Vitamin E: Deficiency and its Treatment and Toxicity

There is no clearly known deficiency disorder of vitamin E. But there is also no doubt that humans need tocopherol or vitamin E in his diet. The deficiency of vitamin E is seen only after resection of small intestine and in prolonged malabsorptive diseases, like celiac disease. There is also a very rare familial form of vitamin E deficiency disease, which is due to defect in alpha-tocopherol transport protein.
Children may develop vitamin E deficiency due to prolonged cholestasis (stasis of bile) or cystic fibrosis of long duration and this is characterized by hemolytic anemia and areflexia. If children suffer from abetalipoproteinemia, they develop vitamin E deficiency very rapidly as they can not absorb or transport vitamin E.

Symptoms of Vitamin E Deficiency:

Vitamin E deficiency causes degeneration of large myelinated axons. Peripheral neuropathy is also a major sign which is characterized by at first areflexia that progresses to ataxic gait and decrease in position and vibration sensation. Pigmented retinopathy, ophthalmoplegia and skeletal myopathy are some other symptoms of vitamin E deficiency. Deficiency of vitamin E increases virulence of viral infection due to increase in viral mutation.

Diagnosis of Vitamin E Deficiency:

Laboratory diagnosis of vitamin E deficiency is done by measuring the blood levels of ? tocopherols. Vitamin E deficiency is if the level of ? tocopherol is less than 5µgm/ml or ? tocopherol is less than 0.8 mg per gram of total lipids.

Vitamin E Toxicity:

High dose of vitamin E (more than 800 mg per day) daily can cause vitamin E toxicity. All forms of vitamin E can cause toxicity. High dose of vitamin E can interfere with vitamin K metabolism and high dose is contraindicated if a patient is taking anticoagulant like warfarin. The symptoms of vitamin E toxicity are diarrhea, nausea, flatulence etc. if the daily intake is more than 1 gram.

Treatment of Vitamin E Deficiency:

Treatment of vitamin E deficiency depends on the severity and type of deficiency. Moderate deficiency with symptoms can be treated with 800-1200 mg of ? tocopherol per day (RDA is about 15 mg per day). If deficiency is due to abetalipoproteinemia, than as much as 5000-7000 mg per day may be required. Children with symptomatic vitamin E deficiency can be treated with 400 mg/day of water-miscible (which can be mixed with water by adding an emulsifying agent) esters.

Image courtesy of Piyachok Thawornmat /

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