Vitamin E

Vitamin E is a vitamin that dissolves in fat. It is discovered in numerous foods including vegetable oils, cereals, meat, poultry, eggs, and fruits.

Vitamin E is an essential vitamin needed for the proper function of numerous organs in the body. It is likewise an anti-oxidant. Vitamin E that takes place naturally in foods (rrr-alpha-tocopherol) is various from manufactured vitamin E that is in supplements (all-rac-alpha-tocopherol).

Vitamin E is used for dealing with vitamin E shortage, which is uncommon, however can occur in individuals with particular genetic disorders and in extremely low-weight early infants. Vitamin E is likewise used for lots of other conditions, but there is no good clinical evidence to support much of these other usages. (2 ).

History

Vitamin E (α-tocopherol) was found nearly 100 years earlier 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 includes 8 different vitamin E-related particles manufactured by plants; despite the fact that all of these particles are peroxyl extreme scavengers, the human body prefers α-tocopherol. The biological activity of vitamin E is highly dependent upon regulatory mechanisms that serve to retain α-tocopherol and excrete the non-α-tocopherol kinds. This choice depends on the combination of the function of α-tocopherol transfer protein (α-ttp) to enhance the plasma with α-tocopherol and the metabolism of non-α-tocopherols. Α-ttp is important for human health because anomalies in this protein lead to serious vitamin E shortage identified by neurologic problems, especially ataxia and ultimately death if vitamin E is not supplied in large quantities to conquer the absence of α-ttp. Α-tocopherol serves as a peroxyl radical scavenger that secures polyunsaturated fatty acids in membranes and lipoproteins. Although specific paths and particular molecular targets have been sought in a variety of research studies, the most likely description regarding why human beings need vitamin E is that it is a fat-soluble anti-oxidant. (3 ).

Synthesis

Biosynthesis

Photosynthesizing plants, algae and cyanobacteria manufacture tocochromanols, the chemical family of compounds comprised of four tocopherols and 4 tocotrienols; in a nutrition context this family is referred to as vitamin E. Biosynthesis begins with development of the closed-ring part of the molecule as homogentisic acid (hga). The side chain is attached (filled for tocopherols, polyunsaturated for tocotrienols). The pathway for both is the same, so that gamma- is produced and from that alpha-, or delta- is produced and from that the beta- substances. Biosynthesis happens in the plastids.

Regarding why plants synthesize tocochromanols, the major factor seems for antioxidant activity. Different parts of plants, and various types, are controlled by various tocochromanols. The primary kind in leaves, and thus leafy green veggies is α-tocopherol. Place is in chloroplast membranes, in close proximity to the photosynthetic procedure. The function is to secure against damage from the ultraviolet radiation of sunlight. Under normal growing conditions the existence of α-tocopherol does not appear to be essential, as there are other photo-protective substances, and plants that through anomalies have lost the ability to manufacture α-tocopherol demonstrate regular growth. Nevertheless, under stressed growing conditions such as dry spell, elevated temperature or salt-induced oxidative tension, the plants’ physiological status is superior if it has the regular synthesis capability.

Seeds are lipid-rich, to offer energy for germination and early development. Tocochromanols protect the seed lipids from oxidizing and becoming rancid. The presence of tocochromanols extends seed durability, and promotes effective germination and seedling development. Gamma-tocopherol controls in seeds of many plant types, however 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 holds true. Of the typically utilized food oils, palm oil is unique because tocotrienol content is higher than tocopherol content. Seed tocochromanols material is likewise based on ecological stress factors. In almonds, for instance, dry spell or elevated temperature boost α-tocopherol and γ-tocopherol content of the nuts. The very same article discusses that drought increases the tocopherol content of olives, and heat similarly for soybeans.

Industrial synthesis

Naturally sourced d-alpha-tocopherol can be drawn out and cleansed from seed oils, or gamma-tocopherol can be drawn out, cleansed, and methylated to develop d-alpha-tocopherol. In contrast to alpha-tocopherol extracted from plants, which is likewise called d-alpha-tocopherol, commercial synthesis creates dl-alpha-tocopherol. “it is manufactured from a mix of toluene and 2,3,5-trimethyl-hydroquinone that responds with isophytol to all-rac-alpha-tocopherol, using iron in the existence of hydrogen chloride gas as catalyst. The response mixture acquired is filtered and drawn out with liquid caustic soda. Toluene is removed by evaporation and the residue (all rac-alpha-tocopherol) is cleansed by vacuum distillation.” specification for the active ingredient is >> 97% pure. This synthetic dl-alpha-tocopherol has roughly 50% of the potency of d-alpha-tocopherol. Manufacturers of dietary supplements and fortified foods for people or domesticated animals transform the phenol form of the vitamin to an ester using either acetic acid or succinic acid because the esters are more chemically steady, 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 anti-oxidant. This suggests it secures body tissue from damage brought on by compounds called free radicals. Free radicals can harm cells, tissues, and organs. They are thought to play a role in certain conditions associated with aging.
2. It assists keep the immune system strong against infections and bacteria.
3. It assists form red cell and widen blood vessels to keep blood from clotting inside them.
4. It helps the body usage vitamin k.
5. Cells likewise use vitamin E to engage with each other. It helps them perform lots of crucial functions.

