The Best Sources of Vitamin E

The Harvard Physician Health Study II began in 1997 and was designed to test the hypothesis that vitamin E, vitamin C, or a multivitamin may offer protection against cardiovascular disease, cancer, age-related eye disease, and cognitive decline.  The vitamin C and vitamin E components of the study ended in 2007 and found that these vitamin supplements do not prevent major cardiovascular events, cancer, or eye disease.

The multivitamin component of the Harvard Physician Health Study II was based on consistent observations that people consuming greater vitaminsamounts of fruits and vegetables tend to have lower rates of coronary heart disease Joshipura et al AIM and stroke Joshipura et al JAMA.  This part of the study concluded in 2011 and published last year that there is no association between regular consumption of a multivitamin and decreased cardiovascular disease or coronary heart disease mortality.Sesso et al  Although the Harvard Nurses’ Health Study results indicated that multivitamin use was associated with a significant reduction in coronary heart disease incidence,Rimm et al multiple other large studies of single vitamins or combinations of vitamins and minerals (usually at higher than normal doses) have demonstrated no effect on cardiovascular disease. Hennekens et al, Lee et al JNCI, Lee et al JAMA, Leppala et al, and Hsiaet al

As with all clinical studies, there are many factors that may impact how one interprets the results.  If interested in this level of detail, I encourage you to read through or at least skim the original publications.  For example, the Harvard Physician Health Study II may not have seen a difference in cardiovascular disease because the study participants were in general a population that already had adequate intake of nutrients, awareness that exercise and weight loss impact cardiovascular disease, and access to pharmacological interventions such as lipid-lowering medications.  However, excluding the Harvard Nurses’ Health Study, the majority of large studies evaluating the effect of multivitamins on cardiovascular disease have not shown a positive impact.  This doesn’t mean that you shouldn’t take a multivitamin to help ensure you are getting the vitamins you need- you just can’t expect a multivitamin to make up for a deficient diet.

Many consumers, doctors, and corporations are interested in a quick fix, an easy way to avoid cardiovascular disease, like taking a vitamin or a pill every day.  Is it not simple enough to modify our lifestyle based on consistent results that people consuming more vegetables, fruits, whole grains, and legumes live longer and with fewer co-morbidities? Thorogood et al, Chang-Claude et al, Barnard et al, Fraser

Vitamin E

Blueberries are coming into season now in the southeastern US and contain 2.7 mg vitamin E per cup.  Eat them by the handful, on top of granola or yogurt, or incorporated into whole wheat pancakes or muffins.  About 12 raw almonds contain 3.8 mg vitamin E, while 1 T raw sunflower seeds contains 5 mg vitamin E.Barnard and Reilly   Eat no more than one handful of raw nuts and seeds each day unless you are growing or trying to put on weight.  Sprinkling chopped nuts or seeds on salads is a great way to add flavor and texture to a salad. vit-E

Fruits and vegetables contain vitamin E, but so do grains and legumes.  One cup of cooked barley contains 3 mg of vitamin E, while cooked legumes like chickpeas and white beans contain 2 mg per cup.  The daily target for men and women is 15 mg vitamin E. Barnard and O’Reilly   However, we know from large, randomized clinical trials such as the Harvard Physician Health Study II that supplements (even in supra‑therapeutic doses) are not effective in protecting against disease.  While vitamin E is an essential anti-oxidant in protecting your body against free radicals, high intake of vitamin E is not necessarily a good thing.  Saintot et al showed that of women with breast cancer, those with the highest levels of vitamin E in their blood were more likely to succumb to the disease.  Now this may be due to the fact that these women were getting too much fat in their diet, as some of the richest sources of vitamin E (vegetable oils and nuts) also contain excess fat.

This is just another example of whole foods being superior to the sum of their parts.  Pay attention to your consumption of foods with vitamin E this week.  If you’re eating a whole food, plant-based diet with lots of veggies, fruits, legumes, and whole grains, then you’re likely getting your 15 mg per day of recommended vitamin E.

 

References

Barnard ND, Reilly JK. The Cancer Survivor’s Guide. 2008

Barnard ND, Nicholson A, Howard JL. The medical costs attributable to meat consumption. Prev Med. 1995;24:646-655.

Chang-Claude J, Frentzel-Beyme R. Dietary and lifestyle determinants of mortality among German vegetarians. Int J Epidemiol. 1993;22:228-236.

Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr. 1999;70(suppl):532S-538S.

Hennekens CH, Buring JE, Manson JE,  et al.  Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease.  N Engl J Med. 1996;334(18):1145-1149

Hsia J, Heiss G, Ren H,  et al; Women’s Health Initiative Investigators.  Calcium/vitamin D supplementation and cardiovascular events.  Circulation. 2007;115(7):846-854

Joshipura KJ, Hu FB, Manson JE,  et al.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med. 2001;134(12):1106-1114

Joshipura KJ, Ascherio A, Manson JE,  et al.  Fruit and vegetable intake in relation to risk of ischemic stroke.  JAMA. 1999;282(13):1233-1239

Lee IM, Cook NR, Gaziano JM,  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(1):56-65

Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women’s Health Study.  J Natl Cancer Inst. 1999;91(24):2102-2106

Leppälä JM, Virtamo J, Fogelholm R, et al.  Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers.  Arterioscler Thromb Vasc Biol. 2000;20(1):230-235

Rimm EB, Willett WC, Hu FB,  et al.  Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women.  JAMA. 1998;279(5):359-364

Saintot M, Mattieu-Daude H, Astre C, Grenier J, Simony-Lafontaine J, Gerber M. Oxidant-antioxidant status in relation to survival among breast cancer patients. Int J Cancer. 2002;97:574-579.

Sesso, Howard et al. Multivitamins in the Prevention of Cardiovascular Disease in Men:  The Physicians’ Health Study II Randomized Controlled Trial JAMA. 2012;308(17):1751-1760.

Thorogood M, Mann J, Appleby P, McPerson K. Risk of death from cancer and ischaemic heart disease in meat and non-meat eaters. Br Med J. 1994; 308:1667-1670.

 

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