You CAN get vitamin A toxicity from beta-carotene

[Ippodrom47]

We have all been told that only preformed vitamin A in the form of retinol, which is found in supplements, liver, eggs, can be toxic. However, beta-carotene seems to have a very good rep because it is not supposed to give you toxicity due to the fact that the body is able to tightly regulate its conversion to retinol, and, in any case, that conversion rate is reportedly pretty low.

I personally got apparent vit A toxicity from eating too much beef/chicken liver and canned cod liver, as well as eggs and dairy on top of that. Then I continued to have all the classic debilitating vitamin A toxicity symptoms from high beta-carotene foods (slowed metabolism, dry skin, eyes, and mouth, high calcium and cholesterol, irritability, fatigue), and it was only a week ago that I realized that vitamin A/carotene might be the cause.

Here's a case study I found a couple of days ago:
Refractory hypercalcemia owing to vitamin A toxicity in a 4-year-old boy

I understand that a 4 yo boy has a bit different bodily processes and mechanisms than an adult, but the case is still very unusual.

A 4-year-old, previously healthy boy presented to the emergency department with a 2-day history of polydipsia, fatigue, irritability, cheilitis and a refusal to bear weight.
He appeared pale, with significant cheilitis, xerotic skin, diffuse alopecia and periorbital and pedal edema (Figure 1). Initial investigations were significant for severe hypercalcemia, hyponatremia, hypokalemia, mildly elevated creatinine, elevated C-reactive protein, leukocytosis and normocytic anemia (Box 1).

He also had elevated liver enzymes, a prolonged international normalized ratio and hypoalbuminemia. A liver ultrasound showed hepatomegaly, and abnormal sheer wave elastography was suggestive of fibrosis.

...the vitamin A level was significantly elevated at 4.1 (reference 1.0–1.6) μmol/L. Because of his elevated vitamin A level, we carefully reviewed his diet and supplement intake. He was on a predominantly plant-based diet, and we estimated his vitamin A intake to be between 1528 μg and 3304 μg of retinol activity equivalents (RAE) per day, or 31 087–63 507 international units (IU) per day (recommended intake for children at the age of our patient is 400 μg/d RAE). We referred to the US Department of Agriculture to provide the levels of vitamin A in the foods (FoodData Central) and the conversion of factors for RAE and IU from the US National Institutes of Health (Box 2). The patient’s main sources of vitamin A included 1–2 cups of kale, 2–3 cups of green vegetables, 2–3 cups of fruit and 4 oz of meat per day (nonliver), plus a multivitamin containing vitamin A as β-carotene (28 μg RAE). He had previously been taking cod liver oil supplements (276 μg/day RAE) for more than 1 year, but had stopped many months previously.

We managed the patient’s hypercalcemia with IV hyperhydration, multiple doses of subcutaneous calcitonin and IV bisphosphonates and a low vitamin A diet (Figure 2). We discharged him home with a normal ionized calcium, and 1 month after discharge, his hypercalcemia and bicytopenia had resolved. His papilledema improved and he was tapered off acetazolamide. His liver markers remain mildly elevated, with ongoing evidence of fibrosis on liver ultrasound.

Basically, the child used to take cod liver oil in a safe dose several months prior to the admission, but stopped and continued to eat a plant-based diet with lots of carotene-rich products. Most of his issues were resolved or improved in a short period of time on a low-A diet.
The initially consumed amount of beta-carotene was enough to cause vit A toxicity, even though his body should have stopped converting it to retinol once its liver stores were full in order to prevent hypervitaminosis.
Also, note that his skin is a healthy color, even "pale" as mentioned in the article, with no signs of carotenemia. Once again, in a normal "defense mechanism" against vit A toxicity, the body should have stopped the conversion and started to direct it to the subcutaneous fat and cause apparent carotenemia (which I also had and thus was anything but "pale". In fact, I was so yellowish that my docs all asked me about any liver issues).

Would like to hear your thoughts!

 

[Tim Lundeen]

This is correct, I've seen a few other people reporting the same. I suspect the problem is that we can up or downregulate beta-carotene conversion within some range, but can't shut it down altogether.

 

[aliml]

Genes Associated With Beta-carotene Levels:

BCO1 (beta-carotene oxygenase 1) gene produces the enzyme responsible for converting beta-carotene into vitamin A (retinoid).

BCO2 (beta-carotene oxygenase 2) is a key enzyme that prevents oxidative stress by breaking down beta-carotene in the mitochondria.

BCO2 breaks down beta-carotene in a different way than BCO1, without producing vitamin A. Mutations in these two gene increase beta-carotene levels.

