Bigger doses aren’t always better

I received a great question from a Daily Dispatch reader who lives in Walla Walla, Washington. The question came in response to my report on a study examining vitamin E and Alzheimer’s disease (AD). The study showed that AD patients who took large doses of vitamin E significantly delayed the progress of this brutal disease.

At the end of the Dispatch, I warned readers that we still need more research. But in the meantime, you can’t go wrong taking 50 IU of vitamin E per day (as d-alpha tocopheryl acetate) to support good health. I also said that larger doses could be appropriate for dementia patients. But you should always work with a qualified physician. (Hopefully he or she is not still following the misguided, outdated research from 10 years ago.)

Well, the Walla Walla reader asked, “Surely you do not mean 50 IU of vitamin E per day. I have never seen vitamin E in an amount less than 400 IU. This must be a typo?”

I surely did mean 50 IU! That was no typo.

Yes, in this study, Alzheimer’s disease patients took 2,000 IU of vitamin E daily. And their symptoms improved. But remember, when you take a vitamin to treat a disease, it will most likely require much higher doses than when you take one for general health. Unfortunately, most researchers don’t get this right when they study nutrients for chronic diseases. Instead, they use low-ball doses that can’t reverse a disease that took a lifetime to develop.

But when you use vitamins primarily to support general health, you must consider many different factors, such as:

1. How much of the nutrient do multivitamins or once-a-day vitamins contain?
When I make dosage recommendations for individual nutrients, such as vitamin E, I must consider that many people probably already take a daily multivitamin. And when recommending a specific dosage, I allow for the amount many already get in the daily multivitamin. In this case, typical multivitamins contain 100 IU of vitamin E. So, when I recommend taking 50 IU of vitamin E, it takes into account that many already get 100 IU from multivitamins.

2. How much is the Daily Recommended Allowance?
I also consider the USDA’s Daily Recommended Allowance (RDA). While RDA’s are by no means the basis of my recommendations, and they are wholly inadequate for reversing chronic diseases, I certainly don’t ignore the standard. In this case, the RDA for vitamin E is only 22 IU. However, the RDA goes on to state a “safe upper limit” of 1500 IU.

3. How much of the nutrient can we assume an average healthy adult already gets through diet?
Remember, the purpose of dietary of supplements is to “supplement” what is already in your diet. For general health, your goal should be to get most of your nutrition from the whole foods you eat. And I assume if you’re interested in supplementing with vitamin E, you’re also highly educated about good nutrition. And probably eating better than average to begin with. You also get large amounts of vitamin E by eating green, leafy vegetables, healthy oils, eggs, nuts, and seafood. So, when I recommend supplementing with vitamin E, I take these dietary sources of vitamin E into account.

4. What other supplements do you take?
Manufacturers often add vitamin E to their “custom” supplements. So starting with 50 IU gives you room to get vitamin E from these other supplements as well as from dietary sources.

All things considered, 50 IU of vitamin E is a safe place to start for anyone and everyone who wants to support their general health. Now, as I said, if you want to treat a specific disease, like Alzheimer’s disease, you will likely need a higher dose. But in that case, as with the management of any medical condition, a qualified doctor should closely supervise your regimen.

I often look with alarm at some of the dosages I see in typical, “run-of-the-mill” dietary supplements. It seems to me that much of the supplement industry just throws in “mega” doses and “super” doses. But they don’t have any real science to support these excessive doses in the general population.

Maybe they think it looks more impressive. But excess does not equal success. That’s just not how a healthy, balanced approach works.

My mentor, the late C. Everett Koop, former U.S. Surgeon General, used to quote, “the least medicine that works is the best medicine.”

Let’s keep working with the right doses, not just the largest.