 Hey, everybody. Dr. O here. Welcome to chapter 11. We just got done talking about the water soluble vitamins. Now we are talking about the fat soluble vitamins, vitamins A, D, E, and K. Before we come, we jump in a couple of things. We covered some of this in the last chapter. Remember, fat soluble vitamins, you need dietary fat to absorb them. You need bile to be released in response to dietary fat. Then as these long chain fats are absorbed, so are the fat soluble vitamins. They're actually carried then on the lipoproteins like LDL and HDL that carry triglycerides and those kind of things are on the blood. So you do need dietary fat in order to get your fat soluble vitamins. I generally recommend making sure you have at least eight grams of fat in a meal. If you're trying to maximize the absorption of the fat soluble vitamins, I think more is better from that standpoint. But again, fats are very calorie dense and you have to decide how they fit in your diet. But if you're eating the AMDR or acceptable macronutrient distribution range of fats, which is 20 to 35% of your calories, then you should have plenty of fat in your meals. But keep this in mind, like let's say you have a bowl of cereal. An example I used last chapter, but a bowl of cereal with skim milk for breakfast. Or you have a salad, but you don't put salad dressing on it, these types of things. Remember that your fat soluble nutrients like vitamins A, D, E, and K, and like the carotenoids that we'll talk about here in this chapter, they need that fat to be absorbed. So just because a food says it has fat soluble vitamins doesn't mean you're actually going to get any value out of them or any use out of them if there's no fat along for the ride. So just be careful with meals that don't have any fat. But at the same time, fat soluble vitamins are stored in a way that most almost all water soluble vitamins are not. So that means that you don't need to absorb them at every meal. Okay, just a couple things to consider there. The other thing I want to talk about besides the need for dietary fat is the fact that I think it's true with all nutrients, there's lots of synergy, lots of relationships that nutrients have with each other. But to me, I always try to look at the fats of vitamins as a group. So vitamins A, D, E, and K, it seems to be a lot better for you if you increase your intake of all of them rather than individual ones. So you have, you know, some people take vitamin E as an antioxidant, some people take vitamin D, everyone hears about how good vitamin D is. So sometimes people take individual nutrients, but I've found that it's better to get these from Whole Foods like any other nutrient. And generally when you find them in food, you're going to find them in combination with each other. So I just think that don't let these get out of whack. Like if you take a bunch of extra B vitamins, it won't really impact vitamin C or other nutrients, but these seem to all kind of play and work together. Just a couple little things to consider. All right, so an icebreaker. Do you have a favorite vegetable? Mine's broccoli for sure. What vitamins? Well, maybe not anymore. Nothing you need to care about that, but you guys are thinking about it for yourself. But broccoli used to be, but now I really like broccoli sprouts. So we have a hydroponic garden. So we do a lot of, we do a lot of sprouts. And so broccoli sprouts are now my favorite. I really like Kohlrabi sprouts as well. Wheatgrass is kind of good. But yeah, I would say broccoli sprouts are my number one now. But what vitamins do you think that vegetables might supply? I mean, we'll talk about that. But generally you think about what I think of vegetables, I think of things like vitamin K and beta protein and the like. Broccoli sprouts, I specifically like those because they're really high in a phytochemical called sulforaphane that is very good for you. Does this affect your choice of what to eat? Why or why not? So when you decide, when you go to the store and you decide what vegetables to eat, are you thinking about their nutritional qualities? Are you thinking about what nutrients they may be adding to your diet? Or are you thinking about something else? I mean, that's for you to decide. But I guess the answer is you should, right? The nutrients that are in the food you eat should impact your choice of whether to eat them or not. Especially if you track your diet and you know where you might be lacking in some nutrients, then finding specific foods to fill those gaps is a really good idea. All right, learning objectives, you'll see that they say the same thing here, but for the four nutrients we're going to cover. So identify the main roles, deficiency symptoms and food sources for vitamins A, D, E, and K. I don't want to read that sentence four times. Let's start with vitamin A and beta carotene. Remember from last chapter that beta carotene is what's known as a precursor. So it's not an essential nutrient. Beta carotene can become vitamin A and that's why we have the discussion here. It's really important to know that because when you look at foods, they will often talk about their vitamin A content and then being high in vitamin A. But if you look at them with plant-based foods, but they actually are high in its beta carotene, which needs to be converted to vitamin A. So we'll come back to that. That's why you might see that some nutrients will say they have preformed vitamin A, meaning they actually already have vitamin A in that, whereas other foods will say that they're a good source of vitamin A, but what they really are is a good source of beta carotene. All right, vitamin A's roles in the body. So remember I have a couple of my little sheets here with some FDA documents and one that I put together that I'm going to add a few things here. So we just talked about how vitamin A and beta carotene, so beta carotene can become vitamin A. Some genetic