Vitamin
    Moderate Evidence

    Vitamin E

    Alpha-tocopherol

    TL;DR

    Vitamin E is a family of eight fat-soluble antioxidants; alpha-tocopherol is the form humans retain. Deficiency is rare, and high-dose supplements have not delivered the cardiovascular or cancer benefits once hoped for. The clearest modern use is 800 IU/day in biopsy-confirmed NASH.

    Ideal For

    • People with fat malabsorption or cholestatic liver disease
    • Adults with biopsy-confirmed NASH, under hepatology care
    • Those on very low-fat diets with minimal nuts, seeds and oils

    Avoid If

    • You take warfarin or other anticoagulants without monitoring
    • You are scheduled for surgery within two weeks
    • You have a history of haemorrhagic stroke
    • You are taking high doses purely for cancer or heart disease prevention

    Frequently Asked Questions

    Overview

    Vitamin E is not a single compound. It is a family of four tocopherols and four tocotrienols, and the liver preferentially retains alpha-tocopherol via the alpha-tocopherol transfer protein, which is why that form dominates supplements and blood levels. Its principal job is to terminate lipid peroxidation chains in cell membranes and lipoproteins, where it works alongside vitamin C and glutathione that regenerate it after it has quenched a radical.

    Frank deficiency is essentially confined to fat malabsorption states — cystic fibrosis, cholestatic liver disease, abetalipoproteinaemia — where it causes a peripheral neuropathy and ataxia. In the general population intake from nuts, seeds and vegetable oils is adequate, and the large prevention trials tell a sobering story: high-dose alpha-tocopherol did not reduce cardiovascular events in HOPE or the Physicians Health Study II, and in SELECT it modestly increased prostate cancer incidence. A meta-analysis also raised a signal for all-cause mortality above 400 IU/day.

    Where it still earns a place is non-alcoholic steatohepatitis. In the PIVENS trial, 800 IU/day of natural alpha-tocopherol improved steatosis, inflammation and histological resolution in non-diabetic adults with biopsy-confirmed NASH, and that indication survives in hepatology guidelines. Topical and dietary vitamin E also contribute to photoprotection and skin barrier lipids, though supplementation for cosmetic purposes is weakly supported.

    How It Works

    • Chain-breaking antioxidant that halts lipid peroxidation in membranes and LDL particles
    • Regenerated by vitamin C and glutathione after quenching a peroxyl radical
    • Retained selectively as alpha-tocopherol by hepatic alpha-tocopherol transfer protein
    • Inhibits protein kinase C signalling in smooth muscle and platelets
    • Reduces hepatocyte oxidative stress and apoptosis in steatohepatitis
    • Supports T-cell membrane integrity and immune signalling in older adults

    Quick Facts

    • Powerful antioxidant
    • Protects cell membranes
    • Supports immune function
    • May benefit skin health

    Benefits & Outcomes

    Oxidative Damage Repair

    Longevity
    Not supported
    Strong Evidence

    High-dose vitamin E supplementation does not reduce disease risk and has been associated with increased mortality and prostate cancer risk.

    Skin Hydration

    Beauty
    Insufficient evidence
    Limited

    Vitamin E supports barrier lipids topically; oral supplementation adds little.

    Reduced Oxidative Stress

    Mood
    Not supported
    Strong Evidence

    High-dose vitamin E is the clearest example of antioxidant supplementation causing net harm.

    Telomere Protection

    Longevity
    Not supported
    Moderate Evidence

    Vitamin E supplementation shows no telomere benefit and carries mortality concerns at high doses.

    UV Protection

    Beauty
    Insufficient evidence
    Limited

    Vitamin E contributes little alone and only modestly when combined with vitamin C.

    Platelet Aggregation Reduction

    Cardiovascular
    Not supported
    Moderate Evidence

    High-dose vitamin E reduces platelet function but increases haemorrhagic stroke risk without cardiovascular benefit.

    Antioxidant Protection

    Longevity
    Mixed evidence
    Moderate Evidence

    Vitamin E is a genuine lipid-phase antioxidant in vitro, but supplementation has repeatedly failed to translate to health benefit.

