Fat-soluble

vitamins
Dr. Reyhaneh Sabourian
PhD candidate at drug and food control department
Fat Soluble Vitamins
• Are absorbed and transported by fat
• Excess vitamins are stored in the liver
• Body draws on stored vitamins when needed
• Large amounts can harm the body
• People who take vitamin supplements are advised to
use caution
Vitamin
A
• Vitamin A is the name of a group of fat-soluble retinoids, including retinol, retinal, and
retinyl esters.

• Vitamin A is involved in immune function, vision, reproduction, and cellular

communication.
• Vitamin A is critical for vision as an essential component of rhodopsin, a protein that absorbs
light in the retinal receptors, and because it supports the normal differentiation and functioning
of the conjunctival membranes and cornea.

• Vitamin A also supports cell growth and differentiation, playing a critical role in the normal
formation and maintenance of the heart, lungs, kidneys, and other organs.
• Two forms of vitamin A are available in the human diet:
– preformed vitamin A (retinol and its esterified form, retinyl ester)
– provitamin A carotenoids

• Preformed vitamin A is found in foods from animal

sources, including dairy products, fish, and meat
(especially liver).

• Most important provitamin A carotenoid: beta-carotene;

other: alpha-carotene and beta-cryptoxanthin.
• The body converts plant pigments into vitamin A.

• Both must be metabolized intracellularly to retinal and retinoic acid,

the active forms of vitamin A.

• Other carotenoids found in food, such as lycopene, lutein, and

zeaxanthin, are not converted into vitamin A.

• Most of the body’s vitamin A is stored in the liver in the form of retinyl
esters.
• Plasma retinol levels: for assess vitamin A inadequacy.

• However, do not decline until vitamin A levels in the liver are

almost depleted.

• A plasma retinol concentration lower than 0.70 micromoles/L

(or 20 micrograms [mcg]/dL) reflects vitamin A inadequacy in a
population, and concentrations of 0.70–1.05 micromoles/L could
be marginal in some people.
• Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the
nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan
nutritionally adequate diets for individuals.

• Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established
when evidence is insufficient to develop an RDA.

• Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the
requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of
groups of people and to plan nutritionally adequate diets for them; can also be used to assess
the nutrient intakes of individuals.

• Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health
effects.
• Retinol activity equivalents (RAE)

• One mcg RAE is equivalent to 1 mcg retinol, 2 mcg

supplemental beta-carotene, 12 mcg dietary beta-
carotene, or 24 mcg dietary alpha-carotene or beta-
cryptoxanthin.
Recommended dietary (RDAs) allowance for Vitamin A
International Units and mcg RAE
• Vitamin A is now measured in mcg RAE, but it was previously measured
in International Units (IUs).

• 1 IU retinol = 0.3 mcg RAE

• For example, the RDA of 900 mcg RAE for adolescent and adult men is
equivalent to 3,000 IU if the food or supplement source is preformed
vitamin A (retinol).
Food Sources of Vitamin A
• Concentrations of preformed vitamin A are
highest in liver and fish oils. Other sources of
preformed vitamin A are milk and eggs.

• Most dietary provitamin A comes from leafy green

vegetables, orange and yellow vegetables,
tomato products, fruits, and some vegetable oils.

• The top sources of provitamin A in diet of people

include carrots, broccoli, cantaloupe, and squash.
Dietary supplements
• Vitamin A is in the form of retinyl acetate or retinyl palmitate.

• A portion of the vitamin A in some supplements is in the form of beta-carotene.

• Multivitamin supplements typically contain 750–3,000 mcg RAE (2,500–10,000 IU)

vitamin A, often in the form of both retinol and beta-carotene.

• Adults aged 71 years or older and children younger than 9 are more likely than
members of other age groups to take supplements containing vitamin A.
Vitamin A Deficiency
• Vitamin A deficiency is common in many developing countries.

• In developing countries, vitamin A deficiency typically begins during infancy, when

infants do not receive adequate supplies of colostrum or breast milk.
• Chronic diarrhea also leads to excessive loss of vitamin A in young children, and vitamin A
deficiency increases the risk of diarrhea.

