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Nutritional Supplement

Vitamin A

Possible Deficiencies

People who limit their consumption of liver, dairy foods, and beta-carotene-containing vegetables can develop a vitamin A deficiency. Extremely low birth weight babies (2.2 pounds or less) are at high risk of being born with a deficiency, and vitamin A shots given to these infants have been reported in double-blind research to reduce the risk of lung disease.118 The earliest deficiency sign is poor night vision. Deficiency symptoms can also include dry skin, increased risk of infections, and metaplasia (a precancerous condition). Severe deficiencies causing blindness are extremely rare in Western societies.

Less severe deficiencies are more likely to occur with a variety of conditions causing malabsorption. A high incidence of vitamin A deficiency in people infected with HIV has also been reported. People with hypothyroidism have an impaired ability to convert beta-carotene to vitamin A.119,120 For this reason, some doctors suggest taking supplemental vitamin A (perhaps 5,000–10,000 IU per day) if they are not consuming adequate amounts in their diet.

Very old people with type 2 diabetes have shown a significant age-related decline in blood levels of vitamin A, irrespective of their dietary intake.121

Side Effects

Since a 1995 report from the New England Journal of Medicine,122 women who are or could become pregnant have been told by doctors to take less than 10,000 IU (3,000 mcg) per day of vitamin A to avoid the risk of birth defect. A recent report studied several hundred women exposed to 10,000–300,000 IU (median exposure of 50,000 IU) per day.123 Three major malformations occurred in this study, but all could have happened in the absence of vitamin A supplementation. Surprisingly, no congenital malformations happened in any of the 120 infants exposed to maternal intakes of vitamin A that exceeded 50,000 IU per day. In fact, the high-exposure group had a 50% decreased risk for malformations compared with infants not exposed to vitamin A. The authors noted that some previous studies found no link between vitamin A and birth defects, and argued the studies that did find such a link suffered from various weaknesses. A closer look at the recent study reveals a 32% higher than expected risk of birth defects in infants exposed to 10,000–40,000 IU of vitamin A per day, but paradoxically a 37% decreased risk for those exposed to even higher levels. This suggests that both “higher” and “lower” risks may have been due to chance.

Excessive dietary intake of vitamin A has been associated with birth defects in humans in fewer than 20 reported cases over the past 30 years.124,125 Presently, the level at which vitamin A supplementation may cause birth defects is not known, though combined human and animal data suggest that 30,000 IU per day should be considered safe.126 Women who are or who could become pregnant should consult with a doctor before supplementing with more than 10,000 IU per day.

Vitamin A supplements can both help and hurt children. Many people have heard that vitamin A supplements support immune function and prevent infections. This is true under some circumstances. However, vitamin A can also increase the risk of infections, according to the findings of a double-blind trial.127 In a study of African children between six months and five years old, a 44% reduction in the risk of severe diarrhea was seen in those children given four 100,000–200,000 IU applications of vitamin A (the lower amount for those less than a year old) during an eight-month period. On further investigation, the researchers discovered that the reduction in diarrhea occurred only in children who were very malnourished. For children who were not starving, vitamin A supplementation actually increased the risk of diarrhea compared with the placebo group. The vitamin A-supplemented children also had a 67% increased risk of coughing and rapid breathing, signs of further lung infection, although this problem did not appear in children infected with AIDS. These findings should be of concern to American parents, whose children are not usually infected with AIDS or severely malnourished. Such relatively healthy children fared poorly in the African trial in terms of both the risk of diarrhea and the risk of continued lung problems. Vitamin A provided no benefit to the well-nourished kids. Therefore, it makes sense to not give vitamin A supplements to children unless there is a special reason to do so, such as the presence of a condition causing malabsorption (e.g., celiac disease).

In a study of people with retinitis pigmentosa (a degenerative condition of the eye), participants received 15,000 IU of vitamin A per day for 12 years with no signs of adverse effects or toxicity.128 For other adults, intake above 25,000 IU (7,500 mcg) per day can—in rare cases—cause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage.129 At higher levels (for example 100,000 IU per day) these problems become more common.

