Vitamin E

Vitamin E is a vitamin that liquifies in fat. It is found in numerous foods consisting of veggie oils, cereals, meat, poultry, eggs, and fruits.

Vitamin E is an important vitamin required for the appropriate function of many organs in the body. It is likewise an antioxidant. Vitamin E that takes place naturally in foods (rrr-alpha-tocopherol) is various from man-made vitamin E that is in supplements (all-rac-alpha-tocopherol).

Vitamin E is used for treating vitamin E shortage, which is rare, however can happen in individuals with certain genetic disorders and in extremely low-weight premature infants. Vitamin E is likewise used for lots of other conditions, but there is no good clinical proof to support many of these other uses. (2 ).

History

Vitamin E (α-tocopherol) was found nearly 100 years ago due to the fact that it was needed to prevent fetal resorption in pregnant, vitamin E-deficient rats fed lard-containing diets that were quickly oxidizable. The human diet plan contains 8 different vitamin E-related particles manufactured by plants; despite the fact that all of these particles are peroxyl radical scavengers, the human body prefers α-tocopherol. The biological activity of vitamin E is extremely reliant upon regulative mechanisms that serve to keep α-tocopherol and excrete the non-α-tocopherol kinds. This choice depends on the mix of the function of α-tocopherol transfer protein (α-ttp) to enhance the plasma with α-tocopherol and the metabolic process of non-α-tocopherols. Α-ttp is vital for human health due to the fact that anomalies in this protein lead to severe vitamin E shortage characterized by neurologic problems, especially ataxia and eventually death if vitamin E is not supplied in big quantities to conquer the lack of α-ttp. Α-tocopherol acts as a peroxyl extreme scavenger that safeguards polyunsaturated fats in membranes and lipoproteins. Although specific paths and specific molecular targets have actually been looked for in a range of research studies, the most likely description as to why people require vitamin E is that it is a fat-soluble anti-oxidant. (3 ).

Synthesis

Biosynthesis

Photosynthesizing plants, algae and cyanobacteria synthesize tocochromanols, the chemical household of compounds made up of 4 tocopherols and 4 tocotrienols; in a nutrition context this family is referred to as vitamin E. Biosynthesis starts with formation of the closed-ring part of the molecule as homogentisic acid (hga). The side chain is connected (filled for tocopherols, polyunsaturated for tocotrienols). The path for both is the same, so that gamma- is developed and from that alpha-, or delta- is developed and from that the beta- substances. Biosynthesis takes place in the plastids.

As to why plants synthesize tocochromanols, the significant reason appears to be for antioxidant activity. Various parts of plants, and various types, are dominated by various tocochromanols. The predominant form in leaves, and thus leafy green vegetables is α-tocopherol. Area remains in chloroplast membranes, in close proximity to the photosynthetic procedure. The function is to secure against damage from the ultraviolet radiation of sunshine. Under typical growing conditions the presence of α-tocopherol does not seem necessary, as there are other photo-protective substances, and plants that through anomalies have lost the ability to synthesize α-tocopherol demonstrate typical growth. Nevertheless, under stressed out growing conditions such as dry spell, elevated temperature level or salt-induced oxidative tension, the plants’ physiological status is superior if it has the normal synthesis capability.

Seeds are lipid-rich, to supply energy for germination and early development. Tocochromanols safeguard the seed lipids from oxidizing and becoming rancid. The existence of tocochromanols extends seed longevity, and promotes successful germination and seedling growth. Gamma-tocopherol dominates in seeds of many plant types, but there are exceptions. For canola, corn and soy bean oils, there is more γ-tocopherol than α-tocopherol, but for safflower, sunflower and olive oils the reverse is true. Of the commonly used food oils, palm oil is unique in that tocotrienol content is higher than tocopherol material. Seed tocochromanols material is likewise based on ecological stressors. In almonds, for instance, drought or elevated temperature level boost α-tocopherol and γ-tocopherol content of the nuts. The very same post mentions that drought increases the tocopherol content of olives, and heat likewise for soybeans.

