Vitamin E prevents the perioxidation of polyunsaturated fatty acid in membranes. The most active and available form of vitamin E is α-tocopherol. Vitamin E is incorporated into lipoproteins and cell membranes, limiting LDL oxidation. Vitamin E is the predominant antioxidant in LDL.

Vitamin E is found in vegetable and seed oils, in wheat germ and, in smaller quantities, in meats, fish, fruits and vegetables.

The recommended dietary allowance RDA of vitamin E is 30 IU per day equivalent to 30 mg per day. It is difficult to obtain high doses of vitamin E in the average diet.

Multivitamins usually contain 30 to 50 IU of vitamin E. Vitamin C is the predominant plasma antioxidant. This water-soluble vitamin scavenges plasma free radicals and prevents their entry into LDL particles. Vitamin C improves endothelium-dependent vasodilation and reduces monocyte adhesion.

Dietary sources of vitamin C include citrus fruits, strawberries, cantaloupe, tomatoes, cabbage and leafy green vegetables. Cooking can destroy vitamin C; therefore, the vitamin is best obtained in raw foods or supplements. The RDA for vitamin C is 60 mg, but increased amounts are recommended for smokers, patients with healing wounds and pregnant or lactating patients.

Many carotenoids are known, but their functions are not yet understood. β-Carotene is a vitamin A precursor carried in plasma and LDL. No RDA has been established for carotenoids.

Many epidemiologic studies have linked diets high in antioxidants with reduced CHD risk Tables 1 13 — 16 and 2 17 — Epidemiologic studies cannot prove causality for various reasons, such as selection bias.

Thus, randomized, controlled trials are essential to assess treatment benefits. Plasma levels of vitamins E and C, β-carotene and selenium have been inversely correlated with cross-cultural CHD mortality Table 1. study found an inverse correlation of CHD with fruit and vegetable consumption.

Prospective cohort studies are summarized in Table 2. In a study of more than , female nurses between the ages of 30 and 55 years, food frequency questionnaires assessed daily intake of dietary and supplemental vitamins E, C and β-carotene.

Risk reduction was noted with a daily intake of greater than IU of vitamin E but not with daily use of multivitamins, vitamin C supplements or β-carotene supplements. The Health Professionals Study, 20 which included 39, male health care professionals, noted a 40 percent risk reduction for men in the upper quintile of vitamin E intake about IU per day compared with men in the lowest quintile 6 IU per day.

In this study, no benefits were found for vitamin C supplementation. After adjustment for risk factors and vitamin C intake, men in the highest quintile of β-carotene intake 19, IU per day demonstrated a 29 percent CHD risk reduction compared with those in the lowest quintile 3, IU per day ; however, this benefit occurred only in smokers.

Both studies of health care professionals found that vitamin benefits occurred only after one to two years of supplementation.

Supplement use was also examined in a study of 11, elderly persons. Combined vitamin E and C supplementation reduced total mortality by 42 percent and CHD mortality by 53 percent. The average dosage of vitamin E was greater than IU per day. Randomized, controlled trials of antioxidant vitamin supplementation are summarized in Table 3.

Supplementary vitamin E in a dosage of greater than IU per day was associated with reduced lesion progression.

Vitamin C supplementation was not associated with this benefit. In another study, a single high-fat meal i. The Chinese Cancer Prevention Trial 23 randomized patients to receive either β-carotene 15 mg per day , vitamin E 30 mg per day and selenium 15 μg per day , or placebo.

This study found that supplementation resulted in a 9 percent reduction in total mortality and a 21 percent decrease in deaths from gastric cancer. The Alpha-Tocopherol Beta-Carotene Cancer Prevention Study 24 measured the effects of vitamin E 50 IU per day and β-carotene 20 mg per day supplementation on lung cancer and CHD.

The incidence of nonfatal myocardial infarction was lower in all groups receiving supplementation and was significantly lower 32 percent in the group that received vitamin E.