    Skin Health Enhancement

    Beauty
    Insufficient evidence
    Moderate Evidence

    Oral vitamin E for skin appearance or scar healing is not supported by trial evidence.

    Immune Function

    Immune
    Insufficient evidence
    Moderate Evidence

    Some older-adult studies show improved immune markers with vitamin E, but clinical infection outcomes are unconvincing.

    Heart Health Support

    Cardiovascular
    Not supported
    Moderate Evidence

    Large randomised trials consistently show no cardiovascular benefit from vitamin E supplementation.

    Supporting Research
    46 studies

    Effect of Selenium and Vitamin E on Risk of Prostate Cancer and Other Cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT)

    Score: 10/10
    2009
    rct
    n=35533

    Lippman SM, Klein EA, Goodman PJ +30 more

    Selenium 200 mcg/day did not prevent prostate cancer, and a non-significant increase in type 2 diabetes risk was observed in the selenium arm.

    View source

    Anticoagulant activity of select dietary supplements

    Score: 7/10
    2012
    systematic_review

    Stanger MJ, Thompson LA, Young AJ

    Fish oil, garlic, ginkgo, ginger, vitamin E and others show antiplatelet activity and can potentiate bleeding risk with anticoagulants.

    View source

    Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement

    Score: 9/10
    2022
    systematic_review

    US Preventive Services Task Force

    The evidence is insufficient to recommend multivitamins for preventing cardiovascular disease or cancer, and beta-carotene and vitamin E are recommended against.

    View source

    Nutritional supplements and cognition in healthy aging and mild cognitive impairment patients: a systematic review and network meta-analysis

    Score: 8/10
    2026
    systematic_review

    Liu X

    Network meta-analysis of nutritional supplement trials in healthy older adults and people with mild cognitive impairment found omega-3 fatty acids and B-vitamin combinations ranked highest for global cognition and memory outcomes, while most single-nutrient interventions including vitamin E and standalone vitamin D showed no significant benefit versus placebo; effect sizes were small overall.

    View source

    Vitamin E and cardiovascular disease prevention

    Score: 6/10
    2004

    Rimm, E.B., Stampfer, M.J.

    Large observational cohorts reported lower coronary heart disease rates among people with high vitamin E intake, but randomised trials of alpha-tocopherol supplementation, including HOPE and GISSI, found no reduction in cardiovascular events. High-dose supplementation showed signals of harm, including increased heart failure and haemorrhagic stroke risk in some trials.

    View source

    Selenium and Vitamin E Cancer Prevention Trial (SELECT): null and adverse findings

    Score: 10/10
    2011
    rct
    n=35533

    Klein EA, Thompson IM, Tangen CM +18 more

    Vitamin E supplementation significantly increased prostate cancer risk by 17%

    View source

    Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality

    Score: 9/10
    2005
    meta_analysis
    n=135967

    Miller ER, Pastor-Barriuso R, Dalal D +3 more

    High-dosage vitamin E supplementation (400 IU/day or more) may increase all-cause mortality.

    View source

    Age-related cataract in a randomized trial of vitamins E and C in men

    Score: 9/10
    2010
    rct
    n=11545

    Christen WG, Glynn RJ, Sesso HD +2 more

    There were 579 cataracts in the vitamin E-treated group and 595 in the vitamin E placebo group (hazard ratio, 0.99; 95% confidence interval, 0.88-1.11).

    View source

    Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT)

    Score: 9/10
    2011
    rct
    n=35533

    Klein EA, et al

    Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men.

    View source

    Therapeutic effects of vitamin E on cyclic mastalgia

    Score: 6/10
    2009
    rct
    n=150

    Parsay S, Olfati F, Nahidi S

    The administration of Vit E had significant curative results.

    View source

    Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis

    Score: 9/10
    2023
    meta_analysis
    n=589

    Zheng SH, Chen XX, Chen Y +3 more

    antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans

    View source

    Efficacy of vitamins C, E, and their combination for treatment of restless legs syndrome in hemodialysis patients: A randomized, double-blind, placebo-controlled trial

    Score: 6/10
    2012
    rct
    n=60

    Sagheb MM

    Vitamins C and E and their combination are safe and effective treatments for reducing the severity of RLS in hemodialysis patients over the short-term.