studies have shown that up to 30 plus percent of people have a really hard time converting beta carotene to vitamin A. I think this is why we see so much vitamin A deficiency globally. What last number? I saw 124 million children are vitamin A deficient, but they're often eating foods that have beta carotene. So a couple of issues there. Number one, beta carotene is a crotinoid and crotinoids are fat soluble just like vitamin A. So if you're consuming a lot of foods with beta carotene, but there's not any fat in the meal, then the absorption is going to be decreased by about 500 percent. So it's a major, major difference. So in lots of parts of the world, people are eating foods that have beta carotene, but no fat in that meal. It's going to impair the absorption. So most of it would be kind of passing through them. And vitamin, you know, to me, the preformed vitamin A is the way to go. I try not to ask the human body to do conversions when it doesn't need to because these conversions are inefficient. Let's say you're one of those 30 plus percent of people and you don't convert beta carotene to vitamin A very well. Well, you're better off consuming vitamin A. So we'll talk about where it comes from. So I just mentioned the absorption and the conversion. Collectively, the vitamin A is known as what are called the retinoids. We have retinol, retinol, and retinoic acid, and they each have their own function. I'll show you a little picture in a minute here, but retinol is what we need for vision. Retinol supports reproduction and is the major transport and storage form. So we'll look at one of the main functions of vitamin A being involving reproductive health. And then retinoic acid regulates cell differentiation, growth, and embryonic development. So also growth and reproduction, but this is where the immune functions of vitamin A come from, too. When I think of vitamin A, the first thing I think of is vision. The second thing I think of is your immune system. A vitamin A deficiency can decrease some antimicrobial peptides in your body by as much as 30 or 35 percent. So this is, it's a very, very big deal. If I'm looking at critical nutrients to improve immune function, vitamin A and vitamin D are both really, really high up on that list, as is zinc is another one that I think is really, really important. Okay, before we get to the forms, let me just kind of talk about what I have on my little document here. So we talked about the different roles. So the two primary roles are vision and immune functions, what I see, and then the growth and reproduction stuff. I have noted, and it'll come up in the slides, but that's what I make sure I cover it all, deficiencies cause night blindness. So if I ask you what the most common symptom of vitamin A deficiency is, it's definitely night blindness. And that's because we need vitamin A to make the compounds that are involved in vision. If you don't have enough of those, you really don't notice when there's plenty of light because your vision is inefficient, but there's more than enough light to make up for it. But when you get in the dark, when you get into lower light situations, that's when you can see that you don't have enough vitamin A for proper vision. So night blindness is a key one there. I already mentioned that the fat cell vitamins, they all work synergistically. Food sources, I'll give you my list, but you'll see the book's list in a moment. The best food sources by far are animal products, including organ meats. And that's because animal products have the preformed vitamin A, not asking your body to convert beta-carotene to vitamin A. The best sources are liver and turkey giblets or giblets, actually, I don't know how to say that. Eggs and dairy. We talked about, all right, you must have dietary fat in the meal to absorb the fat cell vitamins. So I talked about that. What's the FDA document say? Functions of vitamin A, growth and development, immune function, reproduction, red blood cell formation, skin and bone formation and vision. So clearly an important nutrient. Our daily value is 5,000 IUs or international units. And then where is it found? So you'll see here a list of foods that have actually vitamin A and have beta carotene. So cantaloupe carrots, those would have beta-carotene. You'll notice that they're orange. That's usually a good source of beta-carotene. Dairy products, eggs, fortified cereals were either beta-carotene or vitamin A would be added. Green, leafy vegetables like spinach and broccoli, pumpkin, red peppers and sweet potatoes. So that's the FDA's list of good sources of vitamin A. But don't forget that some of those actually have beta-carotene and they're trusting the conversion. All right, so here we see retinol, retinol, retinolic acid, we just mentioned them. But at the bottom we have beta-carotene. So how does this actually work? Sometimes cleavage, oh, so the cleavage, you take a beta-carotene and split it in half. That will yield two molecules of vitamin A. But as you see here, sometimes the cleavage occurs at other points as well so that one molecule of beta-carotene may yield only one molecule of vitamin A. Furthermore, not all beta-carotene is converted to vitamin A, talked about that. An absorption of beta-carotene is not as efficient as that of vitamin A. For these reasons, 12 micrograms of beta-carotene is equivalent to one microgram of vitamin A in nutritional value. Conversion of other carotenoids to vitamin A is even less efficient. So just, you know, that's why I like vitamin A better. Now, so globally, I had a student from Ethiopia that part of his job was twice a year. They would go around to different villages and they would give children especially, but I think everyone, really high doses of vitamin A. So the cool thing about vitamin A, since it's stored, a couple of pills a year, I mean, costing maybe a quarter a piece, can prevent some serious, serious problems that