Industrial synthesis

Naturally sourced d-alpha-tocopherol can be drawn out and purified from seed oils, or gamma-tocopherol can be extracted, purified, and methylated to create d-alpha-tocopherol. In contrast to alpha-tocopherol extracted from plants, which is also called d-alpha-tocopherol, industrial synthesis develops dl-alpha-tocopherol. “it is synthesized from a mix of toluene and 2,3,5-trimethyl-hydroquinone that reacts with isophytol to all-rac-alpha-tocopherol, using iron in the presence of hydrogen chloride gas as driver. The reaction mix gotten is filtered and extracted with aqueous caustic soda. Toluene is gotten rid of by evaporation and the residue (all rac-alpha-tocopherol) is cleansed by vacuum distillation.” requirements for the component is >> 97% pure. This synthetic dl-alpha-tocopherol has approximately 50% of the strength of d-alpha-tocopherol. Manufacturers of dietary supplements and fortified foods for people or domesticated animals convert the phenol form of the vitamin to an ester using either acetic acid or succinic acid because the esters are more chemically stable, attending to a longer shelf-life. The ester types are de-esterified in the gut and absorbed as totally free alpha-tocopherol. (4 ).

Function

Vitamin E has the following functions:.

1. It is an antioxidant. This means it secures body tissue from damage brought on by substances called free radicals. Free radicals can harm cells, tissues, and organs. They are believed to play a role in particular conditions associated with aging.
2. It assists keep the immune system strong versus viruses and germs.
3. It helps form red cell and broaden capillary to keep blood from clotting inside them.
4. It helps the body use vitamin k.
5. Cells likewise utilize vitamin E to connect with each other. It helps them carry out lots of important functions.

Whether vitamin E can avoid cancer, heart disease, dementia, liver illness, and stroke still requires additional research. (5 ).

Food sources

Vitamin E is discovered in plant-based oils, nuts, seeds, fruits, and vegetables.

• Wheat germ oil
• Sunflower, safflower, and soybean oil
• Sunflower seeds
• Almonds
• Peanuts, peanut butter
• Beet greens, collard greens, spinach
• Pumpkin
• Red bell pepper
• Asparagus
• Mango
• Avocado (6 )

System of action

The system of action for most of vitamin E’s results are still unknown. Vitamin E is an antioxidant, avoiding complimentary extreme reactions with cell membranes. Though in many cases vitamin E has been revealed to have pro-oxidant activity.

One system of vitamin E’s antioxidant effect remains in the termination of lipid peroxidation. Vitamin E responds with unstable lipid radicals, producing stable lipids and a relatively stable vitamin E radical. The vitamin E radical is then decreased back to stable vitamin E by response with ascorbate or glutathione. (7 ).

Benefits of vitamin E

Though vitamin E is often considered a single substance, it’s really a group of eight fat-soluble substances with powerful antioxidant effects.

Of these 8 chemical forms, alpha-tocopherol best meets the dietary requirements of humans.

Vitamin E exists naturally in particular foods, including seeds, nuts, some veggies, and some strengthened products. You can also take it as a dietary supplement.

It plays lots of roles in your body. It’s perhaps best known for its antioxidant results, securing your cells from oxidative damage by reducing the effects of hazardous particles called complimentary radicals. In addition, it’s required for correct immune function and cellular signaling.

That’s why it’s not surprising that research recommends taking vitamin E supplements may benefit your health in a number of ways.

This article covers 8 potential benefits of vitamin E.

Might minimize markers of oxidative stress and improve antioxidant defenses

Oxidative tension is a condition that takes place when there’s an imbalance between your body’s antioxidant defenses and the production and build-up of substances called reactive oxygen species (ros). This can result in cellular damage and increased disease risk.

Due to the fact that vitamin E acts as an effective antioxidant in the body, studies have revealed that supplementing with high doses of it can minimize markers of oxidative stress and boost antioxidant defenses in some populations.

For instance, a 2018 study in 54 people with diabetic nephropathy– kidney damage triggered by high blood sugar level– discovered that supplementing with 800 iu of vitamin E each day for 12 weeks considerably increased levels of glutathione peroxidase (gpx) compared to a placebo.

Gpx is a group of antioxidant enzymes that protect your cells from oxidative damage.

A 2021 study likewise revealed that supplementing with a mix of vitamin E and vitamin c daily for 8 weeks reduced markers of oxidative tension, such as malondialdehyde and ros, in females with endometriosis.

Might reduce heart disease danger aspects

Having high blood pressure and high levels of blood lipids such as ldl (bad) cholesterol and triglycerides might increase your threat of developing heart problem.

