Vitamin E

1. http://www.thedailygreen.com/healthy-eating/eat-safe/top-sources-vitamin-E-44111408http://www.thedailygreen.com/healthy-eating/eat-safe/top-sources-vitamin-E-44111408 http://science.kqed.org/quest/2011/10/14/vitamin-e-supplements-increase-prostate-cancer-risk/ Vitamin E Corey Crowe, Brittany Shannon, Amanda Sperry, and Jocelyn Tomsic

2. Overview: • Composition • Food Sources (plant/animal) • Digestion & Absorption • Transport & Metabolism • Storage & Excretion • Functions • Interactions with other nutrients/medications • Deficiencies • Toxicity • Vitamin E and Diseases

3. Vitamin E Composition • Composed of 8 compounds (vitamers) divided into two classes: • Tocopherols: • which have saturated side chains with 16 carbons • Tocotrienols: • which have unsaturated side chains with 16 carbons • Each class is composed of 4 vitamers that differ in the # and location of methyl groups on the chromanol ring.

4. Vitamin E Composition http://lipidlibrary.aocs.org/topics/tocopherols/index.htm • Only the alpha-tocopherol has biological activity and can meet the body’s requirement for the vitamin.

5. Vitamin E Classification • Is part of the fat-soluble vitamin family (A,D,E,K) • Is also an important antioxidant (A,C,E) • Like the other fat-soluble vitamins, vitamin E, is very susceptible to destruction during food preparation and storage. • Tocopherols can become oxidized with long-term exposure to air. • Exposure to light and heat can also lead to its increased destruction.

6. DietaryVitamin http://www.fitnessrxwomen.com/nutrition/healthy-eating-tips/improve-health-performance-with-vitamin-e/

7. Plant Sources Food Sources • Vegetable Oil • Nuts • Seeds • Avocados • Spinach • Kale Animal Sources • Concentrated fats of meats • Found in various forms however, is predominantly found in plant sources, especially the oils from plants. • It is recommended getting proper amounts of vitamin E from mostly food sources rather than supplements. http://ljayhealth.wordpress.com/2012/02/23/health-benefits-of-spinach-2/

8. Supplementation Sources • Vitamin E is present in almost every multivitamin pill. • Alpha-tocopherol in dietary supplements and fortified foods is often esterified to prolong its shelf life while protecting its antioxidant properties. • People need approximately 50% more IU of synthetic alpha tocopherol from dietary supplements and fortified foods to obtain the same amount of the nutrient when compared to the natural form. http://www.ehow.com/how_4542_absorb-vitamin-e.html http://ods.od.nih.gov/factsheets/VITAMINE-HealthProfessional/

9. Digestion & Absorption http://cnx.org/content/m44742/latest/

10. Digestion • Tocopherols are found free in foods, whereas the tocotrienols are found esterified and must be hydrolyzed before absorption. • Pancreatic esterase and duodenal mucosal esterase function in the lumen and/or at the brush border membranes of enterocytes to hydrolyze tocotrienols and synthetic ester alpha-tocopherols for absorption.

11. Absorption • Vitamin E is primarily absorbed in the jejunum by passive diffusion. • Diffused like lipids using bile salts for emulsification, solubilization, and micelle formation • Uptake of vitamin E into cells occurs as lipoproteins are taken up by body tissues and can occur in several ways: • Through receptor-mediated uptake of LDLs • Through lipoprotein lipase-mediated hydrolysis of chylomicrons and VLDLs • Through HDL-mediated nutrient delivery http://www.smscs.com/picview.php?title=digestive+system+images&photo=http%3A%2F%2Fwww.macroevolution.net%2Fimages%2Fhuman-digestive-system-225-401-12.jpg

12. Transport &Metabolism

13. Transport • In the enterocyte, absorbed tocopherols are incorporated into chylomicrons for transportation through the lymph and then into circulation. • During transport in the chylomicrons, tocopherol is transferred among the other lipoproteins, including HDLs and LDLs. • LDLs posses the highest concentrations of vitamin E. http://www.sigmaaldrich.com/life-science/metabolomics/enzyme-explorer/learning-center/plasma-blood-protein/lipoprotein-function.html

