Friday, April 24, 2009

Nutrition and Infectious Disease

Dr. Edward Mellanby's book Nutrition and Disease contains a chapter titled "Nutrition and Infection". It begins:
There is general agreement among medical men that the susceptibility of mankind to many types of infection is closely related to the state of nutrition. The difficulty arises, when closer examination is given to this general proposition, as to what constitutes good and bad nutrition, and the problem is not rendered easier by recent advances in nutritional science.
Dr. Mellanby was primarily concerned with the effect of fat-soluble vitamins on infectious disease, particularly vitamins A and D. One of his earliest observations was that butter protected against pneumonia in his laboratory dogs. He eventually identified vitamin A as the primary protective factor. He found that by placing rats on a diet deficient in vitamin A, they developed numerous infectious lesions, most often in the urogenital tract, the eyes, the intestine, the middle ear and the lungs. This was prevented by adding vitamin A or cabbage (a source of beta-carotene, which the rats converted to vitamin A) to the diet. Mellanby and his colleagues subsequently dubbed vitamin A the "anti-infective vitamin".

Dr. Mellanby was unsure whether the animal results would apply to humans, due to "the difficulty in believing that diets even of poor people were as deficient in vitamin A and carotene as the experimental diets." However, their colleagues had previously noted marked differences in the infection rate of largely vegetarian African tribes versus their carnivorous counterparts. The following quote from
Nutrition and Disease refers to two tribes which, by coincidence, Dr. Weston Price also described in Nutrition and Physical Degeneration:
The high incidence of bronchitis, pneumonia, tropical ulcers and phthisis among the Kikuyu tribe who live on a diet mainly of cereals as compared with the low incidence of these diseases among their neighbours the Masai who live on meat, milk and raw blood (Orr and Gilks), probably has a similar or related nutritional explanation. The differences in distribution of infective disease found by these workers in the two tribes are most impressive. Thus in the cereal-eating tribe, bronchitis and pneumonia accounted for 31 per cent of all cases of sickness, tropical ulcers for 33 per cent, and phthisis for 6 per cent. The corresponding figures for the meat, milk and raw blood tribe were 4 per cent, 3 per cent and 1 per cent.
So they set out to test the theory under controlled conditions. Their first target: puerperal sepsis. This is an infection of the uterus that occurs after childbirth. They divided 550 women into two groups: one received vitamins A and D during the last month of pregnancy, and the other received nothing. Neither group was given instructions to change diet, and neither group was given vitamins during their hospital stay. The result, quoted from Nutrition and Disease:
The morbidity rate in the puerperium using the [British Medical Association] standard was 1.1 per cent in the vitamin group and 4.7 in the control group, a difference of 3.6 per cent which is twice the standard error (1.4), and therefore statistically significant.
This experiment didn't differentiate between the effects of vitamin A and D, but it did establish that fat-soluble vitamins are important for resistance to bacterial infection. The next experiment Dr. Mellanby undertook was a more difficult one. This time, he targeted puerperal septicemia. This is a more advanced stage of puerperal sepsis, in which the infection spreads into the bloodstream. In this experiment, he treated women who had already contracted the infection. This trial was not as tightly controlled as the previous one. Here's a description of the intervention, from Nutrition and Disease:
...all patients received when possible a diet rich not only in vitamin A but also of high biological quality. This diet included much milk, eggs, green vegetables, etc., as well as the vitamin A supplement. For controls we had to use the cases treated in previous years by the same obstetricians and gynecologists as the test cases.
In the two years prior to this investigation, the mortality rate for puerperal septicemia in 18 patients was 92%. In 1929, Dr. Mellanby fed 18 patients in the same hospital his special diet, and the mortality rate was 22%. This is a remarkable treatment for an infection that was almost invariably fatal at the time.

Dr. Mellanby was a man with a lot of perspective. He was not a reductionist; he knew that a good diet is more than the sum of its parts. Here's another quote from
Nutrition and Disease:
It is probable that, as in the case of vitamin D and rickets, the question is not simple and that it will ultimately be found that vitamin A works in harmony with some dietetic factors, such as milk proteins and other proteins of high biological value, to promote resistance of mucous membranes and epithelial cells to invasion by micro-organisms, while other factors such as cereals, antagonise its influence. The effect of increasing the green vegetable and reducing the cereal intake on the resistance of herbivorous animals to infection is undoubted (Glenny and Allen, Boock and Trevan) and may well indicate a reaction in which the increased carotene of the vegetable plays only a part, but an important part.

P.S.- I have to apologize, I forgot to copy down the primary literature references for this post before returning the book to the library. So for the skeptics out there, you'll either have to take my word for it, or find a copy of the book yourself.

78 comments:

Frederic said...

The chapiter 4 "Nutrition and infection" is online :

http://www.whale.to/a/mellanby.html

And also found that :
http://jn.nutrition.org/cgi/reprint/129/4/783.pdf

Bryan - oz4caster said...

Looks like Mellanby was way ahead of his time, and ahead of most "scientists" and "health researchers" today. It's just so disappointing that great knowledge like this is lost or ignored by those intent on making a profit at the expense of other people's ill health rather than actually helping people improve their health. You'd think hospitals would have caught on to this ages ago. That's where much of infectious disease occurs nowadays. I guess they make more money by treating people with antibiotics than giving them healthy food with plenty of vitamins A and D. What a shame!

Monica said...

Bryan -- another area where older wisdom has gone by the wayside is the medicinal use of honey. Of course it's been used as a treatment on wounds, even during the first two world wars, to prevent infection. It's coming back. There is now an FDA-approved wound dressing now called Medihoney. Honey is being increasingly used in MRSA, can be used on stomach ulcers, and has also healed diabetic foot ulcers by injecting honey straight into the wound.

One of the biggest problems is that continuing education in medicine is funded largely by pharmaceutical companies. They are the only ones that have the money to fund large educational programs. There is also the problem of the AMA, the ACCME, and all the government regulations surrounding physician education.

After WWII and the penicillin wonder, doctors seemed to think everything could be cured by popping a pill. The only chance of getting an alternative perspective now is in medical school or if you are a naturopath. Or if you think for yourself... I think this situation is getting better but it has a long way to go. But there's also more to it than that hospitals/doctors simply haven't caught onto this. The foot ulcer case study was a self-experiment by a doctor on himself. Can you imagine the regulatory hurdle to inject a patient's toe with honey? I'm serious. I know of a doctor who left the traditional medical profession for such reasons. Here is an account by his son, which speaks to two problems. 1) conventional wisdom and a lack of scientific thinking and 2) government/insurance-based regulations:

..............................

My father was reading about WW2 navel battles and one of the big killers was fire but one of the things that they found was that the guys that were in the cool ocean that they fished out last had a much better recovery then the guys they got out and started treatment on right away. So here is the idea behind it. The rate of bacterial growth is exponential with temperature (think how long can you refrigerate meat) so if you can decrease the bacterial growth then you can allow the cells that are not destroyed to start to recover. You are saving everything that is not dead yet (the cell growth is reduced under the reduced temp but not as much).
He had one patient that had most of her arm burned 3rd degree due a cooking oil fire. She kept her arm in a 45 degree saline solution for a month and all her skin grew back with minimal scarring. If she were to have gone with the conventional method she would have required skin grafts costing lots of money and a much higher risk of infection.

Of course no one in the medical community believe it because it healed so well and was too simple. There is no money for research into this kind of treatment.

