What are Vitamins?

Vitamins are essential micronutrients your body needs in small amounts for
various roles throughout the human body. Vitamins are divided into two groups:
water-soluble (B-complex vitamins and C vitamins) and fat-soluble vitamins (A,
D, E and K). Unlike water-soluble vitamins that need regular replacement in the
body, fat-soluble vitamins are stored in the liver and fatty tissues, and are
eliminated much more slowly than watersoluble vitamins. For more information
on water-soluble vitamins, see fact sheet 9.312 Water-Soluble Vitamins: Vitamin
B-Complex and Vitamin C.
What are Fat-Soluble Vitamins?
The fat-soluble vitamins, A, D, E, and K, are stored in the body for long periods of
time and generally pose a greater risk for toxicity when consumed in excess than
water-soluble vitamins. Eating a normal, well-balanced diet will not lead to
toxicity in otherwise healthy individuals. However, taking vitamin supplements
that contain megadoses of vitamins A, D, E and K may lead to toxicity. The body
only needs small amounts of any vitamin.
While diseases caused by a lack of fat-soluble vitamins are rare in the United
States, symptoms of mild deficiency can develop without adequate amounts of
vitamins in the diet. Additionally, some health problems may decrease the
absorption of fat, and in turn, decrease the absorption of vitamins A, D, E and K.
Consult a medical professional about any potential health problems that may
interfere with vitamin absorption.
Vitamin A: Retinol
What is Vitamin A
Vitamin A, also called retinol, has many
functions in the body. In addition to helping the
eyes adjust to light changes, vitamin A plays
an important role in bone growth, tooth
development, reproduction, cell division, gene
expression, and regulation of the immune
system. The skin, eyes, and mucous
membranes of the mouth, nose, throat and
lungs depend on vitamin A to remain moist. Vitamin A is also an important
antioxidant that may play a role in the prevention of certain cancers.
Food Sources for Vitamin A
Eating a wide variety of foods is the best way to ensure that the body gets
enough vitamin A. The retinol, retinal, and retinoic acid forms of vitamin A are
supplied primarily by foods of animal origin such as dairy products, fish and liver.
Some foods of plant origin contain the antioxidant, betacarotene, which the body
converts to vitamin A. Beta-carotene, comes from fruits and vegetables,
especially those that are orange or dark green in color. Vitamin A sources also
include carrots, pumpkin, winter squash, dark green leafy vegetables and
apricots, all of which are rich in beta-carotene.
How much Vitamin A

The recommendation for vitamin A intake is expressed as micrograms (mcg) of

retinol activity equivalents (RAE). Retinol activity equivalents account for the fact
that the body converts only a portion of betacarotene to retinol. One RAE equals
1 mcg of retinol or 12 mcg of beta-carotene (Table 1). The Recommended Dietary
Allowance (RDA) for vitamin A is 900 mcg/ day for adult males and 700 mcg/day
for adult females.
Compared to vitamin A, it takes twice the amount of carotene rich foods to meet
the bodys vitamin A requirements, so one may need to increase consumption of
carotene containing plant foods.
Recent studies indicate that vitamin A requirements may be increased due to
hyperthyroidism, fever, infection, cold, and exposure to excessive amounts of
sunlight. Those that consume excess alcohol or have renal disease should also
increase intake of vitamin A.
Vitamin A Deficiency
Vitamin A deficiency in the United States is rare, but the disease that results is
known as xerophthalmia. It most commonly occurs in developing nations usually
due to malnutrition. Since vitamin A is stored in the liver, it may take up to 2
years for signs of deficiency to appear. Night blindness and very dry, rough skin
may indicate a lack of vitamin A. Other signs of possible vitamin A deficiency
include decreased resistance to infections, faulty tooth development, and slower
bone growth.
Too much Vitamin A
In the United States, toxic or excess levels of vitamin A are more of a concern
than deficiencies. The Tolerable Upper Intake Level (UL) for adults is 3,000 mcg
RAE (Table 2). It would be difficult to reach this level consuming food alone, but
some multivitamin supplements contain high doses of vitamin A. If you take a
multivitamin, check the label to be sure the majority of vitamin A provided is in
the form of beta-carotene, which appears to be safe. Symptoms of vitamin A
toxicity include dry, itchy skin, headache, nausea, and loss of appetite. Signs of
severe overuse over a short period of time include dizziness, blurred vision and
slowed growth. Vitamin A toxicity also can cause severe birth defects and may
increase the risk for hip fractures.
Vitamin D
What is Vitamin D
Vitamin D plays a critical role in the bodys use
of calcium and phosphorous. It works by
increasing the amount of calcium absorbed
from the small intestine, helping to form and
maintain bones. Vitamin D benefits the body by
playing a role in immunity and controlling cell
growth. Children especially need adequate
amounts of vitamin D to develop strong bones
and healthy teeth.
Food Sources for Vitamin D

