What is the recommended form and composition of a vitamin E supplement, specifically regarding tocopherol (T) and tocotrienol (T3) content, and whether it should be taken with or without omega 3?

Vitamin E Supplementation Recommendations

Alpha-tocopherol is the recommended form of vitamin E supplement, as it is the only form that contributes to meeting vitamin E requirements, and it should be taken with fat to enhance absorption. 1

Recommended Form of Vitamin E

• Alpha-tocopherol is the natural vitamin E with the highest biological activity and the only form that contributes toward meeting vitamin E requirements 1
• Other naturally occurring forms of Vitamin E (β, γ, and δ-tocopherol and tocotrienols) are not converted to α-tocopherol by humans and therefore do not contribute toward meeting vitamin E requirements 1
• Despite some research suggesting tocotrienols may have superior antioxidant and anti-inflammatory properties, only α-tocopherol has been definitively shown to prevent human vitamin E deficiency disease 2, 3

Dosage Recommendations

• The Recommended Dietary Allowance (RDA) for vitamin E is 15 mg α-tocopherol per day for adult men and women 1
• For older adults, intakes as high as 200 mg/day may be needed for optimal immune function 1
• Vitamin E requirements depend on polyunsaturated fatty acid (PUFA) intake: 0.5 mg RRR-α-tocopherol should be consumed for every gram of diene fatty acids 1, 4

Food vs. Supplement Form

• Food sources of vitamin E include plant oils, nuts, seeds, and green leafy vegetables
• Supplemental forms are typically available as α-tocopherol or α-tocopheryl acetate
• Both natural and synthetic forms of α-tocopherol are effective, though natural forms may have slightly higher bioavailability 1

Absorption Considerations

• Vitamin E absorption is enhanced when supplements are consumed with fat 1
• Absorption is inhibited by disorders causing impaired bile secretion 1
• The mechanism of vitamin E absorption requires solubilization in a micellar form before uptake by enterocytes 1

Omega-3 and Vitamin E Interaction

• When taking omega-3 supplements (EPA and DHA), vitamin E requirements increase due to the higher oxidative potential of these fatty acids 4
• The standard recommendation of 0.6 mg α-tocopherol equivalents per gram of PUFA may be insufficient when consuming highly unsaturated fatty acids like EPA and DHA 4
• Higher vitamin E intake may be necessary when consuming omega-3 supplements to prevent lipid peroxidation 4

Safety Considerations

• Vitamin E has a relatively low toxicity profile at recommended doses 5
• The Tolerable Upper Limit for vitamin E supplementation in adults is set at 1000 mg (approximately 1500 IU) 1, 5
• High-dose vitamin E supplementation (≥300 mg/day) may increase bleeding risk, particularly in patients taking anticoagulant medications 5, 6
• Individuals taking anticoagulant drugs like warfarin should not take vitamin E supplements without medical supervision 1, 5

Clinical Applications

• For patients with long-standing fat malabsorption (e.g., short bowel syndrome), vitamin E supplementation of 200 mg/day can improve neurological symptoms 1, 5
• Vitamin E should be supplemented if plasma α-tocopherol levels are below 12 μmol/L, starting with 100 mg per day depending on the cause of deficiency 1

In conclusion, when selecting a vitamin E supplement, choose one containing α-tocopherol, take it with a fat-containing meal to enhance absorption, and consider your omega-3 intake when determining the appropriate dosage. If you're taking anticoagulant medications, consult with your healthcare provider before starting vitamin E supplementation.