Vitamin E is an essential fat-soluble vitamin that supports heart health and strengthens the immune response. On the other hand, high-dose supplements may worsen inflammation and do more harm than good. What does that mean amid the current coronavirus pandemic?
This article is for informational purposes only. The current coronavirus outbreak is an ongoing event and certain details may change as new information comes to light.
What Role Can Vitamin E Play In COVID-19?
First off, there is no evidence that vitamin E can prevent or treat coronavirus. The 2019 coronavirus (also known as SARS-CoV-2 and 2019-nCoV) is extremely recent and we are still lacking robust studies on it. No effective or FDA-approved products are yet available.
At the same time, doctors are in need of general supportive and preventive measures for COVID-19, the disease caused by the 2019 strain. Hospitals around the world are faced with COVID-19 patients who also suffer from various chronic diseases that increase their chance of dying [1].
Staying healthy seems to be more important than ever.
To maintain good health, we need to get plenty of nutrients from food. Vitamin E intake may be problematic in the US, but the data are conflicting [2].
Some estimates that rely on surveys suggest that over 90% of the US population don’t get adequate amounts of dietary vitamin E [3, 4, 5].
On the other hand, national reports that rely on vitamin E blood levels say otherwise. According to them, under 1% of the US population aren’t consuming enough vitamin E. Experts say more high-quality analyses are needed to determine how big of a concern vitamin E intake is for Americans [6].
To stay on the safe side, it’s a good idea to be mindful of your diet. Be sure to include healthy vitamin E-rich foods, as your immune system needs this vitamin.
Vitamin E is also considered a general supportive treatment for coxsackievirus and bovine coronavirus in states of deficiency. There’s no evidence that it can do the same for patients infected with the new coronavirus, though [7].
Coxsackievirus is a distant relative of the 2019 coronavirus. Bovine coronavirus, on the other hand, is somewhat of a closer relative. It has been around for a while, infects cows, and there’s a vaccine against it [8].
The best preventive measures you can take against 2019-nCoV are those of standard care: stay at home, wash your hands, and avoid touching your face.
Why Your Immune System Needs Vitamin E
The primary function of vitamin E is to combat oxidative stress by getting rid of free radicals. Along with vitamin C, it protects fat molecules like LDL cholesterol from harmful oxidation and helps maintain the structure and function of each cell [9, 10].
Vitamin E plays vital roles in [11, 12]:
- Heart and brain health
- Immunity
- Skin health
- Fertility
In animals, vitamin E helps prevent a decrease in immunity that happens with aging [13].
Immune Benefits
Dietary antioxidants like vitamin E contribute to strong immunity and general wellness, and they might be particularly important for the elderly [14, 13].
Vitamin E plays a big role in your immune response. It helps immune cells stay active while protecting them against oxidative stress [15].
Vitamin E deficiency impairs immune defense, making the body more prone to infectious and chronic diseases. According to limited studies on older people, vitamin E intake may lower the risk of bacterial and viral infections. Scientists observed the same trend in lab animals [13, 16, 17].
In preliminary trials on HIV patients, vitamin E supplementation improved drug treatment efficacy, slowed down the progression into AIDS, and prevented other infections. Researchers underlined the need for further, well-designed clinical trials [18, 19].
Future studies have yet to test whether vitamin E status can contribute to coronavirus prevention.
The Dangers of Deficiency
Mild vitamin E deficiency usually goes unnoticed. More severe cases may cause immune deficiency, muscle weakness, vision problems, and cognitive impairment [9, 20].
Genetic disorders and impaired fat absorption are the leading causes of vitamin E deficiency in developed countries, while most cases in poor regions of the world occur due to inadequate nutrition [21].
Any condition that impairs fat absorption in the gut can increase the risk of vitamin E deficiency, including [22, 23, 24, 25]:
- Cystic fibrosis
- Short bowel syndrome
- Celiac disease
- Abetalipoproteinemia (a rare inherited disorder)
- Crohn’s disease
- Liver disease
- Blocked bile flow
Smoking and obesity also increase your risk of vitamin E deficiency. These two factors also increase inflammation and lower immune defense, increasing the risk of infection [26, 27, 28, 29].
Can Vitamin E Help Prevent or Fight Respiratory Infections?