The primary food sources of vitamin D are milk and other dairy products fortified
with vitamin D. Vitamin D is also found in oily fish (e.g., herring, salmon and
sardines) as well as in cod liver oil. In addition to the vitamin D provided by food,
we obtain vitamin D through our skin which produces vitamin D in response to
sunlight.
How much Vitamin D
The Recommended Dietary Allowance (RDA) for vitamin D appears as
micrograms (mcg) of cholecalciferol (vitamin D3) (Table 1). From 12 months to
age fifty, the RDA is set at 15 mcg. Twenty mcg of cholecalciferol equals 800
International Units (IU), which is the recommendation for maintenance of healthy
bone for adults over fifty. Table 1 lists additional recommendations for various life
stages.
Exposure to ultraviolet light is necessary for the body to produce the active form
of vitamin D. Ten to fifteen minutes of sunlight without sunscreen on the hands,
arms and face, twice a week is sufficient to receive enough vitamin D. This can
easily be obtained in the time spent riding a bike to work or taking a short walk.
In order to reduce the risk for skin cancer one should apply sunscreen with an
SPF of 15 or more, if time in the sun exceeds 10 to 15 minutes.
Vitamin D Deficiency
Symptoms of vitamin D deficiency in growing children include rickets (long, soft
bowed legs) and flattening of the back of the skull. Vitamin D deficiency in adults
may result in osteomalacia (muscle and bone weakness), and osteoporosis (loss
of bone mass).
Recently published data introduces a concern that some adults and children may
be more prone to developing vitamin D deficiency due to an increase in
sunscreen use. In addition, those that live in inner cities, wear clothing that
covers most of the skin, or live in northern climates where little sun is seen in the
winter are also prone to vitamin D deficiency. Since most foods have very low
vitamin D levels (unless they are enriched) a deficiency may be more likely to
develop without adequate exposure to sunlight. Adding fortified foods to the diet
such as milk, and for adults including a supplement, are effective at ensuring
adequate vitamin D intake and preventing low vitamin D levels.
Vitamin D deficiency has been associated with increased risk of common
cancers, autoimmune diseases, hypertension, and infectious disease. In the
absence of adequate sun exposure, at least 800 to 1,000 IU of vitamin D3 may
be needed to reach the circulating level required to maximize vitamin Ds
benefits.
Who is at Risk These populations may require extra vitamin D in the form of
supplements or fortified foods:

Exclusively breast-fed infants: Human milk only provides 25 IU of vitamin

D per liter. All breast-fed and partially breast-fed infants should be given a
vitamin D supplement of 400 IU/day

Dark Skin: Those with dark pigmented skin synthesize less vitamin D upon
exposure to sunlight compared to those with light pigmented skin.

Elderly: This population has a reduced ability to synthesize vitamin D upon

exposure to sunlight, and is also more likely to stay indoors and wear
sunscreen which blocks vitamin D synthesis.

Covered and protected skin: Those that cover all of their skin with clothing
while outside, and those that wear sunscreen with an SPF factor of 8, block
most of the synthesis of vitamin D from sunlight.

Disease: Fat malabsorption syndromes, inflammatory bowel disease (IBD),

and obesity are all known to result in a decreased ability to absorb and/or
use vitamin D in fat stores.

