Vitamin E deficiency is rare in healthy adults. Almost all cases come from fat malabsorption disorders or rare genetic conditions that affect how vitamin E is carried in the body. Severe deficiency causes progressive nerve damage, including loss of balance and coordination (ataxia) and peripheral neuropathy. Premature infants are also vulnerable because they have small stores at birth.
Common symptoms
Loss of balance and coordination (ataxia)
Loss of position and vibration sense (proprioceptive loss)
Muscle weakness
Loss of deep tendon reflexes (areflexia)
Numbness or tingling in hands and feet (peripheral neuropathy)
Eye problems such as limited upward gaze, retinal damage and reduced vision
Hemolytic anemia (red blood cells more susceptible to oxidative damage)
Difficulty walking, especially in the dark
Slurred speech (dysarthria) in advanced cases
At-risk groups
People with fat malabsorption disorders such as cystic fibrosis, cholestatic liver disease or short-bowel syndrome
People with abetalipoproteinemia (rare genetic disorder of fat metabolism)
People with ataxia with vitamin E deficiency (AVED, caused by TTPA gene mutations)
Premature or low birth weight infants
People who've had extensive intestinal surgery
People with chronic pancreatic insufficiency
Note: vitamin E deficiency from inadequate diet alone is essentially unheard of
When to see a doctorSee a doctor for a neurological check that includes a blood alpha-tocopherol test if you notice worsening balance or clumsiness, loss of vibration sense or muscle weakness, especially in a young person or someone with known fat malabsorption. In the genetic forms, early treatment with high-dose vitamin E can halt progression and partly reverse symptoms.