    View source

    Vitamin E for hot flushes and night sweats in menopausal women: a randomized controlled trial

    Score: 6/10
    2007
    rct
    n=54

    Ziaei S, Kazemnejad A, Zareai M

    Vitamin E produced a small but statistically significant reduction in hot flush frequency and severity

    View source

    Colorectal adenomas in participants of the SELECT randomized trial of selenium and vitamin E

    Score: 8/10
    2017
    rct
    n=6546

    Lance P, Alberts DS, Thompson PA +2 more

    the effect of vitamin E (as α-tocopherol) supplementation on colorectal adenoma occurrence considered as a secondary objective

    View source

    Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency

    Score: 6/10
    2001
    observational
    n=24

    Gabsi S, Gouider-Khouja N, Belal S

    High-dose vitamin E halted progression and improved some neurological signs in early-stage patients.

    View source

    Antioxidants for male subfertility

    Score: 9/10
    2022
    systematic_review
    n=10303

    de Ligny W, et al

    Subfertile couples should be advised that overall, the current evidence is inconclusive based on serious risk of bias.

    View source

    A double-blind placebo-controlled trial of antioxidant therapy in limited cutaneous systemic sclerosis

    Score: 6/10
    2000
    rct
    n=33

    Herrick AL, Hollis S, Schofield D

    No clinical benefit could be demonstrated from active treatment. There are several possible explanations for this negative result, including the short duration of therapy. It is possible that antioxidant therapy, to be effective, needs to be given early in the SSc disease process, before the onset of irreversible tissue damage.

    View source

    Antioxidant vitamin supplementation prevents oxidative stress but does not enhance performance in young football athletes

    Score: 6/10
    2019
    rct
    n=21

    de Oliveira DCX, Rosa FT, Simões-Ambrósio L +1 more

    Antioxidant vitamin supplementation prevents oxidative stress but does not enhance performance in young football athletes.

    View source

    Antioxidants for male subfertility

    Score: 8/10
    2014
    systematic_review

    Antioxidant supplementation, including vitamin E, was associated with improved pregnancy and live birth rates in subfertile men.

    View source

    Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration

    Score: 9/10
    2023
    systematic_review

    Antioxidant vitamin formulations including vitamin E slowed progression of age-related macular degeneration.

    View source

    A selected controlled trial of supplementary vitamin E for treatment of muscle cramps in hemodialysis patients

    Score: 4/10
    2010
    rct
    n=19

    El-Hennawy AS, Zaib S

    Short-term treatment with vit. E is safe and effective in reducing number of attacks of muscle cramps in HD patients, as shown in our study.

    View source

    A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial

    Score: 7/10
    2019
    rct

    Bo Y, Liu C

    A high whey protein, vitamin D and E supplement preserved muscle mass and strength in sarcopenic older adults

    View source

    Antioxidants for female subfertility

    Score: 9/10
    2020
    systematic_review

    Showell MG, Mackenzie-Proctor R, Jordan V +1 more

    Antioxidants for female subfertility.

    View source

    Efficacy and Safety of the Combination of Palmitoylethanolamide, Superoxide Dismutase, Alpha Lipoic Acid, Vitamins B12, B1, B6, E, Mg, Zn and Nicotinamide for 6 Months in People with Diabetic Neuropathy

    Score: 6/10
    2024
    rct

    In the active group, there was a large improvement of pain (PS from 20.9 to 13.9, p < 0.001).

    View source

    Effects of long-term vitamin E supplementation on cardiovascular events and cancer: the HOPE and HOPE-TOO randomized controlled trial

    Score: 10/10
    2005
    rct
    n=9541

    Lonn E, Bosch J, Yusuf S +3 more

    Long-term vitamin E did not prevent cancer or major cardiovascular events and increased heart failure.

    View source

    Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases

    Score: 9/10
    2012
    meta_analysis
    n=296707

    Bjelakovic G, Nikolova D, Gluud LL +2 more

    Antioxidant supplements did not reduce mortality; beta-carotene and vitamin E were associated with increased mortality

    View source

    Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study

    Score: 5/10
    2007
    rct
    n=236

    Safarinejad MR, et al.

