This is a narrative review of the evidence of α-tocopherol importance in human health, especially with regards to its vitamin role. α-Tocopherol is a potent peroxyl radical scavenger, and this role is prominent in its efficacy in maintaining the metabolic health of tissues. Vitamin E deficiency is discussed as a tool to understand the impact of α-tocopherol’s absence promoting increased lipid peroxidation and polyunsaturated fatty acid depletion. Downstream deficiency consequences include impacts on choline and one-carbon metabolism, glucose and energy metabolism, and their interactions with critical thiols, such as glutathione. Importantly, human vitamin E deficiency, caused by genetic defects in the α-tocopherol transfer protein (α-TTP), provides important clues for the necessity of α-tocopherol for the peripheral nervous system. Moreover, α-TTP expression in the liver, brain, eyes, and placenta illustrates that these tissues are especially vulnerable and require this specific α-tocopherol delivery mechanism for their protection. Although clinical trial evidence is limited and equivocal about the health benefits of vitamin E supplements, there is epidemiologic evidence of the long-term benefits of increased α-tocopherol intakes in ’healthy’ diets (high in vegetables and fruits, fish, nuts, and seeds, as well as fiber). Significance statement The elaborate regulation of α-tocopherol concentrations by the human body suggests that the consistent consumption of the recommended amounts of dietary α-tocopherol (15 mg) over a lifetime are protective of the at-risk tissues, as well as providing protection from chronic diseases.
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