Promisingly, research study suggests that vitamin E supplements might help in reducing cardiovascular disease threat factors such as these in some people.

A 2019 evaluation of 18 studies found that, compared with placebo treatments, vitamin E supplements considerably decreased systolic however not diastolic blood pressure– the top and bottom varieties of high blood pressure readings, respectively.

Some studies also reveal that taking vitamin E with omega-3 supplements might lower ldl and triglyceride levels in people with metabolic syndrome– a cluster of conditions, including high blood fat levels, that increases the danger of heart problem and other health conditions.

Might advantage those with nonalcoholic fatty liver illness (nafld)

Nafld consists of a number of conditions that trigger a build-up of fat in the liver in individuals who drink little or no alcohol.

According to research study findings, vitamin E supplements may improve some aspects of health in individuals with nafld.

A 2021 review of eight studies found that supplementing with vitamin E minimized levels of the liver enzymes alanine aminotransferase (alt) and aspartate aminotransferase (ast), decreased blood lipid levels, and improved liver health in people with nafld.

Elevated ast and alt levels can show liver inflammation and damage in people with nafld, so lower levels agree with.

Might help manage dysmenorrhea

Dysmenorrhea is a condition defined by extreme and regular menstrual discomfort, such as cramps and pelvic discomfort.

Promisingly, research recommends vitamin E supplements might lower discomfort in females with this condition.

In a 2018 study in 100 females with dysmenorrhea, taking 200 iu of vitamin E daily relieved menstrual pain more than a placebo. The effects were even much better when the vitamin was combined with an omega-3 supplement consisting of 180 mg of epa and 120 mg of dha.

In addition, a 2021 study showed that supplementing with a combination of vitamin E and vitamin c daily for 8 weeks helped in reducing the severity of pelvic pain and dysmenorrhea in females with endometriosis.

Other prospective health advantages

Vitamin E supplements have actually likewise been linked to numerous other health advantages:.

May advantage skin health. Vitamin E supplements might be helpful for those with specific skin disorders, such as eczema. Nevertheless, research is currently limited, and more research studies are required to learn more about this potential advantage.

May benefit cognitive health. Preserving optimal vitamin E levels and taking supplements may assist safeguard against cognitive decrease. But it’s still uncertain whether the supplements benefit individuals with cognitive conditions like alzheimer’s disease.

May advantage older grownups. Since vitamin E plays important functions in health, such as lowering swelling and improving immune function, supplements might benefit individuals who have increased needs or do not get enough in their diet plans, such as some older adults.

May improve lung function. Research studies have actually revealed that vitamin E supplements could improve lung function and particular symptoms of asthma in children and adults. (8 ).

Role of vitamin E in pregnancy

Vitamins play crucial roles in female health. They are necessary for lots of functions, including menstruation and ovulation, oocyte (egg) quality and maturation. Vitamin E was first discovered in 1922 as a compound needed for recreation. It has actually ended up being commonly known as an effective lipid-soluble antioxidant. There are numerous reports on the advantages of vitamin E on health in general. Vitamin E assists your body produce and maintain red blood cells, healthy skin, eyes and strengthens your natural immune system. However, in spite of it being at first discovered as a vitamin needed for recreation, to date studies relating to its impacts in this area are lacking. Vitamin E supplementation may help in reducing the danger of pregnancy issues including oxidative tension, such as pre-eclampsia. This chapter is written to provide an evaluation of the recognized functions of vitamin E in pregnancy. (9 ).

Skin health advantages of vitamin E for guys

While it may be unusual for guys to have a vitamin E shortage, this hasn’t stopped many of them from scooping up skin care products containing it (including our powerful firming serum). Here is why a growing variety of males are incorporating vitamin E into their day-to-day skin care routine.

Anti-aging

Are you beginning to show indications of crow’s feet? Vitamin E secures skin cells from totally free radicals, which assists slow down signs of aging. This holds true whether you consume foods rich in vitamin E or apply it topically.

In fact, vitamin E is frequently utilized in sunscreens and everyday moisturizers for guys due to its photoprotective properties. Research shows that alpha-tocopherol, the main naturally taking place isomer in vitamin E, can potentially avoid dna cell damage from uv rays (see claim: “topical application of alpha-tocopherol (alphath), the most popular naturally occurring type of vitamin E, inhibits ultraviolet (uv) b-induced photocarcinogenesis and dna photodamage in c3h mice in vivo”.).