Supplementation with vitamin E was associated with a nonsignificant increase in cerebral hemorrhage. Supplementation with β-carotene was associated with increased mortality rates for CHD 11 percent and lung cancer 18 percent , as well as an increase in overall mortality 8 percent.

The incidence of fatal CHD was significantly higher in the group that received β-carotene alone 75 percent and in the group receiving both vitamins 58 percent. Vitamin E supplementation is supported by several studies Tables 2 17 — 21 and 3 22 — Increased vitamin E levels are associated with decreased CHD mortality and inversely correlated with risk of angina.

Vitamin E significantly reduced the incidence of overall fatal and nonfatal CHD events by 47 percent and the incidence of nonfatal myocardial infarction by 77 percent; however, supplementation did not have a significant effect on overall mortality relative risk: 1.

Event reduction was better with supplementation at IU per day, but the study was not powered to assess dose-response significance.

This clinical trial strongly supports evidence that vitamin E in dosages greater than IU per day reduces CHD events. Vitamin C significantly improves arterial vasoreactivity and vitamin E regeneration.

The National Health and Nutrition Examination Survey-I cohort study 29 found an inverse relationship between the highest vitamin C intake diet and supplements and CHD risk over 10 years in 11, U.

men and women 25 to 74 years of age. The only large primary prevention trial has been a study of 29, poorly nourished residents of Linixian, China. The patients who received vitamin C in a dosage of mg per day and molybdenum in a dosage of 30 μg per day demonstrated no significant reduction in total or cerebrovascular mortality.

Many studies have demonstrated the ability of vitamin C to improve arterial vasoreactivity. A single dose 2 g of vitamin C has been found to improve vasoreactivity in chronic smokers, 8 patients with hypercholesterolemia 10 and patients with CHD. Research supports the benefit of a carotenoid-rich diet, but not β-carotene supplementation.

The Beta-Carotene and Retinol Efficacy Trial 27 combined β-carotene and retinol supplementation in 18, smokers and patients with asbestos exposure. However, the study was terminated prematurely because of a significant increase in lung cancer mortality and a non-significant increase in CHD mortality.

In 12 years of β-carotene supplementation in 22, male physicians, no significant beneficial effects on CHD mortality, nonfatal MI or stroke were found. A non-significant 20 to 30 percent reduction in CHD events occurred in the physicians who had clinical evidence of atherosclerosis.

Vitamins C, E and β-carotene have few side effects. No significant toxicity has been noted for vitamin E in dosages of to 3, IU per day.

Therefore, caution is recommended when vitamin E supplementation is used in patients receiving anticoagulant therapy. In vitamin E clinical trials, no significant differences in bleeding rates were noted in supplemented and unsupplemented subjects.

Vitamin C supplementation is usually non-toxic, although diarrhea, bloating and false-negative occult blood tests can occur at dosages greater than 2 g per day. The intestinal absorptive capacity for vitamin C is approximately 3 g per day. However, confusion arises about excess vitamin C intake causing increased oxalic acid excretion and, thus, a possibly increased risk of oxalate kidney stones as urinary vitamin C is converted to oxalate with air exposure.

Given in dosages of 30 to mg per day, β-carotene has minimal side effects. Other antioxidants that may provide protection against CHD include selenium, bioflavonoids and ubiquinone. One study 33 found that selenium levels are inversely associated with CHD mortality.

One review 7 noted that conflicting results were reported in other studies. Flavonoids are antioxidants found in tea, wine, fruits and vegetables. These antioxidants reduce platelet activation, but studies do not yet support an associated reduction in CHD.

Ubiquinone, a reduced form of coenzyme Q 10 , decreases LDL oxidation, but no eventreduction data are available. The results of studies of garlic supplements have been conflicting regarding lipoprotein and platelet effects.

The B-complex vitamins, especially folate, pyridoxine vitamin B 6 and cyanocobalamin vitamin B 12 , may reduce CHD risk through a lowering of homocysteine levels.

Folic acid supplementation in a dosage greater than μg per day reduces the plasma homocysteine level. Use of a daily multivitamin supplement containing folate μg would reduce plasma homocysteine levels in most persons.