 

[Birdie]

Ray has been pointing this out for years. He even advises rinsing carrots to remove part of the beta carotene as well as limiting the amounts or avoiding such high beta carotene foods as sweet potatoes.

 

[Hidden49]

I got bad Vitamin A toxicity from eating 8-10 carrots a day for a month plus butternut squash on some of those days, had severe diabetes symptoms, couldn’t tolerate fructose or sugar anymore at all, couldn’t tolerate fats either, and at the end had liver and gallbladder pain itchy skin, orange and yellow skin.

Going low Vitamin A resolved those issues….

 

[pondering]

How long did you go low vitamin A for?

 

[Hidden49]

How long did you go low vitamin A for?

Since august last year, the first few months of low Vit A I had the most brutal dumping symptoms I’ve ever experienced though, like much worse symptoms than before I went low Vit A, but those have gone now though.

 

[pondering]

Was your diet heavy vitamin A (either retinol or beta carotene) before that month of carrots & butternut squash? What kind of dumping symptoms if I may ask?

 

[Hidden49]

Was your diet heavy vitamin A (either retinol or beta carotene) before that month of carrots & butternut squash? What kind of dumping symptoms if I may ask?

Not particularly but I had serious issues with my gallbladder from May-august so my diet had become quite limited in that period the VA foods I was eating kidney beans, red rice, yogurt, normal amount of carrots, sweet potato occasionally in the first 2 months.

Before my gallbladder went wrong in May I did go through a 8 month period of having 1 heart of little gem lettuce with every meal (sometimes 2) or a carrot or two, a heart of romaine lettuce has 54k iu of Vit A,so the little gem lettuce may have been a similar, some carotenoid herbal supplements like dandelion leaf, 3-4 eggs a day (the kind with orange yolks), cod liver oil for a couple of months (not high dose).

Then in the years before this I did have some periods where I ate a lot of sweet potatoes baked in olive oil.

The dumping symptoms were brutal I had headaches, neuropathy all over body, nausea, extreme anxiety, complete numbness in genitals felt like they were dead, burning rashes, bad autistic symptoms, poor eyesight, inflamed abdomen, veins showing all over abdomen, nocturia.

At first I was confused if I had VA deficiency rather than toxicity because of the eyesight stuff etc but now I know for sure it was toxicity. Gallbladder and liver pain, diabetes symptoms, fructose sugar intolerance all reversed going low VA. Started gaining weight and bile flow improved too.

The mistake I made when first going low VA was eating this organic sourdough bread, it was making the dumping symptoms a million times worse but took me a couple of weeks to realise. I now know this bread had glyphosate which shuts down the livers metabolism for VA.

I’ve become extremely sensitive to glyphosate containing foods (that’s a whole other story) and a lot of the organic grains and veg in the UK still have glyphosate.

I now know that if you are getting stuff like rashes etc it’s likely from glyphosate exposure negatively impacting VA metabolism rather than detox symptoms from the VA.

 

[pondering]

@Hidden49
I appreciate the detailed response! Your experience strikes a chord. It is good to know your gallbladder function improved as mine is less than optimal at times (get the itchies). Been doing low to moderate vitamin A for the last 2.5 months, while also trying to improve my zinc status (which I learned was deficient). Wondering now though (as you did), whether I’ve thrown myself into VA deficiency. Good to know about the glyphosate aspect which I wasn’t aware of affecting VA.

 

[pondering]

Carrot man: a case of excessive beta-carotene ingestion

“In this case report, the authors describe a 48-year-old male who complained to his primary care physician of abdominal discomfort and yellow/orange skin discoloration. Physical examination was normal except for some mild mid-abdominal discomfort (no observed skin color changes). An abdominal CT scan indicated a colon that was full of stool. Laboratory studies indicated elevated liver enzymes. Upon further questioning, the patient reported ingesting 6-7 pounds of carrots per week to facilitate his dieting effort. The patient was diagnosed with constipation, hypercarotinemia, and possible vitamin A toxicity. Following the cessation of excessive carrot ingestion, his liver enzymes normalized within 1 month.”

 

[pondering]

Vitamin A toxicity secondary to excessive intake of yellow-green vegetables, liver and laver

“We report a case of sudden onset of vitamin A poisoning. A 20-year-old Japanese woman had been eating pumpkin and only a very limited amount of other foods on a daily basis for 2 years. She was overlyconcerned about weight reduction. Aurantiasis cutis and abnormal liver function tests were noted by her family doctor in 1995 when she was 18 years old. At that time, she stopped eating pumpkin. However, she secretly continued an excessive intake of other beta carotene-rich vegetables, liver and laver for about 2 years. Two and one-half years after being seen by her family physician, she experienced sudden onset of low-grade fever, limb edema, cheilitis, dry skin, and headache. These symptoms worsened daily. A liver needle biopsy was performed, and it showed a normal portal tract along with fat-laden Ito cells in the space of Disse. A final diagnosis of vitamin A poisoning and hepatic injury secondary to an eating disorder was made. Her symptoms and serum beta-carotene levels returned to normal with successful adjustment of her diet.”

No access to full article but found this interesting

 

[Ippodrom47]

Vitamin A toxicity secondary to excessive intake of yellow-green vegetables, liver and laver

“We report a case of sudden onset of vitamin A poisoning. A 20-year-old Japanese woman had been eating pumpkin and only a very limited amount of other foods on a daily basis for 2 years. She was overlyconcerned about weight reduction. Aurantiasis cutis and abnormal liver function tests were noted by her family doctor in 1995 when she was 18 years old. At that time, she stopped eating pumpkin. However, she secretly continued an excessive intake of other betacarotene-rich vegetables, liver and laver for about 2 years. Two and one-half years after being seen by her family physician, she experienced sudden onset of low-grade fever, limb edema, cheilitis, dry skin, and headache. These symptoms worsened daily. A liver needle biopsy was performed, and it showed a normal portal tract along with fat-laden Ito cells in the space of Disse. A final diagnosis of vitamin A poisoning and hepatic injury secondary to an eating disorder was made. Her symptoms and serum beta-carotene levels returned to normal with successful adjustment of her diet.”

No access to full article but found this interesting

here u go :)

 

[pondering]

@Ippodrom47 Thanks!

 

[Hidden49]

Carotenemia. A review - PubMed

Awareness of carotenemia is important to avoid confusion with jaundice and unnecessary diagnostic studies. It is surprising how little information can be found about this relatively common condition in the standard pediatric textbooks. Ingestion of excessive amounts of carrots is the usual cause...

pubmed.ncbi.nlm.nih.gov

“Hypothyroidism, diabetes mellitus, hepatic and renal diseases may be associated with carotenemia, but are not caused by ingestion of carotene. “

^ Weird statement that doesn’t make sense as the only way to raise carotene levels is through ingestion of carotene foods or supplements.

Also I find the diabetes and carotenemia link to be correct, I had carotenemia and severe diabetes/blood sugar symptoms and when I cut out high beta carotene foods like carrots the diabetes stuff went away.

 

[Hidden49]

@Hidden49
I appreciate the detailed response! Your experience strikes a chord.

No worries, I am going to write a more detailed post on my issues with VA and VA detox experience in the future

A correlation between carotenemia and biliary dyskinesia - PubMed

The interrelationship between carotenemia and biliary dyskinesia was studied in eighty-two biliary dyskinesia patients and twenty-seven normal subjects. Incidence of serum carotene levels of more than 300 micrograms/dl was more frequent in biliary dyskinesia patients without liver damage or...

pubmed.ncbi.nlm.nih.gov

Possible role of endogenous retinoid (Vitamin A) toxicity in the pathophysiology of primary biliary cirrhosis - PubMed

Primary biliary cirrhosis (PBC) is a chronic, cholestatic disease of unknown etiology commonly affecting women. It is characterized by progressive destruction of the small intrahepatic bile ducts and portal inflammation, leading to fibrosis and cirrhosis. The major signs and symptoms of PBC...

pubmed.ncbi.nlm.nih.gov

 

[Ippodrom47]

Carotenemia. A review - PubMed

Awareness of carotenemia is important to avoid confusion with jaundice and unnecessary diagnostic studies. It is surprising how little information can be found about this relatively common condition in the standard pediatric textbooks. Ingestion of excessive amounts of carrots is the usual cause...

pubmed.ncbi.nlm.nih.gov

“Hypothyroidism, diabetes mellitus, hepatic and renal diseases may be associated with carotenemia, but are not caused by ingestion of carotene. “

^ Weird statement that doesn’t make sense as the only way to raise carotene levels is through ingestion of carotene foods or supplements.

Also I find the diabetes and carotenemia link to be correct, I had carotenemia and severe diabetes/blood sugar symptoms and when I cut out high beta carotene foods like carrots the diabetes stuff went away.

That makes sense. Beta-carotene is anti-thyroid, and the thyroid is responsible for blood sugar control, among other things.