Injury healing

There has actually been a substantial amount of anecdotal evidence that vitamin E can speed up injury recovery and potentially minimize acne scars. While there isn’t much in the method of medical proof on vitamin E’s role in wound healing, research study does recommend that keeping skin hydrated is crucial to reducing the look of scars (see claim: “the discovery that a wet environment actively supports the healing action when compared to a dry environment highlights the value of water and excellent hydration levels for optimum recovery.”).

Male who slather on cream consisting of vitamin E may be seeing a reduction in scarring merely because they are hydrating their skin regularly. Utilizing a day-to-day men’s moisturizer can assist you achieve comparable skin care benefits by raveling flaws and safeguarding your face from sun damage.

Fights acne

Men tend to have oilier skin compared to females, which can cause extreme acne breakouts. If you’re questioning whether vitamin E can help you manage your breakouts, the response is perhaps.

There are some research studies which suggest that a diet rich in vitamin E (along with vitamin a and zinc) can help in reducing acne symptoms. Nevertheless, studies on how vitamin E can benefit acne victims are limited and undetermined.

With studies being so restricted, vitamin E isn’t suggested as a standalone service to acne. Rather, men are far better off utilizing an acne treatment system created for their skin. (10 ).

What can vitamin E provide for hair?

Vitamin E has natural antioxidant impacts that could assist to maintain hair development.

Individuals have declared that vitamin E uses a number of benefits for hair health, but much of these claims do not have rigorous scientific evidence to back them up.

Most of the claims about vitamin E’s role in hair health relate to its antioxidant properties. These focus on the idea that it can decrease cell damage and improve hair development.

We examine some of the most common claims below.

Might help support a healthy scalp

Vitamin E may help support a healthy scalp and hair as it has natural antioxidant results that could assist with preserving hair development.

The vitamin’s antioxidant residential or commercial properties could help in reducing the amount of oxidative tension and complimentary radicals that cause the hair follicle cells in an individual’s scalp to break down.

Assist prevent loss of hair

There is some minimal proof to support the claim that vitamin E can assist avoid loss of hair.

A little research study using an overall of 38 volunteers experiencing hair loss took a look at the role that vitamin E played in preventing this loss. The study found that one of the parts of vitamin E did enhance the hair growth of the volunteers compared to a placebo.

More research is still necessary to determine how vitamin E affects loss of hair.

Increased shine

According to some people, vitamin E can assist replenish shine that the hair loses as a result of damage. Chemicals, heat, and other styling products can all harm the hair.

An individual can bring back shine utilizing oils, which offer an extra layer of security to the skin and hair. Many manufacturers will add vitamin E to their products to assist restore shine.

There is restricted research study on how effective vitamin E is at making the hair shinier again. (11 )

Eye advantages of vitamin

Almonds and other nuts are exceptional sources of natural vitamin E.

Research recommends vitamin E might help reduce the worsening of age-related macular degeneration (amd) amongst individuals who show early indications of the eye disease.

In the age-related eye disease study (areds) including almost 5,000 individuals, participants with early amd had a 25 percent lower threat of developing advanced phases of the illness when taking a daily dietary supplement consisting of vitamin E. The areds supplement included 400 worldwide units (iu) of vitamin E, in addition to high levels of vitamin a (as beta-carotene), vitamin c and zinc.

Based upon areds and other nutritional studies, many optometrist suggest that their patients supplement their diet with a day-to-day multivitamin which contains approximately 400 iu of vitamin E in combination with other antioxidants as part of their preventative eye care.

Some research studies suggest vitamin E likewise might contribute in avoiding cataracts:.

In a big, long-term study of more than 3,000 grownups (ages 43 to 86) in wisconsin, five-year risk for cataracts was 60 percent lower among individuals who reported using multivitamins or any supplement consisting of vitamin E or vitamin c for more than ten years, compared with nonusers.

In a 2008 study that examined the dietary consumption of more than 35,000 female health professionals, ladies whose diet plans (including supplements) had the highest levels of lutein and vitamin E had a lower relative risk of cataracts than ladies whose diets remained in the lowest 20 percent for levels of these nutrients.

