What causes your vitamin E to be low?

In developed nations, dietary insufficiency is rarely the sole cause of low vitamin E; most deficiencies arise from underlying medical conditions that impair nutrient absorption. This is because vitamin E is a fat-soluble vitamin, and its proper absorption is heavily dependent on the body's ability to digest and assimilate dietary fats.

Quick Summary

Low vitamin E is predominantly caused by fat malabsorption disorders, rare genetic conditions, or extremely low-fat diets. Underlying diseases like cystic fibrosis, liver disease, and celiac disease are common culprits that impair absorption, rather than inadequate intake alone.

Key Points

• Malabsorption is key: Most low vitamin E cases are caused by underlying medical conditions that impair fat absorption, not just dietary intake.

• Genetic disorders exist: Rare inherited conditions like Ataxia with Vitamin E Deficiency (AVED) directly prevent the liver from properly transporting vitamin E.

• Fat is necessary: Vitamin E is fat-soluble, so a severely low-fat diet can inhibit its absorption, although this is less common in developed countries.

• Neurological symptoms: Low vitamin E can cause neurological problems such as muscle weakness, poor coordination, and vision issues.

• High-risk groups: Individuals with cystic fibrosis, celiac disease, and certain liver diseases are at increased risk due to impaired fat metabolism.

• Infants are vulnerable: Premature and low-birth-weight infants are born with low vitamin E stores and are at a higher risk of deficiency.

Understanding Vitamin E and Its Absorption

Vitamin E is a group of fat-soluble compounds that act as powerful antioxidants, protecting your cells from oxidative damage. As a fat-soluble nutrient, it requires dietary fat for absorption in the intestines. From there, it is incorporated into lipoproteins and distributed throughout the body. Any condition that disrupts the normal digestion, absorption, or transport of fats can therefore lead to low vitamin E levels, even if your dietary intake is adequate.

Medical Conditions Affecting Vitamin E Levels

Fat Malabsorption Disorders

By far the most common cause of vitamin E deficiency in developed countries is a medical condition that leads to poor fat absorption. These disorders prevent the intestines from properly absorbing dietary fat, and thus, the vitamin E contained within it. Key examples include:

• Cystic Fibrosis (CF): A genetic disorder affecting the exocrine glands, CF often causes a lack of pancreatic enzymes necessary for fat digestion. This leads to severe fat malabsorption and a high risk of vitamin E deficiency, necessitating supplementation.
• Celiac Disease: An autoimmune disorder where consuming gluten damages the small intestine lining, which can impede nutrient absorption. Studies show that untreated celiac patients have significantly lower vitamin E levels, though a strict gluten-free diet often helps normalize them.
• Crohn's Disease: A type of inflammatory bowel disease (IBD) that causes inflammation of the digestive tract. Chronic inflammation, particularly in the small intestine (ileum), can interfere with fat and fat-soluble vitamin absorption, including vitamin E.
• Liver and Gallbladder Diseases: Conditions like chronic cholestasis (decreased bile flow from the liver) and primary biliary cirrhosis impair the production and release of bile, which is essential for fat emulsification and absorption. This is a major cause of vitamin E deficiency in affected individuals.
• Pancreatic Insufficiency: Conditions like chronic pancreatitis can damage the pancreas, leading to a deficiency of fat-digesting enzymes. This directly impairs the absorption of fat-soluble vitamins.
• Bariatric Surgery: Certain weight-loss surgeries, particularly malabsorptive procedures, can alter the digestive system and reduce the body's ability to absorb fats and fat-soluble vitamins.

Rare Genetic Conditions

Some hereditary disorders specifically affect the body's metabolism and transport of vitamin E, bypassing issues with fat absorption entirely.

• Ataxia with Vitamin E Deficiency (AVED): This rare, inherited disorder is caused by mutations in the TTPA gene, which codes for the alpha-tocopherol transfer protein (αTTP). The protein is responsible for transferring vitamin E from the liver to other tissues. Without it, vitamin E levels in the blood and nervous system become severely low, leading to progressive neurological damage.
• Abetalipoproteinemia: A very rare inherited disorder where the body cannot produce lipoproteins, which are necessary for transporting dietary fats and fat-soluble vitamins, including vitamin E, from the gut into the bloodstream. This results in profound malabsorption and extremely low vitamin E levels.

Dietary Factors and Risk

While less common in well-nourished populations, dietary intake can play a role, especially in conjunction with other risk factors. A severely low-fat diet, by restricting the vehicle for vitamin E absorption, can lead to a deficiency over time. Some individuals may also follow diets that simply lack vitamin E-rich foods. Foods high in vitamin E include vegetable oils (especially wheat germ, sunflower, and safflower), nuts, seeds, and leafy green vegetables.