He had to fight with the Hospital to let him use the Maggot treatment and even after seeing the results they are still skeptical (besides the fact that the surgeons would have to admit that the Maggots work better).

He had to close his private practice due mostly to Government regulations and high insurance costs. He now works for the government working on the Makah Indian Reservation in NW Washington State. The last time I talked to him he told me he does a little celebration each time he crosses the border because there is very little government interference once he is on the Reservation.
..................................

Monica said...

And wrt to this topic, imagine the hurdle trying to get you patients adequate non-hospital food or a higher dose of a vitamin than the RDA recommends. It's just speculation, but I can imagine it would be difficult.

Stan (Heretic) said...

Frederic,

Fantastic sources, thanks for posting!

Thomas said...

http://bacteriality.com/2007/09/15/vitamind/#4

What's your opinion on this article regarding Vitamin D?

Robert M. said...

Thomas:

Ummm... that article looks impressive, if you don't actually read any of the provided references. However, the claims about the references appear to be completely fabricated.

E.g.

In April of 2000 a study published in the Archives of Internal Medicine by doctors at the State University of New York at Buffalo found that five patients confined to wheelchairs with severe weakness and fatigue were able to walk after supplementing with 300,000 IU’s of vitamin D (a huge amount!) over a period of six weeks. Sadly, the patients were not “cured”, and no follow-up study was done on the group. They were simply feeling the effect of a temporary decrease in cytokine and toxin release that resulted after the high levels of vitamin D completely shut down their innate immune systems. In fact, one of the patients actually died in the weeks during which vitamin D was administered.[29]"But guess what, I have access through my university, and no one died in the study. It fact all the patients responded very favourably.

http://archinte.ama-assn.org/cgi/content/abstract/160/8/1199

TedHutchinson said...

Wiki on Trevor Marshall has some history and interesting details.
Dr Davis posted this
If Marshall is right would we find
least incidence of chronic disease
in folks with 25(OH)D around 50ng?

Anna said...

Has anyone else noticed an unusual amount of "marshall promotion" in online blog comments the past few days?

Hard to tell if the questions/comments are genuine or merely posers trying to increase exposure for Marshall's theories, but my skepticism leans towards the latter.

Stan (Heretic) said...

Re: "Marshall Protocol" theory (MP)

This is intriguing. I do not know enough about molecular biology to comment on that, that's why I would like to ask some questions to people like you that do know.

Could this vitamin D3 case be like with that infamous "cholesterol causes heart disease theory", where some correlations may appear coincidentally, but not causually?

Or should the MP enthusiasts' claims of curing chronic diseases by lowering their vitamin D intake and exposition to sunlight, be totally dismissed? I have no qualms about throwing out someone's theoretical model (in any discipline, any time!) but I have a very fundamental bias AGAINST dismissing experimental results. Are these MP experiments and the anecdotical reports from patients real?

Could that be (see the quoted text below) that D3 may acts in two ways, one stimulates inflammation, the other suppressing it, and the actual effect may depend upon the ratio between the two paths, not just on the absolute level of D?

Stan

-----------------

A.Proal wrote in http://bacteriality.com/about-the-mp/

Unlike its inactive counterpart, 25-D, that inactivates the VDR [=Vitamin D Receptor] in healthy individuals, 1,25-D binds and activates the VDR. But in individuals who have 25-D and bacterial proteins blocking the VDR, 1,25-D is forced out of the receptor and into the surrounding environment.

Chris Keller said...

Stephan, I remember reading on Dr. Mercola's site that Vitamin A actually competes with Vitamin D so he doesn't recommend cod-liver oil anymore.

Do you have any references to those two vitamins being more bio-available when taken together vs. separately?

Stephan said...

Thomas,

I'm not going to follow the link because I've already formed my opinion of the Marshall protocol people. They're science abusers. They believe that vitamin D deficiency is not the cause of rickets. They believe that vitamin D is toxic, despite the fact that we evolved with high levels of it. They misinterpret the scientific literature to support their outlandish claims. If there is any truth to their theory that L-form bacteria are behind chronic disease, they're doing it a disservice by associating it with these other theories.

Chris,

If you have a low level of vitamin D, a modest amount of vitamin A can exacerbate the deficiency. That's because vitamin A increases the requirement for vitamin D. In that sense, you can say that they compete. But that doesn't seem to apply when you have sufficient vitamin D, and in fact the two vitamins work together in many ways. Here's an article written by Chris Masterjohn that contains all the information and references you could want.

Thomas said...

Thanks for the reply, guys!

I stumbled on that Vitamin D article a few weeks ago while trying to research Lyme disease. It's had me 2nd guessing my decision to supplement Vitamin D.

I think I'll go back to taking my Cod Liver Oil and D3.

Thanks,

arnoud said...

Until about two months ago, I was supplementing Vit D3 to achieve 50+ ng/ml, without concerning myself with Vitamin A. The vitamin D3 supplementation resulted in
- first winter without cold/flu symptoms
- elimination of 'chronic' gum disease
- Serum HDL improved from 35 to 70.

Two months ago I added Cod Liver Oil for Vitamin A, without chaning the overall level of Vit D3 supplementation. Interestingly, 3 weeks later a 25(OH)D test showed a near 50% drop from the level prior to Vitamin A supplementation.
At the time Chris Masterjohn commented that the Vit A is required for the body to use Vit D: They work together.

Within a couple of weeks after starting the Cod Liver Oil, my acne/rosacea largely resolved itself for the first time in 30 years.

homertobias said...

My take on Vitamin A: This is a true vitamin not a hormone (secosteroid) like Vitamin D. Vitamin D is essentially sunshine and is extremely fundamental to life on earth. Vitamin A is essentially something missing from our diet, a true vitamin.
Vitamin A appears to help our "interface" with the external environment, which primarily is our skin. Also less directly interfacing our environment are our the inner lining "epithelial cells" of our respiratory tract, intestinal tract, and if you count retrograde flow and childbirth, our genitourinary tract.
So retin A is given topically for diseases of the skin (acne, wrinkles,superficial skin pre cancers, "sun damage"). So, yes on the skin, A appears to have an antagonistic effect to D.
Inside the body Vitamin A may also antagonize Vitamin D. High dose vitamin A produces birth defects in humans. Most of this data is from purified petroleum based vitamin A supplements, not from cod liver oil but believe me there never will be a randomized placebo controlled trial in humans. So prenatal vitamins mostly do not contain any preformed Vitamin A and many don't even contain any betacarotene. I also would advise any young woman who is thinking of becoming pregnant not to use any cod liver oil.
Accutane is a Vitamin A analog used to treat recalcitrant acne in young women. They are required to be on two forms of birth control because of the large increase in birth defects in this group.
Epidemiological studies in Scandinavia (VESPIT), have shown an increase in all cause mortality (16%) in those who supplement preformed Vitamin A and a smaller increase in those who supplement betacarotene (approx 6%) I know,its an epidemiological study, but the "healthy user bias" would tend to push the results in the opposite direction this time.

I find Chris MasterJohn's theory very interesting and respect his work. I hope he goes further though.

For me, Vitamin A goes on the skin and Vitamin D goes into the body. Since we have polluted our atmosphere with both ozone and smog and I have to work indoors, I do supplement Vitamin D.

Stephan said...

Arnoud,

Interesting. Glad to hear you've seen improvements.

Homertobias,

I think vitamin A actually bears a lot of resemblance to D. I think you can make the argument that it's a hormone as well. It has its own nuclear receptor in a number of tissues that regulates gene expression just like vitamin D.

