Supplement Series Part 2 – Fat-Soluble Vitamins

In part 2 of this series, Dr Sandra Cabot and naturopath Margaret Jasinska discuss fat-soluble vitamins D, K, E and A. Learn about the causes and symptoms of deficiencies of these vitamins, the foods they are found in, their health benefits and where supplementation may be appropriate.

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DR CABOT: Hello. This is Dr Sandra Cabot. I’m joined today by naturopath Margaret Jasinska.

Hi, Margaret.

MARGARET: Hi, Dr Cabot. Good to chat with you again.

DR CABOT: Yes, so exciting! And we’re talking about nutritional supplements. So, whether you need to take them and the best way to take them. And Margaret and I both agree that most people need to take nutritional supplements because we see so many deficient people, even though they think they’re having a reasonably healthy diet.

MARGARET: Yes, absolutely. And these are people who come to see us because they’re dissatisfied with their health, in some way. And when we do some investigations, like some tests, and find out what symptoms they’ve got, almost always close to 100% of them have nutrient deficiencies.

DR CABOT: Yes, that’s true! It’s really surprising. And some of them are very severe nutrition deficiencies. Their level of vitamin D may be woefully low. We like it to be around 100. We might see it around 15. It’s not uncommon.

MARGARET: Yes. They are Australian, European, Canadian figures that we’re talking about there, not American figures.

DR CABOT: Yes. That’s true. So, you don’t want your vitamin D level to be just at the lower limit of normal. When the doctor says, “Well, it’s in the normal range. So, you’re okay. You don’t need to take anything.”

MARGARET: That’s right! Who wants to just survive? We want to thrive, don’t we?

DR CABOT: Yes. We want it to be right in the middle of the normal range. Or if we have an inflammatory problem, particularly autoimmune or something that’s causing pain, like fibromyalgia or muscle pain, then we want to get our vitamin D level up towards the upper limit of the normal range.

MARGARET: Yes. And it can be very therapeutic for people who have inflammatory conditions or painful conditions or autoimmune conditions, if we get the level up, they get faster relief from their health problems.

DR CABOT: That’s right. And remember, that if you use sunblock a lot, you won’t make vitamin D in your skin. So, using a lot of sunblock regularly can make your vitamin D deficient.

MARGARET: Yes. And also fake tan reduces your ability to make vitamin D in your skin. And very few people are outside for long enough or often enough to be able to make vitamin D. So, we make it in our skin from UVB rays, which are really only out there in the middle of the day. So, you’d need to be outside with very little clothing on. So, as much as your skin gets sunshine as possible for 15-20 minutes, depending on your skin tone. We never, ever want to get burnt. But you’d need to do that just about every day of the week to get enough vitamin D. And who has the time to do that, unless they’re an outdoor worker?

So, very often, people will say, “Oh, yes, I get some sunshine. I walk to the bus stop in the morning.” Well, that’s nice and that’s good for you. But you’re not really getting vitamin D that way.

DR CABOT: That’s right! And lunchtimes would be a lot more fun. See, there will be a lot of people with less clothes on and they’ll all be…

MARGARET: Well, look. The way people are dressed to work, it’s pretty covered up most of the time.

DR CABOT: That’s right!

MARGARET: So, again, it’s not convenient in most people’s lifestyles to be able to be in the sun often enough or long enough to not be vitamin D deficient. So, in the end, really, a blood test is the only way we know for sure. So, we don’t have to guess whether you’ve got enough vitamin D or not. You can find out for sure.

DR CABOT: And blood tests are very accurate and it’s good to have one every year, because vitamin D is essential for your immune system. So that’s going to be able to reduce your risk of cancer, inflammation and infections.

MARGARET: Yes. And I recommend people get the blood test at the end of winter, beginning of spring, because that’s going to be your lowest level all year. So, it’s important to see what it is then.

DR CABOT: Yes, that’s true. And you can get some vitamin D in your food, but you really can’t rely on it. And as Margaret said, unless you are out in the sun during those crucial times in the middle of the day, in the winter, particularly, then you are not going to make enough vitamin D in your own body.

MARGARET: Yes. Or unless you’re eating cod liver, like the actual liver from the fish. People in the Arctic climates, they survived historically. So, there weren’t vitamin D supplements for them and the sun wasn’t very strong for much of the year. But they tended to eat a lot of oily fish…

DR CABOT: Yes, whale. Whale blubber.

MARGARET: …and other seafood. So, there is vitamin D in the fat of some seafood and in the liver of some fish.

DR CABOT: Yes, cod liver.

MARGARET: Not commonly eaten foods these days, though.

DR CABOT: No, that’s right! Well, no wonder we’re seeing so many deficient people. It’s an epidemic.

MARGARET: And I ask my patients to take their vitamin D supplement either with breakfast or with lunch – not in the evening – because there is some research that it can reduce melatonin production if taken at night. And the sun doesn’t shine at night. So, it would make more sense to take the vitamin D either in the beginning of the day or around lunchtime.

DR CABOT: Yeah. And when you take it, have some fat in the food because it’s a fat-soluble vitamin. So, you won’t absorb very well if there’s not some fat in the food you’re taking it with.

