Written by Luc Geeraert and the CAM-Cancer Consortium.
Updated September 30, 2015

Vitamin E during cancer treatment

What is it?


Natural Vitamin E includes eight chemical forms (alpha-, beta-, gamma-, and delta-tocopherol, and alpha-, beta-, gamma-, and delta-tocotrienol), which have different metabolism and biopotency in vivo 1,2. Alpha-tocopherol (d-alpha-tocopherol or RRR-alpha-tocopherol) is considered the biologically most important form of vitamin E. The synthetic form of vitamin E is known as all-rac-alpha-tocopherol (dl-alpha-tocopherol). Often commercial supplements of synthetic (all-rac-alpha-tocopherol) or natural (alpha-tocopherol) vitamin E contain the vitamin as an acetate or succinate ester.


Vitamin E is fat-soluble and can be found in a wealth of food sources, e.g., green leafy vegetables, whole grains, nuts and seeds, wheat germ, eggs, and in plant oils (especially oils derived from safflower, sunflower, cottonseed, and palm) 3,4. The ratios of the different chemical forms of vitamin E depend on the food source.

Commercial supplements contain vitamin E derived from natural sources or synthetic vitamin E. Supplements derived from natural sources contain only one chemical form of vitamin E, most often alpha-tocopherol, or a mixture of tocopherols and even tocotrienols. Synthetic preparations contain exclusively all-rac-alpha-tocopherol. Often the vitamin E in supplements has been esterified (acetate or succinate ester) to prevent its oxidation by air oxygen.

Application and dosage

The recommended daily allowance for adults is 15 mg per day for alpha-tocopherol, an amount which is easily met by dietary sources, and 30 mg per day for synthetic all-rac-alpha-tocopherol 5. The upper limit for intake is 1,000 mg per day. Very often, the dosage of vitamin E is given in international units (IU) referring to the activity in the rat resorption-gestation test: 1 mg is equivalent to 1.49 IU of natural alpha-tocopherol or 2.22 IU of all-rac-alpha-tocopherol. It is important to note that the different chemical forms of vitamin E might have different biological functions and that activity measurements based on the rat resorption-gestation test are indicative for activity in only one biological role.

Vitamin E supplements are taken as capsules, with a typical dose being 400 IU per day, which is above the recommended daily allowance. Vitamin E is also an ingredient in many multivitamin-mineral supplements.

Plasma alpha-tocopherol levels are saturable; a dose of approximately 800 IU is sufficient to achieve the upper limit 2. In healthy subjects, the alpha-tocopherol concentration cannot be increased beyond two to three times the normal one, irrespective of the amount supplied or the duration of supplementation 6.


Vitamin E was discovered in 1922 as a micronutrient necessary for reproduction in female rats 7. Since, it has been proposed to have numerous biological functions in humans, though its essential functions are still not understood 6. Vitamin E deficiency due to dietary limitations has not been established.

Most research has focused on the antioxidant properties of vitamin E. Being an antioxidant, it was assumed that the vitamin might be beneficial against chronic diseases with oxidative stress components, including cancer 2.

Claims of efficacy / Mechanism(s) of action / Alleged indication(s)

Vitamin E, in all its chemical forms, is primarily considered a fat-soluble antioxidant 2,8. It was found to prevent lipid peroxidation and other radical-driven oxidative events in lipophilic compartments (e.g., cell membranes).

Moreover, vitamin E has activities beyond its antioxidant properties that might be more important to understand its biological roles 1,2. Although various mechanisms of action have been proposed, the mechanisms leading to the putative anticancer effects of (some chemical forms of) vitamin E have not been conclusively described.

In vitro and animal studies showed limited or no evidence for an anticancer effect of alpha-tocopherol, while gamma-tocopherol, the succinate ester of alpha-tocopherol, and tocotrienols were found to be more promising vitamin E forms in cancer 1,3,9-11.

In general, vitamin E has also a modulating effect on the immune system 12.

The metabolic fate of the individual tocopherols and tocotrienols in the body is very different, which may influence their respective activities in the body. In general, plasma and tissues are enriched in alpha-tocopherol due to the activity of the hepatic alpha-tocopherol transfer protein 2,8,13. Hence, there is a concern that alpha-tocopherol supplementation might deplete the body of other vitamin E forms like gamma-tocopherol and tocotrienols 3,14.

Prevalence of use

The use of vitamin E supplements is widespread among cancer patients and longer-term survivors, with 20-50% of the patients using supplements of the vitamin 15.

Legal issues

In many countries, vitamin E is available as over-the-counter supplement.

Cost(s) and expenditures

Vitamin E supplements are very inexpensive, costing around 10 euro cent or dollar cent for 400 IU.


Luc Geeraert, CAM-Cancer Consortium. Vitamin E during cancer treatment [online document]. http://cam-cancer.org/The-Summaries/Dietary-approaches/Vitamin-E-during-cancer-treatment. September 30, 2015.

Document history

Summary updated in September 2015 by Luc Geeraert.
Summary fully revised and updated in July 2013 by Luc Geeraert.
Summary first published in August 2011, authored by Luc Geeraert.


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