14. Metabolism • Chylomicron remnants deliver vitamin E to the liver to be metabolized. • However only RRR alpha-tocopherol is incorporated into VLDL for recirculation back into the blood to be transported to other tissues. http://www.theheart.org/fr/documents/infoSite/infocus/infocus.html

15. Storage &Excretion

16. Storage • There is no single storage organ for vitamin E. • The liver, lungs, heart, muscles, adrenal glands, spleen, and the brain are the major tissues that take up small amounts of vitamin E. • The largest amount (over 90%) occurs in concentrated unesterified form in fat droplets in adipose tissue. • The vitamin E in adipose tissue increases linearly with the intake of it, however the release of it from adipose tissue is much slower even during times of low intake.

17. Excretion • After the liver has absorbed the alpha-tocopherol form of vitamin E and absorption in the small intestine has occurred, the liver secretes only alpha-tocopherol via the hepatic alpha-tocopherol transfer protein. • The liver will metabolize and excrete other forms of vitamin E. • Begins with a hydroxylation reaction that requires Cytochrome P-450. • Then a series of reactions within Beta -oxidation occurs to shorten vitamin E’s side chains. • The end product results in a group of carboxyethyl hydroxychroman • For urinary excretion this carboxyethyl hydroxychroman combines with sulfate to be eliminated.

18. http://novenamaternity.com/ingredients/ Antioxidant Function http://www.wesleyvirgin.com/give-your-body-the-gift-of-kale/

19. Antioxidant Role • The main function of vitamin E: • As an antioxidant, it helps to maintain membrane integrity within cells. • The mechanism by which vitamin E protects the membranes from destruction is through its ability to prevent oxidation of unsaturated FA contained in the phospholipids of the membrane. • The lungs, brain, and RBCs are the most vulnerable AND are the most susceptible to oxidation. http://face-and-emotion.com/dataface/anatomy/brain-cranium.jsp http://www.odiadoctors.com/respiratory-functions-lungs/

20. Antioxidant Role • As an antioxidant, vitamin E can destroy singlet molecular oxygen and stop reactions involving free radicals. • Its ability to diminish free radicals is related to the hydroxyl group on the chromane ring portion of the vitamin. • The hydroxyl group gives up hydrogen and therefore inactivates the free radical. • Not all tocopherols are equal in their ability to diminish free radicals. • Alpha-tocopherol was found to be more effective than beta-tocopherol, gamma-tocopherol, or sigma-tocopherol.

21. http://trialx.com/curebyte/2011/07/06/immune-function-photos-and-related-clinical-trials/http://trialx.com/curebyte/2011/07/06/immune-function-photos-and-related-clinical-trials/ Immune Function

22. Immune Response • Needed to boost the body’s immune system so that it can fight off invading bacteria and viruses. • Vitamin E can partially overcome immunosuppression of substances like: • High levels of PUFA • Severe selenium deficiency • High levels of vitamin C can protect tissue levels of vitamin E and may indirectly contribute to the immunoenhancement by vitamin E. http://healthy-proteins.blogspot.com/2012/11/optimize-your-immune-system-naturally.html

23. Interactions with Other Nutrients

24. How Does Vitamin E Get Along With…? • Selenium • Vitamin C • Dietary polyunsaturated FA • Other fat-soluble vitamins (especially Vitamin K)

25. Vitamin E and Selenium • Selenium has roles in reproduction, thyroid hormone metabolism, DNA synthesis, and protection from oxidative damage and infection. • The actions of both nutrients complement each other • Higher concentrations of one can reduce the effects of lower concentration of the other, creating a counterbalancing body system. http://healthfreedoms.org/2009/05/27/selenium-in-diet-overview/

26. Vitamin E and Vitamin C • Similar to vitamin E’s relationship with Selenium, Vitamin C also complements vitamin E. • Though vitamin E is an antioxidant, it can become oxidized when it interacts with a free radical, therefore creating more oxidative damage. • But vitamin C can interact with oxidized vitamin E, reducing free radicals and regenerating the benefits of vitamin E. https://az.naturesgardendelivered.com/blog/increase-your-vitamin-c-intake-and-ward-off-seasonal-allergies/ http://reebokcrossfit5thave.com/tag/vitamin-c/

