What is Vitamin E Toxicity?
Vitamin E is an important antioxidant that is primarily obtained from the food we eat. This vitamin, first discovered in the 1920s as a necessary dietary compound for rats to reproduce, does exist in about eight different forms. However, alpha-tocopherol is the main type found in humans. Another form called “tocotrienols” often comes under study regarding vitamin E supplements. Researchers have explored various amounts of these two substances and their potential benefits for health. Vitamin E acts as a protector against harmful radicals in the body. Excessive vitamin E can, however, lead to an increased risk of bleeding, while a lack of it has been linked to neurological diseases and anemia.
What Causes Vitamin E Toxicity?
Vitamin E is a nutrient that’s commonly found in many foods like spinach, avocados, seeds, vegetable oil, and almonds. It can even be found in breast milk. People who follow a Mediterranean diet often have higher levels of Vitamin E in their bodies. Although the suggested daily intake of Vitamin E is 15 mg/day, some supplements offer higher daily doses, such as 100 to 1000 mg.
Generally, people don’t notice any symptoms unless they consume more than 1000 mg of Vitamin E every day. However, taking more than 300 mg per day may affect how other medications work in the body.
Usually, a person who gets Vitamin E from their diet will have an average level of alpha-tocopherol (a type of Vitamin E) of roughly 20 micromol/L. For people who take additional Vitamin E supplements, their levels usually exceed 30 micromol/L.
Studies show that eating foods rich in Vitamin E doesn’t have any harmful effects, unless you’re taking additional supplements. Too many supplements may lead to Vitamin E toxicity, which could increase the risk of bleeding.
Vitamin E deficiency is quite rare, but when it does occur, symptoms include worsening nerve damage in the extremities, lack of coordination, and weakened reflexes. Certain conditions that make it hard to absorb fat, like cystic fibrosis, Crohn disease, and chronic pancreatitis, may cause Vitamin E deficiency. In these cases, Vitamin E supplements may be necessary.
Risk Factors and Frequency for Vitamin E Toxicity
People take vitamin E supplements for many reasons, often in large doses. In scientific studies, vitamin E has shown various effects in different circumstances. Here’s a summary:
- In rats, low concentrations of vitamin E, applied topically, were found to delay the onset of cataracts. However, at high concentrations, it actually caused cataracts to happen faster.
- More studies with rats who have diabetic kidney disease have shown that vitamin E can improve kidney function, manage blood sugar levels, and improve fat levels in the blood.
- Vitamin E can reduce the amount of a chemical called glutamate. That’s important because high glutamate levels are associated with neurodegenerative diseases. Therefore, vitamin E may help prevent damage to nerve cells caused by high levels of this chemical.
- Vitamin E has been investigated as an antioxidant and anti-inflammatory treatment for bone loss disease, with mixed results.
- For people with diabetes, vitamin E improved wound healing.
- In inflammatory diseases like asthma, Crohn’s disease, and rheumatoid arthritis, a certain type of vitamin E, called tocotrienol, was more effective at reducing inflammation than alpha-tocopherol, another form of vitamin E.
- Vitamin E can be particularly helpful to patients who have been exposed to a large amount of radiation – it can assist in blood cell production after exposure.
- Vitamin E’s effect on preventing heart disease, including coronary heart disease, stroke, and heart attacks, have been studied. Particularly, tocotrienols were found to be beneficial for coronary artery disease and stroke.
- In a study from 2017, Alzheimer’s patients and those with mild cognitive impairment who took vitamin E didn’t show any difference in cognitive decline compared to those who didn’t take any supplement.
- High doses of vitamin E (over 400 I.U. daily) were found to be harmful for patients in a situation of acute stroke.
That said, many people still take vitamin E supplements because of the potential benefits described here.
Signs and Symptoms of Vitamin E Toxicity
When someone takes too much vitamin E, it can lead to an increased risk of bleeding. Therefore, it’s crucial to know what other medicines they’re on, especially ones that already affect blood clotting. Over-the-counter supplements play a role too, as people sometimes take these without a doctor’s guidance. Changes in weight could also hint at issues with how well the body is absorbing vitamins that dissolve in fat, like vitamin E. An overdose of vitamin E can lower levels of other fat-soluble vitamins.
Some medications can cause problems when mixed with vitamin E, particularly those that already affect bleeding, liver and gallbladder function, and absorption of fat-soluble vitamins. When Vitamin E is taken at doses higher than 300 mg daily, it may interact with common medications such as aspirin, warfarin, cyclosporine, and tamoxifen.