we'll look at in just a little bit. So vitamin A is the way to go. If those two doses were beta-carotene, that conversion would be so inefficient that I wouldn't trust it would have the same impact. Hey, nothing wrong with carrots. I'm not saying there is, but when in doubt, I recommend getting nutrients in the form our body needs them and not asking for these types of conversions to take place. All right, so the conversion, speaking of the devil, so we have the retinoids that will come from animal foods and they become retinols which support reproduction, which can then become retinols which participate in vision and retinoic acid regulates growth. If you eat carotenoids, then they start off as those retinols but then they can become either. So as long as you have good conversion and you're getting more than enough, then beta-carotene should be all that you need. But there's just a few ifs and buts there. All right, reflection questions, you can pause and try to answer these yourself and then fat-soluble vitamins differ from water-soluble vitamins. In that one, they require bile for digestion and absorption. So that's why you need the more fat in the meal, the more likely you are to have the bile you need to properly digest and absorb your fat-soluble vitamins. Number two, they travel through the lymphatic system. So remember, they're going to be captured with your long-chain fats in the micelles and carried in the body, travel through your lymphatic system and then be transported through the blood. Number three, excesses are stored in the liver and adipose tissue. So that's a huge difference compared to water-soluble vitamins. So since they're stored, you don't have to eat them on a regular basis. And then also, number four, they are not readily excreted. This increases the risk of toxicity. So since they are stored and that means that you are more likely to get too much in your system and lead to toxicities. So that's almost always supplementation or diets that have way too much of certain foods in them. It's not common to see toxicities, but it would be more common here than with the water-soluble vitamins because with the water-soluble vitamins, the excess is lost in your urine. All right, rolls of vitamin A in the body. So we talked about vitamin A in vision. It helps maintain a clear cornea, which is a transparent portion of the eye, which you need for light to travel to the back of the eye. It helps convert light energy to nerve impulses in the retina, which is where these photosensitive cells are. So that's where we rely on vitamin A. If you don't have vitamin A, that's when you will develop night blindness. All right, so and then just we use it. So it has to be replenished, which is why you need it or at least beta-carotene in your diet. This shouldn't say physical activity. I don't know why it does, but it's just showing how we need, how we need vitamin A so to actually trigger the electrical impulses that allow us to see. So without vitamin A, this is why blindness is a very sadly very common and very serious consequence of vitamin A deficiency globally. You won't see it much, you know, here, but globally it's a major, major issue. All right, the next major function of vitamin A is in protein synthesis and cell differentiation. So you see here it affects epithelial cells lining the outside and inside of your body especially. So epithelial cells on the outside of your body will form your skin. They also line the inside of your body forming what are called your mucous membranes. This would be like your respiratory tract, gastrointestinal tract, et cetera. So vitamin A maintains healthy cells in the mucous membrane. And you see here that without vitamin A, the normal structure and function of the cells in the mucous membrane are impaired. So that's not good, right? You don't have, your mucous membrane won't have the mucous that it needs and the cell lining won't be good. And the cell lining is very important because just like your skin is a barrier on the outside, mucous membranes are a barrier on the inside to pathogens and toxins and things that could get into your body. So not good. And then you see here goblet cells of the cells that synthesize and secrete mucous. And then vitamin A in reproduction and growth. It's needed for sperm development, normal fetal development, growth of children including bone remodeling. I have a nat flying in front of me. And also it has antioxidant functions, which means that it can stabilize free radicals before they do more damage in your body. So here we see the consequences of vitamin A deficiency. The picture here is showing so you'll see here if you don't have enough vitamin A that causes keratinization of the skin, which we need keratin, but you don't want too much of it. And that generally is what's going to occur on your skin in the GI tract. Not having a vitamin A is going to impact mucous production, which we need that barrier. That's what keeps the trillions of microbes away from our immune system where we don't we don't want them to have this big interaction. The extreme of this condition is called hyper keratinization or usually I call it hyperkeratosis. When keratin accumulates around hair follicles, the condition is known as follicular hyperkeratosis. So vitamin efficiency, huge problem in developing countries. A lot in a lot of countries they don't eat animal products. They're eating maybe they're eating a lot of crotinoids, but with low fat diets. So there's the absorption is impaired. And then people are clearly just, you know, malnutrition and starvation across the board vitamin A status, you know, it should if we have if you have access it can be stored in the liver. That's why a couple of huge doses a year can stave off most of these deficiency problems. You'll see here that vitamin you need protein in order to for most of vitamin A's functions to actually occur. So someone can maybe be getting a