27. Vitamin E and Polyunsaturated Fatty Acids • Vitamin E requirements increase or decrease as the degree of unsaturated fatty acids in body tissues rise or fall, respectfully. • Body tissue lipids are in turn influenced by dietary lipid intake. • Foods high in polyunsaturated FA also tend to be relatively good sources of vitamin E. http://www.beefitzxt.com/main/products

28. Vitamin E and Fat-soluble Vitamins • High intake of vitamin E can interfere with other fat-soluble vitamins. • Vitamin E inhibits beta-carotene absorption and its metabolism in the intestine. • Impairs vitamin K absorption and its metabolism. • The effects of vitamin E may increase the risk for bleeding secondary to the interference of vitamin K’s ability to clot blood • Vitamin E is also important in helping your body make red blood cells, and it helps the body to use vitamin K. http://www.hollandandbarrett.com/pages/categories.asp?cid=70

29. Possible Interactions with Medications: -Antidepressant medications (ex: Norpramin) -Antipsychotic medications (ex: chlorpromazine) -AZT (A medication used to treat HIV and AIDS) -Bile acid sequestrants (ex: Cholestyramine, cholestipol) -Statins (ex: Niacin and Zocor) • -Chemotherapy drugs (ex: chlorambucil) • -Anticoagulant and antiplatelet medications • -Chemotherapy and radiotherapy • -Aspirin • -Orlistat • -Beta-blockers (ex: Propranolol)

30. Deficiencies and Symptoms

31. Deficiencies • Deficiencies of vitamin E are rare in humans, but many people have slightly low levels. • Since the digestive tract requires fat to absorb vitamin E, people with fat-malabsorption disorders (for example steatorrhea or cystic fibrosis) are more likely to become deficient rather than people without such disorders. • Deficiencies that last a long time could cause liver and kidney problems. http://www.123rf.com/photo_7732679_feet-on-a-bathroom-scale-with-the-word-help-on-the-screen-isolated--includes-clipping-path.html http://immunetreeblog.com/extreme-fatigue-what-causes-extreme-tiredness/

32. Symptoms • Myopathy (skeletal muscle pain) and Weakness • Ceroid Pigment Accumulation (fat accumulation) • Hemolytic Anemia • Degenerative Neuropathy • Ataxia • Loss of Vibratory Sense • Loss of Coordination of Limbs http://myweb.tiscali.co.uk/ataxia.pages/

33. Toxicity http://www.newautism.com/heavy-metal-toxicity/158/

34. Problems Associated with Toxicity • Vitamin E appears to be one of the least toxic vitamins. • It is not mutagenic, carcinogenic, or teratogenic • Oral supplementations of vitamin E do not result in serious side effects • Mild gastrointestinal problems may occur with intake between 200 and 800 mg. • Due to the increased tendency for bleeding, because of antiplatelet effects and/or abnormal blood clotting, a Tolerable Upper Intake of 1,000 mg/day of alpha-tocopherol has been suggested.

35. Toxicity Symptoms • Gastrointestinal Distress • Nausea • Diarrhea • Flatulence • Impaired Blood Coagulation • Increased Severity of Respiratory Infections • Muscle Weakness • Fatigue • Double Vision http://news.softpedia.com/news/Common-Antibiotic-Effective-Against-Bloating-and-Flatulence-18165.shtml http://medicalmarijuanalabprojectthursdayam.wikispaces.com/file/detail/nausea.gif/386256408

36. Vitamin E and Disease

37. Vitamin E & Heart Disease • Results have not shown that vitamin E helps lower the risk of Heart Disease • One of the largest studies, the Heart Outcomes Prevention Evaluation (HOPE) trial, found that taking 400 IU of vitamin E (d-alpha-tocopherol) daily did not lower the number of heart attacks, strokes, or deaths from heart disease among men and women who already had heart disease or were at high risk for it. • What about in healthy people who were at low risk for heart disease? • Two large trials also found no protection from vitamin E. In one -- the Physicians' Health Study II -- vitamin E was associated with a higher risk of stroke http://health.allrefer.com/pictures-images/vitamin-e-and-heart-disease.html

