Vitamin E: An Essential Nutrient for Optimal Bone Health

Vitamin E is a powerful antioxidant that plays a crucial role in maintaining our overall health and well-being. It is a fat-soluble nutrient that helps protect our cells from damage caused by free radicals, thus reducing the risk of chronic diseases such as heart disease and cancer. In addition to its antioxidant properties, vitamin E also supports our immune system, aids in cell communication, and helps with blood clotting.

Vitamin E plays a role in maintaining bone health by reducing oxidative stress and inflammation in the bones. Oxidative stress can lead to bone loss and weaken the structure of the bones, increasing the risk of fractures and osteoporosis. Vitamin E helps protect against oxidative damage, allowing the bones to maintain their strength and density.

Additionally, vitamin E supports the absorption and utilization of other nutrients involved in bone health, such as calcium and vitamin D. While more research is needed to fully understand the specific mechanisms by which vitamin E affects bone health, it is clear that adequate intake of this nutrient is important for maintaining strong and healthy bones.

1. How do you know that your vitamin E is low?

Vitamin E deficiency is relatively rare, but certain factors can increase the risk of inadequate levels. Symptoms of a vitamin E deficiency may include muscle weakness, reduced coordination, vision problems, and impaired immune function. However, these symptoms are non-specific and can also be caused by various other health conditions. Therefore, it is best to consult with a healthcare professional for an accurate diagnosis.

2. What is the best test for determining adequate vitamin E levels?

The most commonly used test to determine vitamin E levels is the plasma alpha-tocopherol concentration. However, this test may not always provide an accurate reflection of overall vitamin E status. It is important to note that vitamin E deficiency is usually diagnosed based on clinical symptoms rather than blood tests alone.

3. What are the forms of vitamin E and which one is the best and why?

When it comes to supplementing with vitamin E, there are two main forms available: tocopherols and tocotrienols. While both forms belong to the vitamin E family, there are some notable differences between them.

Tocopherols are the most known and studied form of vitamin E. They come in various types, including alpha-, beta-, gamma-, and delta-tocopherol. Alpha-tocopherol is the most biologically active form and is commonly found in dietary supplements and fortified foods. It is known for its antioxidant properties and its ability to protect cells from damage caused by free radicals. Alpha-tocopherol is also believed to have anti-inflammatory effects.

On the other hand, tocotrienols are a less well-known form of vitamin E. They have a slightly different chemical structure compared to tocopherols, with an unsaturated side chain. This structural difference allows tocotrienols to have unique health benefits that set them apart from tocopherols. Tocotrienols have been shown to have stronger antioxidant activity compared to tocopherols, meaning they are more effective at neutralizing free radicals and preventing oxidative damage. They are also believed to have anti-inflammatory properties and may provide additional protection against chronic diseases such as heart disease and cancer.

Ingestion of vitamin E, especially tocotrienols, may benefit bone health in terms of maintaining higher bone mineral density and improving bone microstructure and quality, especially as people age and experience age-related bone loss. The beneficial effects of tocotrienols on bone health appear to be mediated via antioxidant/anti-inflammatory pathways and/or 3-hydroxy-3-methylglutaryl coenzyme A mechanisms.¹

In one study, supplementing post-menopausal women with tocopherols had a significant effect on preventing bone resorption compared to a group receiving a placebo, indicating that supplementation may have a preventative effect on bone loss.²  It has also been suggested that tocotrienols may be beneficial for peri-menopausal women in preventing osteoporosis because there is evidence that it is effective in post-menopausal women, although further research is needed. ³

A systematic review of 9 studies comprised of 30, 845 patients showed that vitamin E supplementation was beneficial for Rheumatoid Arthritis (RA) patients, particularly those with sensitive joints. Authors concluded that vitamin E’s role in restoring the intestinal barrier may be linked to the prevention and treatment of RA and that when used regularly can help reduce joint discomfort, edema, and stiffness, as well as enhance quality of life.⁴  

Low vitamin E levels have been shown in observational studies to be correlated with osteoarthritis and it is thought that supplementation with the right forms of vitamin E may help improve osteoarthritis outcomes, although more research is needed. ⁵ Tocotrienols have anti-inflammatory effects and can help repair cartilage and bone.⁶

Overall, tocotrienols have been shown to have positive osteoprotective properties, anti-inflammatory, and antioxidant effects that can reduce oxidative stress and inflammation, thereby alleviating inflammation and pain associated with musculoskeletal disorders and conditions such as osteoarthritis in addition to promising effects on muscle health and regeneration.⁷

4. What foods are high in vitamin E?

While supplementation can be beneficial, it is always best to obtain nutrients from whole foods whenever possible. Fortunately, there are plenty of delicious foods that are rich in vitamin E. Some excellent sources include nuts and seeds (such as almonds, sunflower seeds, and hazelnuts), spinach, broccoli, avocados, mangoes, and vegetable oils (such as sunflower, safflower, and wheat germ oils).

Tocotrienols are found in specific grains and plant sources like palm oil, rice bran oil, coconut oil, barley germ, wheat germ, and annatto. Other sources include grapefruit seed oil, oats, hazelnuts, maize, olive oil, flaxseed oil, poppy seed oil, and sunflower seed oil.