Oxidized LDL is atherogenic, and specific antioxidants can inhibit LDL oxidation. Epidemiologic studies report inverse relationships between CHD and supplementation with vitamins E, C and β-carotene.

Clinical trials to reduce CHD events currently support vitamin E supplementation in dosages greater than IU per day. Vitamin C promotes vitamin E regeneration and significantly improves vasoreactivity, but clinical event reduction has not been established.

The results of β-carotene studies have generally been unfavorable, primarily for smokers. Folate reduces serum homocysteine levels, but trials focusing on CHD events have not been completed.

Ubiquinone, flavonoids, garlic and other supplements have not been adequately tested for CHD event reduction, appropriate dosing, reliability or long-term safety.

Because of the benefits from dietary antioxidants and other micronutrients, physicians should recommend consumption of a diet containing five to seven servings of fruits and vegetables per day Table 4. Based on current evidence, patients with CHD should probably take vitamin E in a dosage of IU per day; vitamin C supplementation in a dosage of to 1, mg per day should also be considered in these patients.

Patients receiving warfarin Coumadin therapy should limit vitamin E intake to IU per day and should avoid vitamin E if they are at high risk for bleeding. Cohort studies suggest that patients with conditions in which LDL oxidation is common i.

Supplementation of β-carotene is not recommended for CHD prevention because of the possible harm demonstrated in several studies. A high-quality diet or a daily multivitamin may be a useful way to obtain important B vitamins, especially folate μg per day , which lowers homocysteine levels.

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The effect of dietary fat, antioxidants, and pro-oxidants on blood lipids, lipoproteins, and atherosclerosis. J Am Diet Assoc. Heitzer T, Just H, Munzel T. Antioxidant vitamin C improves endothelial dysfunction in chronic smokers. Reilly M, Delanty N, Lawson JA, FitzGerald GA.

Modulation of oxidant stress in vivo in chronic cigarette smokers. Ting HH, Timimi FK, Haley EA, Roddy MA, Ganz P, Creager MA. Vitamin C improves endothelium-dependent vasodilation in forearm resistance vessels of humans with hypercholesterolemia. Plotnick GD, Corretti MC, Vogel RA.

Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal. Gaziano JM, Hatta A, Flynn M, Johnson EJ, Krinsky NI, Ridker PM, et al. Supplementation with beta-carotene in vivo and in vitro does not inhibit low-density lipoprotein oxidation.

Gey KF, Puska P, Jordan P, Moser UK. Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology. Am J Clin Nutr. A research review concluded that antioxidants in cocoa called flavanols improved brain function in young adults, including learning and memory.

Whip cocoa powder into smoothies or add it to oatmeal, overnight oats, pancakes, and energy balls. Cocoa powder can also be incorporated into savory recipes, like mole and chili, and countless healthy treats, from lightly sweetened chocolate hummus to oat milk-based hot cocoa, and date-based fudge.

Cruciferous vegetables, which include cabbage, broccoli, cauliflower, kale , and Brussels sprouts, are rich in antioxidants, including various carotenoids beta-carotene, lutein, and zeaxanthin , flavonoids , anthocyanins, and terpenes. Consuming these vegetables is strongly linked to protecting against cancer, and slowing cancer growth.

Cruciferous vegetables are low in calories and rich in fiber, vitamins, and minerals. One cup of raw broccoli contains 30 calories, 2. Whip kale into smoothies or use it as a salad base. Transform shredded cabbage or broccoli or shaved Brussels sprouts into slaw.

Enjoy sides of cauliflower rice. Or sautéed, grilled, or oven roasted broccoli, cauliflower, or Brussels sprouts. You can also incorporate these veggies into stir fries, soups, and stews.

Catechins, the main antioxidants in green tea , are known to be preventative against a number of cancers, including lung, breast, esophageal, stomach, liver, pancreatic, and prostate cancer. A research review concluded that green tea, which also contains polyphenol and flavonoid antioxidants, has anti-inflammatory and anti-diabetic effects.