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

Food sources

Vitamin E is found in plant-based oils, nuts, seeds, fruits, and veggies.

• Wheat bacterium 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 effects are still unknown. Vitamin E is an antioxidant, avoiding complimentary extreme responses with cell membranes. Though in many cases vitamin E has actually been shown to have pro-oxidant activity.

One mechanism of vitamin E’s antioxidant result is in the termination of lipid peroxidation. Vitamin E reacts with unstable lipid radicals, producing steady lipids and a fairly steady vitamin E radical. The vitamin E radical is then decreased back to steady vitamin E by response with ascorbate or glutathione. (7 ).

Benefits of vitamin E

Though vitamin E is typically considered a single substance, it’s in fact a group of eight fat-soluble compounds with effective antioxidant impacts.

Of these 8 chemical types, alpha-tocopherol finest meets the dietary requirements of human beings.

Vitamin E exists naturally in certain foods, including seeds, nuts, some vegetables, and some fortified items. You can likewise take it as a dietary supplement.

It plays many roles in your body. It’s possibly best known for its antioxidant impacts, protecting your cells from oxidative damage by neutralizing hazardous particles called free radicals. In addition, it’s needed for appropriate immune function and cellular signaling.

That’s why it’s not surprising that research recommends taking vitamin E supplements might benefit your health in several methods.

This article covers 8 prospective advantages of vitamin E.

May reduce markers of oxidative stress and improve antioxidant defenses

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

Due to the fact that vitamin E serves as a powerful anti-oxidant in the body, studies have shown that supplementing with high dosages of it can minimize markers of oxidative stress and increase antioxidant defenses in some populations.

For example, a 2018 research study in 54 people with diabetic nephropathy– kidney damage brought on by high blood sugar level– found that supplementing with 800 iu of vitamin E daily for 12 weeks significantly increased levels of glutathione peroxidase (gpx) compared to a placebo.

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

A 2021 study also showed that supplementing with a combination of vitamin E and vitamin c daily for 8 weeks decreased markers of oxidative stress, such as malondialdehyde and ros, in women with endometriosis.

Might lower heart problem threat 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 recommends that vitamin E supplements may help in reducing heart disease risk factors such as these in some people.

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

Some studies likewise show that taking vitamin E with omega-3 supplements might minimize ldl and triglyceride levels in individuals with metabolic syndrome– a cluster of conditions, including high blood fat levels, that increases the danger of heart disease and other health conditions.

Might advantage those with nonalcoholic fatty liver illness (nafld)

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

According to research findings, vitamin E supplements might enhance some aspects of health in individuals with nafld.

A 2021 evaluation of 8 research studies found that supplementing with vitamin E decreased levels of the liver enzymes alanine aminotransferase (alt) and aspartate aminotransferase (ast), reduced blood lipid levels, and enhanced liver health in individuals with nafld.

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

May help manage dysmenorrhea

Dysmenorrhea is a condition defined by severe and regular menstrual pain, such as cramps and pelvic pain.

Promisingly, research study suggests vitamin E supplements might lower pain in females with this condition.

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

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

Other potential health benefits

Vitamin E supplements have actually also been connected to numerous other health benefits:.

May advantage skin health. Vitamin E supplements might be valuable for those with certain skin disorders, such as eczema. Nevertheless, research is currently limited, and more research studies are needed to get more information about this potential benefit.

May benefit cognitive health. Keeping optimal vitamin E levels and taking supplements may assist secure versus cognitive decline. However it’s still unclear whether the supplements benefit individuals with cognitive conditions like alzheimer’s disease.

May advantage older grownups. Due to the fact that vitamin E plays important functions in health, such as decreasing swelling and enhancing immune function, supplements might benefit people who have increased requirements or do not get enough in their diets, such as some older grownups.

May enhance lung function. Research studies have actually shown that vitamin E supplements could improve lung function and particular signs of asthma in kids and grownups. (8 ).

Role of vitamin E in pregnancy

Vitamins play essential functions in female health. They are important for many functions, including menstruation and ovulation, oocyte (egg) quality and maturation. Vitamin E was first found 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 helps your body produce and keep red blood cells, healthy skin, eyes and reinforces your natural immune system. Nevertheless, in spite of it being initially found as a vitamin necessary for reproduction, to date research studies relating to its effects in this area are doing not have. Vitamin E supplementation may help reduce the danger of pregnancy problems including oxidative tension, such as pre-eclampsia. This chapter is written to offer a review of the known functions of vitamin E in pregnancy. (9 ).