Vitamin A has antiproliferative effects in rat and dog cancer models. In rats, the effect is synergistic with vitamin D. You would expect this effect to be strongest in species that are accustomed to getting a large supply of vitamin A, like dogs and humans (and maybe rats, I don't know enough about their wild diet).

The studies that show increased mortality, osteoporosis and birth defects in people supplementing with A were all done in populations with low vitamin D. A high intake of vitamin A does exacerbate vitamin D deficiency. I would be surprised if you would see those effects in populations that have good D status. But it hasn't been tested, to my knowledge.

Stephan said...

By the way, here are some references:

Vitamin A as a hormoneAnti-cancer effect of vitamins A and D in rats

arnoud said...

Stephan,

thank you for regularly replying and expanding on comments in your posts!

As the current post discusses "Nutrition and Disease," I wonder if you could comment with some thoughts on the recent swine-flu development.

Dr. J. Cannell's proposed link between Vitamin D and flu is very interesting and promising. However, it is rather puzzling that many fatal swine-flu cases are occurring in Mexico, but the cases in the US seem to be quite mild. More likely than not, it is much too early to jump to any meaningful conclusions at this point in time.

Bruce K said...

Stephan, I tried to post here yesterday when you mentioned the "high-everything diet" in another thread. I hope you are willing to consider this idea.

I've posted about it on Peter's blog. I have posted on Eades's blog. My group's now buzzing with almost 600 members and many are seeing dramatic health changes and improvements by eating the HED way.

I've heard more people benefit rapidly and dramatically eating HED than ever before in my life on many extreme diets that limited foods (Primal Diet, paleo, low-carb, and Weston Price type diets). People with chemical sensitivities and food allergies eliminated them within a month. People who couldn't eat fruit or milk or other foods are now eating them without a reaction, improved digestion, and better energy. In a year or two, I think there won't be anyone intelligent who avoids foods or limits carbs, fats, calories. Dieting is dead. Eating "high everything is the only diet that works and is sustainable. In a few years, you won't be able to sell a diet book which pushes elimination of food or limits on food intake.

People are sick and unhealthy because of dieting, which damages the metabolism & ruins health. Dieting causes allergies, food intolerances, chemical sensitivity, and overall poor health. Dieting is not the solution. It's the problem. The HED is the solution. Eating paleo, low-carb, grain-free, lactose-free, gluten-free, and other diets degrades healthy. People are limiting and avoiding the wrong things. It's all a fallacy.

High-Everything is the new way of eating and it will drive every other diet into the ground. I have talked to a woman who was on Armour Thyroid and increased her metabolism by eating HED for a little over a month now. Her temperature is now above normal and she feels like she is on drugs, so she's cutting the thyroid medication. I have high hopes that she will be healthy and free of drugs within six months. I hope you are open to this information. I know that it sounds too good to be true, but you really need to consider this carefully.

HEALTHY PEOPLE DON'T DIET.
BE HEALTHY. EAT EVERYTHING.

http://groups.yahoo.com/group/High-Everything-Diet

http://d.yimg.com/kq/groups/10655729/656391700/name/High-Everything-Diet.html

Anna said...

This woman has an interesting perspective on the swine flu outbreak, linking it to Smithfield-owned hog CAFO in Mexico.

http://www.foodrenegade.com/deadly-swine-flu-outbreak-linked-to-smithfields-cafos/

And yet another viewpoint:

http://coolinginflammation.blogspot.com/2009/04/inflammatory-protection-from-swine-flu.html

Robert M. said...

Bruce:

Is it true that your resting heart rate is 120 beats per minute? Do you think this is healthy, and why?

homertobias said...

Vitamin A is an antioxidant. It fits the classic definition of a vitamin as something our bodies cannot synthesize, are necessary for proper functioning, and must be injested from food.
Vitamin D is not an antioxidant, it is a secosteroid, its primary source is not a food but the sun itself. It is fundamentally necessary for all forms of life on earth. Even the most primitive organism in the primordial soup makes it. For life on this planet you need: Earth,Water,Air and.....Sunshine (vitamin D) period.
Vitamin A and cancer: Cancer — Studies of relationships between vitamin A and carotenoids and cancer have provided mixed results. Results of observational studies and clinical trials have not been consistent, limiting our ability to make conclusive recommendations.

Two large, randomized, placebo-controlled trials assessed the effects of beta-carotene on risk of lung cancer among men at increased risk for lung cancer because of smoking or asbestos exposure [54,55]. Both showed significant increases in lung cancer risk among men who received the supplements. The excess risk appears to resolve over time once supplements are stopped [56]. (See "Chemoprevention of lung cancer", section on Primary chemoprevention).
The Physicians Health Study found that 12 years of beta-carotene supplements (50 mg every other day) produced neither benefit nor harm with respect to the incidence of malignant neoplasms [57]. Overall, the cohort was at low risk for lung cancer since few smoked. The Women's Health Study also found no effects [58].
The ATBC Cancer Prevention Study showed an increase in both prostate cancer incidence and mortality (23 and 15 percent, respectively) among subjects randomized to beta-carotene [54]. The excess risk appears to resolve over time once supplements are stopped [56].
An analysis of 7627 women who were free of cancer at random assignment in the Women's Antioxidant Cardiovascular Study found that after a mean follow-up of 9.4 years, beta carotene 50 mg every other day had no effect on the incidence of cancer (relative risk 1.00, 95% CI 0.85-1.17) [59].
As I said before, Chris Masterjohn's theory on D deficiency enabling A toxicity is interesting but is just a theory. You can't just dismiss reams of data because "we didn't know their vitamin d levels." You have no data one way or the other on d levels, a/d levels, and incidence of human fetal birth defects.

Bruce K said...

Robert M: "Is it true that your resting heart rate is 120 beats per minute? Do you think this is healthy, and why?"

As I explained in Peter's blog, that was after eating a 1,000 Calorie meal. My metabolism is ridiculously high, thanks to eating the "high everything" way.

HyperLipid: SabbaticalI subscribe to the "Metabolic Exercise" theory, which was developed jointly by Matt Stone and myself. It means "Eating is Exercise for Digestion and Metabolism." Dieting (as in eliminating foods or restricting macro-nutrients) causes atrophy of your metabolism. Diet dogma makes you fat and/or unhealthy to varying degrees, whereas eating a "high everything diet" takes you to a level of health that few have imagined.

Here is a post to explain it in more of layman's terms. Read the Potbelly Syndrome to see how over-eating can reverse insulin and leptin resistance, high cortisol, low seritonin, etc. The HED addresses all diseases, IMO. It has eliminate allergies, food intolerances, and chemical sensitivities. Many people have taken their health to a level where they can eat like 10-12 different foods in a meal and have perfect digestion of the meal every time. It's stunning how easy digestion becomes - effortless.

Metabolic Exercise - Anecdote

Jenny Light said...

homertobias:

I believe the benefits of vitamin A in humans comes from the animal form as found in cod liver oil and other animal fats. Usefulness of beta carotene in supplement form has been questionable for awhile now. Vitamin A from animal sources is what Chris Masterjohn's theory is about.

BTW, Masterjohn's hypothesis has just been confirmed in a study published in December 2008: "Tufts University confirmed my hypothesis that vitamin A protects against vitamin D's induction of renal calcification (kidney stones) by normalizing the production of vitamin K-dependent proteins in December, 2008".

Read this post in full (with commments) at his blog here:

http://www.cholesterol-and-health.com/cholesterol-blog.html

Richard Nikoley said...

