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Vitamin E Deficiency: Causes, Symptoms and Treatment

Vitamin E deficiency refers to abnormally low levels of the fat-soluble vitamin E in the body. It can cause neurological problems, muscle weakness, and a weakened immune system.

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Things worth knowing about "Vitamin E Deficiency"

Vitamin E deficiency refers to abnormally low levels of the fat-soluble vitamin E in the body. It can cause neurological problems, muscle weakness, and a weakened immune system.

What is Vitamin E Deficiency?

Vitamin E is a fat-soluble vitamin that acts as a key antioxidant in the human body. It protects cells from oxidative damage, supports immune function, and plays a role in neurological and muscular cell signalling. Vitamin E deficiency occurs when blood levels of the vitamin fall below the normal reference range – generally below 12 µmol/l for alpha-tocopherol, the most biologically active form of the vitamin.

Causes

Vitamin E deficiency is uncommon in healthy adults with a balanced diet in developed countries. It more frequently arises as a consequence of underlying conditions or specific circumstances:

Fat malabsorption: Because vitamin E is fat-soluble, conditions such as Crohn's disease, coeliac disease, short bowel syndrome, or cystic fibrosis can significantly impair its absorption in the intestine.
Liver disease: The liver is involved in processing and transporting vitamin E. Severe liver disease can therefore contribute to deficiency.
Genetic disorders: Rare conditions such as ataxia with vitamin E deficiency (AVED) impair the normal transport of vitamin E throughout the body.
Premature birth: Premature infants have limited vitamin E stores and are at particularly high risk.
Very low-fat diets: Extremely fat-restricted diets over a long period can reduce the absorption of vitamin E.

Symptoms

The symptoms of vitamin E deficiency develop gradually and primarily affect the nervous and muscular systems:

Peripheral neuropathy: Tingling, numbness, or pain in the hands and feet due to nerve fibre damage
Ataxia: Loss of balance and coordination, unsteady gait
Muscle weakness (myopathy): Reduced muscle strength and muscle wasting
Visual disturbances: Deterioration of vision due to damage to the retina (retinopathy)
Weakened immune system: Increased susceptibility to infections
Haemolysis: Premature breakdown of red blood cells, especially in newborns

Diagnosis

Vitamin E deficiency is primarily diagnosed through a blood test measuring serum alpha-tocopherol levels. Since vitamin E is transported bound to lipoproteins, results should ideally be interpreted relative to total lipids or cholesterol levels. Additional neurological examinations and, where appropriate, genetic testing for AVED may also be performed.

Treatment

Dietary Adjustment

For mild deficiency, targeted dietary changes can be beneficial. Good dietary sources of vitamin E include:

Vegetable oils (wheat germ oil, sunflower oil, rapeseed oil)
Nuts and seeds (almonds, hazelnuts, sunflower seeds)
Green leafy vegetables (spinach, Swiss chard)
Avocado and red pepper

Supplementation

In cases of more severe deficiency or when malabsorption is present, vitamin E supplementation is necessary. The dosage depends on the severity of the deficiency and any underlying condition. In AVED, very high doses under medical supervision may be required. The World Health Organization (WHO) and the European Food Safety Authority (EFSA) set the tolerable upper intake level for adults at 300 mg per day. Standard recommended daily intakes for adults range from approximately 11–15 mg of alpha-tocopherol equivalents.

Treatment of the Underlying Condition

Because vitamin E deficiency is often a consequence of another illness, treating the underlying cause is essential for achieving lasting improvement.

Risk Groups

Individuals at particular risk of vitamin E deficiency include:

People with chronic bowel conditions or fat malabsorption
Premature infants and newborns
Individuals with rare genetic disorders of lipoprotein metabolism
Patients with severe liver disease
People following very one-sided, extremely low-fat diets

References

Traber MG. Vitamin E deficiency in humans: Causes and consequences. Free Radical Biology and Medicine. 2014;84:357-366. doi:10.1016/j.freeradbiomed.2015.04.006
World Health Organization (WHO): Vitamin and Mineral Requirements in Human Nutrition. 2nd edition. Geneva: WHO Press, 2004.
European Food Safety Authority (EFSA): Dietary Reference Values for Vitamin E as alpha-tocopherol. EFSA Journal. 2015;13(7):4149. doi:10.2903/j.efsa.2015.4149

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