Laura Schoenfeld: Liz, I don’t know if you mean the vitamin A levels are normal or high or if you mean vitamin D levels are normal or high. At the end of the day, it really comes down to what the person is eating and if they’re getting preformed retinol in their food. If they’re eating liver regularly and if they don’t have symptoms of vitamin A deficiency, then maybe they don’t need to take a little vitamin A with the vitamin D and K2. I don’t really see a reason not to unless there’s some kind of sign of toxicity of vitamin A because even vitamin A toxicity is more of a vitamin D deficiency issue as opposed to vitamin A toxicity. I’ll put this in my notes to share on Facebook, but there is a really good article by Chris Masterjohn about vitamin A toxicity and how vitamin D and K2 actually affect the toxicity of either vitamin A or vitamin D. There’s research showing that overdosing on vitamin D is dangerous, overdosing on vitamin A is dangerous, but if you “overdose” so if you take the same dose of both at the same time, that you won’t actually get any sort of toxicity issue. I think that’s really interesting because it’s basically showing that the toxicity is really more because you’re out of balance as opposed to getting too much of a certain nutrient. As far as balancing the supplements is concerned, I think we’ve talked about this a little bit in the Facebook group possibly, but usually I like to do a ratio of 1,000 IU of vitamin D to about, let’s say, 3,000 to 5,000 IU of vitamin A. If you’re doing 1,000 IU of vitamin D, you want to make sure that person is getting at least 3,000 to 5,000 IU of vitamin A. Then K2, usually at least, like, 100 micrograms per 1,000 IU of vitamin D. All of the supplements I use are kind of combined in that ratio already, which is awesome, and if you’re doing things separately, like if you’re doing a D-and-K2 combo with a separate vitamin A, which I do that sometimes if I have a client that eats liver irregularly. If they’re having liver once a month or something and they’re not eating it consistently enough to totally not need a supplement, but I don’t want them supplementing with vitamin A the weeks that they are eating liver, then maybe I’ll do a D-and-K2 combo and then do a vitamin A on top of that and say, “OK, when you’re not eating liver, have a little bit of the vitamin A extra. When you’re eating it, then you don’t need to supplement with vitamin A.”
Really, I can’t see a time where if you’re going to do D supplementation that you wouldn’t want to also do A and K2. Again, that’s my opinion. I’m not 100 percent sure what Chris would say, but I feel that he’s probably on the same page as far as balancing them because, again, I’ll share that article, but it’s essentially saying that you protect against toxicity by taking A and D together. If you’re doing any sort of high doses for somebody, then taking A is really going to protect against any sort of toxicity, especially if somebody is possibly vitamin A deficient. I don’t know if there’s a lot of evidence that blood levels of retinol is really something you can use in a clinical sense as far as identifying if somebody is vitamin A deficient. I think the reason for that would be that blood levels don’t necessarily indicate what the storage amount of a nutrient is. Vitamin A is stored in your liver and then it’s released into the bloodstream. You could say that maybe you’re 90 percent deficient in your liver in vitamin A but your bloodstream is still normal because your body is keeping your bloodstream at homeostasis, so I don’t necessarily think that blood level of vitamin A is a great indicator of deficiency or not. Now, if it’s high, possibly, but again, if you’re doing D and A together, you’re usually protecting against toxicity there. Again, you don’t want to do megadoses. You don’t want to be doing, like, 10,000 IU of D and like 50,000 IU of A every day, but 2,000 or 3,000 IU D and then 10,000 to 15,000 IU A is pretty normal as far as the physiological dose is concerned. Then K2 doesn’t have any toxicity that they’ve established yet, so if you’re doing K2 in MK-7 form, usually 200 micrograms a day is perfectly reasonable. If you’re doing K2 in MK-4 form, usually you’re looking at 1,000 micrograms of that a day as a good dose.