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Introduction
Vitamin A, the first fat-soluble vitamin to be Roughness of the skin occurs due to
recognized, has been described as one of the most hyperkeratosis of the hair follicles. During
versatile vitamins due to its many roles in body development, a deficiency of vitamin A leads to
functions. The most well-defined function of abnormalities in dentine formation and bone
vitamin A is its role in vision. It is also involved growth.
in maintenance and integrity of the mucous mem- Causes of vitamin A deficiency include
branes, skin, remodeling, and growth of bones. inadequate intake, impaired absorption or
Other roles include maintaining the stability of storage, and poor conversion of carotene to active
cell membranes and nerve sheaths, synthesis of vitamin A. Poor absorption and/ or storage is
adrenal cortical hormones (corticosterone), and associated with excessive alcohol intake, celiac
regulation of thyroxin output. Vitamin A is also disease, cystic fibrosis of the pancreas, ulcerative
involved in the manufacture of red blood cells colitis, biliary obstruction, and cirrhosis of the
and assists the immune reaction. More recently liver.4
researchers have suspected that vitamin A is
involved in cellular differentiation and gene Hypervitaminosis A
expression. Over the past 10 years vitamin A has Toxicity of vitamin A occurs with protracted
been investigated for the prevention and treat- high doses. Acute toxicity has been observed
ment of various types of cancers. 1 2 3 following the consumption of polar bear liver,
which contains 20,000 LU. per gram.5
Vitamin A Requirements Symptoms of vitamin A toxicity include joint
The terminology for the measurement of pain, decalcification, and fragility of bone.
vitamin A is presently in transition. This is due to Increased intracranial pressure produces pseudo
the various forms of the pre-vitamin, which are brain tumor symptoms. Red blood cells lose
converted into the active form (retinol) at hemoglobin, and bleeding can occur easily.
different efficiencies. Therefore the term retinol Nervous system symptoms include irritability,
equivalents (R.E.) is beginning to replace restlessness, fatigue, anorexia, and muscle
international units (LU.). RE is the amount of weakness. Rashes may develop on the skin,
retinol a vitamin A compound will yield causing dryness and peeling along with hair loss.
following conversion by the body. The lips may also become scaly. The spleen and
Recommended dietary allowances for infants and liver enlarge and jaundice may develop.6
children are 420-700 RE, males 1,000 RE, Symptoms of toxicity subside with reduced
females 800 RE. During pregnancy and lactation, intake of the vitamin.
the RDA is increased 200 and 400 RE
respectively. Larger doses of short duration are Vitamins Synergistic to Vitamin A
required when deficiency symptoms exist. As with minerals, rarely does a vitamin
deficiency develop singularly. Synergistic co-
Hypovitaminosis A factors should also be taken into consideration
The most recognized early sign of vitamin A when determining vitamin A requirements and
deficiency is night blindness (impaired night during therapy.
vision), xeropthalmia, and Bitot's spots. Vitamin E is considered synergistic to vitamin
A due to its antioxidant activity, which results in
1. Trace Elements, Inc., P.O. Box 514, Addison, Texas a sparing effect upon vitamin A.7 Vitamin E also
75001. aids in stabilization of cell membranes. Loss of
vitamin A from liver stores is accelerated in the
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Journal of Orthomolecular Medicine Vol. 6, No. 1, 1991
28
The Nutritional Relationships of Vitamin A
soluble vitamins.24
Iodine in the form of T4, although synergistic
to vitamin A, is antagonistic as well. 25 Adrenal Hormones and Vitamin A
The minerals copper, calcium, and sodium can The adrenocortical hormones increase the
have an indirect antagonistic effect upon vitamin mobilization of vitamin A from the liver. This
A due to their interrelationship with the thyroid effect has also been reported in the treatment of
gland.26 27 rheumatic children with cortisone.33 Adequate
Any factor that antagonizes the mineral zinc adrenal function is also necessary for the
can be a potential antagonist to vitamin A, e.g., mobilization of vitamin A stores. It is possible
cadmium and mercury. that adrenal and thyroid insufficiency contributes
to signs of vitamin A deficiency or increased
Endocrine Relationship to Vitamin A requirements due to an inability to mobilize it
As with minerals, vitamins are also affected by from storage.
endocrine activity. Hormone levels can directly
affect vitamin A status and requirements.
Protein
Thyroid and Vitamin A Adequate protein is necessary for the
The conversion of carotene to vitamin A is mobilization of vitamin A from the liver to the
influenced by thyroxine. Studies show that blood stream. Vitamin A deficiency is associated
thyroidectomy or suppression of the thyroid with protein malnutrition. Normal serum vitamin
produces hypercarotenemia and reduced retinol A levels can be restored when protein is added to
levels in the liver.28 29 It has been speculated that the diet, providing there are adequate liver
vitamin A deficiency is associated with reserves of the vitamin. However, if liver reserves
hypothyroidism. Studies reveal that low vitamin of vitamin A are depleted, dietary protein may
A levels are associated with goiter formation.30 precipitate an acute vitamin A deficiency.34
Overactivity of the parathyroid due to its
suppressing effect upon the thyroid and its Assessment of Vitamin A Status
relationship with vitamin D may also increase Over 90% of the vitamin A reserves are in the
vitamin A requirements.31 liver; therefore, serum levels do not truly reflect
vitamin A status. The serum levels however do
Estrogen and Vitamin A reflect a deficiency when liver reserves are
Tissue estrogen sensitivity is increased in the depleted and an excess when liver stores are over
presence of vitamin A deficiency.32 The saturated.35
concentrations of RBP are lowest prior to the
preovulatory peak in estradiol levels. According Conclusion
to the study reported by Keyvani, et al, females As with other nutrients, requirements for
are affected by goiter more than males due to the vitamin A should be assessed in conjunction with
fact that females have lower vitamin A levels. its co-factors. Nutritional therapeutics involving
29
Journal of Orthomolecular Medicine Vol. 6, No. 1, 1991
30