Vitamin A (Retinol)
Vitamin A is a fat-soluble vitamin that has several important functions in the body.
- It helps cells reproduce normally, a process called cellular differentiation.
- It is essential for good vision. The first sign of a vitamin A deficiency is often poor sight at night.
- It is needed for the proper development of an embryo and fetus.
Vitamin A helps keep skin and mucous membranes that line the nose, sinuses, and mouth healthy. It also plays a role in:
- Immune system function
- Bone formation
- Wound healing
Vitamin A comes from two sources. One group, called retinoids, comes from animal sources and includes retinol. The other group, called carotenoids, comes from plants and includes beta-carotene. The body converts beta-carotene to vitamin A. Major carotenoids, including lycopene, lutein, and zeaxantuin, have important biological properties, including antioxidant and photoprotective activities.
It is rare in the developed world to have a serious deficiency of vitamin A. Symptoms include:
- Dry eyes
- Night blindness
- Skin problems
While vitamin A is essential for good health, it can be toxic in high doses. Never take more than the recommended daily allowance without first talking to your doctor.
Acne, psoriasis, and other skin disorders
Prescription creams and pills containing retinoids, a synthetic form of vitamin A, are used to help clear up severe acne and psoriasis. They have also shown promise for treating other skin disorders, warts, and premature aging from the sun. Recent studies show that topical forms along with antioxidants may help minimize the appearance of fine lines and wrinkles. These medications require close supervision by a doctor. Isotretinoin (Accutane), an oral medication for acne, can cause very serious side effects and must not be used by pregnant women or women of child-bearing age who are not taking birth control.
Getting enough vitamin A in your diet is essential for good vision. Research shows that people who eat more foods with vitamin A are less likely to develop age-related macular degeneration (AMD). In addition, a large population study found that people who got high levels of vitamin A though their diets had a lower risk of developing cataracts. But researchers don't know whether taking vitamin A supplements would work the same way. Vitamin A supplements may help slightly slow down the damage from retinitis pigmentosa, a hereditary disease that causes poor night vision. However, the study used high doses, which can be toxic.
For children who have vitamin A deficiency, supplements can reduce the severity and complications of measles. Children who are deficient in vitamin A are more likely to develop infections, including measles. In areas of the world where vitamin A deficiency is widespread or where at least 1% of those with measles die, the World Health Organization (WHO) recommends giving vitamin A supplements to children who have measles. However, vitamin A does not seem to help unless a child has vitamin A deficiency. Never give a child vitamin A supplements without a doctor's supervision.
Inflammatory bowel disease (IBD)
People with IBD, either ulcerative colitis or Crohn disease, may have a hard time absorbing all the nutrients their bodies need. Doctors often recommend that people with IBD take a multivitamin, including vitamin A.
Whether vitamin A can reduce the risk of cancer is not clear. People who eat a healthy diet with enough beta-carotene and other carotenoids from fruits and vegetables seem to have a lower risk of certain cancers, such as:
- Breast cancer
- Colon Cancer
- Esophageal cancer
- Cervical cancer
Some laboratory studies suggest that vitamin A and carotenoids may help fight certain types of cancer in test tubes.
Few studies have shown that taking vitamin A supplements will help prevent or treat cancer. In fact, there is some evidence that it may be harmful. Taking beta-carotene or vitamin A supplements has been linked to a higher risk of lung cancer in people who smoke or drink alcohol. However, some researchers say more studies are needed to confirm this.
One preliminary study suggests that a topical form of vitamin A may reduce abnormal growth of cells on the cervix, called cervical neoplasia.
Researchers are also investigating retinoids, a synthetic form of vitamin A, for skin cancer. People with certain types of skin cancer tend to have lower levels of vitamin A and beta-carotene in the blood. However, studies that have looked at whether taking higher amounts of vitamin A or beta-carotene would prevent or treat skin cancer have had mixed results.