• The most common symptom of vitamin A deficiency in young children and pregnant women
is xerophthalmia. One of the early signs of xerophthalmia is night blindness, or the inability to
see in low light or darkness.

• Vitamin A deficiency is one of the top causes of preventable blindness in children.

• Vitamin A deficiency also increases the severity and mortality risk of infections (particularly
diarrhea and measles) even before the onset of xerophthalmia.
Groups at Risk of Vitamin A Inadequacy
• The following groups are among those most likely to have inadequate intakes of vitamin A.
• Premature Infants
– Preterm infants with vitamin A deficiency have an increased risk of eye, chronic lung, and gastrointestinal
diseases.

• Infants and Young Children in Developing Countries

Xerophthalmia
• Pregnant and Lactating Women in Developing Countries
– Xerophthalmia, and increased maternal and infant morbidity and mortality, increased anemia risk, and slower
infant growth and development.

• People with Cystic Fibrosis

– Most people with cystic fibrosis have pancreatic insufficiency and difficulty absorbing fat.
Health Risks from Excessive Vitamin A
• Excess preformed vitamin A can have significant toxicity (known as hypervitaminosis A)

• Large amounts of beta-carotene and other provitamin A carotenoids are not associated with
major adverse effects.

• Chronic intakes of excess vitamin A lead to increased intracranial pressure, dizziness, nausea,
headaches, skin irritation, pain in joints and bones, coma, and even death.

• When people consume too much vitamin A, their tissue levels take a long time to fall after they
discontinue their intake, and the resulting liver damage is not always reversible.
Interactions with Medications

• Orlistat
– Orlistat can decrease the absorption of vitamin A, other
fat-soluble vitamins, and beta-carotene, causing low
plasma levels in some patients.

• Retinoids
– Retinoids can increase the risk of hypervitaminosis A
when taken in combination with vitamin A supplements.
Vitamin D
Vitamin D (also referred to as “calciferol”)
• It is a fat-soluble vitamin that is naturally present in a few foods, added to others, and
available as a dietary supplement.

• It is also produced endogenously when ultraviolet (UV) rays from sunlight: trigger
vitamin D synthesis.

• Vitamin D obtained from sun exposure, foods, and supplements is biologically inert
and must undergo two hydroxylations in the body for activation.
• The first hydroxylation, which occurs in the liver, converts vitamin D to
25-hydroxyvitamin D [25(OH)D], also known as “calcidiol”.

• The second hydroxylation occurs primarily in the kidney and forms the
physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also
known as “calcitriol”.
• Vitamin D promotes calcium absorption in the gut and maintains adequate
serum calcium and phosphate concentrations to enable normal bone
mineralization and to prevent hypocalcemic tetany (involuntary contraction of
muscles, leading to cramps and spasms).

• It is also needed for bone growth and bone remodeling by osteoblasts and
osteoclasts.

• Without sufficient vitamin D, bones can become thin, brittle, or misshapen.

• Vitamin D sufficiency prevents rickets in children and osteomalacia in adults.

• Together with calcium, vitamin D also helps protect older adults from
osteoporosis.
• Vitamin D has other roles in the body:
• Reduction of inflammation as well as modulation of such processes as cell
growth, neuromuscular and immune function, and glucose metabolism.

• Many tissues have vitamin D receptors, and some convert 25(OH)D to

1,25(OH)2D.

• In foods and dietary supplements, vitamin D has two main forms,

D2 (ergocalciferol) and D3 (cholecalciferol)

• Both forms are well absorbed in the small intestine. Absorption occurs by
simple passive diffusion.
• The concurrent presence of fat in the gut enhances vitamin D absorption,
but some vitamin D is absorbed even without dietary fat.
• Neither aging nor obesity alters vitamin D absorption from the gut.

• Serum concentration of 25(OH)D is currently the main indicator of vitamin

D status.

• In serum, 25(OH)D has a fairly long circulating half-life of 15 days.

• 1 ng/mL is equal to 2.5 nmol/L.

• In contrast to 25(OH)D, circulating 1,25(OH)2D is generally not a good indicator of
vitamin D status because it has a short half-life measured in hours, and serum levels
are tightly regulated by parathyroid hormone.

• Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe.