MARGARET: Yes. So, if you’re just eating a banana for breakfast, don’t have the vitamin D then. Have it with a proper meal that does contain some fat.

DR CABOT: Yeah. Like an egg or a bit of cheese or some coconut oil.

MARGARET: Olive oil, fish, avocado.

DR CABOT: Yeah. You’ll absorb it much better. So, vitamin D is a fat-soluble vitamin and very, very helpful for people who have a lot of aches and pains. We know it’s good for your bones. Everybody knows that. It helps to put calcium in your bones, make your bones strong and reduce osteoporosis. But it also helps your muscles and your ligaments and reduces inflammation in those tissues. So, for people with fibromyalgia, backache, tendonitis, they can get a lot of relief by getting their vitamin D up.

MARGARET: Yeah. Fairly quickly too.

DR CABOT: Yeah, that’s right! We give injections to some people who are very, very low in vitamin D and also people who don’t absorb it very well.

MARGARET: Exactly, yes. And we still have to work on fixing their gut health problems. But we can top up their vitamin D level quickly with an injection.

DR CABOT: But most people do absorb it, if they’re consistent. Once again, we see a lot of people who take the supplements for one or two months, feel great and then they may be told, “Oh! Your blood level’s normal now. You don’t need it anymore. You can stop it because you’ll get too much.” But we don’t find that to be true. If people stop all their supplements and don’t take them for six months, they’re going to go back to the deficient state they first came to us in. We see that all the time that people don’t have that consistency with staying on their supplements.

MARGARET: Yes. I think part of the problem is, life is busy and life can be stressful and people often put themselves last.


MARGARET: So, they have a more pressing to-do-list of life problems and hassles and they put their health last.

DR CABOT: That’s right. But it’s very, very important, if you’ve got excessive inflammation in your body, that’s going to really slow you down and reduce your quality of life. So that should be a priority. You can do so much more in your life and enjoy your life so much more, if you are not deficient in these things.

So, vitamin D, one of the fat-soluble vitamins. Then the other fat-soluble vitamin that’s very important is vitamin K. And vitamin K is another vitamin that we often see people not getting enough of. It could be because of their diet, or it could be that they have gut problems and they’re not absorbing fat and therefore the fat-soluble vitamins efficiently. So, what would you suggest there, Margaret? What foods they should eat?

MARGARET: So, vitamin K1 is found in green, leafy vegetables. And in an ideal world, your gut bugs are supposed to convert the vitamin K1 into vitamin K2, which is the more active form. But certainly, among the patients that we see… Look, how many people have perfect, ideal gut health? Not many. A lot of people are just missing those certain good strains of bugs that do that conversion for you. Maybe because of antibiotic use, because of chlorine in the water, because of food sensitivities, inflammation in the gut, all sorts of things can go wrong.

So, K1 is found in those plant foods and vitamin K2 is found in some animal foods, but not that many foods and not that many commonly eaten foods. So, really, liver, like beef liver, sheep liver, lamb liver, is probably the richest source of vitamin K2. There are small amounts also in oily fish, some types of cheese, fermented cheese, some types of traditional Asian fermented soy products. But not really in commonly eaten foods. So, a lot of people don’t get enough of the vitamin K2 in their diet, either because of lack of ingestion or they’re not making it in their gut properly.

DR CABOT: Yes. They’re not converting the K1 into the K2 and that’s not good. So, vitamin K is very, very important because without vitamin K, you don’t put minerals into your bones in the right places. So, even though you might be getting minerals, like calcium and zinc and manganese in your diet, you’re not really putting them into the architecture of your bone, in the right places.

MARGARET: Yes. So, you weaken your bones significantly if you don’t get enough vitamin K2. There was even a study, it’s on our Liver Doctor website that I wrote about, that children who are lacking vitamin K2 have higher rates of breaking bones when they have a fall. So, it’s not just something to worry about when you’re older. But even in childhood, that can be a problem.

DR CABOT: That’s right. People think about vitamin D for their bones, which is true. It’s very, very important. But vitamin D puts the calcium into your bones, but the calcium has to be distributed into the right places. So, the vitamin K is like an architect, if you like. It knows where to put things in the bones. And so, vitamin K is very, very important for bone density. And in Japan, they use very large doses of vitamin K2 to treat osteoporosis. But in Australia, the doses are tiny and they’re really inadequate, I think, for someone with osteoporosis or somebody with other symptoms of vitamin K deficiency.

So, you can get a Super Vitamin K, which has also got vitamin D in it. Super K, and that’s got several different types of vitamin K, including K2. And that is going to give you 2200 mcg of vitamin K.

MARGARET: Yes. And so, it’s fat soluble. So it can be taken with any meal that contains some fat.