Annatto vitamin E refers to a specific form of vitamin E that is derived from the annatto plant (Bixa Orellana). Annatto is a natural food coloring and flavoring agent that is commonly used in various culinary applications. The vitamin E extracted from annatto seeds is rich in tocotrienols. E. Annatto vitamin E is often available in supplement form and is sought after for its potential health benefits, including its ability to protect against oxidative stress, reduce inflammation, and support cardiovascular health. However, it is important to note that research on annatto vitamin E is still ongoing, and more studies are needed to fully understand its effects and benefits.

5. How much vitamin E should you supplement with daily?

Vitamin E preparations have been limited in their bioavailability. In terms of absorption, tocopherols are generally better absorbed by the body compared to tocotrienols. This is because the body has specific transport proteins that preferentially bind to tocopherols and facilitate their absorption. However, recent research suggests that certain types of tocotrienols, particularly gamma- and delta-tocotrienol, have better bioavailability compared to other forms. This means that although they may not be as readily absorbed as tocopherols, they still have good potential to be utilized by the body.  More recent preparations using Nano formulations have made them more bioavailable.⁸

For adults, it is generally recommended to consume 15 milligrams (22.4 IU) of alpha-tocopherol vitamin E per day. However, higher doses may be needed in certain cases, such as individuals with certain medical conditions. It is important to consult with a healthcare professional before starting any supplementation regimen.

Tocopherol should be taken in limited amounts, as it can interfere with tocotrienols and potentially have negative effects. Annatto is a form of vitamin E containing only tocotrienols whereas palm or rice-containing annatto also contains tocopherols. Dr. Barrie Tan recommends tocotrienol as the recommended form in the amount of 100-200 mg of tocotrienol per day for antioxidant protection but that for some chronic conditions, up to 600 mg per day may be needed.

6. What precautions should you take when supplementing vitamin E?

When supplementing with vitamin E, it is important to exercise caution and follow the recommended dosage. High doses of vitamin E can have adverse effects, including an increased risk of bleeding and impaired blood clotting. Individuals taking blood-thinning medications or with certain health conditions should consult with a healthcare professional before starting vitamin E supplementation.

When it comes to choosing between tocopherols and tocotrienols for supplementation, it ultimately depends on the specific health goals and concerns of the individual. Both forms have their unique benefits and can complement each other. For overall antioxidant protection and general health maintenance, a combination of both tocopherols and tocotrienols may be beneficial. However, if there is a specific need for enhanced antioxidant activity or protection against inflammation, tocotrienols may be preferred.

Conclusion

In conclusion, vitamin E is an essential nutrient that plays a vital role in maintaining our health. While deficiency is rare, it is important to be aware of the symptoms and consult with a healthcare professional if needed. Consuming a balanced diet rich in vitamin E-containing foods is the best way to meet our daily requirements. However, in certain cases, supplementation may be necessary, and it is crucial to consult with a healthcare professional for guidance on dosage and potential interactions. With proper care, we can ensure our bodies receive adequate vitamin E to support optimal health.

References:

1.          Shen CL, Klein A, Chin KY, et al. Tocotrienols for bone health: a translational approach. Ann N Y Acad Sci. 2017;1401(1). doi:10.1111/nyas.13449

2.          Vallibhakara SAO, Nakpalat K, Sophonsritsuk A, Tantitham C, Vallibhakara O. Effect of vitamin e supplement on bone turnover markers in postmenopausal osteopenic women: A double-blind, randomized, placebo-controlled trial. Nutrients. 2021;13(12). doi:10.3390/nu13124226

3.          Liang G, Kow ASF, Tham CL, Ho YC, Lee MT. Ameliorative Effect of Tocotrienols on Perimenopausal-Associated Osteoporosis—A Review. Antioxidants. 2022;11(11). doi:10.3390/antiox11112179

4.          Kou H, Qing Z, Guo H, Zhang R, Ma J. Effect of vitamin E supplementation in rheumatoid arthritis: a systematic review and meta-analysis. Eur J Clin Nutr. 2023;77(2). doi:10.1038/s41430-022-01148-9

5.          Chin KY, Ima-Nirwana S. The role of vitamin E in preventing and treating osteoarthritis – A review of the current evidence. Front Pharmacol. 2018;9(AUG). doi:10.3389/fphar.2018.00946

6.          Tejpal Singh HS, Aminuddin AA, Pang KL, Ekeuku SO, Chin KY. The Role of Tocotrienol in Arthritis Management—A Scoping Review of Literature. Pharmaceuticals. 2023;16(3). doi:10.3390/ph16030385

7.          Saud Gany SL, Chin KY, Tan JK, Aminuddin A, Makpol S. Preventative and therapeutic potential of tocotrienols on musculoskeletal diseases in ageing. Front Pharmacol. 2023;14. doi:10.3389/fphar.2023.1290721

8.          Mohd Zaffarin AS, Ng SF, Ng MH, Hassan H, Alias E. Pharmacology and pharmacokinetics of Vitamin E: Nanoformulations to enhance bioavailability. Int J Nanomedicine. 2020;15. doi:10.2147/IJN.S276355