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Research · Supplements

Vitamin E

In large trials, vitamin E did not change heart events or cancer. In SELECT, 400 IU a day raised prostate cancer 17%. Pooled trials found more hemorrhagic strokes and fewer ischemic strokes. Mortality meta-analyses disagree. In fatty liver disease, pooled trials found lower liver enzymes and more fibrosis improvement. One trial slowed functional decline in Alzheimer's disease.

Add to Bio HackChecked 2026-11-09
Status
Dietary supplement in the US.
Also called
alpha-tocopherol, tocopherol, d-alpha-tocopherol, dl-alpha-tocopheryl acetate, mixed tocopherols, tocotrienols
Taken for
heart health, cancer prevention, antioxidant, Alzheimer's disease, memory, fatty liver, skin, recovery, period pain, endometriosis pain, PMS

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help3

Reported risks4

What people take it for, and what was found

Shown to help3

Moderate

Fatty liver inflammation (NASH)

Shown to improve liver inflammation in adults with NASH without diabetes, 43% against 19% on placebo in one trial. Results on fibrosis disagree.

The numbers and sources
Effect
After 96 weeks, nonalcoholic steatohepatitis improved in 43% on 800 IU a day and 19% on placebo. Liver enzymes, fat and inflammation fell. Fibrosis scores did not improve [6]. Across 3 placebo-controlled RCTs in steatohepatitis, vitamin E lowered ALT (MD -12.27, 95% CI -16.66 to -7.89) and raised the odds of fibrosis improvement (OR 1.96, 95% CI 1.25 to 3.09). Resolution of steatohepatitis did not differ significantly (OR 1.71, 95% CI 0.69 to 4.27) [7]. Across 16 RCTs in fatty liver disease, vitamin E lowered AST (WMD -5.94 IU/L) and ALT (WMD -7.33 IU/L) [8]. In a Chinese trial, liver histology improved in 29.3% on 300 mg a day and 14.1% on placebo, with gains in steatosis, inflammation and fibrosis stage [9].
Population
247 adults with nonalcoholic steatohepatitis and without diabetes [6]; adults with steatohepatitis in 2 US trials and 1 Chinese trial [7]; adults with metabolic dysfunction-associated steatotic liver disease [8]; 124 adults without diabetes with biopsy-proven steatohepatitis in China [9].
Sources
[6], [7], [8], [9]
Caveats
The 3-trial review is small and its resolution result was heterogeneous [7]. The first large trial found no fibrosis improvement [6], while the pooled analysis and the Chinese trial did [7][9]. The enzyme review could not judge fibrosis or long-term liver outcomes [8].
Limited

Alzheimer's disease

One trial found daily living ability declined about 19% more slowly per year on 2,000 IU a day in veterans with mild to moderate Alzheimer's disease.

The numbers and sources
Effect
Over a mean 2.27 years, scores on a daily living scale declined 3.15 units less on 2,000 IU a day than on placebo (95% CI 0.92 to 5.39), which the authors equate to a 19% slower decline per year. Caregiver time rose least in the vitamin E group [10].
Population
613 veterans with mild to moderate Alzheimer's disease taking a cholinesterase inhibitor, 561 analyzed [10].
Sources
[10]
Caveats
One trial at 14 Veterans Affairs centers. 52 participants with no follow-up data were left out of the analysis [10].
ModerateStudied in women

Endometriosis pain, with vitamin C

Shown in pooled trials to ease pelvic pain, period pain and pain with sex in women with endometriosis when vitamin E was taken with vitamin C.

Compared with placebo [19][20][21]

The numbers and sources
Effect
Across 5 RCTs of vitamins C and E together, more women reported less chronic pelvic pain (RR 7.30, 95% CI 3.27 to 16.31), less period pain (RR 1.96, 95% CI 1.25 to 3.07) and less pain with sex (RR 5.08, 95% CI 2.10 to 12.26) than on placebo [19]. A review of 13 RCTs found vitamin E, with or without vitamin C, improved pelvic pain [20]. In one trial, 1,200 IU of vitamin E with 1,000 mg of vitamin C for 8 weeks improved everyday pain in 43% of women (P = 0.0055), with no change on placebo, and period pain fell in 37% [21].
Population
5 RCTs in women with endometriosis [19]; 13 RCTs with 589 women [20]; 59 women aged 19 to 41 with pelvic pain and endometriosis or infertility [21].
Sources
[19], [20], [21]
Caveats
Vitamin E was given with vitamin C, so its share of the effect is not separated. Trials were small and lasted about 8 weeks. The second review's abstract gives no pooled size for vitamin E [20].