decent amount of vitamin A in their diet. But if their protein malnourished, then that will cause problems. So what are the big consequences of vitamin A deficiency? So you see the first one risk of infectious diseases. I already mentioned that let's say that a severe vitamin A deficiency might impair your immune system function by 30% or more. And that's a huge number. It's a difference between getting sick and not getting sick. It's a difference between dying and not dying. Night blindness and then actually like in the US you might see someone with a minor deficiency that has night blindness but it leads to true blindness as well. Or it's hard to get the exact numbers but you could be looking at a couple of hundred thousand plus people going blind. And then death by many severe vitamin A deficiency kills lots of people. So there's a globally this is a serious issue. Thankfully programs like the one I mentioned earlier with the high dose supplementation is helping but this is still a serious serious problem. It's not the most common nutrient deficiency on the planet but it is one of the most serious for sure. On the flip side what happens if you get too much vitamin A. And this is something that you know definitely they talk about not getting too much vitamin A when you're pregnant and now it can lead to spontaneous abortion and things like that. I don't want anyone to get too much vitamin A. This is one of the reasons that I actually put a limit if people like eating organ meats which they are the most nutrient dense food on the planet in my opinion then I usually say definitely no more than a pound a week. I mean even that would be quite a bit. So what happens? How does this develop? Vitamin A toxicity develops when binding proteins are loaded. That means this excess vitamin A can start to damage our cells. So when can we develop toxicity and again with certain diets like a diet high in organ meats this is possible and the same thing with supplementation. A lot of people are supplementing with really high doses of fat-soluble vitamins now. They're using cod liver oil and plus they're eating liver and things like that. So preformed vitamin A from animal sources plus fortified foods plus supplements and especially in children that's a potentially toxic combination can lead to bone defects as well. All right. So how do we find vitamin A? Well it depends on what we're looking for here. So you see here the colors of vitamin A foods dark leafy green, rich yellow or deep orange that's going to be the carotenoids. So that would be the where you'd find the beta carotene that can be converted to vitamin A. Vitamin A I've mentioned liver several times because vitamin A is stored in the liver of animals it is a phenomenal source of vitamin A and that's also why you don't see it as much now as you used to but people use cod liver oil as a way to get the fat-soluble vitamins as well. Golden rice and bio fortified foods so golden rice is a genetically modified rice that I think they use genes from like daffodils and other places but golden rice is a rice that has beta carotene in it. So it's been genetically modified to do that and it's pretty neat. Brilliant idea. It hasn't worked as well as people hoped. You know, there's cost issues but then we also have the issue of getting it to people. They're consuming beta carotene but is there any fat with that meal? If they're just consuming the rice how are they going to absorb the beta carotene? Well, these, you know these are issues. That's why I like the high dose supplementation campaigns. I think they work better than using something like a genetically modified rice. All right. How much do we need? We mentioned it earlier the 5,000 international units. It can also be expressed as retinol activity equivalence. That would be primarily in food. Supplementation is where you see the IU or international units. Food sources, I mentioned my list but here we see some. You got what, beef liver or sweet potatoes? Really off the charts there. Carrots being another really good one. So but just keep in mind that are you getting the preformed vitamin A or are you getting the beta carotene? All right. Vitamin D moving on. So most people have talked heard a lot about vitamin D over the last decade or so. And when I was in college, which has been over 20, right about 20 years ago now I graduated, when I was in college, vitamin D increased calcium absorption, which it still does. But we now know it has just dozens and hundreds of other functions. Vitamin D is linked to thousands of genes. It impacts the gene expression of thousands of genes. Genes, hundreds of those genes are on your white blood cells. So we know that's big role in immunity, auto-immunity, et cetera, et cetera. Like just countless reasons why you need vitamin D. Now, I don't think it's the miracle that people thought it was either. That's why some of the vitamin D supplementation studies have been just not as effective as people hoped. I think that you want to make sure you're getting plenty of vitamin D. Absolutely. I think that it's probably best to get it from sunlight when possible, just because as vitamin D is produced from sunlight, it leads to a lot of cool metabolites that probably impact our health in many positive ways that we don't understand yet. So, but getting enough, not being deficient is certainly important. But if you are deficient in vitamin D, the big question is why, right? Is there an underlying reason why or are you just not consuming it or not making it? I don't know. Okay, so vitamin D, its active form is a hormone. So really calling a vitamin D doesn't do it justice. It is a hormone. It is essential for making and maintaining bones. So that's still the primary thing we think about, but we know it does so much more. It assists in the absorption of calcium and phosphorus. So also really important for bone. It's important for brain and nerve cells. So it does