Skin health benefits of vitamin E for guys

While it might be unusual for guys to have a vitamin E deficiency, this hasn’t stopped a number of them from scooping up skin care items including it (including our powerful firming serum). Here is why a growing number of males are integrating vitamin E into their daily skin care regimen.

Anti-aging

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

In fact, vitamin E is often used in sun blocks and everyday moisturizers for males due to its photoprotective residential or commercial properties. Research shows that alpha-tocopherol, the primary naturally happening isomer in vitamin E, can possibly prevent dna cell damage from uv rays (see claim: “topical application of alpha-tocopherol (alphath), the most popular naturally taking place form 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 quantity of anecdotal proof that vitamin E can speed up wound recovery and potentially reduce acne scars. While there isn’t much in the way of scientific proof on vitamin E’s function in wound recovery, research does recommend that keeping skin hydrated is essential to minimizing the look of scars (see claim: “the discovery that a wet environment actively supports the recovery response when compared with a dry environment highlights the significance of water and great hydration levels for optimal recovery.”).

Men who slather on cream containing vitamin E might be seeing a decrease in scarring simply since they are hydrating their skin frequently. Utilizing a day-to-day men’s moisturizer can assist you achieve similar skin care benefits by smoothing out flaws and protecting your face from sun damage.

Battles acne

Guy tend to have oilier skin compared to women, which can result in extreme acne breakouts. If you’re questioning whether vitamin E can assist you control your breakouts, the answer is perhaps.

There are some studies which recommend that a diet abundant in vitamin E (together with vitamin a and zinc) can help reduce acne symptoms. Nevertheless, research studies on how vitamin E can benefit acne sufferers are minimal and inconclusive.

With studies being so minimal, vitamin E isn’t advised as a standalone service to acne. Rather, men are better off using an acne treatment system developed for their skin. (10 ).

What can vitamin E do for hair?

Vitamin E has natural antioxidant results that could help to keep hair growth.

Individuals have claimed that vitamin E provides numerous benefits for hair health, however a number of these claims lack rigorous scientific evidence to back them up.

Most of the claims about vitamin E’s function in hair health associate with its antioxidant residential or commercial properties. These focus on the idea that it can reduce cell damage and enhance hair development.

We examine some of the most typical claims below.

Could help support a healthy scalp

Vitamin E might help support a healthy scalp and hair as it has natural antioxidant impacts that might help with preserving hair development.

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

Help avoid hair loss

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

A little research study utilizing a total of 38 volunteers experiencing loss of hair took a look at the role that vitamin E played in avoiding this loss. The study discovered that a person of the components of vitamin E did enhance the hair development of the volunteers compared with a placebo.

More research is still essential to identify how vitamin E affects hair loss.

Increased shine

According to some individuals, vitamin E can help replenish shine that the hair loses as a result of damage. Chemicals, heat, and other styling items can all damage the hair.

An individual can bring back shine utilizing oils, which supply an extra layer of protection to the skin and hair. Many makers will add vitamin E to their products to help restore shine.

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

Eye benefits of vitamin

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

Research study recommends vitamin E may help in reducing the worsening of age-related macular degeneration (amd) amongst people who reveal early signs of the eye illness.

In the age-related eye disease research study (areds) including almost 5,000 individuals, participants with early amd had a 25 percent lower threat of developing innovative stages of the disease when taking an everyday nutritional supplement containing vitamin E. The areds supplement included 400 international systems (iu) of vitamin E, along with high levels of vitamin a (as beta-carotene), vitamin c and zinc.

Based upon areds and other dietary studies, lots of eye doctors suggest that their patients supplement their diet with a day-to-day multivitamin which contains approximately 400 iu of vitamin E in mix with other anti-oxidants as part of their preventative eye care.

Some research studies recommend vitamin E likewise might play a role in preventing cataracts:.

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

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

However, a recent research study of obviously healthy older guys in the united states failed to reveal any advantage of vitamin E supplements in the prevention of cataracts.

More than 11,000 males ages 50 and older (african-american participants) or 55 and older (all other individuals) took a day-to-day vitamin E supplement (400 iu of dl-alpha-tocopherol) or a placebo tablet for roughly five and a half years. At the end of the research study period, there was no considerable difference in the variety of cataract medical diagnoses or cataract surgical treatments performed amongst participants of the two groups.

It appears more research study is required to totally comprehend the possible eye advantages of vitamin E– especially in regards to whether vitamin E supplements can reduce the threat of cataracts. (12 ).

Vitamin E shortage

Vitamin E deficiency caused by a diet low in vitamin E is common in developing nations. In industrialized countries, the cause is typically an absorption condition. Some infants are born with vitamin E shortage, which usually enhances with supplements.

