High-dose vitamin E (400 IU/day) increases prostate cancer (SELECT, +17%) and may increase all-cause mortality (Miller 2005: +39 per 10,000).
Original statement
وفي السرطان، أوقفت تجربة CARET عام 1996 مبكراً بعد أن رفع البيتا كاروتين وفيتامين A الإصابةَ بسرطان الرئة لدى المدخنين بنسبة 28%، وأكدت تجربة ATBC الفنلندية النتيجة نفسها. أما تجربة SELECT فأظهرت أن فيتامين E بجرعة 400 وحدة دولية يومياً يزيد سرطان البروستاتا بنسبة 17%. | ثم جاء التحليل التلوي لميلر عام 2005 ليُظهر أن جرعات فيتامين E العالية (≥400 وحدة دولية يومياً) ترفع الوفيات الكلية بمعدل 39 لكل 10,000 شخص.
not verbatim – paraphrase. Translation by the project; the Arabic wording is authoritative.
Translation
High-dose vitamin E (400 IU/day) increases prostate cancer (SELECT, +17%) and may increase all-cause mortality (Miller 2005: +39 per 10,000).
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (eltayebat.com); not verified as Elawady's own words
- Origin
- https://eltayebat.com/rule/oral-supplements/
- Attribution uncertainty
- Written by the archive operators; study selection is the archive's, not necessarily Elawady's.
- Claimed mechanism
Not specified.
- Claimed health effect
Prostate cancer; mortality.
- Population concerned
Healthy men (SELECT); mixed, often chronically ill populations (Miller).
- Geographic restriction by Elawady
none found
Scientific assessment
Mostly true – Correct at its core, but with limitations or minor inaccuracies.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Vitamin E pills raise prostate cancer and mortality.
2. What is demonstrably correct?
SELECT: 620 vs 529 prostate cancers, HR 1.17 (99% CI 1.004–1.36). Miller 2005: pooled risk difference +39/10,000 in high-dose trials. USPSTF recommends against vitamin E for prevention (no net benefit).
3. What is wrong or exaggerated?
The mortality increase is uncertain and is not supported by SELECT itself, which found no difference in all-cause mortality (vitamin E HR 1.01, 99% CI 0.86-1.17) and no significant increase in Gleason >=7 cancer (A-SUP-23). Miller's authors note that high-dose trials were often small and in chronically ill people; later pooled analysis (USPSTF 2022) found no significant mortality effect.
4. What remains unclear?
Why SELECT and ATBC differ for prostate cancer is unclear (dose, form, population).
5. Which studies support it?
A-SUP-23 (prostate cancer incidence only), A-SUP-03 (mortality, meta-analysis), A-SUP-24, A-SUP-30.
6. Which studies contradict it?
O'Connor 2022 (I-SUP-08): vitamin E OR 1.02 for mortality; ATBC (A-SUP-05) fewer prostate cancers with 50 mg.
7. What applies to Germany and Europe?
Applies equally.
8. What is known about Egypt?
Applies equally.
9. What practical conclusion is appropriate?
High-dose vitamin E supplements are not recommended for disease prevention.
Assessment details
- Rationale for certainty of evidence
SELECT is a large RCT (35,533 men) with a statistically significant increase (HR 1.17; absolute +1.6 per 1,000 person-years). The mortality signal comes from meta-analyses of heterogeneous, often small trials in sick populations; the USPSTF 2022 review found no significant effect of vitamin E on all-cause mortality (OR 1.02, 0.97–1.07).
- Source quality
Correctly cited; mortality part less robust.
- Regional transferability
High.
- Individual exceptions
ATBC found fewer prostate cancers with low-dose (50 mg) alpha-tocopherol – a contrasting result.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically well supported – The claim agrees with consistent, high-quality evidence.
Research question: In adults, does high-dose vitamin E (>=400 IU/day), compared with placebo, increase prostate cancer and all-cause mortality?
Research question in detail (PICO)
- Population
- Healthy men (SELECT); mixed trial populations (mortality)
- Intervention or exposure
- Vitamin E >=400 IU/day
- Comparison
- Placebo
- Geographic scope
- universal biology
- Outcomes
- Prostate cancer
- All-cause mortality
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
SELECT: vitamin E and prostate cancer
Klein EA et al.. JAMA 2011 · PMID 21990298 · DOI 10.1001/jama.2011.1437 Randomised controlled trialfull text, structured risk-of-bias assessmentSELECT: 400 IU/day vitamin E increased prostate cancer in healthy men.