Nevertheless, a recent research study of obviously healthy older males in the united states stopped working to show any advantage of vitamin E supplements in the prevention of cataracts.

More than 11,000 guys ages 50 and older (african-american participants) or 55 and older (all other participants) took an everyday vitamin E supplement (400 iu of dl-alpha-tocopherol) or a placebo pill for around five and a half years. At the end of the research study duration, there was no significant distinction in the variety of cataract diagnoses or cataract surgical treatments carried out amongst individuals of the two groups.

It appears more research study is needed to totally understand the possible eye benefits of vitamin E– particularly in regards to whether vitamin E supplements can decrease the risk of cataracts. (12 ).

Vitamin E shortage

Vitamin E shortage triggered by a diet plan low in vitamin E is common in developing nations. In developed nations, the cause is usually an absorption disorder. Some infants are born with vitamin E shortage, which normally enhances with supplements.

• Vitamin E shortage might cause impaired reflexes and coordination, trouble strolling, and weak muscles.
• Early infants with the deficiency may develop a severe form of anemia.
• The medical diagnosis is based upon signs and outcomes of a health examination.
• Taking vitamin E supplements remedies the deficiency.

Vitamin E (tocopherol) is an antioxidant: it protects cells versus damage by totally free radicals, which are by-products of regular cell activity and which participate in chain reactions within cells. Some of these responses can be hazardous.

Vitamin E, like vitamins a, d, and k, is a fat-soluble vitamin, which dissolves in fat and is best taken in when consumed with some fat. Great sources of vitamin E consist of vegetable oils, nuts, seeds, green leafy vegetables, and wheat bacterium.

Babies have a reasonably low reserve of vitamin E because only percentages of vitamin E cross the placenta. Therefore, babies, particularly early babies, are at increased risk of vitamin E shortage. Nevertheless, with age, threat reduces because infants normally get enough vitamin E in breast milk or in industrial formulas. Adults can keep large quantities of vitamin E in fat tissue, making the shortage less most likely.

Causes of vitamin E deficiency

A very low fat diet lacks vitamin E, because vegetable oils are the main source of this vitamin and because vitamin E is finest soaked up when eaten with some fat. Conditions that impair fat absorption (such as specific liver disorders, gallbladder conditions, pancreatitis, and cystic fibrosis) can likewise minimize the absorption of vitamin E and increase the risk of vitamin E deficiency.

In the united states and other developed nations, vitamin E deficiency is rare amongst older children and adults and is generally due to.

• A condition that hinders fat absorption (malabsorption disorder)
• In establishing countries, the most common reason for vitamin E shortage is
• Inadequate consumption of vitamin E

Signs of vitamin E deficiency

In kids, signs might consist of slow reflexes, problem walking, loss of coordination, loss of position sense (understanding where the limbs are without looking at them), and muscle weak point.

In grownups with vitamin E shortage due to a malabsorption condition, these symptoms seldom develop due to the fact that adults keep big quantities of vitamin E in fat (adipose) tissue.

Vitamin E deficiency can trigger a kind of anemia in which red blood cells rupture (hemolytic anemia). Early babies who have a vitamin E deficiency are at danger of this severe condition.

In early babies, bleeding (hemorrhage) may happen within the brain, and blood vessels in the eyes may grow unusually (a condition called retinopathy of prematurity). Affected newborns likewise have weak muscles. (13 ).

Vitamin E side effects

Get emergency medical help if you have any of these indications of an allergic reaction to vitamin E: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking vitamin E and call your physician at the same time if you have:.

• Headache, lightheadedness, vision modifications;
• A light-headed feeling, like you might lose consciousness;
• Unusual weak point or exhausted feeling;
• Diarrhea, stomach cramps; or
• Easy bruising or bleeding (nosebleeds, bleeding gums).

Typical vitamin E adverse effects might include:.

• Queasiness;
• Tired feeling
• Headache; or
• Moderate rash. (14 )

Dose and preparation

The advised dietary allowance (rda) for vitamin E is 15 mg. Most vitamin E supplements offer around 67 mg of the nutrient, which is much greater than the rda. Those needing a vitamin E supplement likely have an identified vitamin E shortage, which is far more suitable for the 60 to 75 mg daily dosage supplied in a supplement. Large dosage vitamin E supplements must be approached with care and gone over with your medical professional in advance.