When examining someone for vitamin E toxicity, doctors pay close attention to the skin for signs of bruising, tiny red spots (petechiae), and paleness. These are symptoms of increased bleeding. Signs of liver and gallbladder problems may also be present, which include yellowing of the whites of the eyes (scleral icterus), an enlarged liver (hepatomegaly), and yellowing of the skin or eyes (jaundice).
Testing for Vitamin E Toxicity
Vitamin E toxicity can be detected by checking the levels of alpha-tocopherol – a type of Vitamin E – in your blood. On a well-balanced diet, the usual range of alpha-tocopherol in your blood should be around 20 micromoles per liter. If you are taking vitamin E supplements, this level may rise to 30 micromoles per liter or more. The standard range for alpha-tocopherols is considered to be from 5.7 to 19.9 mg/L.
However, the levels of alpha-tocopherol in your blood can be influenced by the amount of fat in your blood. Extremely high or low cholesterol levels can skew these measurements and make it harder to accurately measure vitamin E. Moreover, when your body has excess vitamin E, it will try to get rid of it through bile and urine. This may affect the measurement as well.
Because of these factors, there isn’t a set level of alpha-tocopherols in your blood that is considered universally toxic. Two separate studies showed differing ranges of alpha-tocopherol levels in patients who were receiving vitamin E supplements and experienced bleeding in the brain. In one study, they’ve found that calculating the ratio of alpha-tocopherols to the total amount of cholesterol in the blood may give a more accurate measurement of vitamin E levels. Although these measurements aren’t always perfect, they are still the most commonly used tests to understand the effects of vitamin E on the body.
Treatment Options for Vitamin E Toxicity
If someone is experiencing vitamin E toxicity, the most common treatment is to stop taking vitamin E supplements. This makes sense since vitamin E toxicity typically only happens when a person takes an extra (or exogenous) vitamin E supplement.
If the person is bleeding significantly, doctors might consider giving them vitamin K supplements. High levels of vitamin E can affect the way your body forms blood clots, a process that requires vitamin K. This can happen whether or not the person is taking a medication called warfarin. Vitamin E can also affect how platelets (a type of blood cell) stick together to form clots. This can still take place even if the person doesn’t take any medication to prevent clotting (or antiplatelet agents).
So for people who are bleeding a lot or have severe bleeding, doctors often consider giving vitamin K supplements.
What else can Vitamin E Toxicity be?
When a patient has too much vitamin E in their body, it’s important for doctors to consider several conditions that could cause similar problems. For example, they may look for bleeding disorders like hemophilia or von Willebrand’s disease, medication-related blood clotting issues, and a condition known as DIC.
Other signs of having too much vitamin E could include issues with the digestive system like feeling upset, feeling weak, and becoming emotionally unstable. If a patient is having digestive problems (like feeling sick, throwing up, or having diarrhea), doctors could be dealing with stomach flu, an infection causing diarrhea, blockage in the small intestine, inflammation of the pancreas, or cholestasis, which is when bile cannot flow from the liver to the duodenum.
Important factors to consider in diagnosing the cause of weakness are infections that could include urinary tract infections and pneumonia, anemia, acute kidney failure, imbalance of minerals in the body, heart failure, or an underactive thyroid. These are broad possibilities, hence doctors need to be thorough in their investigations to find the right diagnosis.
What to expect with Vitamin E Toxicity
Generally, people who have vitamin E toxicity because they’ve taken too many supplements usually have a good chance of recovery if they stop taking the supplement. However, the outlook isn’t as good if they experience severe bleeding, particularly in cases involving hemorrhagic strokes.
Possible Complications When Diagnosed with Vitamin E Toxicity
While high levels of vitamin E primarily increase the risk of bleeding, there can also be several other potential issues. Some of these might include ailments related to your thyroid, general weakness, emotional problems, stomach and digestion issues, breast tenderness, and thrombophlebitis, which is inflammation associated with blood clots.
- Bleeding
- Thyroid problems
- General weakness
- Emotional problems
- Stomach and digestion issues
- Breast tenderness
- Thrombophlebitis (inflammation associated with blood clots)
Preventing Vitamin E Toxicity
Many people don’t usually worry about the side effects of supplements you can buy without a prescription. These can sometimes lead to serious health problems. It’s important that a detailed health history is recorded. Additionally, patients need to understand how crucial it is to share information about all the medicines they are taking, both prescription and non-prescription. This helps to prevent harmful interactions between different drugs.
