Is it safe to take vitamin E (Vitamin E) 800 mg?

Safety of Vitamin E 800 mg Supplementation

Taking vitamin E at a dose of 800 mg (800 IU) is generally not recommended for routine supplementation due to potential safety concerns, including increased risks of all-cause mortality, hemorrhagic stroke, and prostate cancer.

Safety Concerns with High-Dose Vitamin E

Potential Risks

• Mortality Risk: Some meta-analyses have suggested that high doses of vitamin E (>400 IU/day) may be associated with increased all-cause mortality 1
• Prostate Cancer: A large RCT found vitamin E at 400 IU/day was associated with an increased risk of prostate cancer (absolute increase of 1.6 per 1,000 person-years) 1
• Hemorrhagic Stroke: High-dose vitamin E may increase the risk of hemorrhagic stroke while potentially decreasing ischemic stroke risk 1
• Drug Interactions: High-dose vitamin E (≥300 mg/day) may interact with certain medications including:
  • Anticoagulants (warfarin)
  • Antiplatelet agents (aspirin)
  • Tamoxifen
  • Cyclosporine A 2, 3

Special Considerations

• Bleeding Risk: Vitamin E has anticoagulant properties that may increase bleeding time, particularly important for:
  • Patients on anticoagulant therapy
  • Those requiring surgery (should discontinue in perioperative period) 3
• Smokers: Should avoid vitamin E supplementation due to potential negative effects on vitamin C 3

Therapeutic Uses of High-Dose Vitamin E

The 800 IU (727 mg) dose of vitamin E is primarily recommended only for specific therapeutic purposes:

• Non-alcoholic Steatohepatitis (NASH): 800 IU/day of vitamin E has been shown to improve liver histology in non-diabetic adults with biopsy-proven NASH 1
• Vitamin E Deficiency: Treatment of deficiency states, particularly in patients with malabsorption conditions like post-bariatric surgery 1

Safety Data for Different Doses

• Short-term safety: Studies have shown that 800 IU (727 mg) for 30 days did not adversely affect healthy elderly persons 4
• Medium-term safety: 4-month supplementation with doses up to 800 IU showed no adverse effects on various health parameters in healthy older adults 4
• Long-term safety: Concerns arise primarily with extended use at high doses

Decision Algorithm for Vitamin E Supplementation

1. For general health maintenance:

   • Doses ≤400 IU/day are likely safe for most adults
   • Doses of 800 IU/day are not recommended

2. For specific therapeutic purposes (e.g., biopsy-proven NASH):

   • 800 IU/day may be considered under medical supervision
   • Benefits must outweigh risks
   • Regular monitoring is essential

3. Contraindications for high-dose vitamin E (800 IU):

   • Anticoagulant therapy
   • History of hemorrhagic stroke
   • Planned surgical procedures
   • Smokers
   • Prostate cancer or high risk for prostate cancer

Conclusion

While vitamin E at 800 mg (800 IU) has demonstrated therapeutic benefits for specific conditions like NASH, this dose exceeds what is generally considered safe for routine supplementation. The potential risks of increased mortality, hemorrhagic stroke, and prostate cancer outweigh benefits for general health maintenance. Lower doses (≤400 IU/day) appear safer for most adults when supplementation is indicated.