One Out, One In #3: vitamin E 400 IU→ food, or nothing

One you drop. One you take instead.

3. The 400 IU “antioxidant / prostate / heart” capsule is a 1990s hangover.

2. In 35,000 men, 400 IU a day of synthetic E did not prevent prostate cancer. With longer follow-up it raised it 17%.

1. Skip the capsule. Eat almonds, sunflower seeds, wheat-germ or sunflower oil. Do not start D3 “instead.” Do not buy mixed tocopherols as a rescue.

Vitamin E is a family of fats. Only alpha-tocopherol is recognised to meet human requirements. The US adult target is 15 mg a day (about 22 IU natural or 33 IU synthetic). Australia’s adequate intake is even lower: 10 mg men / 7 mg women. The 1990s capsule is not that.

SELECT put 35,000 men on 400 IU a day of synthetic vitamin E (all-rac / dl-alpha, 180 mg — about 12× the US RDA), selenium, both, or placebo. It did not prevent prostate cancer. After the men came off the pills, vitamin E alone still sat at HR 1.17 (99% CI 1.004–1.36): a 17% increase. About 11 extra cases per 1,000 men over seven years. No difference in overall survival. That is prostate cancer in those men, not “vitamin E causes cancer.”

The heart trials are not a rescue.

Cochrane’s antioxidant review is mortality, not prostate: in lower-bias trials, vitamin E sat at RR 1.03. The prostate number is SELECT only. Do not mash them.

The US Preventive Services Task Force (2022) is Grade D against vitamin E for preventing heart disease or cancer.

Australia does not even sell a 400 IU bottle we could open. The aisle is 500 IU and 1000 IU.

Australia’s upper level is 300 mg a day. A 500 IU natural capsule already exceeds it. Natural is not the rescue: HOPE’s null-and-HF signal was on natural 400 IU. Mixed tocopherols and tocotrienols exist. There is no large trial showing they dodge SELECT or HOPE. They are not the IN.

Park the antioxidant / prostate / heart capsule if that is why you bought it. Keep it only if a clinician put you on vitamin E for a real deficiency, a rare genetic need, or an AREDS eye formula.

Skip the capsule. That is allowed. Sometimes the IN is empty.

Food vitamin E has not shown the supplement harm signals. NIH ODS: no adverse effects from food E. That is not a diet-versus-SELECT trial. It is still the honest lane.

Per serving (ODS):

A handful of almonds plus sunflower seeds, or a spoon of wheat-germ oil, covers the US target from food.

Do not start vitamin D “instead.” Different vitamin, different job. Mega-dose D3 gets its own letter.

Do not swap in mixed tocopherols, tocotrienols, or another antioxidant bottle.

If an ophthalmologist has you on AREDS / AREDS2 (or Macu-Vision) for intermediate AMD, that combination probably slows progression. Vitamin E alone does not prevent AMD. Do not dismantle the eye formula from this email.

“I’ve been taking a 400–1000 IU vitamin E capsule as an antioxidant / for my prostate / for my heart. Given SELECT (17% more prostate cancer in men on 400 IU synthetic a day), the bleeding and haemorrhagic-stroke data, and HOPE-TOO’s heart-failure hospitalisations, is there any reason I should keep it, or is food vitamin E enough for me?”

If you are on warfarin, a DOAC, dual antiplatelets, or an AREDS formula, say that in the same visit.

Men still swallowing 500–1000 IU “for the prostate” are exactly who this issue is for.