Vitamin E supplements are available in 2 forms: artificial and natural. The natural type of vitamin E is alpha-tocopherol while the synthetic kind is di-alpha-tocopherol. Both work well, however, a bigger dose of the synthetic type is required to accomplish comparable outcomes. You can also find vitamin E supplements containing both kinds of alpha-tocopherol, called combined tocopherols. (15 ).

Interactions

Use of some drugs can impact your vitamin E levels. Possible interactions include:.

Alkylating agents and anti-tumor antibiotics. There’s issue that high doses of vitamin E may impact making use of these chemotherapy drugs.

Anticoagulants and anti-platelet drugs, herbs and supplements. Use of vitamin E with these drugs, herbs and supplements to minimize blood clotting might increase the risk of bleeding.

Cytochrome p450 3a4 (cyp3a4) substrates. Use care when taking vitamin E and other drugs impacted by these enzymes, such as omeprazole (prilosec, zegerid).

Statins and niacin. Taking vitamin E with statins or niacin, which might benefit people with high cholesterol, might minimize niacin’s effect.

Vitamin k. Taking vitamin E with vitamin k may reduce the effects of vitamin k. (16 ).

What are warnings and preventative measures for vitamin E?

Cautions

This medication consists of vitamin E. Do not take aquasol e, alpha-tocopherol, or tocopherol if you are allergic to vitamin E or any active ingredients consisted of in this drug.

Stay out of reach of kids. In case of overdose, get medical assistance or contact a poison nerve center right away. (17 ).

Conclusion

Vitamin E was first utilized as a supplement in canada by the physicians shute and shute; based upon the favorable outcomes it achieved, they began utilizing it routinely in their practices. Since then, properly designed experimental and clinical studies have actually advanced gradually and increased our knowledge of vitamin E. The antioxidative properties of vitamin E have actually been found to play a vital role in the fight versus numerous illness such as atherosclerosis, oxidative tension, cancer, cataract and advertisement, among others.

This evaluation concentrated on the crucial functions of vitamin E in some diseases; in addition to these, this vitamin has actually been found to be efficient versus asthma, allergies and diabetes, among others. Conversation of the dietary sources, rda and the interaction of vitamin E supplements with other dietary elements, has actually demonstrated the requirement for and significance of vitamin E in the human context. Therefore, raising public awareness of the function of dietary antioxidants in preserving better health would benefit a number of lives.

Apart from the enormous benefits reported, there has constantly been dispute about the specific function of vitamin E and its function in various diseases. There are many contrasting reports of favorable and unfavorable results on the same biological activities in the literature. The main barrier in determining the functions of vitamin E in human health is the lack of validated biomarkers for vitamin E consumption and status, which would assist to relate intakes to possible clinical results. In conclusion, although the data surrounding vitamin E is contradictory, the existing literature appears to support the view that the benefits outweigh the side-effects. (18 ).

References

1. Https://www.cancer.gov/publications/dictionaries/cancer-terms/def/vitamin-e
2. Https://www.webmd.com/vitamins/ai/ingredientmono-954/vitamin-e
3. Https://www.karger.com/article/abstract/343106
4. Https://en.wikipedia.org/wiki/vitamin_e
5. Https://medlineplus.gov/ency/article/002406.htm
6. Https://www.hsph.harvard.edu/nutritionsource/vitamin-e/
7. Https://go.drugbank.com/drugs/db00163
8. Https://www.healthline.com/health/all-about-vitamin-e#58.-other-potential-health-benefits
9. Https://www.intechopen.com/chapters/76117
10. Https://www.tiege.com/blogs/news/what-are-the-benefits-of-vitamin-e-for-men
11. Https://www.medicalnewstoday.com/articles/322836
12. Https://sinchewoptics.com.sg/blogs/news/vitamin-e-benefits-for-your-eyes-and-vision
13. Https://www.msdmanuals.com/home/disorders-of-nutrition/vitamins/vitamin-e-deficiency
14. Https://www.drugs.com/vitamin_e.html
15. Https://www.verywellfit.com/vitamin-e-supplements-what-you-need-to-know-90042
16. Https://www.mayoclinic.org/drugs-supplements-vitamin-e/art-20364144
17. Https://www.rxlist.com/consumer_vitamin_e_aquasol_e_tocopherol/drugs-condition.htm
18. Https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3997530/