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Vitamin E
Overview

Vitamin E is the collective family name for eight fat soluble compounds that together have many health benefits. The complete Vitamin E family is composed of- 4 forms of Tocopherols (alpha, beta, gamma and delta) and 4 forms of Tocotrienols (alpha, beta, gamma & delta). Each of the 8 forms of vitamin E has its own biological activity and function in the body. Because each form provides slightly different benefits it is therefore important to ideally consume all 8 types of vitamin E. The vast majority of Vitamin E supplement only contain one form of Vitamin E, mostly synthetic dl-alpha tocopherol, or the more preferred natural version d-alpha tocopherol. In order to get the full benefits of vitamin E; especially the benefits to the heart, it is important to get the best full spectrum Vitamin E supplement you can find.

The most important function of vitamin E is to maintain the integrity of the body's intracellular membrane by protecting its physical stability and providing a defense line against tissue damage caused by oxidation. Vitamin E is protective because it helps reduce oxidation of lipid membranes and the unsaturated fatty acids and prevents the breakdown of other nutrients by oxygen. Vitamin E is an antioxidant that prevents free radical damage in biological membranes. Free radicals can cause cell damage that may contribute to the development of cardiovascular disease and cancer. Vitamin E has an effect on several enzyme activities and membrane properties. It is involved in the regulation of vascular smooth muscle cell proliferation and protein kinase C activity. Vitamin E as an antioxidant helps to stabilize cell membranes and protect the tissues of the skin, eyes, liver, breast, and testes, which are more sensitive to oxidation. When applied to the skin, vitamin E-containing creams or oils are believed to promote healing, protecting cells from free-radical damage and reducing itchiness. Many people use such products to ensure optimal skin health. The protective, nutritional antioxidant function of vitamin E is also performed and enhanced by other antioxidants, such as vitamin C, beta-carotene, glutathione (L-cysteine), and the mineral selenium.

What is Vitamin E?

vit
The α-tocopherol form of vitamin E.
 

Vitamin E is a generic term for tocopherols and tocotrienols. Vitamin E is a family of α-, β-, γ-, and δ- (respectively: alpha, beta, gamma, and delta) tocopherols and corresponding four tocotrienols. Vitamin E is a fat-soluble antioxidant that stops the production of reactive oxygen species formed when fat undergoes oxidation. Of these, α-tocopherol (also written as alpha-tocopherol) has been most studied as it has the highest bioavailability.

Where is it Found?
Numerous foods provide vitamin E. Nuts, seeds, and vegetable oils are among the best sources of alpha-tocopherol, and significant amounts are available in green leafy vegetables and fortified cereals (see Table for a more detailed list). Most vitamin E in American diets is in the form of gamma-tocopherol from soybean, canola, corn, and other vegetable oils and food products.

Selected Food Sources of Vitamin E (Alpha-Tocopherol)

 

Food

Milligrams (mg) per serving

Percent DV*

Wheat germ oil, 1 tablespoon

20.3

100

Almonds, dry roasted, 1 ounce

7.4

40

Sunflower seeds, dry roasted, 1 ounce

6.0

30

Sunflower oil, 1 tablespoon

5.6

28

Safflower oil, 1 tablespoon

4.6

25

Hazelnuts, dry roasted, 1 ounce

4.3

22

Peanut butter, 2 tablespoons

2.9

15

Peanuts, dry roasted, 1 ounce

2.2

11

Corn oil, 1 tablespoon

1.9

10

Spinach, boiled, ½ cup

1.9

10

Broccoli, chopped, boiled, ½ cup

1.2

6

Soybean oil, 1 tablespoon

1.1

6

Kiwi, 1 medium

1.1

6

Mango, sliced, ½ cup

0.9

5

Tomato, raw, 1 medium

0.8

4

Spinach, raw, 1 cup

0.6

4

 

DV = Daily Value. The DV for vitamin E is 30 IU (approximately 20 mg of natural alpha-tocopherol) for adults and children age 4 and older.