In addition, green tea supports immune function and protects brain health. Green tea may also provide small amounts of minerals, including copper, manganese, iron, zinc, magnesium, calcium, and potassium.

However, the amounts vary depending on where the tea was grown. In addition to sipping green tea hot or iced, the beverage can be used to steam vegetables or whole grain rice, or as a liquid in smoothies, overnight oats, soups, and sauces.

Mushrooms contain an array of antioxidants, which have been shown to fend off aging and reduce chronic disease risk.

Mushrooms are also low in calories. One cup of whole white mushrooms provides 21 calories and one whole portabella mushrooms contains just Mushrooms are also the only non-animal source of naturally occurring vitamin D , particularly when exposed to ultraviolet UV light.

Adequate vitamin D is important for bone health and muscle function and may protect against some cancers, lung diseases in children, heart and brain diseases, and all types of diabetes.

Blend mushrooms into smoothies or add them to tofu , chickpea, or egg scrambles, salads, soups, stir fries, curries, tacos, pasta dishes, and more.

Mushrooms can even be incorporated into baked goods, like brownies, cupcakes, and rice pudding. All nuts contain powerful antioxidants called polyphenols. Walnuts, pistachios, and pecans are specially high in these antioxidants per serving.

The antioxidants in nuts help reduce inflammation and may play a role in bone and brain health. A research review concluded that the increase in blood antioxidant levels from antioxidant-rich plant foods, including nuts, is tied to a reduced risk of all causes of death, including heart disease and cancer.

Nuts also provide plant protein, healthful fats, fiber, vitamins, and minerals. Nuts and nut butters can be incorporated into a range of dishes as an ingredient or garnish.

Add nuts to smoothies, oatmeal or overnight oats, energy balls, salads, cooked veggies, stir fries, and slaw. You can season nut butter with garlic, ginger, and chili pepper to make a savory sauce for steamed veggies and tofu.

You can also scoop up nut butter with raw veggies or fresh fruit or layer it with melted dark chocolate for a nutritious treat. Extra virgin olive oil EVOO is the type of olive oil that contains the highest levels of polyphenols, the antioxidants known to reduce inflammation, slow the progression of cancer, heart and brain diseases, and reduce overall death risk.

Polyphenols found in EVOO have also been shown to fend off aging, type 2 diabetes, and metabolic syndrome. The healthy fats in EVOO also help the body absorb the fat-soluble vitamins, A, D, E, and K, which play integral roles in vision, bone health, immune function, and blood clotting.

EVOO can be used in a variety of ways. Enjoy EVOO in salad dressings, slaws, and cool vegetable dishes like salad. Potatoes are bursting with antioxidants. Antioxidants in potatoes include carotenoids, flavonols, anthocyanins, and vitamins C and E.

Baked potatoes can be loaded with healthy toppings, like steamed or sautéed veggies paired with hummus, olive tapenade, guacamole, pesto, tomato sauce, or seasoned tahini. For an antioxidant-rich side dish, toss cooked, chilled potatoes with mustard, EVOO, and herbs.

Pulses, which include beans, lentils, peas, and chickpeas , are high in antioxidants, including polyphenols and flavonoids. These antioxidants have anti-inflammatory, anti-tumor, and anti-allergic properties. Pulses are also rich in protein, fiber, and minerals.

Pulses are incredibly versatile. You can use chickpeas in a breakfast scramble or hummus, or oven-roast them and season them for a filling snack. Tomatoes are rich in an antioxidant called lycopene. This compound, which gives tomatoes their color, has also been shown to reduce inflammation, protect heart health, prevent artery hardening, and reduce blood pressure.

Antioxidant-rich tomatoes have also been shown to protect brain health, reduce the risk of cancer and bowel diseases, and improve skin health, exercise recovery, and immune response.

Cooked tomatoes are higher in lycopene versus raw tomatoes. You can consume tomatoes in a scramble or omelet at breakfast. Toss pastas with tomato sauce or roast tomatoes in the over for a delicious side dish. National Center for Complementary and Integrative Health. Antioxidants: In Depth.

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