• Vitamin E shortage might trigger impaired reflexes and coordination, problem walking, and weak muscles.
• Early babies with the shortage might develop a severe kind of anemia.
• The diagnosis is based upon symptoms and outcomes of a physical examination.
• Taking vitamin E supplements fixes the shortage.

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

Vitamin E, like vitamins a, d, and k, is a fat-soluble vitamin, which liquifies in fat and is finest taken in when consumed with some fat. Great sources of vitamin E include vegetable oils, nuts, seeds, green leafy veggies, and wheat germ.

Babies have a fairly low reserve of vitamin E due to the fact that only small amounts of vitamin E cross the placenta. Hence, newborns, especially early babies, are at increased danger of vitamin E deficiency. However, with age, threat reduces since infants normally get enough vitamin E in breast milk or in industrial formulas. Grownups can store big quantities of vitamin E in fat tissue, making the deficiency less likely.

Causes of vitamin E deficiency

A really low fat diet plan lacks vitamin E, since veggie oils are the main source of this vitamin and because vitamin E is finest taken in when consumed with some fat. Disorders that hinder fat absorption (such as specific liver disorders, gallbladder conditions, pancreatitis, and cystic fibrosis) can also reduce the absorption of vitamin E and increase the threat of vitamin E shortage.

In the united states and other industrialized nations, vitamin E deficiency is rare among older kids and adults and is normally due to.

• A condition that hinders fat absorption (malabsorption disorder)
• In developing nations, the most typical reason for vitamin E deficiency is
• Inadequate consumption of vitamin E

Signs of vitamin E deficiency

In kids, symptoms might consist of slow reflexes, problem strolling, loss of coordination, loss of position sense (knowing where the limbs are without looking at them), and muscle weakness.

In adults with vitamin E shortage due to a malabsorption disorder, these symptoms rarely establish because adults keep big amounts of vitamin E in fat (adipose) tissue.

Vitamin E deficiency can trigger a kind of anemia in which red blood cells rupture (hemolytic anemia). Premature babies who have a vitamin E deficiency are at threat of this serious disorder.

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

Vitamin E negative effects

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

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

• Headache, lightheadedness, vision changes;
• A light-headed feeling, like you might lose consciousness;
• Uncommon weakness or exhausted sensation;
• Diarrhea, stomach cramps; or
• Easy bruising or bleeding (nosebleeds, bleeding gums).

Typical vitamin E adverse effects may consist of:.

• Nausea;
• Exhausted sensation
• Headache; or
• Moderate rash. (14 )

Dosage and preparation

The advised dietary allowance (rda) for vitamin E is 15 mg. Many vitamin E supplements supply around 67 mg of the nutrient, which is much greater than the rda. Those requiring a vitamin E supplement likely have a diagnosed vitamin E deficiency, which is much more appropriate for the 60 to 75 mg daily dose offered in a supplement. Large dosage vitamin E supplements need to be approached with caution and gone over with your physician ahead of time.

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

Interactions

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

Alkylating representatives and anti-tumor prescription antibiotics. There’s concern that high doses of vitamin E may affect using these chemotherapy drugs.

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

Cytochrome p450 3a4 (cyp3a4) substrates. Usage 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 individuals with high cholesterol, could minimize niacin’s effect.

Vitamin k. Taking vitamin E with vitamin k may decrease the impacts of vitamin k. (16 ).

What are warnings and safety measures for vitamin E?

Cautions

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

Keep out of reach of children. In case of overdose, get medical help 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 on the positive outcomes it achieved, they started utilizing it regularly in their practices. Since then, well-designed experimental and clinical research studies have actually advanced gradually and increased our knowledge of vitamin E. The antioxidative properties of vitamin E have been found to play an essential role in the fight versus numerous illness such as atherosclerosis, oxidative stress, cancer, cataract and advertisement, to name a few.

This review focused on the important functions of vitamin E in some diseases; in addition to these, this vitamin has been found to be reliable against asthma, allergies and diabetes, to name a few. Discussion of the dietary sources, rda and the interaction of vitamin E supplements with other dietary aspects, has demonstrated the need for and significance of vitamin E in the human context. Thus, raising public awareness of the function of dietary anti-oxidants in preserving better health would benefit a variety of lives.

Apart from the enormous benefits reported, there has always been argument about the exact function of vitamin E and its role in various diseases. There are many conflicting reports of favorable and unfavorable results on the very same biological activities in the literature. The primary hindrance in determining the functions of vitamin E in human health is the lack of validated biomarkers for vitamin E intake and status, which would assist to relate intakes to possible scientific results. In conclusion, although the information surrounding vitamin E is inconsistent, the present literature appears to support the view that the benefits exceed the side-effects. (18 ).

Referrals

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/