Of course vitamin E is still needed. It does not appear to be as effective as the lipophilic polyphenols in protecting fish oil as it is consumed, absorbed and then ferried through the blood stream to the tissues where it will be built into cell membranes. It does, however, play a critical role in protecting the fatty acids once they have been built into those cell membranes, and it is involved in the repair of damaged cell membranes (Howard et al ’11, Labazi et al ‘15).
This means that as more PUFA’s are consumed and built into cell membranes, it becomes important to increase the intake of vitamin E; otherwise the symptoms of vitamin E deficiency may begin to emerge.
This is a real concern because up to 90% of consumers are consuming insufficient levels of vitamin E (McBurney et al ‘15). It becomes an even greater concern for all the consumers taking poorly formulated fish oil capsules that may deliver some omega 3’s, but not enough vitamin E (and none of the critical polyphenols).
One of the reasons vitamin E depletion has become so common is poorly designed research (in my view) that suggested that vitamin E might increase the risk of prostate cancer (SELECT). At around the same time, other work indicated that fish oil might also increase the risk of this cancer (Brasky et al ’14). While the Brasky paper has been thoroughly refuted, due to its gross sampling error, the lingering impact of the SELECT trial undoubtedly hit vitamin E sales. Now, however, new research is starting to debunk that idea too.
At a recent symposium in Stuttgart’s University of Hohenheim, a fascinating new theory was aired which focused on the confusion between vitamins E and K, which are so similar that they can be confused when taking measurements of biological tissues. It was suggested that high doses of vitamin E can lead to reductions in vitamin K levels, and it might have been the changes in vitamin K that caused the increased risk in cancer. As K2 intakes are already low, this suggests that fish oil, vitamin E and vitamin K should always be taken together – with selenium, of course, as this trace element works in tandem with vitamin E.
So here is another argument against treating nutrients as if they were drugs; an argument against monotherapy, which is a pharmaceutical idea, and an argument for integrated nutritional interventions.
If you take fish oil, how much vitamin E should you wash it down with? The first serious attempt to work out this equation has recently been performed by a team from DSM, one of the biggest fish oil producers, working with the well-respected Professor Philip Calder. According to their calculations, the daily requirement for vitamin E for anyone taking a typical dose of PUFA’s ranged from 12 to 20 mg/day (Raederstorff et al ‘15).
Nutrition is extremely complicated, and sadly, the supplement business is still selling badly designed and possibly counter-productive products.
Brasky TM1, Darke AK, Song X, Tangen CM, Goodman PJ, Thompson IM, Meyskens FL Jr, Goodman GE, Minasian LM, Parnes HL, Klein EA, Kristal AR. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst. 2013 Aug 7;105(15):1132-41.
Howard AC, McNeil AK, McNeil PL. Promotion of plasma membrane repair by vitamin E. Nat Commun. 2011 Dec 20;2:597.
Labazi M, McNeil AK, Kurtz T, Lee TC, Pegg RB, Angeli JP, Conrad M, McNeil PL. The antioxidant requirement for plasma membrane repair in skeletal muscle. Free Radic Biol Med. 2015 Jul;84:246-53.
McBurney MI, Yu EA, Ciappio ED, Bird JK, Eggersdorfer M, Mehta S. Suboptimal Serum α-Tocopherol Concentrations Observed among Younger Adults and Those Depending Exclusively upon Food Sources, NHANES 2003-2006. PLoS One Vol 10, Number 8:e0135510. doi: 10.1371/journal.pone.0135510
Raederstorff D, Wyss A, Calder PC, Weber P, Eggersdorfer M. Vitamin E function and requirements in relation to PUFA. British Journal of Nutrition, Published online ahead of print, doi: 10.1017/S000711451500272X