appear to protect against cognitive decline. And it regulates adipose cells to influence obesity development. So it looks like, again, being deficient in vitamin D could increase your risk of being obese. All right, where does it, how do we actually make it? So you see on the right-hand side, we can get it from the diet. The plant form is called vitamin D2. The animal form is vitamin D3, which is better. As far as your body making it, so you have this compound called 7D hydrocholesterol, which is a precursor made in the liver from cholesterol. Then when UV light from the sun strikes that, it forms pre-vitamin D3, which long fancy metabolic pathways becomes vitamin D3. Then that goes to the liver, where it becomes calcidiol. Then it goes to the kidneys, where it becomes calcitriol. So it's a pretty complicated process, but very, very cool. So you do need that cholesterol precursor in order to make it. Now the key here though, is how powerful are the sun's rays where you're at in any given time of year? So how much of your skin is exposed? So are you outside fully clothed? Do you have your shirt off or something? What time of year is it, as far as where you are? Like if you live near the equator, you're probably making it all the time. But here where I'm at in South Dakota, from October to March, the UV rays just aren't powerful enough to make vitamin D. That's why it gets cold, right? Think about it. During the winter, our half of the planet is tilted away from the sun. And the sun's rays are traveling a few hundred more miles to get here, and that weakens them. So they're not strong enough to make a bunch of vitamin D. During the summer, it's a whole different story. So it's where are you out on the planet? What time of year is it? How much skin is exposed? Are you wearing sunscreen? So sunscreen's a great idea for preventing skin cancer, but really any sunscreen with an SPF above like eight pretty much shuts off 5 and D production because you need the UV rays to strike the skin and to form vitamin D. So I kind of recommend again, not medical advice, but personally we do, we like to call smart sun exposure, go outside maybe without sunscreen for a few minutes and then apply it if we're gonna be outside for a long period of time. So a lot of factors are gonna impact vitamin D production. And that's why, but I don't know, like if you ask me, do I need vitamin D? Do I need more? I don't know what to say, because there's so many factors that impact how much vitamin D is in your blood. The only real way to know is to test and then deal with it. If your vitamin D levels are normal, then you're good. If your vitamin D levels are low, then change your diet, change supplement, do those kind of things and get those levels up. And also if you're gonna test your vitamin D levels, I recommend testing at different times of the year. You know, test in July or August here and then test in January and see if there's a huge difference. So pretty cool that you can make it though. All right, a couple of questions for you to answer. Fats have all vitamins different from, wait, that's almost, that's not what it says there. We talked about, that's from the last one. There's a few issues with these PowerPoints. I catch them as we go. Almost 10% of Americans are vitamin D deficient. So depending who you ask, the number would be even higher. List four factors that contribute to deficiency. So here we have dark skin just because again, it's the UV rays striking the skin and being absorbed by the skin is what leads to vitamin D production. Breastfeeding without supplementation, a lack of sunlight because then you're not making it and then not consuming fortified milk because milk's all fortified with vitamin D. Obesity seems to impact this as well. I mean, there's lots of other factors. All the ones I mentioned, are you wearing sunscreen? How much are you outside? What part of the planet are you on? Et cetera, et cetera. Like, so you could make an argument that vitamin D and then a few other things like folic acid destruction are really what determines skin color. So if you look at, you can look at a map of the planet and skin color, basically the closer your genes are or genes came from the equator, the darker your skin and then skin got lighter and lighter and lighter as a species traveled away from the equator. So not always, but like, yeah, the people whose genes are from Scandinavia are going to have lighter skin than people whose genes are from the equator. There are exceptions to those rules. Like if you look at the Inuit, for example, but that's because their skin never had to get lighter and lighter to increase vitamin D production because they were consuming it. They had a diet really high in seafood. So they were eating it. So there was really no evolutionary advantage to having lighter skin when it came to vitamin D production. So that's really what skin color is. We talk about that a lot in anatomy, but it's really just a response to balancing vitamin D production from whatever part of the planet your genes lived in, you know, in your ancestors. And then also the lighter skin though, leading to issues with folic acid, folate destruction. So that's, you know, sadly, skin has led to terrible, terrible things. And, but that's really what it is, right? From an evolutionary standpoint, it is trying to maintain homeostasis on different parts of the planet. All right, vitamin D deficiency subsequently causes a calcium deficiency because one of the key things vitamin D does is it leads to the absorption of calcium. Remember we said earlier, you're not what you eat, you're what you absorb. And if it doesn't matter how much calcium you're consuming, if you're so vitamin D deficient that you're not absorbing it. All right, so what happens with a vitamin D deficiency? Besides some of these other, you know, chronic health issues, the big ones are bone related. So if you're vitamin D deficient, the