Cold & Flu Among the Elderly
Old age is the single biggest independent risk factor for both getting COVID-19 in the first place and for suffering more serious consequences [1].
In a clinical trial on 617 older people, supplementing with vitamin E for a year reduced the incidence of common colds and other upper respiratory tract infections. However, it didn’t prevent lower respiratory tract infections, which tend to be more serious [30, 31].
A similar study on 652 elderly people found the same dose of vitamin E ineffective [32].
Data is also lacking to suggest that vitamin E can speed up flu recovery. In a study on 205 people aged 65 years and older, vitamin E status had no effect on the effectiveness of flu vaccination [33].
Asthma & Lung Health
Asthma and other allergic diseases have been linked to an increased risk of lung diseases like chronic obstructive lung disease (COPD). People who develop asthma in childhood and go on to have breathing difficulties in adulthood may be especially vulnerable [34, 35].
This is not good news for COVID-19, which causes serious complications by infecting the lungs. Any disease that compromises the lungs can make the symptoms more severe and the chance of dying higher. Over 6% of infected people with chronic lung or airway diseases die, compared to under 1% of healthy people [36].
How vitamin E might play in is still uncertain. Previous studies suggest it might hold some value by reducing airway inflammation in asthmatics. More research is needed, though.
In one large study on over 65k women, a high intake of vitamin E protected against asthma [37].
Being born to a mother with lower blood vitamin E (alpha-tocopherol) was associated with wheezing in a study of 652 children [38].
Vitamin E supplements also improved lung function in a clinical trial on 240 asthmatic children but failed to do so in another trial on 72 adults [39, 40].
In asthmatic mice, dietary alpha-tocopherol (but not gamma-tocopherol) reduced lung inflammation. The other form of vitamin E found in food (gamma-tocotrienol) protected mice from allergic asthma in another experiment. Vitamin E supplementation also improved the antioxidant status of asthmatic mice [37, 41, 42].
Pneumonia & Serious Lung Damage
Lung scarring or pulmonary fibrosis is another serious lung disease that can make COVID-19 more fatal. Additionally, the virus itself may cause lung scarring within 6 months of being infected in severe cases [43].
Based on the existing data, vitamin E is probably powerless to prevent further lung damage in people with lung scarring. Also, no data specific to its effects on COVID-19 are available.
Vitamin E intake and blood alpha-tocopherol levels didn’t protect against lung scarring in a study on over 1k children. A large analysis concluded getting enough vitamin E from food only helps improve vitamin E status, but not lung function, in people with lung scarring [44, 45].
However, vitamin E did show some promise in smokers. In 7k elderly men who smoke, vitamin E prevented pneumonia, but more so in those who smoked less than 20 cigarettes per day or exercised [46].
Another life-threatening complication of COVID-19 is acute respiratory distress syndrome or ARDS. In rats with ARDS, vitamin E improved the animals’ antioxidant status and reduced cytokine levels [47].
In rats exposed to pollution, supplementation with vitamin E and fish oil reduced lung injury, inflammation, and oxidative damage. Human data are lacking [48].
The Importance of Vitamin E for Heart Health Amid COVID-19
COVID-19 Can Damage the Heart
Studies are clear on one fact: heart disease increases the risk of COVID-19 complications and death. Data from the Centers for Disease Control and Prevention (CDC) indicate that about 6% of people with high blood pressure and over 10% of people with heart disease die from COVID-19 [1].
New data also reveal that the virus itself may cause irreversible and potentially deadly heat damage [49].
Among 416 hospitalized COVID-19 patients in China, around 20% developed an injury to the heart. More than half of the patients with heart injury died. Many of the people experiencing heart injury also had high levels of inflammation and previous cardiovascular issues [49].
Antioxidants like vitamin E are crucial for a healthy heart and blood vessels. They prevent the oxidation of LDL cholesterol particles and reduce plaque buildup. Additionally, vitamin E lowers inflammation and strengthens the immune system [50, 51].
Higher levels of inflammation in COVID-19 may arise from a weakened immune system that lets the virus hijack cells, divide, and set off a cytokine storm that damages heart cells [49].
Can Vitamin E Reduce Deaths from Heart Disease?
