Vitamins

The Fabulous Four: How Fat-Soluble Vitamins A, E, D, and K Work Together

In the vast world of nutrition, fat-soluble vitamins are champions, quietly orchestrating a wide range of vital biochemical pathways. Unlike water-soluble vitamins (such as vitamin C and B vitamins), vitamins A, E, D, and K are stored in the body's fatty tissues and liver, ready to be called into action when needed. Let's dive into the dynamic interplay of these four stellar vitamins and discover how they team up to keep us healthy and strong.

Vitamin A: The Visionary Leader

Vitamin A is often hailed as the "visionary" of the group, and for good reason. This nutrient is vital for maintaining healthy vision, skin, reproductive function, cellular communication, immune function, and healthy growth and development. We cannot produce our own vitamin A; we must consume it.

Vitamin A comes in two primary forms: retinoids and carotenoids. Retinoids, such as retinol and retinoic acid, are found in animal products such as liver, fish, egg yolks, and dairy—all great sources of vitamin A. Carotenoids, such as beta-carotene, are found primarily in yellow and orange and fruits and vegetables as well as leafy green vegetables. Beta-carotene is a precursor to retinol and is converted into vitamin A in the body.

Vitamin A deficiency is rare in developed countries yet common in many developing countries where access to these foods is limited. It can lead to dry eyes, night blindness, immune deficiencies, respiratory diseases, chronic infections, and anemia.1 On the flip side, too much vitamin A can cause toxicity, leading to liver damage and other health issues. In addition, it is recommended that pregnant women limit their intake of vitamin A to less than 5,000IU per day to avoid the risk of birth defects.2 Consult with your healthcare practitioner before beginning vitamin A supplementation.

Vitamin D: The Sunshine Vitamin

Vitamin D is essential for calcium absorption, bone mineralization, immune health, modulation of inflammation, healthy cognition, and a positive mood.3,4,5 When our skin is exposed to sunlight, it synthesizes vitamin D3 (cholecalciferol), which then travels to the liver and kidneys to be converted into its active form (calcitriol). Vitamin D2 (ergocalciferol), which can be converted into active D3 in the body, is found in some plant-based dietary sources.

Beyond bones, vitamin D helps prevent conditions like rickets in children and osteoporosis in adults. It also supports the immune system and partners with vitamin K2 to maintain cardiovascular health.

Vitamin E: The Antioxidant Defender

Vitamin E is the body's primary fat-soluble antioxidant, protecting our cells, particularly cellular membranes, from oxidative damage.6 It also plays a major role in protecting anti-inflammatory omega-3 fatty acids from free radical damage.7 This vitamin is a true team player, shielding the other fat-soluble vitamins from oxidation and degradation.8,9 Vitamin E has also been shown to increase the bioavailability of vitamin A, making vitamin A stores more accessible in children who supplement with vitamin E.10*

Vitamin E deficiency can lead to nerve, muscle, and tissue damage as well as immune deficiency.11,12

It’s important to note that vitamin K1’s blood clotting capabilities can be decreased by high doses of vitamin E, particularly in those taking anticoagulants. In contrast, vitamin E supplementation may be beneficial for those with a higher clotting risk, as it has been shown to decrease vitamin K clotting in healthy adults.13

It is always advised to consult with a healthcare practitioner before taking vitamin E supplements, especially when taking anticoagulants such as warfarin or coumadin, to assess risk.

Vitamin K Cousins: Vitamin K1 and Vitamin K2

The vitamin K family consists of two main groups: vitamin K1 (phylloquinone) and vitamin K2 (menaquinones). Vitamin K2 itself has several subtypes, MK-4 through MK-13. Vitamin K, as a family, regulates blood clotting, bone mineralization, and blood vessel calcification.14 Vitamin K1 is primarily involved in regulating blood clotting, while vitamin K2 (especially menaquinone-7, AKA MK-7) works closely with vitamin D to regulate calcium in the bones and blood vessels, ensuring strong bones and healthy arteries.14

Vitamin K deficiency can result in easy bruising, excessive bleeding, and/or weakened bones.15,16

The Synergy of the Fabulous Four

Each of the four fat-soluble vitamins plays a role in benefiting our health in specific ways while also supporting and enhancing the others’ functions. Here’s a closer look at their synergistic relationships and health benefits:

  1. Immune function: Vitamins A and D are key players in maintaining a strong immune system. Vitamin E supports them by protecting immune cells, cellular membranes, and lipids from oxidative stress.
  2. Bone and cardiovascular health: Vitamins D3 and K2 work together to regulate calcium, ensuring it is absorbed efficiently and deposited in bones rather than arteries. This partnership is crucial in preventing osteoporosis and heart disease.* Vitamin A also contributes to bone health by supporting the development of bone cells.17
  3. Skin health: Vitamin A promotes skin cell production and turnover, while vitamin E protects these cells from damage.18,19 Together, they keep skin looking youthful and vibrant.
  4. Vision: Vitamin A is essential for healthy eyesight, and vitamin E promotes the bioavailability of vitamin A, preserving healthy vision and eye function.