production of Calbindin and osteocalcin, a few other ones, slows when deficient. This can result in rickets in children. So the rickets in osteomalacia are the same condition. Just rickets happens in children and osteomalacia in adults. Rickets is rare in the United States, but can affect more than half of the children in some countries. So depending on diet and then how much sun exposure they get, the bones fail to calcify normally. Now, if you're an adult and you become vitamin D deficient, you will develop osteomalacia, which means soft bones. Bones become soft, flexible, brittle and deformed. So really the two sides of the same coin. Rickets, just remember, think kids, osteomalacia, think adults. If it gets even worse, then you have osteoporosis where your bones get so weak that it impacts your activities of daily living and can result in fractures. Deficiencies are especially likely in the elderly. So sadly, the group that is already at highest risk of falling and weak bones is also at highest risk for vitamin D deficiency. And this could be because maybe, like I know my grandmother, she got older, she didn't go outside very much. She had rheumatoid arthritis. So she was pretty limited in her movement. So she spent a huge part of her day sitting in a recliner inside. So she was more likely to have issues than someone that's outside on a regular basis. All right, vitamin D toxicity on the other end. So the most likely of the vitamins to have toxic effects when consumed in excessive amounts. And this can happen because people have heard that vitamin D is so good for them that they're constantly looking for ways to, mainly with supplements, taking a bunch of supplements. So it raises, so vitamin D toxicity raises blood calcium concentrations, which can cause calcification of tissues that you don't want to calcify. It can form stones in soft tissues. It can harden your blood vessels. Usually about 25% of the plaque that's in an artery is calcium. That's why we can see them on x-rays and you can do like those calcium scores. They're actually measuring the calcium in your blood vessels. Well, if you have a toxic level of vitamin D, you'll see more of that. So it can lead to death. All right, so supplementation. Vitamin D is found in multivitamin and mineral supplements, and then also high-dose single supplements. Personally, we use drops from Carlson's or, they're called, so vitamin D drops. And the supplements are usually that make sure if you take a supplement, make sure it's the D3 form, the more effective form. All right, so match these. Affects children and causes bones to bend. That's rickets. Number two, reduced ability to activate and make vitamin D, the elderly. So that's why they're increased efficiency risk. Number three, fractures off from result from calcium loss from bones. That's osteoporosis. If you just have weakening bones, but there's no like clinical issues, that's called osteopenia. Affects adults, poor mineralization, causes soft brittle bones. That would be osteomalacia. In what ways does vitamin D protect against disease? This is a very, very long list. So I'll read what they have here though. This is all good stuff. In the brain and nerve cells, vitamin D protects against cognitive decline and slows the progression of Parkinson's disease. Vitamin D in muscle cells encourages growth in children and preserves strength in adults. So that's always good news. Vitamin D signals the cells of the immune system to defend against infectious diseases. So that's why I put it way up on my list of immune enhancing nutrients, along with vitamin A and zinc, those are my big ones. Vitamin D may also regulate the cells of the adipose tissue in ways that might influence the development of obesity. You're seeing a lot of mites, right? A lot more research needs done to really hammer down all these things, but it's all trending in the right direction, I would say. In many cases vitamin D enhances or suppresses the activity of genes that regulate cell growth. So I mentioned earlier that thousands, 3,000 or more genes are regulated by vitamin D. Hundreds of those are on your white blood cells, which is back to that immune system function. This is why vitamin D really kind of modulates things, like modulates the immune system. What I mean by that is it doesn't always make the immune system stronger or weaker, it just makes it function better, I guess. Recent research suggests that vitamin D may protect against heart disease, type 2 diabetes, inflammation, brain disorders, macular degeneration, hypertension, and some cancers. I've seen it linked to decreases in 15 cancers or so. Lots and lots of good stuff, but this doesn't mean that more is always better. Make sure you're not deficient, make sure you have optimal amount of vitamin D in your body, but that doesn't mean that more is better. All right, vitamin E. So halfway through the fat cell of vitamins, vitamin E is an antioxidant, that's the main reason that people have talked about it over the decades. So there are two different subgroups called the tocopherols and the tocatriannols, and then each of those has four different subgroups, I guess, alpha, beta, gamma, and delta. So there are eight different versions of vitamin E, but the one we care about is alpha tocopherol. That's the one that's maintained in your body, and that's the one that when you see vitamin E added to food or in supplements, it's almost always the alpha tocopherol form. So it is an antioxidant, we've talked about how it neutralizes or stops chain reactions of free radicals. Remember free radicals, they form chain reactions because I'm a free radical, I'm unstable because I'm missing an electron. So I'm gonna steal one from you, but now you're unstable because you're missing an electron and now you have to do the same and the same. So it stops that chain reaction from occurring. You'll see here that so vitamin E is the most important