Fat-Soluble Vitamins A, D, E, and K: Review of the Literature and Points of Interest for the Clinician - June 2024
J. Clin. Med. 2024, 13(13), 3641; https://doi.org/10.3390/jcm13133641
by Emmanuel Andrès 1,*ORCID,Noel Lorenzo-Villalba 1,Jean-Edouard Terrade 1 andManuel Méndez-Bailon 2ORCID
- 1Département de Médecine Interne, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
- 2 Servicio de Medicina Interna, Facultad de Medicina, Instituto de Investigación Sanitaria del Hospital San Carlos, Hospital Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
Fat-soluble vitamins, including vitamins A, D, E, and K, are energy-free molecules that are essential to the body’s functioning and life. Their intake is almost exclusively exogenous, i.e., dietary. As a result, fat-soluble vitamin deficiencies are rarer in industrialized countries than in countries with limited resources. Certain groups of people are particularly affected, such as newborns or growing children, pregnant or breastfeeding women, and elderly or isolated individuals. Deficiencies in vitamins A, D, E, and K are also relatively frequent in subjects with digestive tract disorders, liver diseases, chronic pathologies, or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical pictures. Certain syndromes are typical of fat-soluble vitamin deficiency, such as the combination of ophthalmological and immunity impairments in the case of vitamin A deficiency or hemorrhagic syndrome and osteopenia in the case of vitamin E deficiency. This is also the case for osteomalacia, muscular weakness, even falls, and rickets in the case of vitamin D deficiency. Diagnosis of a deficiency in one of the fat-soluble vitamins relies on blood tests, which are not always essential for routine use. In this context, a therapeutic test may be proposed. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet, and treatment of the cause.
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Clipped from PDF: Digestive Tract Disorders and Malabsorption
Gastrointestinal disorders impairing fat absorption can lead to malabsorption of fatsoluble vitamins [1,4]. Examples include
- celiac disease,
- Crohn’s disease,
- ulcerative colitis,
- Whipple’s disease,
- chronic pancreatitis (e.g., cystic fibrosis), and
- chronic cholestasis (e.g.,primary biliary cirrhosis).
Several surgical procedures can also affect the absorption of fats and fat-soluble vitamins, such as bowel resections, gastrectomy (even partial), and bariatric surgery, regardless of the surgical setup (sleeve gastrectomy, gastric bypass, or biliopancreatic bypass) [5–8].
Gastrointestinal disorders can impair fat absorption through a variety of mechanisms, including a reduced surface area for absorption, with damage to intestinal villi (e.g., in celiac disease, Crohn’s disease) or intestinal resection (e.g., in short bowel syndrome) [1,4].
They can also affect fat absorption through decreased digestive enzyme production (e.g., in chronic pancreatitis, cystic fibrosis); bile salt disruption with damage to the ileum (e.g., in Crohn’s disease, short bowel syndrome); and intestinal dysbiosis (disturbance of intestinal
flora) [1,4].
VitaminDWiki – Overview Gut and vitamin D contains gut-friendly information
Getting Vitamin D into your blood and cells has the following chart
Getting Vitamin D into your blood and cells also has the following
If poorly functioning gut
Bio-D-Mulsion Forte – especially made for those with poorly functioning guts, or perhaps lacking gallbladder
Sublingual – goes directly into the bloodstream
Fat-soluble Vitamins go thru the slow lymph system
you can make your own sublingual by dissolving Vitamin D in water or use nano form
Oil: 1 drop typically contains 400 IU, 1,000 IU, or 4,000 IU, typically not taste good
Topical – goes directly into the bloodstream. Put oil on your skin, Use Aloe vera cream with Vitamin D, or make your own
Vaginal – goes directly into the bloodstream. Prescription-only?
Bio-Tech might be useful – it is also water-soluble
Vitamin D sprayed inside cheeks (buccal spray) - several studies
and, those people with malabsorption problems had a larger response to spray
Inject Vitamin D quarterly into muscle, into vein, or perhaps into body cavity if quickly needed
Nanoparticles could be used to increase vitamin D getting to the gut – Oct 2015
Poor guts need different forms of vitamin D has the following
Guesses of Vitamin D response if poor gut
| Bio | Form | Speed | Duration |
| 10 | Injection ($$$) or Calcidiol or Calcitriol | D - Slow C -Fast | Long |
| 10 | Sun/UVB | Slow | Long |
| 10 | Topical (skin patch/cream, vagina) | Slow Fast nano | Normal |
| 9 | Nanoemulsion -mucosal perhaps activates VDR | Fast | Normal |
| 9? | Inhaled (future) | Fast | Normal |
| 8 | Bio-D-Mulsion Forte | Normal | Normal |
| 6 | Water soluble (Bio-Tech) | Normal | Normal |
| 4 | Sublingual/spray (some goes into gut) | Fast | Normal |
| 3 | Coconut oil based | Slow | Normal |
| 2 | Food (salmon etc.) | Slow | Normal |
| 2 | Olive oil based (majority) | Slow | Normal |
10= best bioavailable, 0 = worst, guesses have a range of +-2
Speed: Fast ~2-6 hours, Slow ~10-30 hours
Duration: Long ~3-6 months, Normal = ~2 months