Vitamin A in the form of retinyl palmitate is found in:
- Beef, calf, and chicken liver
- Fish liver oils
- Dairy products, including whole milk, whole milk yogurt, whole milk cottage cheese, butter, and other cheeses
The body can also make vitamin A from beta-carotene and other carotenoids, which are fat-soluble nutrients found in fruits and vegetables that give them their color. Most dark-green leafy vegetables and deep yellow/orange vegetables and fruits, sweet potatoes, carrots, pumpkin and other winter squashes, cantaloupe, apricots, peaches, and mangoes, contain substantial amounts of beta-carotene. By eating these beta-carotene-rich foods, you can increase levels of vitamin A in your body.
Vitamin A supplements are available as either retinol or retinyl palmitate.
Tablets or capsules are available in a variety of doses. The tolerable upper limit, or safe upper limit, is 10,000 IU. For any dose close to that amount, a doctor should help you determine the amount to take. Most multivitamins contain the recommended dietary allowance (RDA) for vitamin A.
Unlike vitamin A, beta-carotene does not build up in the body. However, there is some evidence that high doses of beta-carotene can carry some risk. Talk to your doctor before taking more than the recommended amount.
How to Take It
Vitamin A is absorbed along with fat in the diet. Take it with food.
Studies often use high doses of vitamin A. However, such high doses can be toxic. A doctor should monitor any high-dose therapy (any dose approaching the level of 10,000 IU for an adult, or above the recommended daily allowance for a child).
Daily dietary intakes for vitamin A are:
- Infants, birth to 6 months: 400 mcg
- Infants, 7 to 12 months: 500 mcg
- Children, 1 to 3 years: 300 mcg
- Children, 4 to 8 years: 400 mcg
- Children, 9 to 13 years: 600 mcg
- Boys, 14 to 18 years: 900 mcg
- Girls, 14 to 18 years: 700 mcg
- Men, 19 years and older: 900 mcg
- Women, 19 years and older: 700 mcg
- Pregnant women, 14 to 18 years: 750 mcg
- Pregnant women, 19 years and older: 770 mcg
- Breastfeeding women, 14 to 18 years: 1,200 mcg
- Breastfeeding women, 19 years and older: 1,300 mcg
Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider.
Taking too much vitamin A when you are pregnant can cause serious birth defects. Because all prenatal vitamins contain some vitamin A, you should not take a separate vitamin A supplement.
Synthetic vitamin A can cause birth defects. Women who are pregnant or trying to become pregnant shouldn't take this form of vitamin A.
Too much vitamin A is toxic and can cause liver failure, even death. Symptoms of vitamin A toxicity include:
- Muscle and joint pain
- Dry skin and lips
- Dry or irritated
- Nausea or diarrhea
- Hair loss
Vitamin A from foods is considered safe. But you can get too much from supplements. For adults, 19 and older, the tolerable upper limit for vitamin A is 10,000 IU per day. Talk to your doctor before taking any dose close to that amount.
People who have liver disease or diabetes should not take vitamin A supplements without their doctor's supervision.
Smokers and people who drink heavy amounts of alcohol should not take beta-carotene supplements.
Both vitamin A and beta-carotene may increase triglycerides, which are fats in the blood. They may even increase the risk of death from heart disease, particularly in smokers.
Vitamin A is found in many different vitamin formulas. Supplements that say "wellness formula," "immune system formula," "cold formula," "eye health formula," "healthy skin formula," or "acne formula," all tend to contain vitamin A. If you take a variety of different formulas, you could be at risk for too much vitamin A.
If you take large doses of vitamin A, you may want to avoid eating carob. It increases the amount of vitamin A available in your body.
If you are being treated with any of the following medications, you should not take vitamin A without first talking to your health care provider:
Tetracycline antibiotics: People who take a type of antibiotic called tetracyclines and also take high doses of vitamin A may be at risk for a condition called intracranial hypertension, which is a rise in the pressure of brain fluid. Tetracyclines include:
- Demeclocycline (Declomycin)
- Minocycline (Minocin)
- Tetracycline (Achromycin)
Antacids: One study suggests that the combination of vitamin A and antacids may be more effective than antacids alone in healing ulcers.
Anticoagulants (blood thinners): Long-term use of vitamin A or taking high doses may increase the risk of bleeding for those taking blood-thinning medications, particularly warfarin (Coumadin). Talk to your doctor before taking vitamin A.