Recommended Dietary Allowances (RDAs) for Vitamin D
• 1 mcg vitamin D is equal to 40 IU
Food sources of Vitamin D
• Few foods naturally contain vitamin D.

• The flesh of fatty fish (such as trout, salmon, tuna, and mackerel) and fish liver oils are
among the best sources.

• Beef liver, egg yolks, and cheese have small amounts of vitamin D, primarily in the form
of vitamin D3 and its metabolite 25(OH)D3.

• Mushrooms provide variable amounts of vitamin D2. Some mushrooms available on the
market have been treated with UV light to increase their levels of vitamin D2.
• In addition, the Food and Drug Administration (FDA) has approved UV-treated
mushroom powder as a food additive for use as a source of vitamin D2 in food products.
Food sources of Vitamin D
• Animal-based foods typically provide some vitamin D in the form of 25(OH)D in
addition to vitamin D3.

• The impact of this form on vitamin D status is an emerging area of research.

• Studies show that 25(OH)D appears to be approximately five times more potent
than the parent vitamin for raising serum 25(OH)D concentrations.
Fortified foods

• Almost all of the U.S. milk supply is voluntarily

fortified with about 3 mcg/cup (120 IU), usually
in the form of vitamin D3.

• Ready-to-eat breakfast cereals often contain

added vitamin D,
• Some brands of orange juice, yogurt,
margarine, and other food products.
 Sun exposure
• Type B UV (UVB) radiation with a wavelength of approximately 290–320 nanometers penetrates
uncovered skin and converts cutaneous 7-dehydrocholesterol to previtamin D3, which in turn becomes
vitamin D3.

• Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are
among the factors that affect UV radiation exposure and vitamin D synthesis.

• Older people and people with dark skin are less able to produce vitamin D from sunlight.

• UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not
produce vitamin D.

• Approximately 5–30 minutes of sun exposure, particularly between 10 a.m. and 4 p.m., either daily or
at least twice a week to the face, arms, hands, and legs without sunscreen usually leads to sufficient
vitamin D synthesis.
 Tanning beds
• Moderate use of commercial tanning beds that emit 2% to 6% UVB radiation is also effective.

• But despite the importance of the sun for vitamin D synthesis, limiting skin exposure to
sunlight and UV radiation from tanning beds is prudent.

• UV radiation is a carcinogen, and UV exposure is the most preventable cause of skin cancer.

• For reduce risk of skin cancer: sunscreen with a sun protection factor (SPF) of 15 or higher,
whenever people are exposed to the sun.

• Sunscreens with an SPF of 8 or more appear to block vitamin D-producing UV rays.

Dietary supplements
• Dietary supplements can contain vitamins D2 or D3.

• Vitamin D2 is manufactured using UV irradiation of ergosterol in yeast, and vitamin D3 is

produced with irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of
cholesterol.

• Both forms raise serum 25(OH)D levels, and they seem to have equivalent ability to cure rickets.

• In addition, most steps in the metabolism and actions of vitamins D2 and D3 are identical.
However, most evidence indicates that vitamin D3 increases serum 25(OH)D levels to a greater
extent and maintains these higher levels longer than vitamin D2

• Some studies have used dietary supplements containing the 25(OH)D3 form of vitamin D. Per
equivalent microgram dose, 25(OH)D3 is three to five times as potent as vitamin D3.
• Study of comparing Effects of 1000 IU/day and 50000 IU/Month of Vitamin D
Supplementation on 25-Hydroxy Vitamin D Levels revealed that:

• Monthly and daily supplements improved 25(OH)D levels. Based on 1000 IU

supplement intake, daily supplements caused further decreased parathyroid hormone,
which suggested that daily supplementation might include more benefits than monthly
supplementation.
Vitamin D Intakes and Status
• Most people in the worldwide consume less than recommended amounts of
vitamin D.

• An analysis of data from the 2015–2016 National Health and Nutrition Examination
Survey (NHANES) found that average daily vitamin D intakes from foods and
beverages were 5.1 mcg (204 IU) in men, 4.2 mcg (168 IU) in women, and 4.9
mcg (196 IU) in children aged 2–19 years.
Vitamin D Deficiency
• People can develop vitamin D deficiency when usual intakes are lower over time than
recommended levels, exposure to sunlight is limited, the kidneys cannot convert
25(OH)D to its active form, or absorption of vitamin D from the digestive tract is
inadequate.