Supplements of vitamin E typically provide only alpha-tocopherol, although "mixed" products containing other tocopherols and even tocotrienols are available. Naturally occurring alpha-tocopherol exists in one stereoisomeric form. In contrast, synthetically produced alpha-tocopherol contains equal amounts of its eight possible stereoisomers; serum and tissues maintain only four of these stereoisomers. Alpha-tocopherol in dietary supplements and fortified foods is often esterified to prolong its shelf life while protecting its antioxidant properties. The body hydrolyzes and absorbs these esters (alpha-tocopheryl acetate and succinate) as efficiently as alpha-tocopherol.

 
See Vitamin E related videos:
video icon Dr. Kumar: Benefits of Vitamin E (video module – 5.08 minutes)   
Product related PDF file
Alpha Gamma Tocopherols

Benefits / Uses


arw Maintains cell membrane integrity and helps reduce cellular aging


arw Vitamin E is necessary for the structural and functional maintenance of skeletal, cardiac, and musculature system.


arw Assists in the formation of red blood cells


arw Helps to maintain stores of iron, selenium and vitamin's A and K


arw Can help delay cognitive decline


arw Potent anti oxidant, free radical scavenger of lipids.


arw Helps protect against the oxidative damage that can lead to heart disease.


arw Has preventative effects against cancer; especially prostate cancer.


arw Can help reduce or delay the development of cataracts, and has been shown to increase lens clarity compared to other antioxidants.


arw Improve the metabolism and Immune system, it helps the function of DNA repair and in improves the bodies metabolism processes


arw Vitamin E prevents cholesterol from being converted to plaque. Vitamin E plays a major role in reducing inflammation in the body.


arw Skin and lip protection are also well known benefits of vitamin E. It also helps retain moisture in the skin and prevents dryness, itching, and chapping; as well as speeding up wound healing and protecting against UV radiation.
 

Vitamin E and heart disease - Vitamin E helps protect against heart disease by limiting the oxidation of LDL-cholesterol. Vitamin E helps prevent oxidation of lipoproteins, particularly in smokers, and reduces the stickiness of platelets in the bloodstream. Vitamin E also keeps arteries flexible and elastic, allowing blood to flow freely. Vitamin E helps prevent arteries from clogging by blocking the conversion of cholesterol into the waxy fat deposits called plaque that stick to blood vessel walls. Vitamin E also thins the blood, allowing for blood to flow more easily through arteries even when plaque is present. Vitamin E also may help prevent the formation of blood clots, which could lead to a heart attack. Vitamin C and vitamin E, taken in combination, help to stabilise LDL cholesterol in the body. This may help to reduce the risk of atherosclerosis.

Vitamin E and cancer - Some cancers are believed to result from oxidative damage to DNA caused by free radicals. Free radicals can damage DNA, leading to mutations in cells that may cause cancer. Antioxidants such as vitamin E help protect against the damaging effects of free radicals. The vitamin may also help fight cancer by boosting the immune system. Vitamin E may protect against the development of cancers by enhancing immune function. Some evidence associates higher intake of vitamin E with a decreased incidence of prostate cancer and breast cancer. Cigarette smokers have a higher risk of developing cancers of the mouth, upper airways and lungs, and vitamin E may help protect smokers against these cancers through its antioxidant properties.

Vitamin E and cataracts - Because of its antioxidant action, vitamin E may help to protect against cataracts and age related macular degeneration. Cataracts are growths on the lens of the eye that cloud vision. They increase the risk of disability and blindness in aging adults. Lens clarity, which is used to diagnose cataracts, is better in regular users of vitamin E supplements and in persons with higher blood levels of vitamin E. Uveitis is another eye disorder for which the antioxidant vitamins C and E may be helpful. Uveitis is inflammation of the uvea, the middle layer of the eye between the sclera and the retina.