Public Service Announcement re HED:

http://www.freetheanimal.com/root/2009/04/hed-high-everything-diet-if-eating-garbage-is-your-problem-just-eat-more-of-it.html

Stephan said...

Homertobias,

Vitamin A is much more than an antioxidant. It also functions in visual perception and has its own nuclear receptor.

You said "Chris Masterjohn's theory on D deficiency enabling A toxicity is interesting but is just a theory." There's solid data behind this particular theory. From Chris's article on vitamin A and osteoporosis:

"Research that examines the feeding of high doses of more than one vitamin simultaneously reveals that toxicity is dependent on reactions between different nutrients. For example, studies in rats, turkeys, and chickens have demonstrated that vitamin A both decreases the toxicity of and increases the dietary need for vitamin D, while vitamin D both reduces the toxicity of and increases the dietary need for vitamin A.6

In 2003, Myhre and other researchers examined all 291 cases of hypervitaminosis A in humans reported in the medical literature between 1944 and 2000. Of these, the Myhre team identified 81 reports that provided information about the patient's vitamin D supplementation, and found that concomitant supplementation with vitamin D radically increased the dose of vitamin A needed to cause toxicity. Unfortunately, the researchers only mentioned whether vitamin D was supplemented at all and did not discuss the specific amount of vitamin D being supplemented. Nevertheless, they found that the median dose reported for vitamin A toxicity was over 2,300 IU per kilogram (kg) of body weight per day higher when vitamin D was also supplemented. For a hypothetical 75-kg person representing the median, vitamin D supplementation would have allowed an additional 175,000 IU per day (the amount in five tablespoons of high-vitamin cod liver oil) before toxicity symptoms were likely to be reported!15"

The fact that people are vitamin D deficient in the observational studies looking at vitamin A's effects is not speculative. For example, the Swedish study in Uppsala. The same investigators measured vitamin D intake in the neighboring county and it was 97-185 IU for the lowest to highest quintile! That's in a place where there's no UVB for most of the year.

I don't think controlled trials using beta-carotene supplementation are relevant to the question of whether dietary vitamin A is problematic in people who are vitamin D replete, which is what we're talking about. Only a small fraction of ingested beta-carotene becomes vitamin A.

What we would need to answer the question definitively is a trial using both D3 and preformed vitamin A. Even better, with some K2 as well because they work together. Our species has always gotten preformed vitamin A from liver and other organs, so the idea that it's harmful in a vitamin D replete individual is very hard for me to swallow.

Tom said...

homertobias,

There is nothing about the definition of a vitamin that says it must be an antioxidant or that it can[t be a secosteroid, so those facts are beside the point.

The fact is, vitamin D is a conditional vitamin. Our bodies cannot synthesize it below a certain threshold of UVB radiation, and for many people, that is about half the year. So it's a vitamin half the time in many many people. Thus it's pretty important IMO.

On a related note, I get really annoyed at the current trend of claiming that "vitamin D is not a vitamin, it's a hormone." Vitamin D in the proper sense = D3 or D2, which are prohormones and vitamins but certainly not hormones. 1,25-cholecalciferol is a hormone but not a vitamin, and I don't think it should be considered a "form" of vitamin D but rather a derivative. Otherwise we're just going to run around in semantic circles.

Bruce K said...

Richard Nikoley: "Public Service Announcement re HED:"

I posted your comment to my blog/forum. Just keep the criticism coming. You are doing more to undermine yourself than I ever could. And BTW, I think HED has an overwhelming potential to eliminate the diabetes, along with other diseases. My health is at an unimaginable level now, thanks to eating HED. I can skip nights of sleep with no sleep deprivation. And I need less sleep than ever. In a normal people, sleep deprivation causes insulin resistance. But HED combats the insulin resistance, head-on. I can skip nights of sleep and then eat a pint of Haagen Dazs and a pint of orange juice as a snack with no energy spike and no energy crash. My energy is steady, no matter what I eat and my digesiton is utterly effortlesss. Try skipping a night of sleep with low-carb and and see how you do. The HED will bury all other diets. Join us or watch us surpass your health by an increasing margin.

The HED Anti-Propaganda Begins

Richard Nikoley said...

Shorter Bruce K:

"We will save the world!!! And all your efforts to stop us will only make us stronger!"

(apologies to Stephan)

Bruce K said...

I understand how you feel. Really, I do. But until you have experienced the HED, you're really just talking in ignorance. You have every right to be skeptical or dubious. But that shouldn't stop you from investigating the HED with an open mind.

Richard Nikoley said...

Yea, I get that all the time from the Born Agains in my family.

You just can't know, until you've felt His Saving Power (HSP), or, I guess I HED's case, until you've pigged out at Taco Bell & McDonald's.

Remember where you posted this?

"This was reinforced to an even greater degree when I went to visit my brother, who is like the king of junk food (I once watched him dunk cookies into blue powerade!). I instantly started suffering allergies and a tight asthmatic chest around his pets. But then I started eating fast food with him - Wendy's, Taco Bell, Mickey D's - and I started feeling better right away."

Bruce K said...

Also, Richard, I don't really believe in your concept of "genetic ancestry" as a guide to determining diet. Why use such a false title for your article? You seemed to have read the basic ideas of the group that we are avoiding refined sugar, PUFA oils, trans fats, and even omega-3 fats, yes (based on Ray Peat's influence). But you give a totally biased title: eating garbage..." Getting back to the point. a member of HED is half-navaho (Troy Crowley). He has taken his health to the level that I have. He can eat milk, pasteurized and raw, with effortless digesiton and high energy. He can eat a dozen different foods in a meal with perfect digestion, just like I can. Read his commments on Matt's "180 Degree Health" blog and the HED list. Read others like Esca_lante, who have attained a similar degree of health by eating HED.

The HED will bury all other diets. Join us or watch us surpass your health by an increasing margin.

Bruce K said...

Richard - this was one of Matt Stone's comments from his blog, not mine. Most likely from his post, The Hamburglar's Metabolism. There's a link on the main page of HED website. See my profile.

Matt Stone:
"This was reinforced to an even greater degree when I went to visit my brother, who is like the king of junk food (I once watched him dunk cookies into blue powerade!). I instantly started suffering allergies and a tight asthmatic chest around his pets. But then I started eating fast food with him - Wendy's, Taco Bell, Mickey D's - and I started feeling better right away."

phanamere said...

In response to Arnoud's question about why swine flu appears more virulent in Mexico than the US - it is probably not. Surveillance is less likely to capture all but the most severe cases that seek medical care in Mexico - especially in the beginning before the swine flu was recognized. It is just a phenomenon of case finding differences. If there is a mortality rate of 2-3% (which would be high) then we may not have seen enough cases in the US yet for fatalities to occur. There is another level of selectivity in which samples are sent to specialized labs for confirmation of viral strain.

Richard Nikoley said...

Seems you're right about the quote. Someone on my blog quoted it and I mistakenly attributed it to you when you were the comment just preceding that one.

That said, you do have some references to Taco Bell and fast food in general of your own, just so people here can gage your credibility, y'know.

These are all from the same entry:

http://180degreehealth.blogspot.com/2009/03/everybody-could-use-some-tlc.html (just go to it and search 'taco')

"Pizza and pasta and hamburgers and sandwiches and tacos and burritos and lasagna are the ultimate health foods. "

"Maybe, but there are just as many large corporations - if not more - who would love to give Matt money to prove that a diet of fast food and junk food can be the healthiest of all possible diets. I mean, take McDonald's and taco Bell and Burger King and White Castle and Rally's and Hardees and In-n-Out, I'm sure they would be willing to invest $10 million a piece to make the documentary feeding a bunch of obese unhealthy people 5k Calories of fast food during the week and 10k of fast food plus junk food on the weekend. This deal finances itself."