• Obtaining sufficient vitamin D from natural (nonfortified) food sources alone is difficult.

• Diets low in vitamin D are more common in people who have milk allergy or lactose
intolerance and those who consume an ovo-vegetarian or vegan diet.
Vitamin D Deficiency
• In children, vitamin D deficiency is manifested as rickets, a disease characterized by
a failure of bone tissue to become properly mineralized, resulting in soft bones and
skeletal deformities.
– In addition to bone deformities and pain, severe rickets can cause failure to thrive, developmental
delay, hypocalcemic seizures, tetanic spasms, cardiomyopathy, and dental abnormalities.

• In adults and adolescents, vitamin D deficiency can lead to osteomalacia, in which

existing bone is incompletely or defectively mineralized during the remodeling
process, resulting in weak bones.
– Signs and symptoms of osteomalacia are similar to those of rickets and include bone deformities and
pain, hypocalcemic seizures, tetanic spasms, and dental abnormalities.
Groups at Risk of Vitamin D Inadequacy
• Breastfed infants
Consumption of human milk alone does not ordinarily enable infants to meet vitamin D
requirements, because it provides less than 0.6 to 2.0 mcg/L (25 to 78 IU/L).

• Older adults
Older adults are at increased risk of developing vitamin D insufficiency, partly because the
skin’s ability to synthesize vitamin D declines with age.

• People with limited sun exposure

Homebound individuals; people who wear long robes, dresses, or head coverings for religious
reasons; the use of sunscreen also limits vitamin D synthesis from sunlight.
• People with dark skin
Greater amounts of the pigment melanin in the epidermal layer of the skin result in darker
skin and reduce the skin’s ability to produce vitamin D from sunlight.

• People with conditions that limit fat absorption

Because vitamin D is fat soluble, its absorption depends on the gut’s ability to absorb dietary fat. Fat
malabsorption is associated with medical conditions that include some forms of liver disease, cystic
fibrosis, celiac disease, Crohn’s disease, and ulcerative colitis.

• People who are obese or have undergone gastric bypass surgery

Individuals with a body mass index (BMI) of 30 or more have lower serum 25(OH)D levels than
nonobese individuals. Obese individuals who have undergone gastric bypass surgery can also
become vitamin D deficient.
Vitamin E
• Naturally occurring vitamin E exists in eight chemical forms (alpha-, beta-, gamma-, and
delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol) that have varying levels
of biological activity.

• Alpha- (or α-) tocopherol is the only form that is recognized to meet human requirements.

• Serum concentrations of vitamin E (alpha-tocopherol) depend on the liver.

• The liver preferentially resecretes only alpha-tocopherol via the hepatic alpha-tocopherol
transfer protein; the liver metabolizes and excretes the other vitamin E forms.
Vitamin E functions
• Vitamin E is a fat-soluble antioxidant that stops the production of ROS formed when
fat undergoes oxidation.

• By limiting free-radical production, vitamin E might help prevent or delay the chronic
diseases associated with free radicals.

• Involved in immune function, cell signaling, regulation of gene expression, and other
metabolic processes.

• Vitamin E also increases the expression of two enzymes that suppress arachidonic
acid metabolism, thereby increasing the release of prostacyclin from the endothelium,
which, in turn, dilates blood vessels and inhibits platelet aggregation.
Recommended Dietary Allowances (RDAs) for Vitamin E
(Alpha-Tocopherol)
• Naturally sourced vitamin E is called RRR-alpha-tocopherol (commonly labeled as d-alpha-
tocopherol); the synthetically produced form is all rac-alpha-tocopherol (commonly labeled
as dl-alpha-tocopherol).

• One mg vitamin E (alpha-tocopherol) is equivalent to 1 mg RRR-alpha-tocopherol or 2

mg all rac-alpha-tocopherol.

• To convert from mg to IU:

 1 mg of alpha-tocopherol is equivalent to 1.49 IU of the natural form or 2.22 IU of the synthetic form.

