Those of you who are interested in supplements probably know about the controversy around taking extra vitamin A and vitamin E. Some studies in the past have suggested potential concern for excess amounts of these vitamins, especially in synthetic forms. Some even suggesting potentially higher risk of cancers or morbidity associated with taking excess synthetic forms of these two vitamins.[2],[3] However, what you may not know is that some patients with specific health concerns may in fact need some vitamin A and E replacement. Let's take a moment to discuss who those people might be.
In my clinic of integrative medicine in San Jose, Calif., I usually don't prescribe extra vitamin A or E, especially not the synthetic forms, to my patients -- unless they have a specific health condition that suggests that they may require extra or that they can't absorb these nutrients well in their diet. In general, I don't recommend these two specific vitamins to all my patients. I only recommend them with a specific treatment goal in mind for a specific concerning disease state or symptom.
So, if you are interested in using these two vitamins, check with your doctor first as to whether they are a good idea for you or if simply eating a well-balanced, plant-based diet is enough for you to get adequate levels of these in your body.
Some of the common symptoms or disease states I use these vitamins for are various skin or eye diseases, premenstrual syndrome symptoms, fibrocystic breast disease, and vascular diseases, just to name a few common usages for this vitamin. But one important disease concern where these two vitamins are crucial for repletion in a supplement form, above and beyond just simply eating a diet rich in these two vitamins, is inflammatory bowel diseases.
For those who have irritable bowel syndrome, colitis, or leaky gut syndrome, these patients also potentially may need extra supplementation of all vitamins and minerals, including vitamin A and E. So, regardless of what your prior concerns are about these two vitamins, if you have a chronic bowel disease of some sort where you frequently think you have inflammatory symptoms of the bowel, check with your doctor about whether you need additional supplementation with vitamins and minerals. For those of you with the actual diagnosis of inflammatory bowel disease, you should definitely check with your doctor about how much and which types of vitamins to take to make sure that you get adequate amounts of your vitamins and minerals, including vitamin A and E.
In some studies, it is suggested that people with inflammatory bowel disease of ulcerative colitis or Crohn's disease have lower levels of retinol-binding proteins and thus had lower blood levels of vitamin A, even more so than vitamin E. Overall, patients who had inflammatory bowel diseases were seen to have overall low vitamin levels but specifically more so in vitamin A and E. In the studies, even if the patients seem to eat well, the severity of the disease state correlated better with level of low vitamin levels better than how the presumed nutritional status of a patient is.[1],[4]
Vitamins A and E are not supplements I generally recommend to my patients just for overall health concerns -- because of prior concerning studies regarding high dosages of synthetic versions of these -- but when it comes to patients who have chronic bowel disease that leads to inflammation in the intestines, natural forms of vitamins should be given on a daily basis and not just intermittently. These patients do not absorb vitamins well from their food. Basically, based on the studies, when the disease is severe, the intestines cannot absorb from food well because the intestinal tract is inflamed. When there is high level of inflammation, proteins needed to absorb and transport food is less available due to the fact that high levels of protein break down in inflammatory states.
So, for those of you who are otherwise healthy and just want to use vitamins as a gap-filler but have a balanced diet, try to use vitamins just a few days per week to fill in the gaps where your diet may sometimes fall short, and use natural forms (ask your doctor if you're not sure if your vitamin is more natural or artificial in its ingredient base).
For those of you with chronic gut or intestinal issues, ask your doctor about getting an easily-absorbed, natural vitamin supplement that has mildly higher dosages of vitamin A and E as well as other vitamins and minerals so that you can take it every day. Even if you make an effort to eat well, you naturally will not be absorbing your nutrients as well as someone who doesn't have inflammation in their intestinal tract. So, a daily vitamin is necessary.
However, you should still eat as clean and anti-inflammatory as possible with a mostly plant-based diet, because these diets help to decrease overall inflammation. By eating an anti-inflammatory diet, you will be better able to absorb the nutrients in your food... But because you naturally absorb less than those without the chronic inflammatory bowel disease, you should still ask your physician about a natural, food-based multivitamin with minerals to help your body stay as healthy as possible.
Lastly, for those with inflammatory bowel disease, some other common supplements that may have some positive effects on patients with this disease include, but are not limited to: melatonin, fiber, L-carnitine, glutamine, probiotics, vitamin K, vitamin D, DHEA, butyrate, selenium, wormwood, aloe gel, curcumin, boswellia, and fish oil, just to name a few. For those of you who are interested, ask your doctor about these and see if any of these might be helpful for your symptoms.
To go into the evidence and studies of all these supplements would be extensive and beyond the scope of this post, but I wanted to bring these options up because some of these may be helpful and thus would be good to bring up for discussion with your physician.
I highly caution you to not start these on your own and only consider starting them after receiving clearance from your physician, and after reviewing the pros and cons of each of these for your specific medical history with your doctor.
References:
1.Bousvaros, A, et al. Vitamin A and E Serum Levels in Children and Young Adults with Inflammatory Bowel Disease: Effect of Disease Activity. Journal of Pediatric Gastroenterology & Nutrition. 1998. 26(2):129-135.
2.EA Klein, IM Thompson, CM Tangen, JJ Crowley, MS Lucia, PJ Goodman, L Minasian, LG Ford, HL Parnes, JM Gaziano, DD Karp, MM Lieber, PJ Walther, L Klotz, JK Parsons, JL Chin, A Darke, SM Lippman, GE Goodman, FL Meyskens, and LH Baker. Vitamin E and the Risk of Prostate Cancer: Results of The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. October 12, 2011. 306(14) 1549-1556.
3.Heinonen OP, Huttunen JK, Albanes D. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994;330:1029-35
4.Janczewska I, et al. Metabolism of Vitamin A in Inflammatory Bowel Disease. Hepatogastroenterology. 1991. 38(5):391-395.
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