Mixed results1

ModerateStudied in women

Period pain

Mixed results: two reviews found vitamin E lowered period pain more than placebo, while a Cochrane review of two trials found no difference.

Compared with placebo [16][17]; placebo or no treatment [18]

The numbers and sources
Effect
Across 8 RCTs, vitamin E lowered primary dysmenorrhea pain more than placebo in the first month (SMD -1.16, 95% CI -2.16 to -0.17) and the second month (SMD -1.83, 95% CI -2.90 to -0.77), with no serious side effects reported [16]. A review of micronutrients found lower pain on vitamin E than placebo (SMD -0.47, 95% CI -0.74 to -0.20) [17]. A Cochrane review found no difference on a 0 to 10 pain scale (MD 0.00 points, 95% CI -0.34 to 0.34, 2 RCTs, 135 women) [18].
Population
8 RCTs with 1,002 women with primary dysmenorrhea [16]; 16 trials with 1,871 participants aged 13 to 40, 4 of them of vitamin E [17]; 27 RCTs with 3,101 women, mostly students in their late teens or early twenties [18].
Sources
[16], [17], [18]
Caveats
Heterogeneity was high in the second month (I² 76%) [16]. The Cochrane review rated all its evidence low or very low quality, and most trials were from Iran [18]. The reviews included different trials.

Not shown to help4

Moderate

Heart attack, stroke and cardiovascular death

Not shown to lower heart attack, stroke or cardiovascular death in male physicians or in people with vascular disease or diabetes.

The numbers and sources
Effect
Over 8 years, 400 IU every other day did not change major cardiovascular events (HR 1.01, 95% CI 0.90 to 1.13) in male physicians [1]. Over a median 7 years, 400 IU a day did not change major cardiovascular events (RR 1.04, 95% CI 0.96 to 1.14) in people with vascular disease or diabetes [2]. Across 9 trials, total stroke did not change (RR 0.98, 95% CI 0.91 to 1.05) [3].
Population
14,641 US male physicians aged 50 or older [1]; 9,541 people aged 55 or older with vascular disease or diabetes [2]; 118,765 participants in 9 trials [3].
Sources
[1], [2], [3]
Caveats
The stroke total hides opposite effects by subtype (see Risks) [3].
Moderate

Cancer prevention

Not shown to lower cancer in trials mostly of men. One large trial found more prostate cancer on vitamin E.

The numbers and sources
Effect
Prostate cancer did not fall. In SELECT, it rose on vitamin E (HR 1.17, 99% CI 1.004 to 1.36) [4]. In the Physicians' Health Study II, prostate cancer (HR 0.97, 95% CI 0.85 to 1.09) and total cancer (HR 1.04, 95% CI 0.95 to 1.13) did not differ [5]. In HOPE, cancer incidence (RR 0.94, 95% CI 0.84 to 1.06) and cancer death did not differ [2].
Population
34,887 men in SELECT [4]; 14,641 male physicians [5]; 9,541 people with vascular disease or diabetes [2].
Sources
[2], [4], [5]
Caveats
Trials were mostly in men and used synthetic or natural alpha-tocopherol at 400 IU.
Limited

Training adaptation

One trial found muscle mitochondrial markers rose with endurance training on placebo but not with vitamins C plus E. VO2max rose 8% in both groups.

The numbers and sources
Effect
Over 11 weeks of endurance training, VO2max rose 8% with vitamins C plus E and 8% with placebo. Markers of mitochondrial growth in muscle rose on placebo (COX4 59%) but not with the vitamins (-13%) [11].
Population
54 young men and women given 235 mg vitamin E with 1,000 mg vitamin C a day [11].
Sources
[11]
Caveats
One trial of a combination. Performance did not differ. Funders included Sana Pharma AS and Smartfish AS [11].
LimitedStudied in women

PMS symptoms

One small trial found PMS scores on vitamin E did not differ from placebo after 2 months.

Compared with placebo [22]

The numbers and sources
Effect
On 100 mg of vitamin E a day for 2 months, PMS scores fell in all three groups (vitamin D, vitamin E and placebo), and the differences between groups were not significant (P > 0.05) [22]. A later review notes that only 36 of the 86 women completed the trial [23].
Population
86 women with PMS randomized to vitamin D, vitamin E or placebo [22].
Sources
[22], [23]
Caveats
One small trial with many dropouts [23].