• For example, 15 mg of natural alpha-tocopherol would equal 22.4 IU (15 mg x 1.49 IU/mg).
The corresponding value for synthetic alpha-tocopherol would be 33.3 IU (15 mg x 2.22
IU/mg).
Food sources of Vitamin E
• Numerous foods provide vitamin E.

• Nuts, seeds, and vegetable oils are among the best

sources of alpha-tocopherol, and significant amounts
are available in green leafy vegetables.

• Most vitamin E in American diets is in the form of

gamma-tocopherol from soybean, canola, corn, and
other vegetable oils and food products.
Dietary supplements
• Supplements of vitamin E typically provide only alpha-tocopherol, although “mixed”
products containing other tocopherols and even tocotrienols are available.

• Most vitamin-E-only supplements provide ≥67 mg (100 IU of natural vitamin E) of the

nutrient. These amounts are substantially higher than the RDAs.

• Alpha-tocopherol in dietary supplements and fortified foods is often esterified to

prolong its shelf life while protecting its antioxidant properties.

• The body hydrolyzes and absorbs these esters (alpha-tocopheryl acetate and
succinate) as efficiently as alpha-tocopherol.
Vitamin E Deficiency
• Premature babies of very low birth weight (<1,500 grams) might be deficient in
vitamin E.

• Vitamin E supplementation in these infants might reduce the risk of some

complications, such as those affecting the retina, but they can also increase the risk
of infections.
Vitamin E and Health
• Many claims have been made about vitamin E’s potential to promote health and prevent and treat
disease.

• The mechanisms by which vitamin E might provide this protection include its function as an antioxidant
and its roles in anti-inflammatory processes, inhibition of platelet aggregation, and immune enhancement.

• Coronary heart disease

• Cancer: Evidence to date is insufficient to support taking vitamin E to prevent cancer. In fact, daily use of large-dose
vitamin E supplements (400 IU of synthetic vitamin E [180 mg]) may increase the risk of prostate cancer.
• Eye disorder
• Cognitive decline
Health Risks from Excessive Vitamin E
• Research has not found any adverse effects from consuming vitamin E in food.

• However, high doses of alpha-tocopherol supplements can cause hemorrhage and

interrupt blood coagulation in animals, and in vitro data suggest that high doses
inhibit platelet aggregation.

• Two clinical trials have found an increased risk of hemorrhagic stroke in participants
taking alpha-tocopherol.

• Doses of up to 1,000 mg/day (1,500 IU/day of the natural form or 1,100 IU/day of the
synthetic form) in adults appear to be safe.
Interactions with Medications
• Anticoagulant and antiplatelet medications
– Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors.
Probably exceed 400 IU/day.

• Simvastatin and niacin

– Combination of vitamin E supplements with other antioxidants, such as vitamin C, selenium, and
beta-carotene blunted the rise in HDL cholesterol levels among people treated with a combination
of simvastatin and niacin.

• Chemotherapy and radiotherapy

– Oncologists generally advise against the use of antioxidant supplements during cancer
chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by
inhibiting cellular oxidative damage in cancerous cells.
Vitamin K…
• “Vitamin K,” the generic name for a family of compounds with a common chemical
structure of 2-methyl-1,4-naphthoquinone

• These compounds include phylloquinone (vitamin K1) and a series of menaquinones

(vitamin K2).

• Vitamin K2: Menaquinones have unsaturated isoprenyl side chains and are designated
as MK-4 through MK-13, based on the length of their side chain.

• MK-4, MK-7, and MK-9 are the most well-studied menaquinones.

• Phylloquinone is present primarily in green leafy vegetables and is the
main dietary form of vitamin K.

• Menaquinones, which are predominantly of bacterial origin, are

present in modest amounts in various animal-based and fermented
foods.
– Almost all menaquinones, in particular the long-chain menaquinones, are also produced
by bacteria in the human gut.

• MK-4 is unique in that it is produced by the body from phylloquinone

via a conversion process that does not involve bacterial action.
Vitamin K functions as a coenzyme for vitamin K-dependent carboxylase, synthesis of proteins
involved in blood clotting and bone metabolism

1. Prothrombin (clotting factor II) is a vitamin K-dependent protein in plasma that is directly
involved in blood clotting.
• Warfarin and some anticoagulants antagonize the activity of vitamin K
• For this reason, individuals who are taking these anticoagulants need to maintain consistent vitamin K
intakes.