"A Taco Bell bean burrito will heal up your starch and fiber digestion if you stick with it."

"Fast food can be the ultimate food for healing - burgers, tacos, burritos, pasta, pizza, lasagna, etc. Mexican or Italian food, I can eat anything with absolutely no weight gain or digestive problems now. It's unbelievable but in two or three weeks, people are going to start believing it and the idea will be unstoppable. You will read about the High-Everything Diet in every newspaper and every magazine. You will hear about it on the news, The cat is out of the bag and nobody can stop it now."

Well, I think that's enough and I'll leave Stephan's great blog alone.

Bruce K said...

I absolutely believe that fast food can heal people - assuming they avoid all of the followering: soda (including diet), ketchup, mayonnaise, fries (unless beef tallow or coconut oil or lard is used), milk-shakes, and other crap. People who can't tolerate heavy meals (like pizza) have poor digestion and health. I could eat fully loaded pizza every day without any weight gain, digestive problems, or loss of health. That's effortless for me to digest now while eating HED. Typical meals of half-and-half, orange juice, a bagel, 3-4 eggs, and butter are as easy for me to digest as water. And BTW, I'm not using bleached or enriched flour or other crap. I use sprouted whole wheat bagels (Alvarado) or white bagels that are unbleached and unenriched with zero added fat or oil. High Calories is more important than High Nutrients. You can be healthy on a low-nutrient diet, just as long as it's not a NO-Nutrient diet, with refined sugar and processed veggie oils as staples. Why is that idea so hard to accept? Dieting is dead. Eat a high-everything diet and heal. Low-carb just covers up problems or hides them. In Peter's own words, he has no cure for metabolic syndrome, but he can side-step it. I don't want to side-step it. I want absolute and total cure. That is what's separating Matt and I from people like you, who don't beliefve in cure. If it's religious to believe that health problems can be "cured" (not just side stepped or covered up), then yes, we're religious. And you're an atheist. So be it. Continue with your health strategies that do nothing but side-step problems, cover them up, and hide them. People on the HED will eliminate the problems and heal to an unimaginable level.

Bruce K said...

Here is another comment from HED to help clarify my position.

"I think that everyone has been blaming the wrong things all along."

"It's not the carbs that cause obesity. It's eating them in the absence of fat or with the wrong type of fat (PUFAs and other garbage) that makes them addictive, harmful, and fattening."

http://health.groups.yahoo.com/group/High-Everything-Diet/message/13541

Bruce K said...

I'm posting this here, because the old comments are moderated and this may set the record straight some.

Jana:
"As far as I can see, the 'high-everything' diet also restricts a lot. Actually only sat fat, starches and calories are not limited. For example, Kwasniewski differs from this diet more or less only by not allowing too many starches (but they are also the preferred carbs in his diet)."

But other diets restrict one or more of those things (carbs, fats, calories). So the HED is unique and it's not really a diet. It's ANTI-diet or NON-diet. There is no reason to limit anything, like JK does. The body will heal much faster by eating High-Everything (carbs, fat, and calories), with the exception of refined sugar, HFCS, artificial sweeteners, and junk fats (PUFAs and Trans Fats).

"May I ask, which foods have you been eating on this diet?"

I eat anything and everything with great digestion, energy, focus, and attitude. That's the whole point of HED - getting to where you can eat everything (gluten, wheat, lactose, casein, potatoes, beans, fiber, fruit, 100% fruit juiice, honey, maple syrup, occasional sugar). You are not dieting by my definition of the word which is to "avoid foods, restrict *ANY* macro-nutrients, or restrict calories."

I can eat a dozen different foods at the same time and have perfect digestion, no bloating, calm stable energy, no fatigue or indigestion or anything. And I am NOT the only person eating HED who can - the HED has many followers who attained the health I have or discovered they already had it when they gave up dieting. People have improved their health rapidly and dramatically, eliminating allergies and chemical sensitivity, food intolerances, and other problems simply by eating the HED. And you will notice that the final rule of the diet says you should try to overcome the rules. That is what brings you to an entirely new level of health - the level where the rules fade, and you have even more freedom than the HED has given you from the start.

In short, the HED is not a diet. It's a way of overcoming diets and living your life free of dietary rules and dogma. I hope you will consider the ideas with a calm and open mind. Read the testimonies that have already been given on Matt's blog and the HED website. Forget about stupid rat studies cited by people like Stephan and Peter. Rats can't tell you how they feel. Go with your heart and mind and instincts.

The HED will bury all other diets.

Join us or watch us surpass your health by an increasing margin.

Bruce K said...

Also, Jana, sugars are not restricted if you can tolerate them. People are free to eat fruits, 100% fruit juice, grapefruit juice, orange juice, honey, maple syrup, and other natural sugars. The whole myth that fructose is damaging is bullshit. It only applies to people with a crappy slow metabolism caused by dieting (eliminating foods or restricting macro-nutrients or restricting calories by any deliberate or conscious means). The HED is not a diet. It's a way to overcome dieting and get to the level of health where you can TRULY eat high-everything (high-fat, high sugar, high starch, high calories, and even some alcohol and other sugar and other things perhaps). Basically, the term diet doesn't do it justice. It is a tool for overcoming diets.

Bruce K said...

Also, the HED is not a high meat or high protein diet. Protein should not be more than 20% of calories, preferably more in the neighborhood of 6-10% like the human milk contains or the Kitava Diet. I feel that the HED will spare protein strongly by several mechanisms (namely being high in carbs, fat, and calories).

I agree with Stephan and Peter and JK: a high-protein diet is undesirable.

The Myth of the High-Protein Diet

Bruce K said...

And here's another addition to the HED Anti-Diet Manifesto.

The rules are simply guidelines for getting started. The goal is a total freedom from diet dogma, including in the extreme case the dogma that you think the HED may contain (if any).

I don't want to brag, but I believe very strongly that Matt and I and the people who read us are the most open-minded people in the world. Nobody else could have come up with the HED Änti-Diet and the radical ideas that accompany it. It goes against everything, every diet you have ever heard of - ever WILL hear of.

And if you're not interested, if you're not curious, if you're not a little bit open to the idea, then there is no hope for you at all. Open your mind or die in misery while we grow and improve to the level where we make you look like you're not even the same species as us.

Bruce K said...

Here is the newest version of the HED's Rules. Rule #10 is particularly radical, but there are other small changes here and there, as well.

http://tinyurl.com/cvsmzc

Bruce K said...

Here is Rule #10 of the HED Anti-Diet, a rule which shows just how radical of an idea the HED is. It's not a diet as I've said repeatedly. It's a tool you use to overcome the need to follow ANY diet. In the end, you attain a level of health in which the rules start to fade.

"The rules are simply guidelines for getting started. In the long run, you should try to become more flexible. The goal is a total freedom from diet dogma, including in the extreme case the dogma that you think the HED may contain (if any). Experiment with varying the amount of carbs and fats in your meals over an extreme range. Experiment with mixing large amounts of foods together in meals. Eventually try to eat foods that you were previously allergic or intolerant to, like whole grains, wheat, beans, fiber, starches, sugars, dairy, fruits, vegetables, etc. The goal is to be able to eat everything, literally, not just large amounts of a few foods. The concept of going beyond the rules is also integral to the HED. You are trying to attain a level of health where there are no rules. You start with a high degree of dietary freedom and aim to end with an even higher degree."