DR CABOT: Yes. And I will mention vitamin K as being helpful for people with vertigo, which is a horrible thing. People get these repetitive, intermittent attacks of vertigo, where they feel like they’re going to fall over. That everything is spinning around, like you’re on a merry-go-round. You lose your balance, you can fall over, you feel like you want to vomit, you feel really wobbly. And that is coming from the inner ear. And this can be associated with noises in the ear and hearing loss. But in many people, it’s just the dizziness or the vertigo that occurs repetitively. And we call this benign positional vertigo. And what I’ve found, that vitamin K is very, very helpful to prevent that. But you need to take it regularly. You need to take it every day. And, as Margaret said, you need to take it with fat in your food. And you need a fairly big dose, not a minuscule dose of 180 mcg. You need a proper dose, so 2200 mcg. And the vitamin K works to reduce vertigo because it puts the crystals – the calcium crystals and the manganese crystals – into the right position, in the little balance canals in your ear. So clever.

MARGARET: Yes, it is.

DR CABOT: It’s like a little architect that knows where to put the crystals. And people tell me, “I don’t have vertigo anymore.” They’re so grateful.

MARGARET: Yeah. And it’s a terrible problem and a really common problem. And isn’t that a simple solution?

DR CABOT: Yes, it is! Simple and inexpensive solution and much better than waiting for the attack to come and having to take stemetil for it every time it comes. So, vitamin K, very good for your bones, very good for vertigo and your liver loves it as well. And Margaret said, the liver has a lot of vitamin K in it because it stores it, because it’s good for it. And we know that there’s studies that show that people with liver cancer have less spread of the cancer in their liver by taking high dose vitamin K.

MARGARET: Yeah, absolutely. Like, making sure you’re not nutrient deficient can protect your health in so many important ways.

DR CABOT: Yes. Preventative medicine, that’s what it’s all about. And trying to get this in your diet, it’s difficult. Particularly if you don’t have a perfect diet or your gut is not working at 100% level or the soils are deficient. So, these simple supplements can really prevent a lot of chronic illness and improve the quality of your life.

And the other fat-soluble vitamin we should mention is vitamin E. But that’s something that’s easier to get in your diet and usually people don’t need to supplement with that as much or hardly at all, really. And you can get that in avocados. Very good source of vitamin E.

MARGARET: Yes. And also, extra virgin olive oil. So, the thick, gluggy variety that hasn’t been refined and purified. It’s also full of other antioxidants, not just vitamin E. And almonds and hazelnuts, particularly the skin of the nuts, is high in vitamin E. And also, the fat on red meat can contain a lot of vitamin E. It is influenced by the quality of the diet of the animal. But the fat on beef and the fat on lamb can usually be quite a good source of vitamin E that’s well absorbed, because, let’s face it, it’s going from one animal into another animal. We are more similar to a cow or a sheep than we are to an almond. So, our body knows how to use that vitamin E.

DR CABOT: Yeah. And so, vitamin E is good for your cardiovascular system, has anti-inflammatory effects.

MARGARET: And the brain. It protects the brain.

DR CABOT: Yeah. Well, they’re all antioxidants, aren’t they? All these minerals and vitamins we talk about, they’re powerful antioxidants. And we love that because that’s reducing inflammation in the body, reducing our risk of cancer and slowing down the aging process.

MARGARET: Yes. Who wouldn’t want that?

DR CABOT: Yes. Particularly of your brain.

And so, the other fat-soluble vitamin, is vitamin A. So, there’s A, D, E and K. So A, our body can make that out of beta carotene. But some people have a problem doing that, don’t they, Margaret?

MARGARET: Yes. And typically, if you read an article on the internet about vitamin A, it’ll say it’s found in foods like carrots, pumpkin, sweet potato. No, it’s not. Vitamin A is only found in animal foods. But an article like that would be making an assumption that if you eat beta carotene-rich vegetables or fruits, you’re going to make vitamin A out of that. But not everybody’s body does that well enough. And in fact, there is a genetic condition, where approximately 35% of Europeans don’t convert the beta carotene they’ve consumed into vitamin A. and so, they can be low in vitamin A, if they’re not eating vitamin A-rich foods. So, animal foods, such as egg yolks, oily fish, liver again. The liver is where animals and humans store a large proportion of their nutrients. So, if you eat liver, you’ll get a lot of nutrients. But I guess more commonly, egg yolks and oily fish, like salmon, is where more people would get their vitamin A.

DR CABOT: Yeah. And vitamin A is good for your mucous membrane. So, for people with dry eyes or itchy allergic eyes, or dry mouth, or mouth ulcers, or gastritis, or cystitis.

MARGARET: Yes. Asthma, it’s really very good for asthma. For calming inflammation in the bronchial tubes and any kind of gut inflammation. If you’re wanting to heal leaky gut, vitamin A is important. It actually works well with zinc. So, vitamin A and zinc work well to heal the gut lining.

DR CABOT: And you can buy vitamin A supplements, if you don’t want to eat liver. I mean, I think lamb’s fry is quite tasty, really. But not everybody likes it.

MARGARET: Yep, I’ve always liked it. So, I’m lucky in that regard.

DR CABOT: Yes. So, there you go. So, if you’d like more information about the fat-soluble vitamins, and particularly our Super Vitamin K, send us an email. We’d love to hear from you. And thanks for listening.

MARGARET: Thank you so much, everybody. Bye, bye!