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Consequences of Poor Digestive Function: Vitamin E Malabsorbtion
by Andreas M. Papas, PH.D.

It may be hard to believe that amid the abundance of food and a plethora of supplements in the U.S. that many people develop clinical vitamin E deficiency. Vitamin E is an essential fat-soluble antioxidant that helps prevent heart disease, diabetes, and cancer. If a digestive condition such as IBS, celiac, or Crohn's disease exists, vitamin E absorption is easily compromised. To further complicate matters, vitamin E deficiency may go undetected for decades, resulting in cumulative damage to our health that may become debilitating and irreversible. Unfortunately, when digestion is compromised, deficiency is inevitable.


To explain how this happens, let's explore some of the dynamics. Humans are water-based organisms. Our blood, which carries the nutrients necessary to nourish our tissues, is water and makes up more than half of our weight. Vitamin E, however, is fat-soluble. Since oil and water do not mix, the body compensates for this by producing micelles, unique tiny spheres with a hydrophilic (water loving) outer layer designed to ferry fat material from the gut across the intestinal wall into the blood stream.

Two major components are required for micelle production:
  • Bile, a yellow-green liquid produced in the liver and secreted into the gut, helps emulsify our dietary fat and can be found in the outer layer of micelles
  • Pancreatic juice, a secretion delivered into the upper part of the small intestine (duodenum), where it works to aid digestion
In the blood stream, vitamin E is transported by lipoproteins, the vehicles that transport lipid materials in our body. These are minute spheres with a water-friendly outer layer, which allow them to circulate freely in the blood. They carry vitamin E and other lipids in their lipophilic or fat-friendly interior.


Despite this clever design, there are a number of diseases and physiological conditions that may reduce the uptake of vitamin E.

1. Liver and pancreatic insufficiency:
Because bile and pancreatic juices are critical for its transport and absorption, any condition that compromises the function of the liver and pancreas can lead to malabsorption. For example:
  • Cholestasis—a condition which reduces or stops the excretion of bile. May be caused by inherited genetic defects, injury, or diseases of the liver, such as hepatitis, alcoholic hepatitis, and damage or inflammation due to the use of powerful medicines or chemotherapy that can affect the production of bile.
  • Cystic Fibrosis—a genetic disease in which the secretion of the pancreatic juice is blocked by thick mucous. This may also affect liver function and bile secretion.
  • Steattorhea—the inability to absorb fat, thus leading to serious vitamin E deficiency. Steattorhea is generally associated with other vitamin E-blocking conditions, such as cystic fibrosis, pancreatitis, and is synonymous with celiac crisis, celiac rickets, celiac sprue, gluten enteropathy, non-tropical sprue, and wheat-sensitive enteropathy.
2. Inflammation, surgical removal of part of the gut, infection, disturbance of its flora, and diarrhea:
  • Inflammatory Bowel Disease (IBD) includes diseases that cause intestinal inflammation, such as Crohn's and Ulcerative Colitis.
  • Short Bowel Syndrome is the result of half or more of the small intestine being removed primarily as treatment for Crohn's.
  • HIV is associated with fungal and other infections of the small intestine, which inhibit absorption of the nutrients, particularly the fat-soluble ones. Other infectious diseases of the gut may cause malabsorption.
  • Irritable Bowel Syndrome (IBS; also known as spastic colon or mucous colitis) can cause diarrhea, decreasing absorption.
  • Bariatric Surgery, a treatment of obesity, is often associated with nutrient deficiency proportional to the length of absorptive area.
3. Nutrient transport defects and their effect on absorption.
These mostly genetic defects include:
  • Abetalipoproteinemia is a rare inherited disease which prevents the formation of normal chylomicrons and very-low density lipoproteins (VLDL), which are essential for proper molecule transport of vitamin E. Though patients with abetalipoteinemia "absorb" vitamin E, most of the vitamin never goes past the gut wall because the patients cannot produce these special vehicles which carry vitamin E.
  • Ataxia with vitamin E deficiency, or familial-isolated vitamin E deficiency, is an extremely rare genetic disease that prevents the transfer of absorbed vitamin E from the liver to the blood and the tissues.
4. Aging.
Aging is known to contribute to significant vitamin E deficiencies. Diminished digestion and absorption combined with increased need equals deficiency. It is estimated that over 50 percent of the elderly may have suboptimal vitamin E status. Such deficiencies may be aggravated by chronic disease conditions and medications, which affect liver and other functions.


Aqua E supplies the complete vitamin E family of tocopherols plus tocotrienols in a patented water-soluble formula designed to enhance absorption. It is particularly rich in the natural unesterified gamma tocopherol and tocotrienols, which are of particular interest because of the increased oxidative stress. Each teaspoon (5 ml) supplies 100 IU plus 59 mg of gamma tocopherol for a total of 150 mg of total tocopherols. In addition, it supplies 9 mg of tocotrienols.

This proprietary formula contains lipoprotein-like micro spheres which have the same action as micelles. In addition, after passing the gut wall these micro spheres may help deliver vitamin E to the tissues even in the absence of a healthy lipoprotein transport system (for example, in abetalipoproteinemia).

Increasing the ease of transportation by making it into odorless, tasteless drops, Aqua E mixes with most beverages and water for trouble-free compliance for children and those who don't want to take pills.

References available upon request.

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