Jana said...

Judge for yourself but I think this HED diet may lead to manic symptoms, from Wikipedia:

"Symptoms of mania include rapid speech, racing thoughts, decreased need for sleep, hypersexuality, euphoria, impulsiveness, grandiosity, and increased interest in goal-directed activities."

"Manic symptoms include irritability, anger or rage, delusions, hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, racing thoughts, talkativeness, pressure to keep talking or rapid speech, and grandiose ideas and plans, decreased need for sleep (e.g. feels rested after 3 or 4 hours of sleep)."

Bruce K said...

"Symptoms of mania include rapid speech, racing thoughts, decreased need for sleep, hypersexuality, euphoria, impulsiveness, grandiosity, and increased interest in goal-directed activities."

I don't suffer hypersexuality or racing thoughts or rapid speech or euphoria or impulsiveness. I do need less sleep. I can skip a night of sleep, then sleep 6 hours and feel fine. So I would say I'm good with 3 hours of sleep. Perhaps far less than that. I"m open to the idea of being able to go a week without sleep & remain healthy by eating HED. See, sleep deprivation causes insulin resistance & the HED combats insulin resistance. When you can't sleep or don't feel like, the best thing to do is to eat large amounts of food to overcome insulin resistance. The same principles are used in the HED to overcome metabolic resistance and put the thyroid into over-drive.

"Manic symptoms include irritability, anger or rage, delusions, hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, racing thoughts, talkativeness, pressure to keep talking or rapid speech, and grandiose ideas and plans, decreased need for sleep (e.g. feels rested after 3 or 4 hours of sleep)."

I don't have any of these symptoms. You may believe the experiences that people are having with HED are delusional, but their reality is very clear. Check this out, for example. A woman is now losing weight (3 pounds so far) after being on the HED and gaining a little weight, at first. This is the most aggressive diet ever created for restoring your optimal metabolic function. Peter freely admits that he has no cure for diabetes - only ways to "side-step" it. What if the HED can eliminate metabolic syndrome? After one or two years, I predict Peter won't be able to dismiss the results of doing the HED Anti-Diet after six months to a year, tops. Because your blog is going to be bombarded by testimonials, Peter. Just wait. Other people are experiencing what Matt and I and others have and our health is getting better, not worse. If you can repair the metabolism, there is no limit to what you can do,

Day 13 of HED

losing weight!

Monica said...

Here is a great article on virulence of animal flus, covered from an evolutionary perspective of how virulence decreases with decreased crowding. http://www.facebook.com/ext/share.php?sid=163811445161&h=E1wVp&u=dxqdg&ref=nf

I think this is what happened with SARS? Let's hope it happens with this flu. Time will tell. But I think it's also entirely conceivable that US citizens will start dying from it, too.

homertobias said...

Richard
It's not worth your time and effort. You're right.
Monica
I hope you are not of childbearing age and supplementing with high dose cod liver oil. I know that my role here appears to be the skeptic/odd man out. Check things out thoroughly.
Tom
Vitamins are a diversified group of unrelated ORGANIC compounds which humans are unable to synthesize and must be INGESTED in trace amounts in order for proper metabolism to take place. I never said it HAD to be an antioxidant or secosteroid to be a vitamin. UVB radiation is neither organic not ingested and our bodies are able to synthesize it. But I do think this is splitting hairs.
Jenny Light
Thanks for the references. I have spent time on Chris's website, have personally emailed him data with questions and got no reply.
Stephan
Have a good trip, enjoy yourself.
The problem with most of Chris's data is that alot of it is in animals. Also, the human data to my knowledge did not measure 25-OH Vitamin D levels or Vitamin A levels. It is well known that Vitamin A inhibits the absorption of Vitamin D and probably vice versa.
Here's data on toxic effects of preformed Vitamin A for all who are interested:

AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.
AU Rothman KJ; Moore LL; Singer MR; Nguyen US; Mannino S; Milunsky A
SO N Engl J Med 1995 Nov 23;333(21):1369-73.

BACKGROUND. Studies in animals indicate that natural forms of vitamin A are teratogenic. Synthetic retinoids chemically similar to vitamin A cause birth defects in humans; as in animals, the defects appear to affect tissues derived from the cranial neural crest. METHODS. Between October 1984 and June 1987, we identified 22,748 pregnant women when they underwent screening either by measurement of maternal serum alpha-fetoprotein or by amniocentesis. Nurse interviewers obtained information on the women's diet, medications, and illnesses during the first trimester of pregnancy, as well as information on their family and medical history and exposure to environmental agents. We obtained information on the outcomes of pregnancy from the obstetricians who delivered the babies or from the women themselves. Of the 22,748 women, 339 had babies with birth defects; 121 of these babies had defects occurring in sites that originated in the cranial neural crest. RESULTS. For defects associated with cranial-neural-crest tissue, the ratio of the prevalence among the babies born to women who consumed more than 15,000 IU of preformed vitamin A per day from food and supplements to the prevalence among the babies whose mothers consumed 5000 IU or less per day was 3.5 (95 percent confidence interval, 1.7 to 7.3). For vitamin A from supplements alone, the ratio of the prevalence among the babies born to women who consumed more than 10,000 IU per day to that among the babies whose mothers consumed 5000 IU or less per day was 4.8 (95 percent confidence interval, 2.2 to 10.5). Using a smoothed regression curve, we found an apparent threshold near 10,000 IU per day of supplemental vitamin A. The increased frequency of defects was concentrated among the babies born to women who had consumed high levels of vitamin A before the seventh week of gestation. CONCLUSIONS. High dietary intake of preformed vitamin A appears to be teratogenic. Among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, we estimate that about 1 infant in 57 had a malformation attributable to the supplement.

AD Evans Department of Medicine, Boston University School of Medicine, MA 02118, USA.

Stephan, Betacarotene may be inefficiently absorbed by humans but two thirds of our Vitamin A is produced from dietary betacarotene. Vitamin A deficiency is rare in the US or Europe. Consuming betacarotene cannot lead to Vitamin A toxicity. Only consuming Preformed Vitamin A either as a supplement or as liver or cod liver oil can lead to toxicity. Children fed large doses of liver have developed chronic hypervitaminosis A. Adults consuming polar bear liver have developed acute Vitamin A toxicity and died.
Goodbye for now.

homertobias said...

Reference for children fed chicken liver causing Vitamin A chronic toxicity for those interested:
Mahoney, CP Pediatrics, 1980

homertobias said...

Errrr. Don't know why my drag and drop decided to repeat itself. Sorry.

Stephan said...

Homertobias,

Are you spamming my blog?? Just kidding.

Several studies have shown that beta-carotene from plant sources is not sufficient to meet vitamin A needs. Humans require preformed A for optimal A status, which will come from animal tissues like we've always gotten it.

It's a misconception that dietary vitamin A causes birth defects. Most of the observational studies have shown no relationship, with hazard ratios ranging from 0.5 to 4.8 (which was the study you cited). Check out this table for a summary of the observational studies as of 2000. I don't know why we're still told vitamin A causes birth defects. I may have to write a post about this.

Actually, vitamin A is essential for development and a lack of it causes birth defects. Check out this paper retinoids in embryonic development.

