Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Nancy Hepp, MS, BCCT Project Manager
Last updated November 20, 2020.
Also known by these names
Vitamin E is a natural antioxidant found in the following foods:
- Green leafy vegetables
- Wheat germ
- Whole grains
- Plant oils, especially from rice bran, sunflower, safflower, cottonseed and palm
Vitamin E is also available in supplement form.
Practice Guidelines and Recommendations
The US Preventive Services Task Force (USPSTF) recommends against vitamin E supplements for the prevention of cardiovascular disease or cancer.”6
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
No reported clinical trials have used vitamin E as a stand-alone anticancer treatment. Most of the studies in humans look at its use in combination with drugs or in combination with conventional chemotherapy or radiotherapy.
Lab and Animal Evidence
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Use in combination with drugs or in combination with conventional chemotherapy or radiotherapy shows that vitamin E may reduce side effects such as oral mucositis and peripheral neuropathy, as shown in several small studies,11 although overall evidence is insufficient to recommend use for treating or preventing chemotherapy-induced peripheral neuropathy (CIPN).12
Antioxidants including vitamin E may protect against cisplatin-induced toxicity in the kidneys (nephrotoxicity) and the ears (ototoxicity).14
Lab and Animal Studies
Reducing the risk of developing cancer or the risk of recurrence
The impacts of vitamin E on cancer risk are complex and vary by the form of vitamin E and by the status of other nutrients and genetic backgrounds of individuals.
Dietary Vitamin E
Higher amounts of dietary vitamin E consumed by prostate cancer patients of European-American descent were associated with less aggressive forms of the disease. This was not seen in patients of African-American descent.17
Results published in 2014 of a large-scale randomized trial in men showed vitamin E and C supplementation had no immediate or long-term effects on the risk of total cancers, prostate cancer, or other site-specific cancers.18
Serum Levels of Vitamin E
Findings with prostate cancer:
- Progressively higher PSA scores with decreasing serum levels of vitamin E with in a small study19
- Decreased risk for developing prostate cancer with higher serum alpha-tocopherol levels, with a higher association of decreased risk for advanced prostate cancer and a greater association among those taking alpha-tocopherol supplements20
- Reduced total prostate cancer risk and aggressive cancer risk in current smokers with higher alpha-tocopherol or gamma-tocopherol levels, with some evidence of differences among genotypes21
Studies have found inconsistent evidence of effects of vitamin E supplementation on prostate cancer risk:
- Increased risk among healthy men in a large study taking synthetic all rac-alpha-tocopheryl acetate supplements,23 limited to those with lower baseline selenium levels, with indications of differences by genetic types24
- Increased risk from alpha-tocopherol supplementation but decreased risk with gamma-tocopherol use25
- Reduced risk for both prostate cancer and advanced cancer with alpha-tocopherol in a pooled analysis, but no association with gamma-tocopherol26
Analyses of data propose that risks associated with vitamin E may vary by genotype of patients or by the specific form of vitamin E (alpha-tocopherol versus gamma-tocopherol, for instance)27
A 2017 review indicates that studies focusing on alpha-tocopherol supplements may be missing important effects from other forms of vitamin E. The authors of this review found that accumulating research results show that other forms of vitamin E—such as gamma-tocopherol, delta-tocopherol, gamma-tocotrienol, and delta-tocotrienol—have far superior cancer-preventive activities than does alpha-tocopherol. Evidence strongly indicates that these lesser-known vitamin E forms are effective agents for cancer prevention or as adjuvants for improving prevention of cancer.28
Findings on colorectal cancer:
- Most supplements contain α-tocopherol, while a γ-tocopherol-rich mixture of tocopherols inhibits growth of colon and other types of tumors in animals29 and in epidemiological studies30
- Reduced risk of colorectal cancer in women taking unspecified forms of vitamin E supplements31 but not in men taking 400 IU/day of all-rac-α-tocopheryl acetate (see the study for an analysis of whether the correct form was used)32 in large studies
- Other reviews and a meta-analysis concluded no reduced risk with vitamin E or other antioxidants33 (but again, the specific forms of vitamin E may have varying effects).
- No reduced risk of adenoma occurrence34
Optimizing Your Terrain
Creating an environment within your body that does not support cancer development, growth or spread
Vitamin E improved immune activity in patients with advanced colorectal cancer.35
Lab and Animal Evidence
Vitamin E has reportedly inhibited protein kinase C activity, which affects cell proliferation (growth) and differentiation.36
Low doses of vitamin E are considered relatively nontoxic. However, vitamin E can cause side effects and drug interactions, some of which can be serious. Daily levels at or above 400 IU are not recommended. Higher levels have been associated with increased mortality:
- Doses greater than 400 IU/day increased all-cause mortality, mostly in patients with chronic diseases. Higher levels of supplements were associated with greater mortality.37
- No increase in mortality at doses up to 800 IU/day was seen in apparently healthy people.38
- Increased mortality was found in mixed studies of healthy individuals and those with diseases.39
Lung cancer patients, especially former or current smokers, “should avoid megadoses of particular antioxidants such as vitamin E and beta-carotene, as well as vitamin A . . . some studies have indicated risks to these patients and to smokers from pro-oxidants formed in the hazardous internal environment that smoking causes.”40
Some researchers express concerns that vitamin E interferes with chemotherapy and radiation therapy.42
Most vitamin E supplements contain only alpha-tocopherol. Integrative oncologist and BCCT advisor Keith Block, MD. cautions against giving alpha-tocopherol alone, as this may deplete the body of other important components of vitamin E.43
Consult your pharmacist for interactions, and discuss using vitamin E with your doctor. See the following sources for more information on specific side effects, cautions and contraindications:
- Memorial Sloan Kettering Cancer Center: Vitamin E
- CAM-Cancer’s Summaries: Vitamin E during cancer treatment
Vitamin E is widely available in food sources and in supplements.
BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated.
As noted above, levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.
Although no optimal vitamin E dose during or after cancer treatment has been established, suggested dosages are listed in these sources:
- Solutions 4 Health:
- Natural Medicines Database (requires purchase)
- Also see the protocols below.
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
Integrative oncology clinicians such as Keith Block, Dwight McKee and Lise Alschuler incorporate vitamin E supplementation into care either during active cancer treatment or after treatment care (or both) to prevent recurrence or secondary cancers.
Programs and protocols
- Alschuler & Gazella complementary approaches44
- Bastyr University Integrative Oncology Research Center protocol for stage IV breast cancer45
- Block program46 (select tocopherols)
- Chemopreventive nutraceutical in remission maintenance program:
- Core diet plan
- Combination antioxidant support formula and terrain modification
- Anti-inflammatory support
- Immune surveillance booster
- Circulatory support supplement
- Remission maintenance program
- Lemole, Mehta & McKee protocols47 (select tocopherols)
- MacDonald breast cancer program48
- McKinney protocols49 (select tocopherols)
- General cancer
- Bladder cancer
- Brain/nerve cancer
- Breast cancer
- Carcinoid/neuroendocrine cancer
- Cervical cancer
- Colorectal cancer
- Esophageal cancer
- Head and neck cancer
- Kidney cancer
- Leukemia and myelodysplastic syndrome
- Multiple myeloma
- Prostate cancer
- Skin cancer
- Stomach cancer
- Thyroid cancer
- Uterine cancer
According to Raymond Chang, MD, tocotrienols are much more potent than the tocopherol form of E vitamins, especially gamma-tocotrienol, and especially against cancer.51
Integrative oncologist and BCCT advisor Keith Block, MD: “Avoid high doses of single antioxidant supplements . . . Labile antioxidants—which include vitamins A, C and E, selenium and beta-carotene—can change into pro-oxidants . . . Thus they can increase the oxidative stress of your terrain and, if used without proper supervision, enhance the growth and spread of cancer cells. Used in the right dosages and combinations, however, they can help control malignancy.”52 Dr. Block advises using antioxidants like vitamin E in a mix of diverse antioxidants to promote a synergistic effect.53
Nutrition Advisor Karen Collins, MS, RDN, CDN, FAND, from the American Institute for Cancer Research, July 26, 2019: There are multiple reasons to be cautious about alpha-tocopherol supplements much beyond RDA level. I cannot find evidence of an effect on absorption of tocotrienols and other tocopherols, but it has been known for many years that high levels of alpha-tocopherol intake tend to decrease blood and tissue levels of gamma-tocopherol. (I'm not sure of the reason—perhaps through effects on absorption from the gut, but perhaps on saturation of metabolic enzymes, preferential saturation of carriers within the body, or other mechanisms.)
While there is great interest in the potential of tocopherols and tocotrienols beyond alpha-tocopherol for anticancer effects, these ideas are largely based on in vitro and animal studies. There is a big leap from these kinds of studies to human application, which need to consider dose, bioavailability, potential differences among human populations.
However, it's important to think more broadly about your question, too. Our antioxidant defense network (from exogenous sources and endogenous elements within our body) interact in many ways. So setting any single element high may have ramifications on others. Selenium is one example, which is noted in the references I share below and is still coming up in studies as recently as May.
Perhaps this summary of research and recommendations written for health professionals will be helpful to you: National Institutes of Health Vitamin E: Fact Sheet for Health Professionals. It focuses on alpha-tocopherol, since that is the only form for which we have established recommended intake at this time. The reason I recommend it for your review is that it provides important perspective on potential for excess. Although the Tolerable Upper Intake Levels (set to accompany the RDAs) were developed based on avoidance of hemorrhagic effects, evidence from studies like the SELECT trial show that problems such as increased risk of prostate cancer can occur at levels above the RDA but well below that upper limit. (Remember back in the day when cardiologists were excited to recommend 400 IU to all their heart patients??)
Another reference that may help explain the strong findings about the dangers of antioxidant supplements during cancer treatment: Avoiding Antioxidant-Drug Interactions During Cancer Treatment.
My bottom line: Concern about interactions of alpha-tocopherol supplements with tocotrienols and other tocopherols is only one of several reasons to be concerned about supplementation beyond the RDA, especially well beyond it.
Non-cancer Uses of Vitamin E
BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.
- National Institutes of Health: Vitamin E Fact Sheet for Health Professionals
- TRC Natural Medicines Database: Vitamin E (subscription required): in-depth information, ratings of effectiveness and safety and evaluation of specific resveratrol products
- Consumer Labs: Product Review (subscription required): Vitamin E Supplements, Cream, and Oil (Including Tocopherols and Tocotrienols)
- Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
- National Cancer Institute at the National Institutes of Health: PDQ® Cancer Information Summaries
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Memorial Sloan Kettering Cancer Center: About Herbs, Botanicals and Other Products
- National Cancer Institute: Complementary and Alternative Medicine for Health Professionals
- National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
- Lone Star Medical Group: Natural Alternative Treatments
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer