Dr C P Ravikumar

Introduction:
Vitamin E is fat soluble nutrient and is utilized by the body for protection against free radicals, which are harmful by products formed when our bodies convert food into energy. Free radicals are also found in our surroundings, in cigarette smoke, ultraviolet light, smoke and air pollution and can damage our bodies through increased exposure.  Vitamin E is also called an antioxidant and helps to boost the body’s immunity so that it can fight off infections.

Required Daily amount:

Life Stage Recommended Amount
Birth to 6 months 4 mg
Infants  7–12 months 5 mg
Children 1–3 years 6 mg
Children 4–8 years 7 mg
Children 9–13 years 11 mg
Teens 14–18 years 15 mg
Adults 15 mg
Pregnant teens and women 15 mg
Breastfeeding teens and women 19 mg

Sources
a. Natural: Vitamin E is found in food sources like:
  • Vegetable oils: sunflower oils, soya bean oil, peanut oil
  • Green vegetables like spinach and broccoli
  • Nuts and seeds like almonds, sunflower seeds
b. Supplements: Vitamin E may be present as part of a multi-vitamin supplement or separately as pure vitamin E supplements, capsules or drops. There are 8 different types of vitamin E compounds that is found in food and in supplements, the most common being- alpha tocopherol. Other forms of vitamin E present in the body are gamma tocopherol, tocotrienols and mixed tocopherols. Some foods like cooking oils may be fortified with vitamin E. it is also found in many skin care products, for its ability to improve regeneration and skin healing.

Health Benefits of Vitamin E
As an antioxidant, vitamin E helps to protect body cells from damage due to free radicals and therefore some studies have shown benefits of vitamin E in preventing heart disease due to its ability to prevent platelet adhesion or clot formation, although more research is required.

Deficiency of Vitamin E
  • Nutritional defect due to decreased intake or decreased assimilation
. Vitamin E is a fat soluble and therefore fat stored vitamin. Deficiency arises when there is a decreased digestion, absorption or retention of fat molecules in the body, for example in Crohn’s disease or cystic fibrosis, or due to a nutritionally deficit diet.
  • Genetic factors
Rare diseases like abetalipoproteinemia, also cause decreased fat absorption, and therefore decrease in fat soluble vitamins like vitamin E. Premature babies may have deficiency of vitamin E which may affect their vision, by causing pigmented retinopathy and visual field constriction.

Vitamin E deficiency:
1. Deficiency of vitamin E reduces the body’s immunity and may lead to increased infections
2. In the nervous system it may present as
  • peripheral neuropathy : pain or tingling numbness or sensation loss at the extremities
  • ataxia : lack of co-ordination or balance
  • skeletal myopathy : atrophy (wasting) and weakness of muscles
  • retinopathy in the eye,  affecting vision
  • cardiac arrythmias
  • premature aging of skin

Excessive Intake of Vitamin E:  
Increased intake of vitamin E may interfere with clotting mechanism in the blood and so would lead to an increased bleeding tendency in some individuals.

Interactions with other medications
  • Vitamin E can interact with anti-coagulant drugs or anti-platelet medications like warfarin, and may hamper the blood’s clotting ability in people who are taking these medications
  • If  vitamin E  is taken with statins or niacin, which are taken by people with high cholesterol, the interaction could reduce niacin’s effect.
  • Taking vitamin E with vitamin K is found to decrease  the effects of vitamin K.
  • It has also been known to decrease the efficacy of chemotherapy or radiotherapy treatments if taken during this period.

Diagnosis
Diagnosis is usually made with the finding of a  low alpha-tocopherol level or low ratio serum alpha-tocopherol to serum lipids measurement. A child with  abetalipoproteinemia will have undetectable serum alpha-tocopherol levels.

Management
Oral supplements of vitamin E have been found effective to treat deficiency states although steps should be taken to treat the underlying cause of the deficiency like malabsorption syndromes

Disclaimer:
The above information is for awareness and education purposes only and cannot be used for diagnosis or treatment of any condition. Please consult with a physician for any concerns or questions


Dr C P Ravikumar

Dr C P Ravikumar

CONSULTANT – PEDIATRIC NEUROLOGY
Aster CMI Hospital, Bangalore