Doses studied

The Physicians' Health Study II used 400 IU every other day [1][5]. HOPE used 400 IU a day of natural vitamin E [2], and SELECT 400 IU a day of synthetic all-rac-alpha-tocopheryl acetate [4]. The first fatty liver trial used 800 IU a day [6], later trials 300 to 800 mg a day [7][9], and the Alzheimer's trial 2,000 IU a day [10]. Trials in the mortality analyses ranged from 16.5 to 2,000 IU a day [12]. EFSA sets a tolerable upper intake level of 300 mg a day for adults and states that a review is ongoing [13].

Risks

Reported risks3

LimitedStudied in menHow often is not known

Prostate cancer

One trial found about 17% more prostate cancer on vitamin E in healthy men aged 50 or older, 1.6 more cases per 1,000 person-years.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
With extended follow-up, 620 men on vitamin E developed prostate cancer against 529 on placebo (HR 1.17, 99% CI 1.004 to 1.36), an absolute increase of 1.6 cases per 1,000 person-years. Vitamin E plus selenium did not significantly differ (HR 1.05) [4].
Population
34,887 relatively healthy men aged 50 or older in the US, Canada and Puerto Rico [4].
Sources
[4]
Caveats
One trial. The Physicians' Health Study II, at 400 IU every other day, found no difference [5].
Why limited
This rests on one trial, of 34,887 people. Strength counts independent studies that agree, so one trial is limited at any size.
ModerateHow often is not known

Hemorrhagic stroke

Shown to raise hemorrhagic stroke about 22%, one extra per 1,250 people, while lowering ischemic stroke, one fewer per 476.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 5 trials reporting it, vitamin E raised hemorrhagic stroke (RR 1.22, 95% CI 1.00 to 1.48) and lowered ischemic stroke (RR 0.90, 95% CI 0.82 to 0.99). That is one extra hemorrhagic stroke for every 1,250 people taking it and one ischemic stroke prevented per 476 [3]. In the Physicians' Health Study II, hemorrhagic stroke rose (HR 1.74, 95% CI 1.04 to 2.91) [1].
Population
118,765 participants in 9 trials [3]; 14,641 male physicians [1].
Sources
[1], [3]
Caveats
Dose and health status did not explain differences between trials [3].
LimitedHow often is not known

Heart failure

One trial found more heart failure and heart failure hospitalization on 400 IU a day in people with vascular disease or diabetes.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
On 400 IU a day, heart failure (RR 1.13, 95% CI 1.01 to 1.26) and hospitalization for heart failure (RR 1.21, 95% CI 1.00 to 1.47) were more common than on placebo [2].
Population
9,541 people aged 55 or older with vascular disease or diabetes, median 7 years [2].
Sources
[2]
Caveats
Heart failure was a secondary outcome in one trial.
Why limited
This rests on one trial, of 9,541 people. Strength counts independent studies that agree, so one trial is limited at any size.

Mixed results1

LimitedHow often is not known

Mortality

Limited evidence: reviews disagree. Two found slightly more deaths, mostly at higher doses, and one found no effect up to 5,500 IU a day.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Sources disagree. A 2005 meta-analysis found 39 more deaths per 10,000 people in trials of 400 IU a day or more (95% CI 3 to 74), with risk rising above 150 IU a day [12]. A 2012 Cochrane review found a small increase with vitamin E in low-bias trials (RR 1.03, 95% CI 1.00 to 1.05, 46 trials) [14]. A 2011 meta-analysis of 57 trials and 246,371 people found no effect (RR 1.00, 95% CI 0.98 to 1.02) and no dose relationship up to 5,500 IU a day [15].
Population
135,967 participants in 19 trials [12]; 296,707 participants in 78 antioxidant trials [14]; 246,371 participants in 57 trials [15].
Sources
[12], [14], [15]
Caveats
High-dose trials in [12] were often small and in people with chronic disease [12]. The three analyses used different trial selections and models.

Claims tested and not found

  1. That vitamin E prevents heart disease. Two large trials found no change in major cardiovascular events [1][2].
  2. That vitamin E prevents prostate cancer. SELECT found more prostate cancer on vitamin E, not less [4].
  3. That antioxidant vitamins boost endurance training gains. VO2max rose the same on vitamins C plus E as on placebo, and muscle mitochondrial markers rose only on placebo [11].