Vitamin E and Alzheimer's disease - Alzheimer's disease is a wasting disease of the brain. Oxidative stress is believed to contribute to the development of Alzheimer's disease. Vitamin E is an antioxidant that prevents free radical damage in biological membranes. Vitamin E supplementation improves cognitive performance in healthy individuals and in those with dementia from causes other than Alzheimer's disease. In addition, vitamin E, together with vitamin C may prevent the development of Alzheimer's disease.

When To Take / Type to takeDosage
Vitamin E dosing can be extremely confusing, since there are different ways to measure vitamin E content. Although current recommendations use milligrams (mg), most supplements still use international units (IU). Converting between mg and IU is not straightforward, since natural vitamin E (RRR-alpha-tocopherol, historically known as d-alpha-tocopherol) is more active than synthetic vitamin E (all-rac-alpha-tocopherol, historically known as dl-alpha-tocopherol). The synthetic form contains several different "isomers," some of which do not contribute to the daily requirement of vitamin E. As a result, it takes more dl-alpha-tocopherol than d-alpha-tocopherol (in terms of IU) to meet the daily requirements.

The Institute of Medicine (IOM) has established an RDA (recommended dietary allowance) for vitamin E (given in mg of alpha-tocopherol, a measure that takes into account only certain forms of alpha-tocopherol). Refer to the following table for RDA values for vitamin E doses, along with the conversions for IU for different forms of vitamin E:

Vitamin E supplements are best taken with a meal. Research has shown a combination of alpha-, beta-, and delta tocopherol together (aka, “mixed tocopherols”) is more effective than alpha-tocopherol alone. For eg. In one study a mixture of these tocopherols was shown to have a stronger effect at inhibiting free radical damage to human blood cells than alpha-tocopherol alone. In another study, the combination of tocopherols were shown to have a synergistic (I,e enhancing) effect in inhibiting platelet aggregation, or the clumping together of blood cells, above and beyond the effect of the individual tocopherols. The prevention of platelet clumping is important since such clumping can be a contributory factor toward certain types of cardiovascular disease.

To stabilize Vitamin E for inclusion in some supplements, it is combined with (chelated to ) either of two organic acids, acetic acid or succinic acid, to create d-alpha tocopheryl acetate or d-alpha tocopheryl succinate. The “O” in tocopherol is then changed to a “y” to designate that it has been chelated with an organic acid.

 

 Age

RDA (in mg of alpha-tocopherol)

Equivalent in IU (for d-alpha-tocopherol)

Equivalent in IU (for dl-alpha-tocopherol)

1 to 3 years

6 mg per day

9 IU

13.3 IU

4 to 8 years

7 mg per day

10.5 IU

15.6 IU

9 to 13 years

11 mg per day

16.5 IU

24.4 IU

14 years and older

15 mg per day

22.5 IU

33.3 IU

Pregnant women

15 mg per day

22.5 IU

33.3 IU

Breastfeeding women

19 mg per day

28.5 IU

42.2 IU

 
For nutrients that can cause toxicity, a "tolerable upper intake level" (UL) is given. This is the maximum dose that can be taken without causing significant toxicity. Refer to the following table for UL values for vitamin E dosages:
 

Age

UL in (in mg of alpha-tocopherol)

Equivalent in IU (for d-alpha-tocopherol)

Equivalent in IU (for dl-alpha-tocopherol)

1 to 3 years

200 mg per day

300 IU per day

220 IU per day

4 to 8 years

300 mg per day

450 IU per day

330 IU per day

9 to 13 years

600 mg per day

900 IU per day

660 IU per day

14 to 18 years

800 mg per day

1200 IU per day

880 IU per day

19 years and older

1000 mg per day

1500 IU per day

1100 IU per day

 

Possible Side-Effects / Precautions / Possible Interactions
High doses have also been reported to cause (or may theoretically cause) the following vitamin E side-effects such as:
Nausea
Diarrhea
Intestinal cramping
Fatigue and weakness
Headaches
Blurred vision
Any unusual bruising or bleeding (vitamin E can increase the risk of bleeding)

Signs of gastrointestinal bleeding, such as black, tarry stools, bright-red blood in the stool, and vomiting of blood. Some people may experience irritation or allergic reactions when vitamin E is applied to the skin.