A controlled clinical trial showed that people who took 25,000 IU of vitamin A per day for a median of 3.8 years had an 11% increase in triglycerides, a 3% increase in total cholesterol and a 1% decrease in HDL cholesterol compared to those who did not take vitamin A.130 Although the significance of these findings is not clear, people at risk for cardiovascular disease should use caution when considering long-term vitamin A supplementation.

One study found that increasing the intake of vitamin A in the diet was associated with bone loss and risk of hip fracture, possibly due to a vitamin A-induced stimulation of cells that break down bone.131 In this study, a vitamin A intake greater than 5,000 IU per day, when compared to a lower intake, was associated with a reduction in bone mineral density that approximately doubles the risk of hip fracture. Beta-carotene (which can be used by the body to make vitamin A) has not been linked to reduced bone mass. Until more is known, people concerned about osteoporosis may consider taking beta-carotene supplements rather than supplementing with vitamin A.

Data from test tube, animal, and human studies show that excessive vitamin A intake can accelerate bone loss and inhibit formation of new bone, increasing the risk of osteoporosis.132 In humans, small studies have found these effects at about 85,000–125,000 IU per day. 133,134

References

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13. Glasziou PP, Mackerras DE. Vitamin A supplementation in infectious diseases: a meta-analysis. BMJ 1993;306:366-70.

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47. Rahmathullah L. Effect of receiving a weekly dose of vitamin A equivalent to the recommended dietary allowances among pre school children on mortality in south India. Indian J Pediatr 1991;58:837-47.

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61. Frieden TR, Sowell AL, Henning KJ, et al. Vitamin A levels and severity of measles. New York City. Am J Dis Child 1992;146:182-6.

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68. Patty I, Tarnok F, Simon L, et al. A comparative dynamic study of the effectiveness of gastric cytoprotection by vitamin A, De-Nol, sucralfate and ulcer healing by pirenzepine in patients with chronic gastric ulcer (a multiclinical and randomized study). Acta Physiol Hung 1984;64:379-84.

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72. Skogh M, Sundquist T, Tagesson C. Vitamin A in Crohn's disease. Lancet 1980; i:766 [letter].

73. Wright JP, Mee AS, Parfitt A, et al. Vitamin A therapy inpatients with Crohn's disease. Gastroenterology 1985;88:512-4.

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81. Hunt TK, Ehrlich HP, Garcia JA, et al. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg 1969;170:633-41.

82. Kligman AM, Mills OH Jr, Leyden JJ, et al. Oral vitamin A in acne vulgaris. Preliminary report. Int J Dermatol 1981;20:278-85.

83. Lithgow DM, Politzer WM. Vitamin A in the treatment of menorrhagia. S Afr Med J 1977;51:191-3.

84. Mejia LA, Chew F. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Am J Clin Nutr 1988;48:595-600.

85. Block E. The use of vitamin A in premenstrual tension. Acta Obstet Gynecol Scand 1960;39:586-92.

86. Argonz J, Abinzano C. Premenstrual tension treated with vitamin A. J Clin Endocrinol 1950;10:1579-89.

87. Hunt TK. Vitamin A and wound healing. J Am Acad Dermatol 1986;15:817-21 [review].

88. Hunt TK, Ehrlich HP, Garcia JA, et al. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg 1969;170:633-41.

89. Smolle J, Wawschinek O, Hayn H, Eber O. Vitamin A and carotene in thyroid disease. Acta Med Austriaca 1983;10:71-3 [in German].

90. Aktuna D, Buchinger W, Langsteger W, et al. Beta-carotene, vitamin A and carrier proteins in thyroid diseases. Acta Med Austriaca 1993;20:17-20 [in German].

91. Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med 1990;323:160-4.

92. Anastasakis A, Plainis S, Giannakopoulou T, et at. Xerophthalmia and acquired night blindness in a patient with a history of gastrointestinal neoplasia and normal serum vitamin A levels. Doc Ophthalmol 2013 Apr;126(2):159-62. doi: 10.1007/s10633-012-9370-x. Epub 2013 Jan 20.

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The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2020.

Copyright © 2020 TraceGains, Inc. All rights reserved.

The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2020.