Vitamin E may reduce heart-related complications, but the data are still inconclusive. Also, its impact on heart damage from COVID-19 is unknown.
In a large meta-analysis, people with the highest blood levels of alpha-tocopherol had 18% lower death rates from a stroke or heart failure. A study of over 29,000 male smokers found a similar correlation between vitamin E supplements and heart disease [52, 53].
Among 1,000 patients with irregular heartbeat, those with a low ratio of alpha-tocopherol to cholesterol had 87% higher rates of heart attack or stroke [54].
However, a meta-analysis of 15 trials failed to confirm the benefits of high vitamin E levels on heart health [55].
Potential Dangers of Vitamin E Supplementation Amid COVID-19
Inflammation & Cytokines
Vitamin E may increase immune-stimulating inflammatory compounds called cytokines. It had mixed effects in animals with the flu, and no data on its impact on coronaviruses is available [56, 57].
Interferons, which are also cytokines, might help fight the virus off in early stages. Many immune-boosters (like echinacea) probably increase interferons [58].
Caution is advised, however, since anything that increases cytokines (e.g. IL-6, IFN-γ, and other interferons) might be harmful in people who are already infected. These inflammatory compounds can wreak havoc in later stages of coronavirus infection, causing “cytokine storms” that seem to worsen lung and even heart damage [58, 59].
Health Risks of High Doses
Excess alpha-tocopherol from supplements reduces blood levels of gamma-tocopherol and may increase the risk of [60, 61, 62, 63, 64, 65, 66]:
- Inflammation
- Atherosclerosis
- Prostate and breast cancer
- Fractures
Inflammation, heart disease (atherosclerosis), and cancer have all been associated with worse COVID-19 outcomes [1].
Since having any chronic disease likely increases the risk of dying from COVID-19 or experiencing severe complications, high-dose alpha-tocopherol supplements should be strictly avoided [1].
According to a large meta-analysis of 19 clinical trials (over 136,000 participants), daily doses above 400 IU may even be associated with increased mortality. However, most studies were conducted on people with advanced chronic diseases, which likely influenced the results [67].
An additional review, which included even more data, confirmed the impact of other diseases and sex difference, with a higher risk for men. Coronavirus aside, high doses of vitamin E are not recommended in general, unless prescribed by a doctor [68].
Dosage & Precautions
Dosage
The recommended daily intake of vitamin E for adults is 15 mg (22.4 IU). Pregnant women need the same amount, while nursing women need 19 mg (28.4 IU) per day [69].
To correct deficiency, doctors may prescribe high-dose vitamin E supplements by mouth (15-25 mg/kg daily or 200 IU of mixed tocopherols). Patients with impaired absorption may receive intramuscular injections [21].
Natural Sources
The best way to boost vitamin E naturally is to consume a variety of vitamin E-rich whole foods like [70, 71]:
- Wheat germ oil
- Sunflower seeds and oil
- Nuts (almonds and hazelnuts)
- Peanuts
- Spinach
- Broccoli
To keep your vitamin E status high, make sure to also eat Vitamin C-rich foods such as [72, 73]:
- Citrus fruits
- Red pepper
- Kiwi
- Strawberries
- Tomatoes
Precautions
People on blood thinners should avoid vitamin E supplements as high levels may increase the risk of bleeding [74].
Side Effects & Overdose Risks
You can’t overdose on vitamin E from food sources, but high-dose supplements are a potential threat. The safe upper limit is 1000 mg daily, which is equivalent to 1100 IU of synthetic or 1500 IU of natural alpha-tocopherol [69].
Higher doses might cause side effects such as [75, 76]:
- Fatigue
- Acne
- Cramps
- Diarrhea
- Mood swings
Takeaway
Older people with chronic health problems and poor immune function are at a higher risk of dying from COVID-19 or experiencing complications. Getting enough vitamin E from food helps support heart and immune health.
The elderly may especially benefit from increasing whole foods that are rich in vitamin E and other nutrients. This is a good strategy for most people since mild vitamin E deficiency is extremely common.
On the other hand, high-dose vitamin E supplements can be dangerous and have been linked with inflammatory diseases. This is particularly concerning in the light of COVID-19. Unless recommended by a doctor, vitamin E supplements should be avoided.