2. Matrix Gla-protein, a vitamin K-dependent protein present in vascular smooth muscle, bone,
and cartilage, help reduce abnormal calcification.

3. Osteocalcin is another vitamin K-dependent protein that is present in bone and may be
involved in bone mineralization or turnover.
Adequate Intakes (AIs) for Vitamin K
Food sources of Vitamin K
• Food sources of phylloquinone include green leafy vegetables, vegetable oils, and some fruits.

• Meat, dairy foods, and eggs contain low levels of phylloquinone but modest amounts of
menaquinones.

• Fermented foods, such as cheese, contain menaquinones.

• Animals synthesize MK-4 from menadione, poultry and pork products contain MK-4 if menadione is
added to the animal feed.

• The absorption rate of phylloquinone in its free form is approximately 80%

• Phylloquinone in plant foods is tightly bound to chloroplasts, so it is less bioavailable than that from
oils or dietary supplements.
 Dietary supplements
• Several forms of vitamin K are used in dietary supplements, including
vitamin K1 as phylloquinone or phytonadione (a synthetic form of vitamin
K1) and vitamin K2 as MK-4 or MK-7.

• Menadione, which is sometimes called “vitamin K3,” is another synthetic

form of vitamin K. It was shown to damage hepatic cells in laboratory
studies conducted during the 1980s and 1990s, so it is no longer used in
dietary supplements or fortified foods.
 ‫عنوان‬ ‫مقدار‬

Calcium Carbonate 625 mg

‫عنوان‬ ‫مقدار‬ Vitamin D3 200 IU

Calcium as elemental (as calcium citrate after 1000 mg Vitamin K2-7 45 mcg
reconstitution)
Vitamin D3 (as Cholecalciferol) 800 IU
‫عنوان‬ ‫مقدار‬ ‫نیاز روزانه‬
Vitamin K2 (as Menaquinone -7) 90 mcg
(Calcium (as Calcium Carbonate 500 mg 50 %

(Magnesium (as Magnesium 175 mg 58.6 %

Oxide

(Vitamin D3 (as Cholecalciferol 600 IU 100 %

Vitamin K2 45 mcg 56.25 %

 Vitamin K Intakes and Status
• In adults aged 20 and older, the average daily vitamin K intake from foods is
122 mcg for women and 138 mcg for men.

• When both foods and supplements are considered, the average daily
vitamin K intake increases to 164 mcg for women and 182 mcg for men.
Groups at Risk of Vitamin K Inadequacy
• Newborns not treated with vitamin K at birth
– Vitamin K transport across the placenta is poor. During the first few weeks of life,
vitamin K deficiency can cause vitamin K deficiency bleeding (VKDB). To prevent
VKDB, the administration of a single, intramuscular dose of 0.5 to 1 milligram
(mg) vitamin K1 at birth is recommended.

• People with malabsorption disorders

– People with malabsorption syndromes and other gastrointestinal disorders, such
as cystic fibrosis, celiac disease, ulcerative colitis, and short bowel syndrome,
might not absorb vitamin K properly.
Vitamin K and Health
• Osteoporosis
– In Japan and other parts of Asia, a pharmacological dose of MK-4 (45 mg) is used as a treatment
for osteoporosis.

• Coronary heart disease

– At this time, the role of the different forms of vitamin K on arterial calcification and the risk of
coronary heart disease is unclear
Interactions with Medications
• Warfarin and similar anticoagulants
– Vitamin K can have a serious and potentially dangerous interaction with anticoagulants such as warfarin, sudden
changes in vitamin K intakes can increase or decrease the anticoagulant effect.

• Antibiotics
– Antibiotics can destroy vitamin K-producing bacteria in the gut, potentially decreasing vitamin K status, Cephalosporin
antibiotics

• Bile acid sequestrants, such as cholestyramine and colestipol

– They can reduce the absorption of vitamin K and other fat-soluble vitamins.

• Orlistat
– It reduces the body’s absorption of dietary fat and in doing so, it can also reduce the absorption of fat-soluble
vitamins, such as vitamin K.