Symptoms of Low Vitamin E

Since vitamin E is vital for neurological function, its deficiency primarily affects the nervous system. Common symptoms include:

• Muscle weakness and poor reflexes
• Loss of body movement coordination (ataxia)
• Numbness or tingling in the extremities (peripheral neuropathy)
• Vision problems, such as impaired eyesight
• Weakened immune function, leading to frequent illnesses

Early signs like muscle weakness or poor coordination may appear gradually over time, making a diagnosis based on symptoms alone challenging.

Comparing Causes of Vitamin E Deficiency

Feature	Malabsorption Disorders	Genetic Disorders (e.g., AVED)	Dietary Deficiency	Premature Infants
Underlying Issue	Impaired fat digestion or absorption	Defective transport or metabolism of vitamin E	Insufficient dietary intake of vitamin E and/or fat	Low initial stores due to poor placental transfer
Primary Mechanism	Lack of bile salts, pancreatic enzymes, or intestinal surface area	Defective liver protein (αTTP) or lipoprotein synthesis	Chronic avoidance of fats and vitamin E-rich foods	Incomplete physiological development before birth
Onset	Dependent on the underlying condition's progression	Often manifests in childhood or adolescence	Chronic, long-term dietary habits	Immediately at or shortly after birth
Key Examples	Cystic fibrosis, Crohn's, celiac, liver disease	Ataxia with vitamin E deficiency (AVED), Abetalipoproteinemia	Very low-fat diets	Babies born with very low birth weight [< 1500g]

Management and Treatment

Treatment for low vitamin E involves addressing the underlying cause and supplementing as needed. For malabsorption issues, this may involve treating the primary condition (e.g., a gluten-free diet for celiac disease) and providing high-dose oral vitamin E, sometimes in a water-soluble form to bypass absorption issues. Genetic disorders often require significantly larger doses of supplementation for life. In contrast, dietary causes are usually remedied by adjusting one's diet to include more vitamin E-rich foods and healthy fats. Premature infants are routinely screened and supplemented if necessary.

Conclusion

While vitamin E deficiency is uncommon in the general healthy population, it is a critical concern for individuals with fat malabsorption disorders, rare genetic conditions, and very low-fat dietary patterns. A wide range of diseases, from cystic fibrosis to celiac disease, can disrupt the body's ability to properly utilize this essential nutrient. Recognizing the symptoms, which often include neurological issues like muscle weakness and coordination problems, is the first step toward diagnosis. As underlying medical issues are the most frequent cause, it is crucial to identify and treat the root problem, often with the help of supplementation, to prevent long-term complications. Consulting with a healthcare provider is essential for accurate diagnosis and a tailored treatment plan.

For more information on the various factors contributing to vitamin E deficiency, you can read detailed health professional fact sheets from the National Institutes of Health.

Frequently Asked Questions

Can I get low vitamin E just from a bad diet?

It is unlikely for a healthy person in a developed country to have a vitamin E deficiency solely due to diet, as it is found in many common foods. However, following a severely low-fat diet for an extended period can be a risk factor because fat is required for absorption.

What is the connection between celiac disease and low vitamin E?

Celiac disease causes damage to the small intestine's lining, which can result in nutrient malabsorption. Because vitamin E is a fat-soluble vitamin, this damage can prevent its proper absorption, leading to a deficiency.

How do genetic disorders cause low vitamin E?

Certain rare genetic conditions, such as Ataxia with Vitamin E Deficiency (AVED), involve a defective liver protein (αTTP) responsible for distributing vitamin E throughout the body. This causes vitamin E levels to plummet even if dietary intake is normal.

What are the first signs of low vitamin E?

Early signs often include neurological symptoms like impaired coordination, muscle weakness, slow reflexes, and numbness or tingling in the extremities. Since these symptoms progress slowly, they can be difficult to detect initially.

Is low vitamin E a common problem?

No, vitamin E deficiency is considered rare, especially in healthy individuals. It is most often linked to an underlying medical condition, like a malabsorption disorder, that interferes with the body's ability to absorb or use the vitamin.

How is low vitamin E diagnosed?

Diagnosis is typically confirmed through a blood test that measures serum alpha-tocopherol levels. A healthcare provider will also perform a physical exam and review your medical history to identify any underlying risk factors.

Does liver disease cause vitamin E deficiency?

Yes, chronic liver diseases like cholestasis, which reduce the flow of bile, can lead to malabsorption of fat and fat-soluble vitamins, including vitamin E. The liver is also critical for metabolizing and transporting vitamin E.