    This study did not show significant improvement in pain, curvature or plaque size in patients with PD treated with vitamin E, propionyl-L-carnitine, or vitamin E plus propionyl-L-carnitine compared with those treated with placebo. Note: an Expression of Concern (PMID 36626346) was issued for this paper in 2023.

    View source

    Vitamin E and risk of age-related cataract: a meta-analysis

    Score: 8/10
    2015
    meta_analysis

    Zhang Y, Jiang W, Xie Z +2 more

    Supplemental vitamin E intake was non-significantly associated with ARC risk (relative risk=0.92; 95% CI 0.78, 1.07).

    View source

    Antioxidant therapies for obstructive sleep apnea: A systematic review and meta-analysis

    Score: 6/10
    2024
    meta_analysis
    n=160

    Boppana TK

    Antioxidant therapy in patients with OSA is associated with improved endothelial function, reduced oxidative stress, and improved sleep parameters.

    View source

    A Systematic Review and Meta-Analysis of the Efficacy of Evening Primrose Oil for Mastalgia Treatment

    Score: 8/10
    2021
    meta_analysis
    n=1752

    Ahmad Adni LL, Norhayati MN, Mohd Rosli RR +1 more

    The results showed that EPO has no difference to reduce breast pain compared to topical NSAIDS, danazol, or vitamin E.

    View source

    Does combined antioxidant vitamin supplementation blunt repeated bout effect?

    Score: 6/10
    2015
    rct
    n=22

    He F, Hockemeyer JA, Sedlock D

    Overall, DOMS of the quadriceps was lower in S (1.1±0.3) than P (2.2±0.5) (P<0.05).

    View source

    Use of a specific anti-stretch mark cream for preventing or reducing the severity of striae gravidarum. Randomized, double-blind, controlled trial

    Score: 6/10
    2013
    rct

    Garcia Hernandez JA

    The use of the anti-stretch mark product is proved to be effective in reducing severity of the striae during pregnancy, prevents the appearance of new striae and halts progression of those already present.

    View source

    Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) updated follow-up

    Score: 10/10
    2011
    rct
    n=35533

    Klein EA, Thompson IM, Tangen CM +18 more

    Vitamin E supplementation significantly increased the risk of prostate cancer among healthy men.

    View source

    Assessment of the use of vitamin C and E supplements concomitantly to antibiotic treatment against Helicobacter pylori: A systematic review and meta-analysis.

    Score: 7/10
    2018
    meta_analysis
    n=973

    Caicedo Ochoa EY, Quintero Moreno CO, Mendez Fandino YR +1 more

    Without discriminating the number of antibiotics used, there was no relationship with the eradication of the infection (OR: 1.98 [95%CI: 0.92-4.29] P=.08).

    View source

    Short-Term High-Dose Vitamin C and E Supplementation Attenuates Muscle Damage and Inflammatory Responses to Repeated Taekwondo Competitions: A Randomized Placebo-Controlled Trial

    Score: 6/10
    2018
    rct
    n=18

    Chou CC, Sung YC, Davison G +2 more

    Short-term high-dose vitamin C and E supplementation attenuates muscle damage, hemolysis, and inflammatory responses to repeated taekwondo competitions.

    View source

    Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis (PIVENS)

    Score: 9/10
    2010
    rct
    n=247

    Sanyal AJ, Chalasani N, Kowdley KV +3 more

    Vitamin E was superior to placebo for improving histological features of nonalcoholic steatohepatitis.

    View source

    Selenium and vitamin E supplementation for male infertility: a randomized controlled trial

    Score: 5/10
    2011
    rct
    n=690

    Moslemi MK, Tavanbakhsh S

    Sperm motility, morphology or both improved in 52.6% of treated men

    View source

    Role of vitamin C and E supplementation on IL-6 in response to training

    Score: 7/10
    2012
    rct
    n=21

    Yfanti C, Fischer CP, Nielsen S +7 more

    Although vitamin C and E supplementation may attenuate exercise-induced increases in plasma IL-6 there is no clear additive effect when combined with endurance training.

