Over 90% of the US population doesn’t get enough of this vitamin, which is essential for immunity, fertility, brain health, and more. Vitamin E deficiency may raise your risk of cancer, heart disease, and dementia. Read on to learn how to recognize the symptoms and boost your vitamin E levels naturally.
What is Vitamin E?
Vitamin E is a broad term for two types of fat-soluble nutrients – tocopherols and tocotrienols – each containing four different classes: alpha, beta, gamma, and delta. The most abundant forms in food are alpha- and gamma-tocopherol [1, 2].
Alpha-tocopherol is the essential form of vitamin E that can meet your dietary needs and prevent deficiency symptoms .
Function and Benefits
The primary function of vitamin E in your body is to combat oxidative stress by blocking the activity of free radicals. Along with vitamin C, it protects fat molecules from oxidation, maintaining the structure and function of each cell [2, 4].
- Heart and brain health
- Skin health
Deficiency in this essential nutrient may thus have detrimental effects on your health. In this article, we’ll cover the main risks and propose natural ways to prevent them.
Vitamin E Blood Test
A blood test is the most common lab method to check vitamin E status. Values above 5 mcg/mL (11.6 μmol/L) of alpha-tocopherol are considered normal, but you may need even higher levels for optimal health [5, 5].
High gamma-tocopherol might also imply alpha-tocopherol deficiency because the blood level of one increases at the expense of the other. However, but both forms have some unique functions and health benefits discussed below [5, 6, 7].
Limitations and Other Tests
Vitamin E is fat-soluble, meaning that lipids must carry it through the bloodstream. High blood lipids (as in older or obese people) increase the amount of vitamin E in the blood but also hinder its transport into other tissues [8, 9, 10].
That’s why blood levels of vitamin E don’t always correlate with its intake and may not provide a clear picture of its status in your body. Experts suggest the ratio of alpha-tocopherol to cholesterol (or total lipids) is a more accurate indicator of vitamin E status [11, 12].
Besides lab testing, a doctor will perform neurological and physical exams to look for signs and symptoms of vitamin E deficiency. We’ll discuss those in more detail later in this post.
Advanced genetic tests can detect mutations that hinder vitamin E metabolism .
Vitamin E Deficiency Symptoms, Causes & Risks
Signs and Symptoms
Typical signs and symptoms of vitamin E deficiency are more common in children; they have limited stores and increased needs because of how quickly they grow and develop .
- Inhibits lipid peroxidation
- Combats photoaging and skin cancer
- Reduces inflammation
- Muscle weakness
- Impaired coordination
- Vision problems
- Slurred speech
- Poor reflexes
Genetic disorders and impaired fat absorption are the leading causes of vitamin E deficiency in developed countries, while most cases in poor regions of the world occur due to inadequate nutrition .
1) Impaired Fat Metabolism
Fats carry vitamin E in the food, enable its absorption, and deliver it to our tissues. Any condition that impairs fat absorption – or the production of lipoproteins that carry vitamin E through the bloodstream – can cause vitamin E deficiency; these include [27, 28, 29, 30]:
- Cystic fibrosis
- Short bowel syndrome
- Celiac disease
- Abetalipoproteinemia (a rare inherited disorder)
- Crohn’s disease
The liver produces bile acids, which enable fats to be absorbed. The following disorders can cause vitamin E deficiency by compromising liver function and bile flow into the intestines [1, 31, 10, 32]:
- Primary biliary cholangitis (destruction of the bile duct)
- Cholestasis (reduced or blocked bile flow)
- Nonalcoholic fatty liver disease
Your liver sends alpha-tocopherol to other tissues using a transport protein called α-TTP. Defects in the TTPA gene (which encodes α-TTP) cause severe vitamin deficiency with blood levels a hundred times lower than normal [1, 33].
Supplementation with high doses of vitamin E from early childhood is essential to prevent permanent nerve damage .
Inadequate food intake or malnutrition is the primary cause of vitamin E deficiency in developing countries. In severely malnourished children, a lack of this nutrient can have detrimental health effects [15, 35].