Interactions with Medications
People taking these and other medications on a regular basis should discuss their vitamin E intakes with their healthcare providers.

Anticoagulant and antiplatelet medications
Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. As a result, taking large doses with anticoagulant or antiplatelet medications, such as warfarin (Coumadin®), can increase the risk of bleeding, especially in conjunction with low vitamin K intake. The amounts of supplemental vitamin E needed to produce clinically significant effects are unknown but probably exceed 400 IU/day [56].

Simvastatin and niacin
Some people take vitamin E supplements with other antioxidants, such as vitamin C, selenium, and beta-carotene. This collection of antioxidant ingredients blunted the rise in high-density lipoprotein (HDL) cholesterol levels, especially levels of HDL2, the most cardioprotective HDL component, among people treated with a combination of simvastatin (brand name Zocor®) and niacin [57,58].

Chemotherapy and radiotherapy
Oncologists generally advise against the use of antioxidant supplements during cancer chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by inhibiting cellular oxidative damage in cancerous cells [59,60]. Although a systematic review of randomized controlled trials has called this concern into question [61], further research is needed to evaluate the potential risks and benefits of concurrent antioxidant supplementation with conventional therapies for cancer.

Research Studies / References



arw Traber MG. Vitamin E. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins R, eds. Modern Nutrition in Health and Disease. 10th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2006;396-411.


arw Traber MG. Vitamin E regulatory mechanisms. Annu Rev Nutr 2007;27:347-62. [PubMed abstract]


arw Sen CK, Khanna S, Roy S. Tocotrienols: vitamin E beyond tocopherols. Life Sci 2006;78:2088-98. [PubMed abstract]


arw Dietrich M, Traber MG, Jacques PF, Cross CE, Hu Y, Block G. Does ã-tocopherol play a role in the primary prevention of heart disease and cancer? A review. Am J Coll Nutr 2006;25:292-9. [PubMed abstract]


arw Verhagen H, Buijsse B, Jansen E, Bueno-de-Mesquita B. The state of antioxidant affairs. Nutr Today 2006;41:244-50.


arw Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press, 2000.


arw U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 16-1, 2004. http://www.ars.usda.gov/ba/bhnrc/ndl


arw Ford ES, Ajani UA, Mokdad AH. Brief communication: the prevalence of high intake of vitamin E from the use of supplements among U.S. adults. Ann Intern Med 2005;143:116-20. [PubMed abstract]


arw Gao X, Wilde PE, Lichtenstein AH, Bermudez OI, Tucker KL. The maximal amount of dietary á-tocopherol intake in U.S. adults (NHANES 2001-2002). J Nutr 2006;136:1021-6. [PubMed abstract]


arw Interagency Board for Nutrition Monitoring and Related Research. Third Report on Nutrition Monitoring in the United States. Washington, DC: U.S. Government Printing Office, 1995.


arw Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev;4:CD003665. [PubMed abstract]


arw Kowdley KV, Mason JB, Meydani SN, Cornwall S, Grand RJ. Vitamin E deficiency and impaired cellular immunity related to intestinal fat malabsorption. Gastroenterology 1992;102:2139-42. [PubMed abstract]


arw Tanyel MC, Mancano LD. Neurologic findings in vitamin E deficiency. Am Fam Physician 1997;55:197-201. [PubMed abstract]


arw Cavalier L, Ouahchi K, Kayden H, Donato S, Reutenaucer L, Mandel JL, et al. Ataxia with isolated vitamin E deficiency: heterogeneity of mutations and phenotypic variability in a large number of families. Am J Hum Genet 1998;62:301-10. [PubMed abstract]