Large doses of retinoic acid given to pregnant mothers as a treatment for promyelocytic leukemia also doesn't cause birth defects (PubMed ID 17852449):

All-trans-retinoic acid (ATRA) has been proved to be an effective treatment for acute promyelocytic leukemia (APL), inducing remission in more than 90% of cases. Treatment of APL in pregnancy is controversial as the use of ATRA has been questioned due to the teratogenic effect of retinoids. We report a case of pregnancy in a woman exposed to ATRA during the first trimester. The baby was born healthy, without any anomalies. Review of all reported cases of the use of ATRA in pregnancy revealed no serious adverse outcomes or congenital anomalies although only very few cases had exposure in the first trimester.

Anna said...

I'm friends with a vegetarian couple who struggled for a decade with infertility, but who eventually had a child (w/o fertility treatments) who was born with a cleft palate birth defect. I've always wondered (mostly to myself, I've not ever mentioned it to the parents, of course) if the lack of animal-food sourced Vit A might have played a role in the birth defect and even perhaps with the infertility (repair from a prior ectopic pregnancy was probably a factor, too). I doubt too much Vit A could have a factor in this case, though both deficient and excessive intakes in animal studies have come up in my casual searches on factors in development of cleft palate defects.

Any thoughts on cleft palate and maternal Vit A intake specifically?

Tom said...

Stephan, you say that dietary vitamin A does not cause birth defects. Are you making a distinction between food sources and supplemental sources here? If so, even food sources could cause teratogenicity (i.e. if a mother ate liver every day while pregnant). The paper you cite says bluntly "Embryonic exposure to either an excess of retinoid or a deficiency of vitamin A leads to abnormal development". Surely you aren't challenging that statement?

The table you mentioned seems to include studies that used 10,000 IU/day as the upper threshold, with one exception. Therefore they wouldn't be expected to find much if any teratogenicity because that's not an especially high dose. Much higher doses are easily achievable with supplementation, of course.

I used to work in a lab focused on retinoids in embryonic development and it's clear to me that deficiency and excess of retinoids can cause birth defects; much of our research depended on this fact.

Stephan said...

Anna,

Price also noticed that cultures switching to white flour and sugar often had a high rate of cleft palate and other congenital malformations. It could have been due to insufficient vitamin A.

Tom,

Yes, excessive doses of vitamin A do cause birth defects in lab animals. And probably in humans too. What we're debating is whether vitamin A from foods like liver or cod liver oil are sufficient to cause birth defects at reasonable doses, particularly in a person who has sufficient vitamin D and K2 stores. And I don't see the evidence for it.

It's not clear to me what effects vitamin A would have on development in an animal that has sufficient vitamins D and K. Do you know of any data that address this?

Stephan said...

Tom,

Also, several of the studies in the table were looking at doses higher than 10,000 IU, because they lumped women eating >10,000 IU into one category. I don't know what the average intake in those groups was, but it must have been more than 10,000 IU.

homertobias said...

Stephan

I would never never spam your blog. ITS YOUR BLOG. And you seem to be such a nice guy. But Stephan, post on the benefits of Vitamin supplementation and pregnancy....ARE YOU OUT OF YOUR MIND? You better have a realllly good lawyer and alot of malpractice insurance dispite any disclaimers you may post on your blog. No matter what you think and whether you are right or wrong DON'T DO IT.
Anyway, back to your last comment. And you know I don't dare drag and drop after my last failed foray into computer literacy. ( MY own 82 year old mother makes fun of my computer skills)
Yes, you are right, Vitamin A deficiency can cause birth defects. But Vitamin A deficiency is rare in the developed world.(Williams, SR "Nutrition and Diet Therapy" p.159) The teratology society states in their position paper that the average balanced american diet contains approximately 7,000 - 8,000 IU's of Vitamin A from various sources and that this should be considered before additional supplementation. It is possible that strict vegans MAY become Vitamin A deficient although this is not common. Their most common deficiency is B12. I do not consider strict vegetarianism a healthy diet.

I looked at your table, I'm with Tom. The US has two standards,the RDA is 8,000IU. The minimal teratogenic dose has yet to be defined but is closer to 25,000IU. Almost everything in that table has much lower doses of vitamin A. Several of the tabled studies show a "well defined increase in specific "Neural crest" defects, which I believe. Then the next study says no effect of (too low a dose) high dose vitamin a on cleft lip?, neural tube?,This is apples and oranges.
"In summary doses of preformed Vitamin A are teratogenic as may be marked maternal deficiency." (Drugs in pregnancy and Lactation, Briggs, Freeman 7th edition)
Acute promyelocytic leukemia: All trans retinoic acid (ALTRA) has been used to treat the above referenced leukemia. Initial studies demonstrated a remarkable response to high dose daily treatment. However later experience demonstrated that such high doses can lead to differentiation syndrome characterized by respiratory distress, fevers, kidney failure, and hypotension. A large number of patients who developed this died. So ATRA must now be used with caution at low doses and in conjunction with other forms of chemotherapy. (Chomienne,C "Retinoid differentiation therapy in Promyelocytic leukemia, FASEB)

homertobias said...

Stephan,
As much as I enjoy our intelectual "fencing matches", and I do enjoy them. Excess Vitamin A in pregnancy is something that I am dead serious about. I have make sure that I don't harm somebody. It would just take one wildly enthusiactic fan of yours to go overboard and.....what if you are wrong. Even if technically your wording is correct, you don't want a birth defect on your conscience.

Tom said...

No I don't, but it would be very interesting to see good data on how toxicity of vitamin A varies with D3/K2 status. I do agree that taking a CLO supplement in pregnancy is probably a good idea, but it's hard to recommend a safe upper limit in the absence of the aforementioned data.

Stephan said...

Homertobias and Tom,

I think we're basically agreeing, or close enough. I would say the evidence is not convincing that doses near 10,000 IU per day are teratogenic in humans. When you get up to 25,000 IU per day, you're in uncharted territory and I would not support going that high for a prolonged period. That much vitamin A would require eating 5 ounces of beef liver or eight ounces of chicken liver per day, assuming no other sources of A. That's probably beyond what we evolved for.

The other wild card is vitamins D and K2. Although I'm not aware of any data to support this notion, I wouldn't be surprised if they protected against excess vitamin A. Vitamin D in particular seems to serve as a balance for vitamin A in a number of processes.

Homertobias, I agree with you that vitamin A deficiency is probably not an issue in the average Western omnivore. Vitamin A is a nutrient that has partially survived our degraded food system, while vitamins D and K2 have been all but eliminated.

Bruce K said...

Some quotes by Bruce Lee, quite relevant to the HED Anti-Diet Philosophy...

http://thinkexist.com/quotes/bruce_lee/

"Use no way as a way. Use no limitation as a limitation."

"All fixed set patterns are incapable of adaptability or pliability. The truth is outside of all fixed patterns.”

"If you always put limits on everything you do, physical or anything else. it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them."

"As you think, so shall you become."

"Empty your mind, be formless, shapeless - like water. Now you put water into a cup, it becomes the cup; you put water into a bottle, it becomes the bottle; you put it in a teapot, it becomes the teapot. Now water can flow or it can crash. Be water, my friend."

"Ever since I was a child I have had this instinctive urge for expansion and growth. To me, the function and duty of a quality human being is the sincere and honest development of one's potential."

"A goal is not always meant to be reached, it often serves simply as something to aim at."

"Forget about winning and losing, forget about pride and pain."

"A wise man can learn more from a foolish question than a fool can learn from a wise answer."

"Always be yourself, express yourself, have faith in yourself, do not go out and look for a successful personality and duplicate it."

"Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind."