- Actual result
- 620 vs 529 cases; HR 1.17 (99% CI 1.004-1.36).
- Methodological quality
- high (large RCT)
- Relevance
- direct
- Limitations
- Mostly low-grade cancers; mortality unchanged in SELECT.
Antioxidant pills and death: Cochrane review
Bjelakovic G et al.. Cochrane Database Syst Rev 2012 · PMID 22419320 · DOI 10.1002/14651858.CD007176.pub2 Meta-analysisabstract checkednewly addedCochrane: vitamin E increased mortality slightly in low-bias trials.
- Actual result
- RR 1.03 (1.00-1.05).
- Methodological quality
- high (Cochrane)
- Relevance
- direct
- Limitations
- Borderline; lower bound 1.00.
Vitamin E, selenium status and prostate cancer (SELECT)
Kristal AR et al.. J Natl Cancer Inst 2014 · PMID 24563519 · DOI 10.1093/jnci/djt456 Randomised controlled trialabstract checkednewly addedSELECT case-cohort: vitamin E increased prostate cancer mainly in men with low selenium status.
- Actual result
- +63% total, +111% high-grade (P=0.008) in low-selenium men.
- Methodological quality
- moderate (subgroup within RCT)
- Relevance
- direct
- Limitations
- Post-hoc subgroup.
What speaks against the claim?
USPSTF evidence review 2022
O'Connor EA et al.. JAMA 2022 · PMID 35727272 · DOI 10.1001/jama.2021.15650 Systematic reviewabstract checkedUSPSTF 2022 review: no significant mortality effect of vitamin E.
- Actual result
- OR 1.02 (0.97-1.07).
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Pooled different doses.
ATBC: beta-carotene raised lung cancer in Finnish smokers
ATBC Study Group. N Engl J Med 1994 · PMID 8127329 · DOI 10.1056/NEJM199404143301501 Randomised controlled trialabstract checkedATBC: low-dose (50 mg) alpha-tocopherol associated with fewer prostate cancers.
- Actual result
- Fewer prostate cancers (secondary).
- Methodological quality
- high (RCT), secondary outcome
- Relevance
- indirect (lower dose, smokers)
- Limitations
- Secondary outcome.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Prostate cancer increase with 400 IU/day is shown in one large RCT; the mortality increase is small and uncertain.
Why some studies weigh more
SELECT is the most direct test; mortality pooled analyses conflict slightly (Cochrane borderline vs USPSTF null).
Is a causal relationship established? Probable Randomised; single trial for prostate cancer.
Remaining uncertainty
Mortality effect; dose and form.
Justified conclusion
High-dose vitamin E is not advisable; the 'may increase mortality' wording is acceptable as a possibility.
Why do studies seem to disagree?
SELECT vs ATBC differ in dose (400 IU vs 50 mg), population (healthy men vs smokers) and endpoint status (primary vs secondary).
Does this depend on the country?
- General biological effects
- Same human physiology everywhere.
- Eating habits
- Supplement use patterns differ by country; not region-specific for this question.
- Origin of the food
- Not relevant.
- Contaminants
- Product quality and contamination vary by market (not assessed here).
- National production conditions
- Not relevant.
- Legal rules
- Supplements are regulated as foods in the EU; Egyptian rules not verified.
- Actual monitoring data
- No monitoring data reviewed.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- CI symmetry vitamin E RR 1.03 (1.00-1.05) – Asymmetry from rounding at the lower bound; effect borderline. recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Prostate cancer with high-dose vitamin E
- Starting level
- high (randomised trials)
- Reasons for downgrading
- imprecision (one trial; 99% CI lower bound 1.004)
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- USPSTF: Vitamin, Mineral, and Multivitamin Supplementation to Prevent CVD and Cancer (A-SUP-30) (2022) · Original publication
Recommends against beta-carotene and vitamin E for prevention of CVD and cancer; evidence insufficient for most other supplements (record re-checked via PubMed efetch 2026-10-26; recommendation grades taken from the existing record).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:"vitamin E" OR TITLE:tocopherol) AND TITLE:"prostate cancer" AND (TITLE:SELECT OR TITLE:"Selenium and Vitamin E" OR PUB_TYPE:"Meta-Analysis") AND PUB_YEAR:[2012 TO 2026] | both directions | 21 | |
| Europe PMC | 26 October 2026 | TITLE:"antioxidant supplements" AND TITLE:mortality AND JOURNAL:"Cochrane Database Syst Rev" | supporting evidence | 2 |
How deeply was this checked?