Too much Vitamin D

The Tolerable Upper Intake Level (UL) for vitamin D is set at 100 mcg for people 9
years of age and older (Table 2). High doses of vitamin D supplements coupled
with large amounts of fortified foods may cause accumulations in the liver and
produce signs of poisoning. Signs of vitamin D toxicity include excess calcium in
the blood, slowed mental and physical growth, decreased appetite, nausea and
vomiting.
It is especially important that infants and young children do not consume excess
amounts of vitamin D regularly, due to their small body size.
Vitamin E: Tocopherol
What is Vitamin E
Vitamin E benefits the body by acting as an antioxidant, and protecting vitamins
A and C, red blood cells, and essential fatty acids from destruction. Research
from decades ago suggested that taking antioxidant supplements, vitamin E in
particular, might help prevent heart disease and cancer. However, newer findings
indicate that people who take antioxidant and vitamin E supplements are not
better protected against heart disease and cancer than non-supplement users.
Many studies show a link between regularly eating an antioxidant rich diet full of
fruits and vegetables, and a lower risk for heart disease, cancer, and several
other diseases. Essentially, recent research indicates that to receive the full
benefits of antioxidants and phytonutrients in the diet, one should consume
these compounds in the form of fruits and vegetables, not as supplements.
Food Sources for Vitamin E
About 60 percent of vitamin E in the diet comes from vegetable oil (soybean,
corn, cottonseed, and safflower). This also includes products made with
vegetable oil (margarine and salad dressing). Vitamin E sources also include
fruits and vegetables, grains, nuts (almonds and hazelnuts), seeds (sunflower)
and fortified cereals.
How much Vitamin E
The Recommended Dietary Allowance (RDA) for vitamin E is based on the most
active and usable form called alpha-tocopherol (Table 1). Food and supplement
labels list alpha-tocopherol as the unit International units (IU) not in milligrams
(mg). One milligram of alpha-tocopherol equals to 1.5 International Units (IU).

RDA guidelines state that males and females over the age of 14 should receive
15 mcg of alpha-tocopherol per day. Consuming vitamin E in excess of the RDA
does not result in any added benefits.
Vitamin E Deficiency
Vitamin E deficiency is rare. Cases of vitamin E deficiency usually only occur in
premature infants and in those unable to absorb fats. Since vegetable oils are
good sources of vitamin E, people who excessively reduce their total dietary fat
may not get enough vitamin E.
Too much Vitamin E
The Tolerable Upper Intake Level (UL) for vitamin E is shown in Table 2. Vitamin E
obtained from food usually does not pose a risk for toxicity. Supplemental
vitamin E is not recommended due to lack of evidence supporting any added
health benefits. Megadoses of supplemental vitamin E may pose a hazard to
people taking blood-thinning medications such as Coumadin (also known as
warfarin) and those on statin drugs.
Vitamin K
What is Vitamin K
Vitamin K is naturally produced by the bacteria in the intestines, and plays an
essential role in normal blood clotting, promoting bone health, and helping to
produce proteins for blood, bones, and kidneys.
Food Sources for Vitamin K
Good food sources of vitamin K are green, leafy-vegetables such as turnip
greens, spinach, cauliflower, cabbage and broccoli, and certain vegetables oils
including soybean oil, cottonseed oil, canola oil and olive oil. Animal foods, in
general, contain limited amounts of vitamin K.
How much Vitamin K
To help ensure people receive sufficient amounts of vitamin K, an Adequate
Intake (AI) has been established for each age group (Table 1).
Vitamin K Deficiency
Without sufficient amounts of vitamin K, hemorrhaging can occur. Vitamin K
deficiency may appear in infants or in people who take anticoagulants, such as
Coumadin (warfarin), or antibiotic drugs. Newborn babies lack the intestinal
bacteria to produce vitamin K and need a supplement for the first week. Those
on anticoagulant drugs (blood thinners) may become vitamin K deficient, but
should not change their vitamin K intake without consulting a physician. People
taking antibiotics may lack vitamin K temporarily because intestinal bacteria are
sometimes killed as a result of long-term use of antibiotics. Also, people with
chronic diarrhea may have problems absorbing sufficient amounts of vitamin K
through the intestine and should consult their physician to determine if
supplementation is necessary.
Too much Vitamin K

Although no Tolerable Upper Intake Level (UL) has been established for vitamin K,
excessive amounts can cause the breakdown of red blood cells and liver
damage. People taking blood-thinning drugs or anticoagulants should moderate
their intake of foods with vitamin K, because excess vitamin K can alter blood
clotting times. Large doses of vitamin K are not advised.
Summary

Fat-soluble vitamins: A, D, E, and K are stored in the body for long

periods of time, and pose a greater risk for toxicity than water-soluble
vitamins. Fat-soluble vitamins are only needed in small amounts.

Beta carotene is an important antioxidant that the body converts to

Vitamin A, and it is found in a variety of fruits and vegetables.

Inadequate dietary consumption of vitamin D, along with limited sun

exposure, makes vitamin D deficiency a growing public health concern.

Vitamin E benefits the body by acting as an antioxidant, and research

indicates that it may offer a protective effect if obtained through a diet
rich in fruits and vegetables, as opposed to a supplement or multivitamin.

