Among dietary supplements, vitamin E is a superstar. Even the mainstream medical establishment recognizes its usefulness. According to the U.S. National Institutes of Health, the alpha-tocopherol form of vitamin E is a "powerful biological antioxidant" that protects cells against "damage that may contribute to the development of cardiovascular disease and cancer." But because there are eight different forms of vitamin E, the question of which vitamin E to supplement with can be confusing. So to answer a question from an HSI member about a specific type of vitamin E, I called on HSI Panelist Allan Spreen, M.D., to help clear up some of the confusion about which forms of vitamin E are the most effective. The question comes from a member named Derek in Melbourne, Australia, who came across a Vitamin E study that he found to be in conflict with some HSI information. Here's Derek's e-mail: "Some time ago an E-alert and other information from HSI indicated the enormous benefits from using tocotrienols over the usual d-alpha tocopherol form of Vitamin E. Having very high triglycerides and slightly elevated cholesterol, I was extremely interested in obtaining a supply. However, a paper, produced by the American Journal of Clinical Nutrition (AJCN), stated that the tocotrienols were 'less effective than the d-alpha tocopherol, had less anti-oxidant activity, and were also 8-9 times more expensive.' This leaves me in rather a quandary." Looking over the details of the AJCN report (Derek kindly provided a link to the study in his e-mail), I'm not surprised that Derek is confused. For instance, the study lasted only 6 weeks. As we've seen with other trials, the positive effects of many supplements often don't reveal themselves within the first three months. In other words: it's impossible to draw hard and fast conclusions from such a brief test. Derek is right about the cost of tocotrienols; they tend to be far more expensive than other forms of vitamin E. So are they worth the cost? They just might be. As Dr. Speen points out, "There has been considerable peer-review research concerning the benefit of tocotrienols in even more than just cardiovascular disease, to include aging, Alzheimer's disease, breast disease and others." And yet, we can't simply conclude that the tocotrienol forms of vitamin E are "expensive, but effective." Dr. Spreen makes it clear that they should not be used in place of the tocopherols, which he calls the "true forms" of the vitamin.
Dr. Spreen begins his response to Derek with a look at two forms of tocopherols: "Any publication (and I don't care what its credentials), or any individual (and I don't care what his reputation) who recommends d-alpha tocopherol in any capacity other than topically (for skin problems, etc.) has missed the boat. Well, actually they haven't missed it completely, but they're hanging on to the transom by their fingernails. To miss the boat completely you'd have to recommend dl-alpha tocopherol (or -tocopheryl), which is the synthetic form. It's very inexpensive, and okay topically, but in no way should it be taken internally. "Now, at least d-alpha vitamin E is natural in form. However, the answer is more complicated than that: there are other fractions of vitamin E (not counting the tocotrienols), specifically beta- and gamma-tocopherols (there are probably others, too, but we haven't found them yet). In this case, even going 'natural' is not the answer. Originally it was thought that only the alpha form had any activity in the body. Then the vitamin E 'gurus' discovered that high doses of alpha-tocopherol lowered the body's amounts of the other two. Since the real effects of vitamin E come with higher doses, that's not something you want to alter over long periods of time." And what happens when a single fraction is taken alone? Dr. Spreen pointed out a 1997 study in the American Journal of Clinical Nutrition that showed that high doses of alpha-fraction vitamin E, taken without the rest of the 'family,' actually became PRO-oxidant, rather than antioxidant! "So, the answer to this problem, assuming you wish to evaluate the effects of vitamin E on yourself, is to take 'mixed tocopherols' so that you get all the fractions."
Where, then, do the tocotrienols that Derek asked about fit in with the mixed tocopherols? Dr. Spreen says he considers them "icing on the cake," and adds: "Tocotrienols even further expand upon the spectrum of vitamin E-like agents, and I would always start with the natural vitamin E and add the new kids on the block if I were wealthy enough or wanted to cover all the bases. Of course 'covering all the bases,' to me, would also mean adding selenium to the mix, which enhances the effect of vitamin E (along with powers in its own right)." My thanks to Dr. Spreen for his vitamin E insights, which I hope will help lift Derek from his quandary. To Your Good Health, Jenny Thompson Health Sciences Institute Sources: "A vitamin E Concentrate Rich in Tocotrienols had No Effect on Serum Lipids, Lipoproteins, or Platelet Function in Men with Mildly Elevated Serum Lipid Concentrations" American Journal of Clinical Nutrition, Vol. 69, No. 2, 213-219, February 1999, ajcn.org | 
