deficiency in children with chronic cholestasis. Gastroenterology 1993; 104:1727.
  27. Kowdley KV. Lipids and lipid-activated vitamins in chronic cholestatic diseases. Clin Liver Dis 1998; 2:373.
  28. Jeffrey GP, Muller DP, Burroughs AK, et al. Vitamin E deficiency and its clinical significance in adults with primary biliary cirrhosis and other forms of chronic liver disease. J Hepatol 1987; 4:307.
  29. Muñoz SJ, Heubi JE, Balistreri WF, Maddrey WC. Vitamin E deficiency in primary biliary cirrhosis: gastrointestinal malabsorption, frequency and relationship to other lipid-soluble vitamins. Hepatology 1989; 9:525.
  30. Lindor KD, Gershwin ME, Poupon R et al. AASLD Practice Guidelines, Primary Biliary Cirrhosis. Available at: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/PrimaryBillaryCirrhosis7-2009.pdf (Accessed on April 25, 2012).
  31. Kalra V, Grover J, Ahuja GK, et al. Vitamin E deficiency and associated neurological deficits in children with protein-energy malnutrition. J Trop Pediatr 1998; 44:291.
  32. Ben Hamida M, Belal S, Sirugo G, et al. Friedreich's ataxia phenotype not linked to chromosome 9 and associated with selective autosomal recessive vitamin E deficiency in two inbred Tunisian families. Neurology 1993; 43:2179.
  33. Schuelke M, Mayatepek E, Inter M, et al. Treatment of ataxia in isolated vitamin E deficiency caused by alpha-tocopherol transfer protein deficiency. J Pediatr 1999; 134:240.
  34. El Euch-Fayache G, Bouhlal Y, Amouri R, et al. Molecular, clinical and peripheral neuropathy study of Tunisian patients with ataxia with vitamin E deficiency. Brain 2014; 137:402.
  35. Schuelke M. Ataxia with Vitamin E Deficiency. 2005 May 20 [Updated 2013 Jun 27]. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2014. Available from: http://www.ncbi.nlm.nih.gov/books/NBK1241/.
  36. Sokol RJ. Vitamin E deficiency and neurological disorders. In: Vitamin E in Health and Disease, Packer L, Fuchs J (Eds), Marcel Dekker, New York 1993. p.815.
  37. Kumar N. Nutritional neuropathies. Neurol Clin 2007; 25:209.
  38. Robinson MH, Dowling BL, Clark JV, Mason CH. Brown bowel syndrome: an unusual cause of massive dilatation of the colon. Gut 1989; 30:882.
  39. Białas M, Demczuk S, Dyduch G, et al. Brown bowel syndrome (intestinal lipofuscinosis) - a case report and review of the literature. Pol J Pathol 2013; 64:228.
  40. Oski FA, Barness LA. Vitamin E deficiency: a previously unrecognized cause of hemolytic anemia in the premature infant. J Pediatr 1967; 70:211.
  41. Natta C, Machlin L. Plasma levels of tocopherol in sickle cell anemia subjects. Am J Clin Nutr 1979; 32:1359.
  42. Ray D, Deshmukh P, Goswami K, Garg N. Antioxidant vitamin levels in sickle cell disorders. Natl Med J India 2007; 20:11.
  43. Walter PB, Fung EB, Killilea DW, et al. Oxidative stress and inflammation in iron-overloaded patients with beta-thalassaemia or sickle cell disease. Br J Haematol 2006; 135:254.
  44. Rachmilewitz EA, Shifter A, Kahane I. Vitamin E deficiency in beta-thalassemia major: changes in hematological and biochemical parameters after a therapeutic trial with alpha-tocopherol. Am J Clin Nutr 1979; 32:1850.
  45. Jaja SI, Aigbe PE, Gbenebitse S, Temiye EO. Changes in erythrocytes following supplementation with alpha-tocopherol in children suffering from sickle cell anaemia. Niger Postgrad Med J 2005; 12:110.
  46. Hathcock JN. Vitamins and minerals: efficacy and safety. Am J Clin Nutr 1997; 66:427.
  47. Miller ER 3rd, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005; 142:37.
  48. Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2012; :CD007176.
  49. Finer NN, Peters KL, Hayek Z, Merkel CL. Vitamin E and necrotizing enterocolitis. Pediatrics 1984; 73:387.
  50. Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2003; :CD003665.
  51. Bieri JG, Corash L, Hubbard VS. Medical uses of vitamin E. N Engl J Med 1983; 308:1063.
  52. Trevithick JR, Robertson JM, Mitton KP. Vitamin E and the eye. In: Vitamin E in Health and Disease, Packer L, Fuchs J (Eds), Marcel Dekker, New York 1993. p.873.
  53. Tasman W, Patz A, McNamara JA, et al. Retinopathy of prematurity: the life of a lifetime disease. Am J Ophthalmol 2006; 141:167.
  54. Grundman M. Vitamin E and Alzheimer disease: the basis for additional clinical trials. Am J Clin Nutr 2000; 71:630S.
  55. Tabet N, Birks J, Grimley Evans J . Vitamin E for Alzheimer's disease. Cochrane Database Syst Rev 2000; :CD002854.
  56. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol 2001; 119:1439.
  57. Evans JR. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 2006; :CD000254.
  58. Lohr JB, Caligiuri MP. A double-blind placebo-controlled study of vitamin E treatment of tardive dyskinesia. J Clin Psychiatry 1996; 57:167.
  59. Soares KV, McGrath JJ. Vitamin E for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev 2001; :CD000209.
  60. Albahrani AA, Greaves RF. Fat-Soluble Vitamins: Clinical Indications and Current Challenges for Chromatographic Measurement. Clin Biochem Rev 2016; 37:27.