Cholesterol-lowering medications (bile acid sequestrants): The medications cholestyramine (Questram) and colestipol (Colestid) may reduce your ability to absorb vitamin A and lead to lower levels in your body. A water-soluble form of vitamin A may help. Another class of cholesterol-lowering medications called statins may actually raise vitamin A levels in your blood.
Doxorubicin: Doxorubicin is a medication used to treat cancer. Test tube studies suggest that vitamin A may make the action of doxorubicin stronger. More research is needed to understand the effect. If you are undergoing treatment for cancer, ask your oncologist before taking vitamin A or any supplement.
Medications processed by the liver: Taking high doses of vitamin A along with some other medications that are processed by the liver may cause liver damage or even liver failure. Some examples of medications processed by the liver include acetaminophen (Tylenol), carbamazepine (Tegretol), isoniazid, and methotrexate. If you are taking any prescription medications, ask your doctor before taking vitamin A.
Neomycin (Mycifradin): This antibiotic may reduce the body's ability to absorb vitamin A, especially when taken in large doses.
Omeprazole (Prilosec): Omeprazole, used for gastroesophageal reflux disease or heart burn, may interact with beta-carotene supplements. Researchers do not know whether it also affects the absorption of beta-carotene from foods.
Retinoids: These medications are a synthetic form of vitamin A and are sometimes prescribed in high doses. People who take retinoids should not take additional vitamin A supplements. In addition, these drugs can cause severe birth defects. Women of child-bearing age must have two negative pregnancy tests and be on two forms of birth control before taking these medications. Anyone taking retinoids will be monitored closely by their doctor. Retinoids include:
- Acitretin (Soriatane)
- Bexarotene (Targretin)
- Isotretinoin (Accutane)
- Tazarotene (Avage)
Tretinoin (Retin-A) is usually prescribed as a skin cream to treat acne or reduce wrinkles and is not as concentrated as other retinoids. However, you may still want to avoid taking a vitamin A supplement while using Retin-A.
Orlistat (Alli) and Olestra: Orlistat, a medication used for weight loss, and olestra, a substance added to certain foods, both prevent the body from absorbing fat and calories. They may also prevent the body from absorbing enough vitamin A. The Food and Drug Administration (FDA) requires that vitamin A and other fat-soluble vitamins (vitamins D, E, and K) be added to food products containing olestra. In addition, people who take either prescription orlistat or over-the-counter Alli may want to take a multivitamin.
Alberts D, Ranger-Moore J, Einspahr J, et al. Safety and efficacy of dose-intensive oral vitamin A in subjects with sun-damaged skin. Clin Cancer Res. 2004;10:1875-1880.
Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: W.B. Saunders Company; 2000:287-294.
Arora A, Willhite CA, Liebler DC. Interactions of beta-carotene and cigarette smoke in human bronchial epithelial cells. Carcinogenesis. 2001;22(8):1173-1178.
Bershad SV. The modern age of acne therapy: a review of current treatment options. Mt Sinai J Med. 2001;68(4-5):279-286.
Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet. 2004;364:1219-1228.
Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study.Ophthalmology. 2000;107(3):450-456.
Flood A, Schatzkin A. Colorectal cancer: does it matter if you eat your fruits and vegetables? J Natl Cancer Inst. 2000;92(21):1706-1707.
Fragoso YD, Stoney PN, McCaffery PJ. The evidence for a beneficial role of vitamin A in multiple sclerosis. CNS Drugs. 2014;28(4):291-9.
French AL, Kirstein LM, Massad LS, et al. Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women. J Infect Dis. 2000;182(4):1084-1089.
Frieling UM, Schaumberg DA, Kupper TS, Muntwyler J, Hennekens CH. A randomized, 12-year primary-prevention trial of beta carotene supplementation for nonmelanoma skin cancer in the Physicians' Health Study. Arch Dermatol. 2000;136(2):179-184.
Fulan H, Changxing J, Baina WY, et al. Retinol, vitamins A, C, and E and breast cancer risk: a meta-analysis and meta-regression. Cancer Causes Control. 2011;22(10):1383-1396.
Hall JA, Grainger JR, Spencer SP, Belkaid Y. The role of retinoic acid in tolerance and immunity. Immunity. 2011;35(1):13-22.
Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press; 2001.