38. Vitamin E and Cancer • There is no concrete evidence to support the fact that Vitamin E can cure/prevent cancer • There is a small amount of evidence suggesting that taking vitamin E along with vitamin A and vitamin C, or as part of a multivitamin would help protect people who had colorectal adenomas, a precursor for colon cancer. • There are several studies showing that intake of multiple vitamin supplements, including vitamin E can lower prostate cancer. • Vitamin E has some positive effects on cancer treatment • A study of 108 people taking chemotherapy drug cisplatin found that taking a vitamin E supplement during and as long as three months after treatment reduced nerve damage from the drug. • Some doctors worry though that large doses of antioxidants could interfere with chemotherapy medications.

39. Vitamin E and Eye Health • Vitamin E (400 IU) combined with other antioxidants including zinc, beta-carotene and vitamin C protect against developing macular degeneration (AMD). • AMD is the leading cause of legal blindness in people over 55 in the United States. • People with advanced AMD seem to benefit the most from this treatment. • Vitamins E and C can also help to treat uveitis, or inflammation of the uvea. This is the middle layer of the eye. • These vitamins can help people with inflammation and help them to have clearer vision. http://www.lookupinfo.org/easy_read_information/easy_read_eye_health_information.aspx

40. Vitamin E and Photodermatitis • Photodermatitis is a condition where an individual has an allergic reaction to UV sun rays. • An 8 day study which compared treatment with vitamins C and E to a placebo found that people who took the vitamins became significantly less sensitive to the sun. • Another study lasting for 50 days showed a protective effect from the vitamin C and E treatment. http://www.abc.net.au/news/2011-10-07/uv-rays-more-damaging-than-thought/3335828

41. Vitamin E and Dementia • Studies have documented low levels of vitamin E in patients with Alzheimer's disease. • A placebo-controlled trial found that supplementation with 2,000 IU of synthetic alpha-tocopherol daily for two years significantly slowed progression of Alzheimer's dementia. • Vascular dementia (dementia resulting from strokes) • A study examining risk factors for vascular dementia in elderly Japanese-American men found that supplemental vitamin E and vitamin C intake was associated with a significantly decreased risk of vascular and other types of dementia but not Alzheimer's dementia. • Among those without dementia, vitamin E supplement use was associated with better scores on cognitive tests.

42. Take Home Points… To be able to discuss the importance of Vitamin E in our diet. To understand the digestion, absorption, transportation and excretion of Vitamin E. To be able to identify the major food sources of Vitamin E. To understand the effects of Vitamin E on certain diseases.

43. Questions? http://www.inc.com/tom-searcy/5-great-questions-ceos-ask-customers.html

44. References • National Institute of Health: Office of Dietary Supplements. Vitamin E. Reviewed: June 05, 2013. Available at http://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/#h2. Accessed November 06, 2013. • Ehrlich S. Vitamin E. University of Maryland Medical Center Complimentary and Alternative Medicine Guide. http://umm.edu/health/medical/altmed/supplement/vitamin-e Published Jan 15, 2012. Last Updated May 7, 2013. Assessed Nov 10, 2013. • Micronutrient Information Center: Vitamin E. Linus Pauling Institute, Oregon State University, Corvallis, OR. Available at: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminE/. Accessed November 13, 2013. • Bendich A. Vitamin E and immune functions. Basic Life Sci. 1988;49:615-20. • Anderson KE. Comparison of fatty acid, cholesterol, vitamin A and E composition, and trans fats in eggs from brown and white egg strains that were molted or nonmolted. Poult Sci. 2013;92(12):3259-65. • Dietary Facts Sheet: Selenium. National Institutes of Health: Office of Dietary Supplements. Available at: http://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/. Accessed October 9, 2013. • Gropper, SS, Smith. Advanced Nutrition and Human Metabolism, 6th Edition, Wadsworth/Cengage Learning, 2012.