arw Glynn RJ, Ridker PM, Goldhaber SZ, Zee RY, Buring JE. Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism: report from the Women's Health Study. Circulation 2007;116:1497-1503. [PubMed abstract]


arw Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993;328:1444-9. [PubMed abstract]


arw Knekt P, Reunanen A, Jarvinen R, Seppanen R, Heliovaara M, Aromaa A. Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 1994;139:1180-9. [PubMed abstract]


arw Traber MG. Heart disease and single-vitamin supplementation. Am J Clin Nutr 2007;85:293S-9S. [PubMed abstract]


arw Jialal I, Devaraj S. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med 2000;342:154-60. [PubMed abstract]


arw Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, et al.; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 2005;293:1338-47. [PubMed abstract]


arw Brown BG, Crowley J. Is there any hope for vitamin E? JAMA 2005;293:1387-90. [PubMed abstract]


arw Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. J Am Med Assoc 2002;288:2432-40. [PubMed abstract]


arw Lee I-M, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA 2005;294:56-65. [PubMed abstract]


arw Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA 2008;300:2123-33. [PubMed abstract]


arw Blumberg JB, Frei B. Why clinical trials of vitamin E and cardiovascular diseases may be fatally flawed. Commentary on "The relationship between dose of vitamin E and suppression of oxidative stress in humans." Free Radic Biol Med 2007;43:1374-6. [PubMed abstract]


arw Weitberg AB, Corvese D. Effect of vitamin E and beta-carotene on DNA strand breakage induced by tobacco-specific nitrosamines and stimulated human phagocytes. J Exp Clin Cancer Res 1997;16:11-4. [PubMed abstract]


arw Chan JM, Stampfer MJ, Giovannucci EL. What causes prostate cancer? A brief summary of the epidemiology. Semin Cancer Biol 1998;8:263-73. [PubMed abstract]


arw Graham S, Sielezny M, Marshall J, Priore R, Freudenheim J, Brasure J, et al. Diet in the epidemiology of postmenopausal breast cancer in the New York State Cohort. Am J Epidemiol 1992;136:3127-37. [PubMed abstract]


arw Kirsh VA, Hayes RB, Mayne ST, Chatterjee N, Subar AF, Dixon LB, et al. Supplemental and dietary vitamin E, â-carotene, and vitamin C intakes and prostate cancer risk. J Natl Cancer Inst 2006;98:245-54. [PubMed abstract]


arw National Cancer Institute. Questions and Answers: Selenium and Vitamin E Cancer Prevention Trial (SELECT). http://www.cancer.gov/newscenter/pressreleases/SELECTQandA


arw Bostick RM, Potter JD, McKenzie DR, Sellers TA, Kushi LH, Steinmetz KA, et al. Reduced risk of colon cancer with high intakes of vitamin E: the Iowa Women's Health Study. Cancer Res 1993;15:4230-17. [PubMed abstract]


arw Wu K, Willett WC, Chan JM, Fuchs CS, Colditz GA, Rimm EB, et al. A prospective study on supplemental vitamin E intake and risk of colon cancer in women and men. Cancer Epidemiol Biomarkers Prev 2002;11:1298-304. [PubMed abstract]


arw Jacobs EJ, Henion AK, Briggs PJ, Connell CJ, McCullough ML, Jonas CR, et al. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. Am J Epidemiol 2002;156:1002-10. [PubMed abstract]


arw Chong EW-T, Wong TY, Kreis AJ, Simpson JA, Guymer RH. Dietary antioxidants and primary prevention of age-related macular degeneration: systematic review and meta-analysis. BMJ 2007;335:755. [PubMed abstract]


arw Evans J. Primary prevention of age related macular degeneration. BMJ 2007;335:729. [PubMed abstract]




