What is Vitamin E Deficiency?
Vitamin E comprises eight different compounds: alpha, beta, gamma, and delta-tocopherol, and alpha, beta, gamma, and delta-tocotrienol. Out of these, only alpha-tocopherol is needed in our diet. When we ingest any form of vitamin E, our small intestine absorbs it, but the liver only processes alpha-tocopherol. The rest of the forms of vitamin E are discarded by the liver.
It’s incredibly rare for someone to have a vitamin E deficiency because it’s quite unusual for it to be caused by a diet low in vitamin E. Instead, it’s generally due to issues with how one’s body absorbs or processes dietary fat. This is because vitamin E is a nutrient that dissolves in fat. Research suggests vitamin E might help in reducing hardening of arteries and decrease rates of a type of heart disease caused by reduced blood supply to the heart. Premature babies typically have low vitamin E levels because vitamin E doesn’t cross the placenta in significant amounts.
What Causes Vitamin E Deficiency?
In developed countries, it’s rare for someone to lack vitamin E because they’re not eating enough of it. More commonly, people might lack vitamin E due to:
* Being born prematurely and weighing less than 3.3 pounds
* Having a mutation in a specific protein that disrupts how your body processes fats
* Having issues absorbing fat in the small intestine, which is necessary to take in vitamin E
* Having cystic fibrosis, which makes it hard to absorb vitamins A, D, E, and K because of a lack of essential pancreatic enzymes
* Having short-bowel syndrome, which can take years to cause symptoms. Some causes of this issue include surgery on the small intestines, blood clots in the gut’s arteries, and fake ‘blockages’ in the intestines
* Having a chronic liver and gallbladder disease that lowers bile flow and the creation of tiny blobs of fat (micelles), which are needed for your body to absorb vitamin E
People with Crohn’s disease, certain pancreatic issues, and liver diseases might also struggle to absorb fats properly. Other causes can include Abetalipoproteinemia, which is a rare, inherited disease that causes your body to make mistakes when manufacturing and moving lipoproteins. Additionally, there is a genetic disorder on the 8th chromosome that causes a specific vitamin E deficiency syndrome.
Meanwhile, in developing countries, not getting enough vitamin E from food is the most common reason for lacking this vitamin.
Risk Factors and Frequency for Vitamin E Deficiency
Alpha-tocopherol, commonly known as vitamin E, is found at insufficient levels in a majority of US adults over the age of 20. Research shows that 0.1% of these adults have a deficiency. Furthermore, diet surveys indicate that about 89.8% of men and 96.3% of women aged 19 or more are not getting enough alpha-tocopherol from their diet. Studies also suggest that levels of this vitamin might be lower in children and higher in pregnant individuals.
Signs and Symptoms of Vitamin E Deficiency
Patients with vitamin E deficiency can demonstrate a range of symptoms, varying from mild to severe. Some people might experience difficulties with balance, moving their eyes upwards, and weakened reflexes. Less common, yet significant, symptoms could be muscle weakness and narrowed field of view. In extreme cases, patients may even suffer from blindness, memory problems, and irregular heartbeats.
If there’s a suspicion of vitamin E deficiency, doctors recommend a complete neurological and routine physical examination. In the early stages, patients might show weak reflex responses, impaired night vision, and reduced sense of touch, but their thinking abilities usually remain unaffected. As the deficiency progresses, people might experience a lack of coordination in limbs, severe muscle weakness, and difficulties with upward gaze. In the most severe stage, there could be irregular heartbeats and potential blindness accompanied by cognitive difficulties. Lack of coordination is the most commonly observed symptom.
Moreover, certain diseases can also exhibit unique symptoms. For instance, patients with abetalipoproteinemia, a disorder that impairs the normal absorption of dietary fats, frequently experience eye disorders, such as pigmented retinopathy and visual field issues. On the other hand, patients who have cholestatic liver disease, a condition where the flow of bile from the liver is slowed or stopped, often exhibit changes in personality and behavior.
Testing for Vitamin E Deficiency
The key to diagnosing conditions like abetalipoproteinemia is testing the levels of alpha-tocopherol, a type of vitamin E, in your blood. Adults generally should have alpha-tocopherol levels lower than 5 mcg/mL.
However, if the patient has high levels of lipids, or fats, in the blood (a condition known as hyperlipidemia), it might tamper with vitamin E levels. In that case, doctors look at the ratio of serum alpha-tocopherol to lipids — specifically, this ratio should be less than 0.8 mg/g for reliable results.
