There have been many studies showing both the health benefits and safety with vitamin E supplementation. A recent study by researchers at Johns Hopkins University suggests that doses of vitamin E greater than 400 I.U. per day can increase the risk of death and should be avoided.

The research was based on meta-analysis of 19 unrelated clinical trials that studied vitamin E supplementation for various health conditions. The trials took place from 1993 to 2004 and included 136,000 patients on doses from 15 I.U. to 2,000 I.U. per day. This type of study, by design, raises questions but does not answer them.

In addition, this study has created a lot of controversy over one of the main tenets of modern nutrition: the health benefits of vitamin E supplementation. While there appear to be many design flaws in this study, it has been helpful in forcing clarification of many clinically relevant issues relating to vitamin E supplements. It has caused many of us to re-examine the published studies and apply common sense to vitamin E recommendations. Some relevant questions it provokes include:

· Do different forms of vitamin E have different health benefits?

· What is a reasonable dosage of vitamin E?

· Is vitamin E supplementation safe?

Vitamin E is fat soluble and found naturally in foods including nuts, seeds, whole grains, fish, vegetable oils and green leafy vegetables. However, vitamin E is not just one substance but is actually eight naturally occurring compounds: 4 tocopherols called

alpha tocopherol, gamma tocopherol, delta tocopherol and beta tocopherol; 4 tocotrienols called alpha tocotrienol, gamma tocotrienol, delta tocotrienol and beta tocotrienol. Since humans do not have the ability to make vitamin E, we must acquire it from foods. In addition, each of the eight components of vitamin E cannot be converted from or to any of the other compounds of vitamin E. Also, they each occur in various ratios in different foods.

Of the eight compounds, gamma tocopherol is approximately 70 percent of the vitamin E consumed from plant foods and seeds. Also, while all eight compounds of vitamin E are important, gamma tocopherol is equally, if not more important, than alpha tocopherol in preventing chronic illness. Unfortunately, until very recently, almost all Vitamin E supplements contained primarily alpha tocopherol. To confuse the issue further, there are two types of alpha tocopherol: a synthetic man-made "dl"- alpha tocopherol and a natural "d"-tocopherol. This is important to know since most of the studies with bad results used man-made, synthetic vitamin E.

Also, researchers have found that large doses of alpha tocopherol supplements suppress levels of gamma tocopherol in the body. This would in effect create a deficiency state of the gamma tocopherol which would not be beneficial to one's health.

Therefore, as a general rule, most individuals should not regularly supplement for extended periods alpha tocopherol by itself in doses greater than 400 I.U. per day. It is my opinion that synthetic, man-made vitamin E should be avoided altogether.

Look for a vitamin E supplement which consists of mixed natural tocopherols with a 1 to 1 ratio of alpha and gamma tocopherol in doses up to 400 I.U. per day. Delta and beta tocopherols should be present in smaller amounts. For optimal health benefits, vitamin E should be taken along with a balanced omega 3 and omega 6 fat supplement (fish oil). Also, most people would benefit from a daily multiple vitamin-mineral supplement.

Remember that supplements are just that. They do not replace healthy dietary habits so we should do the best we can to daily eat healthy proteins, fats, and carbohydrates. Try to avoid added sugars, white flour, hydrogenated fats and other added chemicals.

While the Johns Hopkins study has created a healthy dose of controversy it should be neither disregarded nor taken as gospel. "It should be regarded as a reminder that common sense of balance and moderation is almost always correct. We should continue when appropriate to utilize vitamin E supplements but only those that contain a balance of all the different forms of vitamin E. "(Dr. Jeffrey Moss)

[Information for this article was in part gathered from The Moss Nutrition Report]

Drs. Michael Cocco and Timothy Sweigard practice at Amity Chiropractic and Rehabilitation Center, LLC, in Woodbridge. Questions or comments can be forwarded to