Besides vitamin E content, diets low in fat, protein, and calories increase the risk of deficiency due to general malnutrition.
This issue is not limited to poor regions: more than 90% of Americans fail to meet daily requirements for vitamin E. They are unlikely to experience typical deficiency symptoms, but low levels make them more prone to various diseases discussed below [10, 36].
Choosing the right food source is also important; people who rely on sweets and baked products as their primary source tend to have lower blood levels of alpha-tocopherol .
Low Intake of Vitamin C
Vitamins C and E work hand in hand to shield your cells against oxidative damage. Vitamin C regenerates the antioxidant form of alpha-tocopherol that can scavenge free radicals .
Obese children and adults usually have high lipids and normal vitamin E in the blood. Lipids bind to vitamin E, lowering the ratio of alpha-tocopherol to cholesterol.
In other words, high cholesterol and lipids keep vitamin E “trapped” in the bloodstream, so obese people can’t use it well. This may point to deficiency, even with vitamin E in the normal range [40, 41, 42].
Healthy people with lower vitamin E intake and blood levels won’t experience typical deficiency symptoms. However, they lack the protective effects of this nutrient and, thus, have a higher risk of various diseases.
1) Impaired Immunity
Vitamin E deficiency impairs T-cell immune response, making you more prone to infectious and chronic diseases. According to studies on older people and lab animals, higher vitamin E intake cuts the risk of bacterial and viral infections [51, 52, 53].
People with low vitamin E lack its powerful immune-boosting and anticancer properties.
According to a meta-analysis of 8 clinical trials, people with higher blood alpha-tocopherol have up to 20% lower risk of cancer .
In a study of over 29,000 male smokers, those with high alpha-tocopherol had a 21% lower chance of dying from cancer .
Women with the lowest levels of alpha-tocopherol have up to a 60% higher risk of cancer .
More precisely, low vitamin E levels may raise the risk of:
- Malignant melanoma (skin cancer) 
- Oral cancer 
- Prostate cancer [61, 62]
- Pancreatic cancer 
- Colorectal cancer [64, 65]
Certain vitamin E-related genetic mutations significantly lower the risk of prostate cancer by increasing blood alpha-tocopherol. These include :
However, vitamin E supplements might increase the risk of prostate cancer .
3) Heart Disease and Stroke
Antioxidants like vitamin E are crucial for a healthy heart and blood vessels. They prevent the oxidation of LDL cholesterol particles and reduce plaque buildup. Additionally, Vitamin E lowers inflammation and strengthens the immune system [68, 69].
In a large meta-analysis, people with the highest blood levels of alpha-tocopherol had an 18% lower risk of dying from a stroke or heart failure. A study on over 29,000 male smokers found a similar correlation between vitamin E supplements and heart disease [70, 57].
Among patients with an irregular heartbeat, those with a low ratio of alpha-tocopherol to cholesterol (less than 4.2 micromol/mmol of cholesterol) had an 87% higher risk of heart attack or stroke .
In one Japanese trial, high alpha-tocopherol lowered the risk of fatal stroke by 65% in women, but not in men .
However, a meta-analysis of 15 trials failed to confirm the above benefits of high vitamin E levels .
4) Reduced Fertility
Scientists discovered vitamin E almost 100 years ago and quickly identified it as an essential food component for reproductive health in animals. Recent findings have confirmed its vital role in human fertility and reproduction [1, 73].
In over 1,600 pregnant women from a poor region in Bangladesh, alpha-tocopherol below 12 μmol/L in the 1st trimester increased the risk of miscarriage by 83% .
In 40 infertile men, a supplement with alpha-tocopherol enhanced sperm density by 80%, which resulted in 18 successful pregnancies. Besides vitamin E, the supplement contained L-carnitine, coenzyme Q10 (ubiquinol), and vitamin C .
5) Stunted Growth and Birth Complications
Besides conception and early pregnancy, vitamin E is essential for fetal development, childbirth, and an infant’s growth.