lipid soluble antioxidant, so it's gonna impact lipids primarily. So you see that it protects your cells and their cell membranes because they're made of lipids. It protects the brain and also protects you from heart disease because it protects your LDL cholesterol, those lipoproteins that are carrying fat and cholesterol. And when an LDL cholesterol becomes oxidized, it is much more likely to stick to your blood vessel walls, be driven into your blood vessel walls and form a plaque. So this is all good news. That's not good news. The fact that vitamin A protects you from that is the good news. So what happens with vitamin E deficiency? So primary deficiencies are rare and that's because vitamin E is in all of your vegetable oils and then all the foods made from them. They add vitamin E there to try to stabilize the fat that's in your corn oil, canola oil, et cetera. So really, anytime you're eating something that was made with an oil, you're getting some vitamin E. So you're kind of supplementing with it as you go. So not getting enough in your diet is pretty rare. So that means primary deficiencies are rare. You're probably eating it. Secondary deficiencies are more common and remember a secondary deficiency means you're eating it but it's not being digested, absorbed, stored, utilized. So anything that affects the absorption of fat is going to affect the absorption of your fat cell vitamins. When I was back in college, that was when oline and olestra, these fatty places are really common. Well, all those foods, I remember there being like a reduced fat Dorito and there was Pringles, all these kinds of foods and they don't use them much anymore because when fat passes through you without being digested, it leads to GI problems, gas, bloating, diarrhea, so people didn't like them. But they had to add fat cell vitamins to those foods because those fat replacers were impacting the absorption of your fat cell vitamins. So anything that impacts your ability to digest and absorb fat will also impact these. All right, so what happens if you have a vitamin E deficiency? So the most common one we talk about is called erythrocyte hemolysis, meaning that your red blood cells will split or tear apart where your red blood cells will break open. So that's the most common deficiency, a vitamin E deficiency. They can lead to neuromuscular issues as well but the blood cell one's the big one to remember. Well, how about the other side? If you get too much vitamin E or vitamin E toxicity, it is rare because you need really high doses. This really would only come with high doses of supplementation. As you can see here, the UL or the tolerable upper intake level is 65 times greater than the recommended intake for adults. So you'd need to be supplementing but that people do that and some people do that. So extremely high doses of vitamin E, the main thing they do is they kind of, they thin the blood which is great in smaller doses but if you have excessive amounts, it can interfere with vitamin K activity and vitamin K is needed for blood clotting. So it can lead to some bleeding issues. All right, so vitamin E recommendations, let me go to these lists here. So I talked about vitamin E being a powerful fat soluble antioxidant, plays a crucial role in protecting cell membranes, LDL cholesterol in the brain. It's used in cooking oils to slow the rancidity process. We talked about the forms. So good food sources that I put on my list are almonds, sunflower seeds, and leafy green vegetables. I think that's everything I have there. Let's see what the FDA page has for vitamin E. It's an antioxidant, helps with the formation of blood vessels and immune function. 30 international units are what your goals should be and you find them fortified cereals and juices, green vegetables like spinach and broccoli, nuts and seeds, peanuts and peanut butter and vegetable oils. All right, the RDA is based on the alpha-tacofferol form only because that's the one that's maintained in the human body. Vitamin E is widespread in food. Much of the dietary vitamin E comes from vegetable oils or foods containing them. So I don't know how much vegetable oil you're consuming, but even if someone's trying to minimize exposure to vegetable oil, they're still meeting the needs. Vitamin E is destroyed by oxidation and heat. Therefore, fresh foods are preferred sources. All right, last one, vitamin K. So I like to look at vitamin K like two separate things. So when I just say vitamin K, I'm generally talking about what's called vitamin K one, but there is a vitamin K two that we will talk about separately and you see both the functions on here. So the primary action of vitamin K is blood clotting. You see here it leads to the formation of prothrombin. So if you look at the clotting factors when it comes to blood clotting, like in your anatomy class, you'll see that most of those clotting factor proteins are vitamin K dependent. They need vitamin K. So you see here that vitamin K leads to prothrombin, which is an inactive protein that when it becomes thrombin it is now the enzyme that actually lets your blood clot because the blood clotting cascade leads to fibrinogen, which is a water soluble protein, becoming fibrin, which is an insoluble protein and that's why you form a clot. So without vitamin K, you can't make prothrombin which turns into thrombin, which means that you can't get a blood clot to actually form. So vitamin K first function you should think of is blood clotting. But the metabolism of bone proteins is also really important. You see here this osteocalcin, that's the most important one. So if you're not getting enough vitamin K, and especially this vitamin K2, which you primarily find in fermented foods or it's also called the grass-fed vitamin because you find it more in dairy products and cheeses and stuff from grass-fed animals than grain-fed animals. But vitamin K2, you can get it from eggs. There's a