Natural Vitamin E 500iu

Choosing natural vitamin E is the easy part. Our naturopaths spend more time on the dose, because that's where the evidence has something to say.

A good fit if

• You've already decided on vitamin E and want the form with more activity per milligram
• A doctor has told you that you absorb fat poorly, which is where a real vitamin E shortfall shows up
• You eat very few nuts, seeds, vegetable oils or leafy greens
• You'd rather take a modest dose than a 500 IU capsule

Check with us first if

• You take warfarin or another blood thinner. Vitamin E works against vitamin K-dependent clotting factors and reduces how much platelets clump together, with effects seen from 300 mg a day, which is less than one 500 IU natural capsule.
• You have heart disease or diabetes. The HOPE-TOO trial gave about 9,500 people at high risk of heart disease 400 IU a day of natural vitamin E for around seven years. It found no heart benefit and more heart failure.
• You take a statin with niacin. Antioxidant combinations that included vitamin E reduced how well that treatment raised HDL ("good") cholesterol.
• You're pregnant or breastfeeding. Your adequate intake is 7 to 8 mg or 11 to 12 mg a day, so a high-dose capsule is well above the range set for you.
• You plan to take it daily for years, because that's the kind of long-term use the research on death rates looked at.
• You take prescription medicine. Check with your doctor, pharmacist or our naturopaths before you start.

• Natural vitamin E (d-alpha-tocopherol). Best known for: The single natural form, extracted from vegetable oil, that your liver's transport protein holds on to most efficiently. Absorption: About twice the biological activity of synthetic, by weight. 1 mg is 1.49 IU. Typical use: Single-ingredient capsules, where activity per milligram matters. The label reads d-alpha, with no l.
• Synthetic vitamin E (dl-alpha-tocopherol). Best known for: A mixture of eight isomers made industrially, and only one of them matches the natural form. Absorption: About half the biological activity of natural, by weight. 1 mg is 2.22 IU. Typical use: Most multivitamins. It's the form the SELECT trial tested, where 400 IU a day was linked to 17 per cent more prostate cancer, so that finding belongs to synthetic, not natural.
• Mixed tocopherols. Best known for: Beta, gamma and delta tocopherol alongside alpha, closer to how vitamin E occurs in food. Absorption: We hold no human comparison against natural d-alpha-tocopherol. Typical use: People who want the gamma part. Its distinct antioxidant activity has mainly been shown in the lab, not in clinical trials.

Reference values. Australia sets an adequate intake for vitamin E rather than a recommended intake: 10 mg a day for men and 7 mg for women, as alpha-tocopherol equivalents. In pregnancy it's 7 to 8 mg, and while breastfeeding 11 to 12 mg. Because the natural form counts milligram for milligram, those figures are the amount of d-alpha-tocopherol itself.

Typical supplemental range. Natural vitamin E capsules in Australia are mostly sold at 200 to 500 IU. For the natural form, 1 IU is 0.67 mg, so that's about 134 to 335 mg. Even the smallest of those is many times a day's adequate intake.

Upper level. The NHMRC upper limit is 300 mg a day for adults, including in pregnancy and breastfeeding. A 500 IU natural capsule is about 335 mg, which is over that limit on its own. Children's limits are much lower, from 70 mg at one to three years up to 250 mg at 14 to 18. The US figure of 1,000 mg isn't the Australian limit, so American advice doesn't apply here.

Worth knowing. Vitamin E dissolves in fat, so take it with a meal that has some fat in it. The safety concerns came from trials of 400 IU a day taken for years, so talk to us before taking a high dose every day long term. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Wheat germ oil, 1 tablespoon: 20.3 mg
• Sunflower seeds, dry roasted, 28 g: 7.4 mg
• Almonds, dry roasted, 28 g: 6.8 mg
• Sunflower oil, 1 tablespoon: 5.6 mg
• Hazelnuts, dry roasted, 28 g: 4.3 mg
• Spinach, boiled, half a cup: 1.9 mg

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Warfarin or another blood thinner. Vitamin E works against vitamin K-dependent clotting factors and reduces platelet clumping, with effects noted from 300 mg a day.
• Taking 400 IU a day or more long term. A meta-analysis of 19 trials found the risk of death from any cause rose with dose, from about 150 IU a day.
• Heart disease or diabetes. The HOPE-TOO trial, using natural vitamin E at 400 IU a day, found no heart benefit and more heart failure.
• Chemotherapy or radiotherapy. Antioxidant supplements may make treatment less effective, so your oncology team needs to agree first.
• Statin plus niacin therapy. Antioxidant combinations including vitamin E blunted the rise in HDL (good) cholesterol.
• Pregnancy and breastfeeding. Adequate intakes are 7 to 8 mg and 11 to 12 mg a day, and the upper level is 300 mg. We found no TGA advisory.
• Children. Upper levels run from 70 mg at one to three years to 250 mg at 14 to 18 years, far below adult capsule strengths.
• Skin products with d-alpha-tocopheryl phosphates. Use only on unbroken skin, not in the eye or on damaged skin, at no more than 3 per cent.
• Conditions that affect fat absorption, such as Crohn's disease or cystic fibrosis. These raise the risk of deficiency, so dosing should be medically supervised.
• If you take prescription medicines, check with your doctor, pharmacist or one of our naturopaths before you start.