A study on 900 infants emphasized vitamin E deficiency as one of the risk factors for low birth weight. Mothers of vitamin E deficient infants were more likely to have high blood pressure and diabetes during pregnancy .
6) Cognitive Impairment
Vitamin E supports nervous system function and development, and brain cells are especially vulnerable to deficiency .
7) Weakened Bones
According to a study of over 61,000 older women, lower intake of alpha-tocopherol (less than 4.5 mg/day) raises the risk of hip fractures by up to 86%. In over 1,000 older men, lower intake increased the risk of hip fractures more than 3 times .
In over 2,500 older subjects, those with the lowest alpha-tocopherol (0.5–22.6 μmol/L) had up to 51% higher risk of hip fractures. Women with higher levels of blood vitamin E also tend to recover faster [89, 90].
However, a trial with over 11,000 older women found no connection between dietary intake or blood levels of vitamin E and bone mineral density .
8) Vision Problems
Your eye cells contain exceptionally high amounts of unsaturated fatty acids, which are vulnerable to oxidation. Vitamin E supports your vision by preventing oxidative damage in the eyes .
How to Increase Vitamin E Naturally
The recommended daily intake of vitamin E for adults is 15 mg (22.4 IU). Pregnant women need the same amount, while nursing women need more. The recommended intake during breastfeeding is 19 mg (28.4 IU) per day .
Increased intake and higher blood levels offer certain health benefits, but, as we’ll discuss shortly, more is not always better when it comes to vitamin E.
- Wheat germ oil
- Sunflower seeds and oil
- Nuts (almonds and hazelnuts)
Other vegetable oils (e.g., corn and canola) are high in vitamin E, but you may want to focus on whole foods, as they contain many other healthy nutrients that will help you balance your diet.
People who eat a lot of sweets, bread, meat, and potatoes tend to have lower alpha-tocopherol levels; it might be a good idea to limit the intake of these foods in favor of green vegetables and nuts .
Another way to boost your vitamin E levels is to partly replace saturated fats (such as dairy and animal fats) with polyunsaturated fats from vegetable oils, nuts, and seeds.
Polyunsaturated fatty acids (PUFAs) will also reduce your cholesterol, leading to a higher tocopherol:cholesterol ratio .
- Citrus fruits
- Red pepper
Who should take them?
Severe vitamin E deficiency – due to genetic defects or chronic diseases – requires lifelong supplementation with high doses of vitamin E to prevent nerve damage and other complications [14, 10, 109].
According to a study on smokers, vitamin C supplements (1000 mg daily for 2 weeks) can help retain vitamin E in the bloodstream 25-45% longer .
Vitamin E supplements may also be an option for those who struggle to maintain adequate intake or have increased needs. However, they come with certain health risks.
Toxicity and Side Effects
You can’t overdose on vitamin E from food sources, but high-dose supplements are a potential threat. The safe upper limit is 1000 mg daily, which is equivalent to 1100 IU of synthetic or 1500 IU of natural alpha-tocopherol .
- Mood swings
People on blood thinners should avoid vitamin E supplements as high levels may increase the risk of bleeding .
- Prostate and breast cancer
According to a large meta-analysis of 19 clinical trials (over 136,000 participants), daily doses above 400 IU may even increase the risk of death. However, many studies only included people with chronic diseases, which likely influenced the results .
An additional review, which included even more data, confirmed the impact of other diseases and sex difference, with a higher risk for men. High doses of vitamin E are therefore not recommended unless prescribed by a doctor .
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Vitamin E (alpha-tocopherol) is essential for nerve development, fertility, skin health, and immunity. Low vitamin E levels may reduce fertility and cause muscle, nerve, and skin damage.
An inadequate diet can cause a mild deficiency, which raises the risk of heart disease, cancer, dementia, and depression. Severe deficiency occurs due to genetic disorders or diseases that impair fat metabolism.
To boost vitamin E naturally, eat a variety of nuts, seeds, green vegetables, and other whole foods. You should also refrain from smoking, shed extra pounds, and get enough vitamin C. To prevent unwanted side effects, consult with your doctor before taking vitamin E supplements.