lot of egg yolks as well. But vitamin K2, it activates the proteins that actually take calcium from the blood and put it into your bones. So vitamin K, especially that K2 form, does play a big role in the metabolism of bone proteins. So if you don't have enough vitamin K, then these proteins like osteocalcin will not be functioning 100% and your bones will not get as dense as they should. The other big issue here is, and in class we'll talk more about this, but if the calcium doesn't go into your bones where it's supposed to, where does it go? This is where it ends up in your soft tissues, especially your blood vessels. So lots and lots of studies show that getting enough vitamin K2 reduces cardiovascular disease risk because a quarter or more of the plaque in your blood vessels is calcium. If that calcium is being driven into your bones, it's not gonna be driven into the plaque in your arteries. So we could talk for hours about that, but that's a really big deal. So making sure you're getting plenty of vitamin K very important for blood clotting, also very important for bone density, but also very important for making sure that calcium doesn't deposit in your soft tissues. And that's the other possible roles of vitamin K. All right, vitamin K deficiencies and toxicities. Primary would be just from inadequate dietary intake, which is rare, especially if you're consuming plenty of green leafy vegetables, but I do recommend, you know, if you're looking for, so fermented foods, egg yolks, grass-fed cheeses, these are a good idea if you really wanna ramp up your intake of vitamin K. You can also supplement with it, especially that K2 form. You can actually supplement with the form that's been produced by bacteria. All right, so secondary deficiency, this would be because of the microbiome. If antibodies from your immune system kill off the vitamin K producing bacteria in your gut, then that could lead to a problem because up to half of the vitamin K you're gonna absorb today could come from your gut bacteria. Then you see failure of bowel production, I'll be that secondary malabsorption again. If you're not digesting and absorbing fat, then your vitamin K is not gonna come in, come along for the ride. Infants, so they have a sterile gut, they don't have any vitamin K producing bacteria. That's why when a baby is born, almost always, they're given an injection of vitamin K. Their microbiome is not making vitamin K yet. And that's why if you ever had a baby, you know their first few poops aren't really like poops because they don't have a microbiome yet. All right, so toxicity, not common. No adverse effects with high intakes. There is no tolerable upper intake level, but high doses can reduce the effectiveness of anti-coagulant drugs. So if you're on a blood clotting medication or anti-coagulant, then work with your doctor about vitamin K intake. All right, what are the non-food sources of vitamin K? Are they sufficient and mean the needs of the average human and what food sources can provide vitamin K? So the non-food sources of vitamin K are synthesized by intestinal bacteria. However, the amount is insufficient to meet the needs and bioavailability is limited. So we don't know, like everyone's microbiome is different. So everyone's gonna be getting a different dose of vitamin K every day from their gut bacteria. So you can't rely on that for all of it. Like I said, up to half maybe, but I wouldn't rely on it. So food sources of vitamin K include leafy greens like kale and spinach, fruits such as avocado and kiwi and vegetable oils. So this is where, so leafy green vegetables is a great place to get vitamin K one. When, let's say a cow, when a cow eats leafy greens like grass, they will convert it into vitamin K two. And then that's the kind of vitamin K you'll find in their dairy, like in their cheese. This is why grass fed cheeses are really good sources of vitamin K. Same thing with chickens, right? Chickens are gonna be rooting around and eating weeds and flowers and stuff like that. And that's why a really healthy animal that's been outside eating bugs and these kind of things, they'll have plenty of vitamin K two in there in the yolks of their eggs. So I would say for a typical person's diet, leafy green vegetables, best place to get the vitamin K one. And then the grass fed cheeses or egg yolks would be a great place to get the vitamin K two. So what else do I have here? I talked about the two forms, K one primarily blood clotting, K two bone and blood vessel health. Vitamin K one is easy to find in green leafy veggies. Vitamin K two is much harder to find, I put now at least. It is only found in animal products from grass fed animals especially. So grass fed ghee, grass fed butter, grass fed cheeses. The best source by far on the planet though is fermented food called natto, which is fermented soybeans. That's probably got a thousand micrograms of vitamin K two in it, if you've ever had it. It's basically soybeans, they traditionally, they put them in a burlap sack and they kind of went bad as they fermented and that became natto. So natto and eggs would be a relatively common breakfast traditionally in Japan as far as I know. Much of the vitamin K that you use is produced by good bacteria in the large intestine. So gut health, that's the last thing I have there. What's the FDA site say? Vitamin K needed for blood clotting and strong bones. Where is it found? Green vegetables like broccoli, kale, spinach, turnip greens, collards, Swiss chard and mustard greens. And we need 80 micrograms of it a day. All right, so that's it. We've been through, so we covered the main roles, deficiency symptoms, and food sources for vitamins A, B, E and K, your four fat soluble vitamins. I hope this helps. I'll come back and cover, we have two more chapters covering the major minerals and then the trace minerals coming up. So I hope this helps. Have a wonderful day. Be blessed.