Fat-Soluble Vitamins and IBD

Vitamins A, D, E and K are fat-soluble vitamins that our body needs for numerous functions. Fat-soluble means they can dissolve in fats and oils - they are absorbed along with fats in the diet and are stored in the body’s fatty tissue and in the liver.

Vitamin A is important for vision, reproduction and good skin health. Vitamin E is best known for its antioxidant effects and vitamin K is important for blood clotting and wound healing. These vitamins are key for cell production, hence blood production and bone health. I will be covering vitamin D in more depth in another post. Although vitamin A, E, and K deficiency are rare, low intakes may impair our health overtime. Hence, it is important to get enough from our diet.

 

Fat-soluble vitamins and IBD

IBD patients who have trouble absorbing fat may have low levels of this fat-soluble vitamins. Fat malabsorption in IBD may be due to small bowel inflammation or short bowel syndrome (1). A meta-analysis done in 2017 found that levels of fat-soluble vitamins were generally lower in patients with IBD, and their supplementation could be used as an adjunctive therapy (2). Another study found that bone mineral density (a fancy way of measuring bone strength/ risk of bone issues) in patients with Ulcerative Colitis decreased at a higher pace with lower levels of Vitamin K, D and calcium (3).

 

Vitamins A, E, and K can be found in many plant and animal foods:

 

Vitamin A

There are two types of vitamin A (4):

Preformed vitamin A - This is found in fish, organ meats, dairy products and eggs.

Provitamin A - These are carotenoids that turn into vitamin A by our bodies. These are found in fruits, vegetables, and other plant-based foods.

Did you know? Carotenoids are pigments that give yellow, orange and red fruit and vegetables their colour.

 

Foods rich in Vitamin A:

  • Oily fish

  • Eggs

  • Fortified breakfast cereals

  • Any orange, red or yellow fruit or veg - carrots, red peppers, sweet potatoes

  • Spinach

 

Vitamin E

Just like vitamin A, vitamin E is also known for its antioxidant effects i.e. protecting our cells from damage and it also helps keep our immune system strong. Our cells use vitamin E to communicate with each other (5).

Vitamin E can be found in;

  • Peanuts

  • Sunflower seeds

  • Fortified cereals

  • Sunflower oil

  • Almonds

  • Leafy vegetables

  • Eggs

  • Kiwi

  • Mango

 

Vitamin K

There are two main kinds of Vitamin K;

  • Vitamin K1 (aka phylloquinone)

  • Vitamin K2 (aka menaquinone).

Vitamin K1 comes from plants, particularly green leafy vegetables and vitamin K2 comes from fermented foods, dairy, eggs and meat and is also naturally created in our intestinal tract.

Vitamin K is important for blood clotting - when we get hurt, our blood clots in the area of the open wound to prevent excessive bleeding. This not only happens outside our body but also inside. Although vitamin K deficiency is rare, some conditions and drugs can interfere with vitamin K absorption and creation (6).

 

Here are some foods that contain vitamin K:

  • Kale

  • Spinach

  • Broccoli

  • Soybeans

  • Pomegranate juice

  • Eggs

  • Fermented foods like sauerkraut

  • Ground beef

  • Pork liver

 

How much do I need?

Vitamin A

  • Female – 600mcg (micrograms)

  • Male – 700mcg

Vitamin E

  • Female – 3mg

  • Male – 4mg

Vitamin K

1mcg per kg of body weight

 

Deficiencies in vitamins A, E, and K are rare. However, in Crohn's Disease of the small bowel and if you are following a very restrictive diet, there could be a risk of deficiency. If you are concerned you may be deficient, please discuss this with your IBD team and Doctor/GP. Too much of these fat soluble vitamins can be toxic so please consult your healthcare team before starting any new supplement.

 

Fat-Soluble Vitamin Toxicity

They are stored in our body's fatty tissue and in the liver so there is a risk of toxicity if we have too much which can be dangerous. This is unlikely to happen through food but can happen if too much is taken in supplement form.

There are upper tolerable limits that are set for these fat soluble vitamins - that is the maximum amount that is considered safe to take them in;

Vitamin A - 3,000mcg

Vitamin E - 1,000mg

Vitamin D - 4,000IU (100mcg)

Never take more than these unless directed by your healthcare team.

NB: if you are taking multiple supplements be careful you are not doubling up and putting yourself at risk of toxicity.

 

If you want support with your diet, nutrition and IBD journey we can help.

At The NALM Clinic we have me (Clemmie), an IBD specialist Nutritional Therapist, and specialist gastroenterology Dietician (Jess) and and we are here to support you. We both have IBD too so we ‘get it’ and are so passionate about helping others.

If you would like support with your IBD please book a call with me via the button below.

I have also written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.

Disclaimer: All content found on the nalmclinic.com website, including: text, video, or other formats have been created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, consultant or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.

References

1.      Vitamin and Mineral Supplementation [Internet]. Crohn's & Colitis Foundation. [cited 16 June 2022]. Available from: https://www.crohnscolitisfoundation.org/diet-and-nutrition/supplementation

2.      Fabisiak N, Fabisiak A, Watala C, Fichna J. Fat-soluble vitamin deficiencies and inflammatory bowel disease. Journal of Clinical Gastroenterology. 2017 Nov 1;51(10):878-89.

3.      Sharifi A, Kashani M, Salimzadeh A, Ebrahimi M, Savadkouhi MN. Decreased bone mineral density, Vitamin K and Vitamin D in ulcerative colitis patients. Medicina Clínica Práctica. 2021 Oct 1;4(4):100276.

4.      Office of Dietary Supplements - Vitamin A and Carotenoids [Internet]. Ods.od.nih.gov. 2022 [cited 16 June 2022]. Available from: https://ods.od.nih.gov/factsheets/VitaminA-Consumer/

5.      Office of Dietary Supplements - Vitamin E [Internet]. Ods.od.nih.gov. 2022 [cited 16 June 2022]. Available from: https://ods.od.nih.gov/factsheets/VitaminA-Consumer/

6.      Office of Dietary Supplements - Vitamin K [Internet]. Ods.od.nih.gov. 2022 [cited 16 June 2022]. Available from: https://ods.od.nih.gov/factsheets/VitaminA-Consumer/

Clemmie Macpherson