arw Taylor HR, Tikellis G, Robman LD, McCarty CA, McNeil JJ. Vitamin E supplementation and macular degeneration: randomized controlled trial. BMJ 2002;325:11. [PubMed abstract]


arw Teikari JM, Virtamo J, Rautalahti M, Palmgren J, Liesto K, Heinonen OP. Long-term supplementation with alpha-tocopherol and beta-carotene and age-related cataract. Acta Ophthalmol Scand 1997;75:634-40. [PubMed abstract]


arw Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol 2001;119:1417-36. [PubMed abstract]


arw Leske MC, Chylack LT Jr, He Q, Wu SY, Schoenfeld E, Friend J, et al. Antioxidant vitamins and nuclear opacities: the longitudinal study of cataract. Ophthalmology 1998;105:831-6. [PubMed abstract]


arw Jacques PF, Taylor A, Moeller S, Hankinson SE, Rogers G, Tung W, et al. Long-term nutrient intake and 5-year change in nuclear lens opacities. Arch Ophthalmol 2005;123:517-26. [PubMed abstract]


arw 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 Opthalmol 2001;119:1439-52. [PubMed abstract]


arw Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzehimer’s disease. N Engl J Med 1997;336:1216-22. [PubMed abstract]


arw Morris MC, Evand DA, Bienias JL, Tangney CC, Wilson RS. Vitamin E and cognitive decline in older persons. Arch Neurol 2002;59:1125-32. [PubMed abstract]


arw Kang JH, Cook N, Manson J, Buring J, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med 2006;166:2462-8. [PubMed abstract]


arw Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005;352:2379-88. [PubMed abstract]


arw Espeland MA. Preventing cognitive decline in usual aging. Arch Intern Med 2006;166:2433-4. [PubMed abstract]


arw Isaac MGEKN, Quinn R, Tabet N. Vitamin E for Alzheimer's disease and mild cognitive impairment (review). Cochrane Database Syst Rev 2008;(3):CD002854. [PubMed abstract]


arw Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994;330:1029-35. [PubMed abstract]


arw Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142:37-46. [PubMed abstract]


arw Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842-57. [PubMed abstract]


arw Comments and responses: high dosage vitamin E supplementation and all-cause mortality. Ann Intern Med 2005;143:150-7.


arw Greenberg ER. Vitamin E supplements: good in theory, but is the theory good? Ann Intern Med 2005;142:75-6. [PubMed abstract]


arw Hathcock JN, Azzi A, Blumberg J, Bray T, Dickinson A, Frei B, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr 2005;81:367-45. [PubMed abstract]


arw Various authors. Letters: antioxidant supplements and mortality. JAMA 2007;298:400-3.


arw Huang HY, Caballero B, Chang S, Alberg A, Semba R, Schneyer C, et al. Multivitamin/Mineral Supplements and Prevention of Chronic Disease. Evidence Report/Technology Assessment No. 139. (Prepared by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018). AHRQ Publication No. 06-E012. Rockville, MD: Agency for Healthcare Research and Quality. May 2008.


arw Natural Medicines Comprehensive Database. Vitamin E. http://www.NaturalDatabase.com


arw Brown BG, Zhao X-Q, Chait A, Fisher LD, Cheung MC, Morse JS, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-92. [PubMed abstract]


arw Cheung MC, Zhao X-Q, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol 2001;21:1320-6. [PubMed abstract]


arw Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, et al., for the 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 2006;56:323-53. [PubMed abstract]


arw Lawenda BD, Kelly KM, Ladas EJ, Sagar SM, Vickers A, Blumberg JB. Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? J Natl Cancer Inst 2008;100:773-83. [PubMed abstract]


arw Block KI, Koch AC, Mead MN, Tothy PK, Newman RA, Gyllenhaal C. Impact of antioxidant supplementation on chemotherapeutic efficacy: a systematic review of the evidence from randomized controlled trials. Cancer Treat Rev 2007;33:407-18. [PubMed abstract]