8 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 7 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly true (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly true (moderate)
New sources (Cochrane 2012, SELECT case-cohort) are consistent with the existing assessment.
New sources: I-SUP-122 I-SUP-108
In plain language
A large trial in healthy men found that daily high-dose vitamin E pills slightly increased prostate cancer: about 1.6 extra cases per 1,000 men each year. Whether vitamin E pills also increase deaths is less certain. Either way, they do not help prevent disease and are not recommended.
Studies on this claim
Studies supporting the claim (6)
-
SELECT: vitamin E and prostate cancer
Klein EA et al.. JAMA 2011 · PMID 21990298 · DOI 10.1001/jama.2011.1437Randomised controlled trialcited by the Tayebat archivefull text, structured risk-of-bias assessment★ key studyVitamin E pills raised prostate cancer by 17% (1.6 extra cases per 1,000 men per year).
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Prostate cancer prevention.
- How was the study done?
RCT.
- How many people, animals or samples were studied?
35,533 men.
- What was actually found?
More prostate cancer with vitamin E.
- How large was the observed effect?
HR 1.17; +1.6/1,000 py.
- What do the results mean in everyday life?
Avoid vitamin E pills.
- What are the study's limitations?
Modest effect.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Mortality effects.
-
High-dose vitamin E and mortality
Miller ER et al.. Ann Intern Med 2005 · PMID 15537682 · DOI 10.7326/0003-4819-142-1-200501040-00110Meta-analysiscited by the Tayebat archiveabstract checked★ key studyIn high-dose trials, 39 more deaths per 10,000 people with vitamin E.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Vitamin E and death.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
135,967.
- What was actually found?
Small increase at high dose.
- How large was the observed effect?
+39/10,000.
- What do the results mean in everyday life?
Avoid high-dose vitamin E.
- What are the study's limitations?
Sick populations.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Effect in healthy adults.
-
Antioxidant pills and mortality
Bjelakovic G et al.. JAMA 2007 · PMID 17327526 · DOI 10.1001/jama.297.8.842Meta-analysiscited by the Tayebat archiveabstract checked★ key studyIn low-bias trials, beta-carotene, vitamin A and vitamin E were linked to slightly more deaths.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Mortality.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
232,606.
- What was actually found?
Small increase in low-bias trials.
- How large was the observed effect?
RR 1.05.
- What do the results mean in everyday life?
No benefit, possible harm.
- What are the study's limitations?
Debated methods.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Precise harm.
-
USPSTF 2022: vitamins for prevention
US Preventive Services Task Force et al.. JAMA 2022 · PMID 35727271 · DOI 10.1001/jama.2022.8970Guideline / position statementcited by the Tayebat archiveabstract checked★ key studyRecommends against beta-carotene and vitamin E; evidence insufficient for most others.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Prevention guidance.
- How was the study done?
Guideline.
- What was actually found?
D for beta-carotene, vitamin E; I for others.
- What do the results mean in everyday life?
Don't take for prevention.
- What are the study's limitations?
Not for pregnancy/deficiency.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Advice on deficiency or pregnancy.
-
Vitamin E, selenium status and prostate cancer (SELECT)
Kristal AR et al.. J Natl Cancer Inst 2014 · PMID 24563519 · DOI 10.1093/jnci/djt456Randomised controlled trialindependent cross-checkabstract checkedVitamin E pills raised prostate cancer risk mainly in men who had low selenium levels.
Vitamin E increased prostate cancer (incl. high-grade) in men with lower selenium status; subgroup analysis.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
To see whether selenium status changes supplement effects.
- How was the study done?
Case-cohort analysis in a randomised trial.
- How many people, animals or samples were studied?
1,739 cases; 3,117 subcohort.
- What was actually found?
Vitamin E increased prostate cancer in low-selenium men.
- How large was the observed effect?
+63% total, +111% high-grade.
- What do the results mean in everyday life?
High-dose vitamin E pills are not advisable for men.
- What are the study's limitations?
Subgroup analysis.
- What does it say about Elawady's specific claim?
