What are the signs of vitamin E deficiency?

Vitamin E deficiency damages nerves and muscles, upsets balance, harms the retina and weakens the immune response.

Who is most likely to run low

People with Crohn's disease, cystic fibrosis or blocked bile flow cannot absorb fat properly, and vitamin E needs fat to be absorbed.

What this means for you

Vitamin E deficiency from eating badly is essentially unheard of. Almost every case belongs to someone who cannot absorb fat, because vitamin E needs fat to get into the body at all.

When it does happen, the damage lands on nerves and muscles: numbness and tingling, loss of coordination, weakness, and in long-standing cases damage to the retina and a weaker immune response.

Not for everyone. The conditions that cause it are the ones that stop fat being absorbed: Crohn's disease, cystic fibrosis, and an inability to secrete bile into the digestive tract. Greasy stools and chronic diarrhoea are the signs that absorption is the underlying problem.

If you have one of those conditions, vitamin E is monitored by the team managing it rather than guessed at, because the same absorption problem that causes the deficiency also limits how well an ordinary supplement works.

For everyone else, 15 mg a day comes from sunflower seeds, almonds, hazelnuts, peanut butter and vegetable oils. A handful of sunflower seeds is most of a day.

One thing not to do about it

The obvious response to a page about running short is to buy the biggest capsule on the shelf. With vitamin E that response has been costed.

Not for everyone. Nineteen trials in 135,967 people were pooled by dose. In the trials using 400 IU a day or more there were 39 extra deaths per 10,000 people, and the dose-response curve turns upward above about 150 IU a day. Nine of the eleven high-dose trials pointed the same way. Most of those trials were run in people who already had a chronic illness, so how far the number carries to anyone else is unknown, and the authors say so themselves. It is still a reason to handle a suspected absorption problem with the team who diagnosed it.

That matters more here than on other pages, because the people who genuinely become deficient are the ones least able to absorb an ordinary supplement, so the temptation is to keep raising the dose.

Because deficiency is almost always about absorbing fat rather than about eating too little, the answer is rarely a bigger dose bought off a shelf. It is worth saying why that matters. In the SELECT trial, men who had taken vitamin E ended up with 17 per cent more prostate cancer than men on placebo, so a high dose is not a harmless precaution. The one condition where a high dose is used deliberately is fatty liver disease confirmed by biopsy, and that is a specialist's decision.

The blood test is harder to read than it looks

Unsettled. A plasma or serum vitamin E result means little on its own, because the number rises with blood fats. Vitamin E travels on the same carriers as cholesterol, and those carriers increase with age, so an older person with high cholesterol can produce a comfortable-looking vitamin E level without actually being replete. Correcting the result for blood lipids is needed in anyone with high lipids, and plenty of reports do not do it. If a result is being used to decide something, it is fair to ask whether it was corrected.

Breast milk, and a question nobody has asked

Unsettled. Breast milk carries vitamin E, and how much depends on the mother. Obesity, smoking and possibly preterm birth before 37 weeks all go with less of it. Ordinary prenatal multivitamins raise milk vitamin E modestly and safely, and improve the infant's status against taking nothing. What has never been examined is what a larger maternal dose would do to the baby. So the ordinary prenatal is supported, the ordinary prenatal is where the evidence stops, and there is no basis for going above it.

Fat is what this deficiency is really about

Vitamin E needs fat to be absorbed, and how much gets across ranges from 10 to 79 per cent of what was eaten depending mostly on how much fat came with it. That is the mechanism behind the standard line that deficiency almost always belongs to someone who cannot absorb fat.

Unsettled. The timing of that fat is less settled than the advice suggests. In one study, a 40 per cent fat breakfast and a fat-free breakfast gave the same vitamin E levels at four hours, and the difference only appeared after the next meal, where the fat-free group got 55 per cent more out of it. In women with obesity and fatty liver, that catch-up worked about a third less well. The direction is clear enough to act on, which is to eat vitamin E alongside fat. The mechanism underneath is not.

Written from the evidence cards and the data on this page, then checked back against the sources. Bioma Learn has no human medical reviewer at this time and we say so rather than invent one. Information, not medical advice. How we verify.

Where to get it from food

• Sunflower seed kernels, oil roasted — 49 mg per 1 cup (327% DV)
• Almonds, oil roasted — 40.8 mg per 1 cup whole kernels (272% DV)
• Almonds, blanched — 34.4 mg per 1 cup whole kernels (230% DV)
• Sunflower seed kernels from shell, dry roasted — 33.4 mg per 1 cup (223% DV)
• Almonds, dry roasted — 33 mg per 1 cup whole kernels (220% DV)

All vitamin E sources ranked →

Full guide: Vitamin E: the antioxidant that failed its trials and then caused harm