Food Sources of A, E, D, and K

Incorporate a variety of foods rich in these vitamins into your diet to harness their full benefits:

  • Vitamin A: liver, fish, cod liver oil, dairy products, carrots, sweet potatoes, squash, bell peppers, and leafy greens
  • Vitamin D: UVB sunlight exposure, fatty fish, egg yolks, fortified milk and nondairy milks, and mushrooms exposed to UVB light
  • Vitamin E: nuts, seeds, vegetable oils, and leafy vegetables such as spinach and broccoli
  • Vitamin K1: leafy greens, broccoli, Brussels sprouts, blueberries, and pine nuts
  • Vitamin K2: natto, sauerkraut, eggs from pastured chickens, and grass-fed, pastured dairy and beef

Consume these foods with healthy fats (if the food itself does not contain much fat or oil), as fat enables their absorption. Dietary supplements may be necessary for adequate levels of each.*

The Balance of Intake: Avoiding Deficiencies and Toxicities

While these vitamins are essential, balance is key. Fat-soluble vitamin deficiencies are common in those who have trouble absorbing fat due to health conditions.20,21

On the flip side, given that fat-soluble vitamins are stored away in fat cells and not easily excreted, taking too much can lead to a toxic overload. It is therefore important to make sure you’re getting enough of each vitamin without getting too much.

The recommended dietary allowance (RDA) for each vitamin varies by age, gender, pregnancy status, current blood levels, medication intake, and current diagnoses. Therefore, it’s important to consult with your healthcare provider for individualized and optimized dosage recommendations specific to your needs for each vitamin. A comprehensive multivitamin should provide many, if not all, of the fat-soluble vitamins along with other important micronutrients for good health. Read the label to make sure you’re getting comprehensive support.

In conclusion, the fat-soluble vitamins A, E, D, and K form a harmonious quartet that keeps our bodies functioning optimally. By understanding their individual roles and how they work together, we can appreciate the importance of a balanced diet that includes these essential nutrients.

If you enjoyed this blog, you may also like these:

Heart Health Heroes: The Vital Roles of Vitamin D3 and Vitamin K2
Nourish Your Body with Vitamin D3 and Vitamin K2
The Power Duo for Strong Bones: Vitamin D3 and Vitamin K2
Why You Should Include Vitamin K2 With Your Vitamin D3 Supplement


References:

1. NIH. Vitamin A and carotenoids fact sheet for professionals. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/. Accessed July 12, 2024.
2. Monga M. Semin Perinatol. 1997;21(2):135-142.
3. NIH. Vitamin D fact sheet for professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed July 12, 2024.
4. Landel V et al. J Alzheimers Dis. 2016;53(2):419-444.
5. Musazadeh V et al. Pharmacol Res. 2023;187:106605.
6. Niki E et al. Acc Chem Res. 2004;37(1):45-51.
7. Sepidarkish M et al. Clin Nutr. 2020;39(4):1019-1025.
8. Wang X et al. Prog Lipid Res. 1999;38(4):309-336.
9. Traber MG et al. Free Radic Biol Med. 2007;43(1):4-15.
10. Jagadeesan V et al. Clin Chim Acta. 1978;90(1):71-74.
11. Tanyel MC et al. Am Fam Physician. 1997;55(1):197-201.
12. Lewis ED et al. IUBMB Life. 2019;71(4):487-494.
13. Booth SL et al. Am J Clin Nutr. 2004;80(1):143-148.
14. Bus K et al. Foods. 2021;10(12):3136. Published 2021 Dec 17.
15. Fusaro M et al. J Bone Miner Res. 2012;27(11):2271-2278.
16. Dong R et al. Clin Lab. 2018;64(4):413-424.
17. Green AC et al. J Steroid Biochem Mol Biol. 2016;155(Pt A):135-146.
18. Polcz ME et al. Nutr Clin Pract. 2019;34(5):695-700.
19. Evans JA et al. Nutrients. 2010;2(8):903-928.
20. Farahbakhsh N et al. J Med Case Rep. 2022;16(1):188. Published 2022 May 12.
21. Albrecht H et al. Digestion. 2014;89(2):105-109.

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