Supports C-SUP-03.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot prove the subgroup effect.
-
Antioxidant pills and death: Cochrane review
Bjelakovic G et al.. Cochrane Database Syst Rev 2012 · PMID 22419320 · DOI 10.1002/14651858.CD007176.pub2Meta-analysisindependent cross-checkabstract checked★ key studyIn 78 trials, antioxidant pills did not lower death rates; beta-carotene and vitamin E slightly increased them in the best trials.
Vitamin E: RR 1.03 (1.00-1.05) in low-bias trials; borderline.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
To see whether antioxidant supplements prevent death.
- How was the study done?
Cochrane meta-analysis of randomised trials.
- How many people, animals or samples were studied?
78 trials; 296,707 people.
- What was actually found?
No benefit; small increase in deaths with beta-carotene and vitamin E in low-bias trials.
- How large was the observed effect?
Low-bias RR 1.04 (1.01-1.07); beta-carotene 1.05; vitamin E 1.03.
- What do the results mean in everyday life?
Antioxidant pills do not help you live longer and some may slightly shorten life.
- What are the study's limitations?
Mixed populations; older search.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Does not apply to antioxidants in food.
No study in this group is marked as key.
Studies contradicting or limiting the claim (1)
-
USPSTF evidence review 2022
O'Connor EA et al.. JAMA 2022 · PMID 35727272 · DOI 10.1001/jama.2021.15650Systematic reviewindependent cross-checkabstract checked★ key studySupplements gave little or no protection; beta-carotene harmful; multivitamins slightly fewer cancers.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Supplement benefits/harms.
- How was the study done?
SR.
- How many people, animals or samples were studied?
739,803.
- What was actually found?
Little benefit; some harms.
- How large was the observed effect?
OR 0.93 MV cancer; 1.20 beta-carotene lung cancer.
- What do the results mean in everyday life?
Supplements are not a prevention strategy.
- What are the study's limitations?
Not for deficiency.
- What does it say about Elawady's specific claim?
Mixed.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Effects in deficient people.
No study in this group is marked as key.
Studies with mixed or unclear results (1)
-
ATBC: beta-carotene raised lung cancer in Finnish smokers
ATBC Study Group. N Engl J Med 1994 · PMID 8127329 · DOI 10.1056/NEJM199404143301501Randomised controlled trialcited by the Tayebat archiveabstract checkedBeta-carotene raised lung cancer by 18% and deaths by 8%; vitamin E did not prevent lung cancer.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Cancer prevention in smokers.
- How was the study done?
Factorial RCT.
- How many people, animals or samples were studied?
29,133 men.
- What was actually found?
Harm from beta-carotene.
- How large was the observed effect?
+18% lung cancer.
- What do the results mean in everyday life?
Avoid beta-carotene pills.
- What are the study's limitations?
Men smokers only.
- What does it say about Elawady's specific claim?
Supports C-SUP-02.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Non-smokers.
No study in this group is marked as key.
Regional context
Germany / EU
Applies equally.
Egypt
Applies equally.
What applies in my country?
General scientific assessment
Mostly true Mostly true: vitamin E pills raised prostate cancer risk; the mortality effect is uncertain.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT).. Klein EA et al.. JAMA 2011 · PMID 21990298 · DOI 10.1001/jama.2011.1437
- Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality.. Miller ER et al.. Ann Intern Med 2005 · PMID 15537682 · DOI 10.7326/0003-4819-142-1-200501040-00110
- Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis.. Bjelakovic G et al.. JAMA 2007 · PMID 17327526 · DOI 10.1001/jama.297.8.842
- Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement.. US Preventive Services Task Force et al.. JAMA 2022 · PMID 35727271 · DOI 10.1001/jama.2022.8970
- Baseline selenium status and effects of selenium and vitamin e supplementation on prostate cancer risk.. Kristal AR et al.. J Natl Cancer Inst 2014 · PMID 24563519 · DOI 10.1093/jnci/djt456
- Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases.. Bjelakovic G et al.. Cochrane Database Syst Rev 2012 · PMID 22419320 · DOI 10.1002/14651858.CD007176.pub2
- Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.. O'Connor EA et al.. JAMA 2022 · PMID 35727272 · DOI 10.1001/jama.2021.15650
- The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers.. ATBC Study Group. N Engl J Med 1994 · PMID 8127329 · DOI 10.1056/NEJM199404143301501