For children with abetalipoproteinemia, an inherited condition affecting fat absorption, doctors wouldn’t be able to detect any alpha-tocopherol levels in their blood serum.
Treatment Options for Vitamin E Deficiency
If someone is deficient in vitamin E, the first step to treatment is to address the root cause, such as problems with fat absorption or metabolism. After that, taking a vitamin E supplement orally can help. Dietary changes can also aid in increasing vitamin E intake – this includes eating more leafy vegetables, whole grains, nuts, seeds, vegetable oils, and fortified cereals. While these foods are usually part of our standard diets, adults specifically need to ensure they get 15mg of vitamin E per day.
In terms of supplementation, a daily dose of 15 to 25 mg/kg of vitamin E, or 200 IU of mixed tocopherols could be used. However, if a person has trouble with their small intestine or taking medication by mouth, they might need to get their vitamin E through an injection into a muscle.
The recommended daily intake of alpha-tocopherol, a form of vitamin E, varies by age. For children aged 0 to 6 months, it’s 3mg. For those between 6 months to a year, it’s 4mg. Children from 1 to 3 years of age should get 6mg, those from 4 to 10 years should receive 7mg, and adults and elderly patients should aim for 10mg daily.
What else can Vitamin E Deficiency be?
While trying to diagnose a vitamin deficiency, doctors also need to think about other potential health conditions that might be causing the problem. These could include:
- Friedreich ataxia (a condition that affects the nervous system)
- Vitamin E deficiency related ataxia (a loss of functionality due to a lack of vitamin E)
- Stroke (a sudden interruption in the blood supply to a part of the brain)
- Cerebral palsy (a group of disorders that affect a person’s ability to move and maintain balance and posture)
- Paraneoplastic syndrome (an abnormal immune response to a cancerous tumor known as a neoplasm)
- Biliary disease (issues with the gallbladder and bile ducts)
- Short-Bowl syndrome (a condition where you can’t absorb enough nutrients from the food you eat)
- Mutations in genes that result in problems with fat metabolism
- Cystic fibrosis (a hereditary disease that affects the lungs and digestive system)
- Chronic cholestatic hepatobiliary disease (a problem with the liver and gallbladder that affects the flow of bile)
- Crohn’s disease (an inflammation of the bowel)
- Exocrine pancreatic insufficiency (a condition where the pancreas can’t make enough enzymes to digest food properly)
- Liver disease (conditions that cause liver damage)
- Abetalipoproteinemia (a disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food)
- Isolated vitamin E deficiency (when the body can’t properly absorb or use vitamin E)
It’s crucial for doctors to carefully consider these conditions while diagnosing the problem, and to conduct the appropriate tests to get an accurate diagnosis.
What to expect with Vitamin E Deficiency
If symptoms are not addressed, they could become more severe. However, once the deficiency is diagnosed, the prognosis is typically very good since most symptoms are likely to improve rapidly. But the more serious the deficiency, the more limited the treatment options become. So, those who may be susceptible to a vitamin E deficiency should be regularly checked and assessed.
Possible Complications When Diagnosed with Vitamin E Deficiency
Vitamin E can interfere with a few medications, impacting their effectiveness. Here are some key interactions:
- Anti-clotting medications: Vitamin E can hinder the clotting process and stop blood platelets from clumping together. This means if you’re taking anti-clotting medications or antiplatelet drugs, Vitamin E could increase your risk of bleeding.
- Simvastatin and niacin: If you’re on simvastatin or niacin to increase your high-density lipoprotein (HDL) levels, Vitamin E might be counterproductive. This is because it can actually reduce the amount of HDL in your body, which goes against the purpose of these medications.
Preventing Vitamin E Deficiency
The recommended amounts of Vitamin E supplementation can vary greatly depending on the specific medical condition. These recommendations include:
For Abetalipoproteinemia, the suggestion is from 100 to 200 IU per day for each kilogram of body weight.
For Chronic cholestasis, you’d need about 15 to 25 IU per day for each kilogram of body weight.
For those with Cystic fibrosis, about 5 to 10 IU per day for each kilogram of body weight is the recommendation.
For Short-bowel syndrome, it’s a bit more variable, with anywhere from 200 to 3600 IU daily.
For an isolated vitamin E deficiency, the recommended intake is between 800 to 3600 IU daily.
Vitamin E supplementation is considered safe for those who are pregnant or breastfeeding. However, if you’re taking high doses of Vitamin E, you might need more of both Vitamin K and omega-6 fatty acids.