    View source

    Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial

    Score: 8/10
    2014
    rct
    n=613

    Dysken MW, Sano M, Asthana S +3 more

    Alpha-tocopherol 2000 IU/day slowed functional decline in mild to moderate Alzheimer disease.

    View source

    Are antioxidant supplements effective in reducing delayed onset muscle soreness? A systematic review

    Score: 6/10
    2014
    meta_analysis

    Candia-Luján R, De Paz Fernández JA, Costa Moreira O

    Both vitamins and commercial supplements have low effectiveness in reducing DOMS, while polyphenols and other antioxidant supplements show moderate to good effectiveness in combating DOMS.

    View source

    The effects of vitamin E on the intensity of primary dysmenorrhea: A systematic review and meta-analysis

    Score: 7/10
    2022
    meta_analysis
    n=1002

    Alikamali M, et al.

    Vitamin E could be an adjunctive treatment for women with PD. However, higher-quality clinical trials with larger sample sizes are recommended for a more definite conclusion.

    View source

    Efficacy of vitamin E in the conservative treatment of Peyronie's disease: legend or reality? A controlled study of 70 cases

    Score: 5/10
    2013
    rct
    n=70

    Paulis G, et al.

    We can affirm that vitamin E can help to prevent the progression of PD. This study strongly supports the recommendation that the best approach for treating PD is multimodal therapy.

    View source

    Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial

    Score: 10/10
    2008
    rct
    n=14641

    Sesso HD, Buring JE, Christen WG +7 more

    Neither vitamin E nor vitamin C reduced major cardiovascular events in male physicians.

    View source

    Effect of antioxidant supplementation on the auditory threshold in sensorineural hearing loss: a meta-analysis

    Score: 5/10
    2017
    meta_analysis
    n=372

    de Souza MEDCA, Costa KVT, Menezes PL

    Meta-analysis of randomized controlled trials evaluating antioxidant supplementation and auditory threshold change in sensorineural hearing loss.

    View source

    The Effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers

    Score: 9/10
    1994
    rct
    n=29133

    The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group

    Alpha-tocopherol supplementation did not reduce lung cancer incidence in male smokers.

    View source

    An Oral Combination of Vitamins A, C, E, and Mg++ Improves Auditory Thresholds in Age-Related Hearing Loss

    Score: 4/10
    2018
    observational
    n=40

    Alvarado JC, Fuentes-Santamaria V, Gabaldon-Ull MC +1 more

    An oral combination of vitamins A, C, E, and Mg++ improves auditory thresholds in age-related hearing loss.

    View source

    Safety Information

    Potential Side Effects

    Generally well tolerated. High doses may increase bleeding risk, especially with blood thinners

    Contraindications

    Anticoagulant therapy without monitoring, bleeding disorders, imminent surgery, and prior haemorrhagic stroke. Avoid chronic doses above 400 IU/day without a defined indication.

    Drug Interactions

    • Warfarin — increased bleeding risk, monitor INR
    • Antiplatelet drugs — additive bleeding risk
    • Statins and niacin — high-dose vitamin E may blunt HDL response
    • Chemotherapy and radiotherapy — discuss with oncology before antioxidant use

    Pregnancy & Breastfeeding

    Pregnancy: likely_safe

    Breastfeeding: likely_safe

    Dosage Guidelines

    Dosage Used in Studies

    15-800 IU

    Best Time to Take

    Once daily with the largest fat-containing meal

    Best Form

    Natural d-alpha-tocopherol, or mixed tocopherols for general use

    Bioavailability

    Fat-soluble; absorption requires bile and dietary fat and ranges widely. Natural RRR-alpha-tocopherol is retained roughly twice as efficiently as the synthetic all-rac form.

    Forms Compared

    d-alpha-tocopherol (natural, RRR-)

    dl-alpha-tocopherol (synthetic, all-rac-)

    Mixed tocopherols

    Tocotrienols

    Food & Timing

    With a meal containing fat — absorption is poor on an empty stomach

    Medical Disclaimer

    The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.