The bacteria in our gut produce vitamin K, and it is also found in green
leafy vegetables.

Table 1. Recommended Dietary Intake (RDA) and Adequate Intake (AI)

for Fat-Soluble Vitamins
Life Stage
Group

Vitamin A Vitamin Vitamin E Vitamin K

(mcg1/RA D
(mcg a(mcg)
E)
(mcg2) TE3)

Infants4
0 - 6mo

400*

10*

4*

2.0*

6mo - 12mo 500*

10*

5*

2.5*

Children
1 - 3y

300

15

30*

4 - 8y

400

15

55*

9 - 13y

600

15

11

60*

14 - 18y

900

15

15

75*

19 - 30y

900

15

15

120*

31 - 50y

900

15

15

120*

Males

51 - 70y

900

15

15

120*

>70y

900

20

15

120*

9 - 13y

600

15

11

60*

14 - 18y

700

15

15

75*

19 - 30y

700

15

15

90*

31 - 50y

700

15

15

90*

51 - 70y

700

15

15

90*

>70y

700

20

15

90*

14 - 18y

750

15

15

75

19 - 30y

770

15

15

90

31 - 50y

770

15

15

90

14 - 18y

1200

15

19

75

19 - 30y

1300

15

19

90

31 - 50y

1300

15

19

90

Females

Pregnant

Lactation

As retinol activity equivalents (RAEs). 1 RAE = 1mcg retinol or 12 mcg betacarotene.

2

As cholecalciferol (vitamin D3). 10 mcg cholecalciferol = 400 IU of Vitamin D.

As alpha-tocopherol equivalents. 1 mg of alpha-tocopherol = 1.5 IU of Vitamin

E=22IU of d-alpha-tocopherol=33 IU of dl-alpha- tocopherol
4

At 6 months of age, infants may be introduced to solid foods while remaining on

formula or breast milk. There may be some overlap in specific nutrient
requirements.
*Indicates an Adequate Intake (AI). All other values are Recommended Dietary
Allowance (RDA).
Table 2. Tolerable Upper Intake Levels (UL) for Fat-Soluble Vitamins
Life Stage Group
Infants1

Vitamin A
(mcg/d)

Vitamin D
(mcg/d)

Vitamin E
(mg a-TE)

Vitamin K*

0 - 6mo

600

25

ND2

ND

6mo - 12mo

600

38

ND

ND

1 - 3y

600

63

200

ND

4 - 8y

900

75

300

ND

9 - 13y

1700

100

600

ND

14 - 18y

2800

100

800

ND

19 - 70y

3000

100

1000

ND

>70y

3000

100

1000

ND

<18

2800

100

800

ND

19 - 50y

3000

100

1000

ND

Children

Males/Females

Pregnant and Lactating

At 6 months of age, infants may be introduced to solid foods while remaining on

formula or breast milk. There may be some overlap in specific nutrient
requirements.
2

ND = not determinable due to insufficient data

*An UL for vitamin K was not established.

References
Advanced Nutrition: Macronutrients, Micronutrients, and Metabolism (2009). CRC
Press, Taylor & Francis Group.
Advanced Nutrition and Human Metabolism (2009). Wadsworth, Cengage
Learning.
Biochemical, Physiological, Molecular Aspects of Human Nutrition (2006).
Saunders, Elsevier Inc.
Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National
Academy Press, 2011.
Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids.
Washington, DC: National Academy Press, 2000.
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium,
Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and
Zinc. Washington, DC: National Academy Press, 2001.

Dietary Supplements: What you need to know (2011). NIH Clinical Center.
Available on
http://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx
Duyff, ADA . American Dietetic Association: Complete Food and Nutrition Guide.
Hoboken: John Wiley & Sons, Inc., 2006. Ebook Library Web. 02 Oct. 2012.
Holick, M.F. and Chen, T.C. Vitamin D deficiency: a worldwide problem with health
consequences. American Journal of Clinical Nutrition. 2008. April 87 (4): 1080S6S.
U.S. Department of Agriculture and U.S. Department of Health and Human
Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC:
U.S. Government Printing Office, December 2010.
Wagner CL, Greer FR. American Academy of Pediatrics, Section on Breastfeeding
and Committee on Nutrition. Prevention of rickets and vitamin D deficiency in
infants, children, and adolescents. Pediatrics. 2008; 122(5): 11421152.