Vitamin E deficiency is fairly rare with vague symptoms that are difficult to diagnose, causing some question as to its importance since there is no clear deficiency disease in humans as there is with deficiency of vitamin C or many of the B vitamins. Infertility as an effect of vitamin E deficiency has not been revealed as clearly in humans as it was in the rat study. It is likely that vitamin E deficiency is simply more difficult to diagnose symptomatically because of its wide range of effects on the nervous, reproductive, muscular, and circulatory systems and because other nutrients may mask vitamin E deficiencies. However, biochemically, low levels of vitamin E can be measured in the blood and have been seen in such conditions as acne, anemia, infections, some cancers, periodontal disease, cholesterol gallstones, neuromuscular diseases, and dementias such as Alzheimer’s disease.

Deficiencies are more of a concern in premature babies, since there is no maternal-fetal vitamin E transfer; vitamin E depletion may also appear in newborns fed on cow’s milk, which contains no vitamin E, instead of breast milk, which does contain some if the mother’s diet is healthy. Deficiency is also more likely in adults with gastrointestinal disease, with poor fat digestion and metabolism, or with pancreatic insufficiency.

Iron, especially the inorganic form, depletes vitamin E absorption in the small intestine. The two should not be taken together, as this causes the absorption of both to be diminished. Chlorine, ferric chloride, and rancid oils also deplete or destroy vitamin E.

The first sign of vitamin E deficiency may be loss of red blood cells due to fragility caused by the loss of cell membrane protection. Oxidized polyunsaturated fatty acids may also weaken the red blood cell membranes and cause rupture. The generalized decrease in cell and tissue protection from free radical molecules may lead to abnormal fat deposits in muscles, muscle wasting, and problems in the kidneys and liver because of the circulating dead cells and toxins released. Men may have changes in the testicular tissue with vitamin E deficiency.

With increased oxidation, there is an increased requirement for vitamin E. Vitamin E deficiency may lead to free radical effects on the unsaturated fatty acids, inhibiting their functions in the health of cell membranes and tissues. Pituitary and adrenal function may be lowered, as these glands may suffer from the cumulative effects of oxidation. Degenerative changes produced by deficiency of vitamin E may not be corrected by vitamin E therapy.

There is some question as to whether tocopherol ("to bear children") deficiency reduces the ability to carry pregnancy to term and increases the likelihood of premature birth or causes problems in infants. Is it related to increased heart disease or atherosclerosis or even cancer? Surely, there is a lot more to learn about vitamin E.

Requirements: The amount of vitamin E required depends upon body size and the amount of polyunsaturated fats in the diet, since vitamin E is needed to protect these fats from oxidation. More is needed when any refined oils, fried foods, or rancid oils are consumed. Supplemental estrogen or estrogen imbalance in women increases the need for vitamin E, as does air pollution. And, as I have mentioned, vitamin E should not be taken with iron, especially inorganic iron, such as ferrous sulfate or the iron added to food products. Selenium, another important antioxidant, however, may increase the potency of vitamin E.