Sources

  1. Sesso HD, Buring JE, Christen WG, et al. Vitamins E and C in the Prevention of Cardiovascular Disease in Men. JAMA. 2008. https://doi.org/10.1001/jama.2008.600
  2. Lonn E, Bosch J, Yusuf S, et al. Effects of Long-term Vitamin E Supplementation on Cardiovascular Events and Cancer. JAMA. 2005. https://doi.org/10.1001/jama.293.11.1338
  3. Schürks M, Glynn RJ, Rist PM, et al. Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials. BMJ. 2010. https://doi.org/10.1136/bmj.c5702
  4. Klein EA, Thompson IM, Tangen CM, et al. Vitamin E and the Risk of Prostate Cancer. JAMA. 2011. https://doi.org/10.1001/jama.2011.1437
  5. Gaziano JM, Glynn RJ, Christen WG, et al. Vitamins E and C in the Prevention of Prostate and Total Cancer in Men. JAMA. 2009. https://doi.org/10.1001/jama.2008.862
  6. Sanyal AJ, Chalasani N, Kowdley KV, et al. Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. New England Journal of Medicine. 2010. https://doi.org/10.1056/NEJMoa0907929
  7. Hussaini H, Kaur Dhanjal M, Mohammed Abdul RH, et al. Efficacy and Safety of Vitamin E in Adults With Metabolic Dysfunction-Associated Steatohepatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus. 2025. https://doi.org/10.7759/cureus.88949
  8. Karimi M, Abidi M, Gholamian R, et al. Vitamin E administration reduces liver enzyme levels in patients with Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD): evidence from a systematic review and meta-analysis. Nutrition & Metabolism. 2026. https://doi.org/10.1186/s12986-026-01158-5
  9. Song Y, Ni W, Zheng M, et al. Vitamin E (300 mg) in the treatment of MASH: A multi-center, randomized, double-blind, placebo-controlled study. Cell Reports Medicine. 2025. https://doi.org/10.1016/j.xcrm.2025.101939
  10. Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease. JAMA. 2014. https://doi.org/10.1001/jama.2013.282834
  11. Paulsen G, Cumming KT, Holden G, et al. Vitamin C and E supplementation hampers cellular adaptation to endurance training in humans: a double-blind, randomised, controlled trial. The Journal of Physiology. 2014. https://doi.org/10.1113/jphysiol.2013.267419
  12. Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality. Annals of Internal Medicine. 2005. https://doi.org/10.7326/0003-4819-142-1-200501040-00110
  13. European Food Safety Authority. Overview on Tolerable Upper Intake Levels as derived by the Scientific Committee on Food (SCF) and the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Version 11. 2025. https://www.efsa.europa.eu/sites/default/files/assets/UL_Summary_tables.pdf
  14. Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews. 2012. https://doi.org/10.1002/14651858.CD007176.pub2
  15. Abner EL, Schmitt FA, Mendiondo MS, et al. Vitamin E and All-Cause Mortality: A Meta-Analysis. Current Aging Science. 2011. https://doi.org/10.2174/1874609811104020158
  16. Alikamali M, Mohammad-Alizadeh-Charandabi S, Maghalian M, Mirghafourvand M. The effects of vitamin E on the intensity of primary dysmenorrhea: A systematic review and meta-analysis. Clinical Nutrition ESPEN. 2022. https://doi.org/10.1016/j.clnesp.2022.10.001
  17. Saei Ghare Naz M, Kiani Z, Rashidi Fakari F, et al. The Effect of Micronutrients on Pain Management of Primary Dysmenorrhea: a Systematic Review and Meta-Analysis. Journal of Caring Sciences. 2020. https://doi.org/10.34172/jcs.2020.008
  18. Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database of Systematic Reviews. 2016. https://doi.org/10.1002/14651858.cd002124.pub2
  19. Bayu P, Wibisono JJ. Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE. 2024. https://doi.org/10.1371/journal.pone.0301867
  20. Zheng SH, Chen XX, Chen Y, et al. Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis. Reproductive Biology and Endocrinology. 2023. https://doi.org/10.1186/s12958-023-01126-1
  21. Santanam N, Kavtaradze N, Murphy A, et al. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational Research. 2013. https://doi.org/10.1016/j.trsl.2012.05.001
  22. Dadkhah H, Ebrahimi E, Fathizadeh N. Evaluating the effects of vitamin D and vitamin E supplement on premenstrual syndrome: A randomized, double-blind, controlled trial. Iranian Journal of Nursing and Midwifery Research. 2016. https://doi.org/10.4103/1735-9066.178237
  23. Robinson J, Ferreira A, Iacovou M, Kellow NJ. Effect of nutritional interventions on the psychological symptoms of premenstrual syndrome in women of reproductive age: a systematic review of randomized controlled trials. Nutrition Reviews. 2025. https://doi.org/10.1093/nutrit/nuae043

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