Kang S, Fisher GJ. Voorhees JJ. Photoaging: pathogenesis, prevention, and treatment. Clin Geriatr Med. 2001;17(4):643-659.
Kliegman. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.
Michels KB, Giovannucci E, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92:1740-1752.
National Institutes of Health, Office of Dietary Supplements. Facts About Dietary Supplements: Vitamin A and Carotenoids. December 2001.
Patrick L. Beta-carotene: the controversy continues. Altern Med Rev. 2000;5(6):530-545.
Patrick L. Nutrients and HIV:Part 2 -- vitamins A and E, zinc, B-vitamins, and magnesium. Altern Med Rev. 2000;5(1):39-51.
Prakash P, Krinsky NI, Russell RM. Retinoids, carotenoids, and human breast cancer cell cultures: a review of differential effects. Nutr Reviews. 2000;58(6):170-176.
Rai SK, Nakanishi M, Upadhyay MP, et al. Effect of intestinal helminth infection on retinol and beta-carotene status among rural Nepalese. Nutr Res. 2000;20(1):15-23.
Ribaya-Mercado JD, Blumber JB. Vitamin A: is it a risk factor for osteoporosis and bone fracture? Nutr Rev. 2007;65(10):425-438.
Rock CL, Michael CW, Reynolds RK, Ruffin MT. Prevention of cervix cancer. Crit Rev Oncol Hematol. 2000;33(3):169-185.
SanGiovanni JP, Chew EY, Clemons TE, Ferris FL, Gensler G, Lindblad AS, Milton RC, Seddon JM, Sperduto RD. The relationship between dietary carotenoid and vitamin A, E and C intake with age-related macular degeneration in a case-control study. Report No. 22. Arch Ophthalmol. 2007;125(9):1225-1232.
Sei H. Vitamin A and sleep regulation. J Med Invest. 2008;55(1-2):1-8.
Sommer A, Vyas K. A global clinical view on vitamin A and carotenoids. Am J Clin Nutr. 2012;96(5):1204S-62.
Sorg O, Saurat JH. Topical retinoids in skin ageing: a focused update with reference to sun-induced epidermal vitamin A deficiency. Dermatology. 2014;228(4):314-25.
Steck-Scott S, Forman MR, Sowell A, et al. Carotenoids, vitamin A and risk of adenomatous polyp recurrence in the polyp prevention trial. Int J Cancer. 2004;112(2):295-305.
Stratton SP, Dorr RT, Alberts DS. The state-of-the art in chemoprevention of skin cancer. Eur J Cancer. 2000;36(10):1292-1297.
Tafti M, Ghyselinck NB. Functional implication of the vitamin A signaling pathway in the brain. Arch Neurol. 2007;64(12):1706-1711.
Thornquist MD, Kristal AR, Patterson RE, et al. Olestra consumption does not predict serum concentrations of carotenoids and fat-soluble vitamins in free-living humans: early results from the sentinel site of the olestra post-marketing surveillance study. J Nutr. 2000;130(7):1711-1718.
van Dam RM, Huang Z, Giovannucci E, et al. Diet and basal cell carcinoma of the skin in a prospective cohort of men. Am J Clin Nutr. 2000;71(1):135-141.
van Zandwijk N, Dalesio O, Pastorino U, de Vries N, van Tinteren H. EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. For the European Organization for Research and Treatment of Cancer Head and Neck and Lung Cancer Cooperative Groups. J Natl Cancer Inst. 2000;92(12):959-960.
Vetrugno M, Maino A, Cardia G, et al. A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy. Br J Ophthalmol. 2001;85(5):537-539.
Villamor E, Fawzi WW. Vitamin A supplementation: implications for morbidity and mortality in children. J Infect Dis. 2000;182 Suppl 1:S122-S133.
Wang A, Han J, Jiang Y, Zhang D. Association of vitamin A and B-carotene with risk for age-related cataract: a meta-analysis. Nutrition. 2014;30(10):1113-21.
Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis. PLoS One. 2014;9(7):e102527.
Zouboulis CC. Retinoids -- which dermatological indications will benefit in the near future? Skin Pharmacol Appl Skin Physiol. 2001;14(5):303-315.
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.