"Take no thought of who is right or wrong or who is better than. Be not for or against."

"The less effort, the faster and more powerful you will be."

"Obey the principles without being bound by them."

"If you want to learn to swim, jump into the water. On dry land, no frame of mind is ever going to help you."

"I am learning to understand rather than immediately judge or to be judged. I cannot blindly follow the crowd and accept their approach. I will not allow myself to indulge in the usual manipulating game of role creation. Fortunately for me, my self-knowledge has transcended that and I have come to understand that life is best to be lived and not to be conceptualized. I am happy because I am growing daily and I am honestly not knowing where the limit lies. To be certain, every day there can be a revelation or a new discovery. I treasure the memory of the past misfortunes. It has added more to my bank of fortitude."

Bruce K said...

EVERYTHING MOST PEOPLE THINK THEY KNOW ABOUT DIET AND HEALTH IS 100% WRONG.

Eating saturated and mono-unsaturated fats with unlimited starches and/or unrefined sugars is absolutely healthy - even burgers, pizza, tacos, burritos, pasta, hot dogs, etc. Junk food and refined sugar can be healthy, as long as you don't eat them often. Comfort foods can be more healing than "high quality" foods. The greatest dietary villains in fast food are refined sugars, HFCS, artificial sweeteners, PUFA oils, and trans fats, i.e. sodas, fries, ketchup, mayo, and desserts. The best way to maintain a healthy body is not by restricting calories or foods or macro-nutrients, but rather by eating all you want and sometimes much more than you want - emphasizing nutritious foods, not refined sugars and processed vegetable oils.

HEALTHY PEOPLE DON'T DIET.
BE HEALTHY. EAT EVERYTHING.

The Way of the High-Everything-Diet (HED)

1. Eat all the fat you want, especially saturated fat : coconut oil, butter, cream, whole milk, half and half, cheese, beef, lamb, goat, buffalo, etc. Other good fats : macadamia nut oil, foie gras, pork leaf fat, olive oil in small amounts, and occasional avocados. Poly Unsaturated Fats (PUFAs) and Trans Fats are best avoided, like most commercial mayonnaise, salad dressing, chicken fat, turkey fat, fried food, hydrogenated oil, etc. Use normal pork, lard, duck, and goose fats in moderation. You may have fish occasionally, but don't eat just fatty fish : like salmon, sardines, mackerel, and tuna. Eat leaner fish, as well : cod, haddock, pollock, etc. Eating too much PUFAs from fatty fish (or fish-derived oils) can deplete Vitamin E. Beware of mercury content in certain fish, like albacore tuna and swordfish. If you can't digest fat well, eat less fat for a while and build up. If you are overweight or obese, try reducing fats some and eating more starch instead. Don't eat a fat-free diet, like idiot body-builders promote. Egg whites, skim milk products, light tuna, potatoes, and skinless chicken breasts are virtually devoid of fat. Never eat those foods exclusively, or any similar foods, as the basis of your diet.

2. Eat all the starch you want : unbleached unenriched bagels, organic white rice (esp sushi rice), brown rice, sprouted bread, potatoes, sourdough, corn tortillas treated with lime, soaked beans / peas / lentils. Don't fear natural starches, whether refined or unrefined. They help you to heal. Do not believe anyone who says starches are fattening. That's only true for unhealthy people. Starches are not fattening for healthy people and they can help you get healthy faster than anything (with saturated fats). Try to avoid any bread or starch with the wrong kind of oils : like corn, soybean, sunflower, safflower, cottonseed, canola, rapeseed, or hydrogenated oils. Eat all the vegetables you like, preferably boiled (as in soup) or steamed. Raw veggies can be hard on digestion. Vegetable juices can be used, either raw or cooked. A properly functioning metabolism can quickly digest fiber and starch without gas, bloating, or other problems. Most people don't have such a strong metabolism, so they should initially limit fiber, esp whole grains, beans, raw vegetables, fruit peels and seeds, or nuts.

3. Eliminate white sugar, High Fructose Corn Syrup (HFCS), and other refined sweeteners from your regular diet. Preferably avoid food with HFCS in general, like most packaged foods in the USA. A small amount of sugar in breads is OK, but don't eat food high in refined sugar (like more than 10% of its calories or with sugar in the first few ingredients). Beware that HFCS hides in many foods. The less of that garbage you eat, the better. Eat natural sugars cautiously, like fruits, 100% juices (preferably "Not From Concentrate" or Fresh), maple syrup, or raw honey (preferably "Unheated" honey). Eat starches before trying natural sugars. Avoid the sugars if they cause hypo-glycemia (low energy) or food cravings. In time, you may heal enough to eat natural sugars in whole foods. Always eat fat and protein along with carbs, esp sugars. Don't eat ANY artificial sweeteners or diet sodas. All they will do is make you hungry and fat, messing up your body's ability to respond to foods naturally.

4. Eat satisfying amounts of protein, animal or vegetable. Avoid soy protein and vegan diets, and preferably avoid vegetarianism, too. Aim for about 10-40g protein per meal. Limit processed or nitrate-cured meats. Try to use fresh food. Don't eat protein powders, protein shakes, or protein bars. They're rubbish. Protein should not be emphasized too heavily, like the so-called high-protein diets. Excess protein is bad for the metabolism. Aim for 10-20% protein, more or less. Carbs and fats spare protein. So, always eat plenty of carbs and fats. Fermented soy can be used in moderation : natto, tempeh, miso, tamari, shoyu...

5. Don't count calories or restrict them. Eat all you want and occasionally much more than you want to keep your metabolism fast, prevent weight loss plateaus, and to minimize weight gain. Aim for at least 3 meals a day with a mix of natural carbs, fat, and protein. Once you have healed some, you can have desserts occasionally - but only if you can eat them infrequently without cravings. It is best to begin with natural foods, like fruit, fruit juice, unheated honey, or maple syrup (poured on pancakes with lots of butter). If you choose to expand your diet with occasional desserts (once or twice a week), it would be best to choose desserts with the most saturated fat and the least PUFAs and trans fats. Good dessert choices would be cheesecake, tiramisu, Danish butter cookies, high-cream ice cream, premium chocolate, organic cream pies, macaroons, pancakes with loads of butter and maple syrup, etc. High fat is better, so look for ice cream with cream as the first ingredient (like Häagen-Dazs). Don't eat food if it makes you feel bad or causes any cravings. If you can't eat junk infrequently and sporadically, do not eat it at all.

6. Don't believe in the quick fix. A healthy person loses weight on HED, if they have weight to lose. The unhealthy person might gain weight temporarily, because of previous dieting and starvation. Dr. Diana Schwarzbein says: "You have to get healthy to lose weight - not the other way around." So, give your body a chance to heal. Another good quote from Schwarzbein: "If eating well (high-everything) causes you to gain weight, then you have a damaged metabolism." If you have a damaged metabolism, you need to heal. Don't let anything (or anybody) discourage you. Things can get worse before they get better. Be patient and optimistic. You did not damage your metabolism in a day and you may not fix it overnight. Also, you need to get healthy to exercise, not the other way around. Exercise if you feel like it - not to burn off excess calories. Make it fun and spontaneous, like playing and short intense bursts. Lift weights to build muscle and strength, but allow yourself several days to recover between work-outs. Just walking is fine to begin. Remember, you're re nourishing yourself, rather than starving. Excessive exercise is a form of starvation. Work with your body, not against it.

7. These guidelines are simply a frame-work for getting started. In the long run, you should try to become more flexible. The goal is a total freedom from diet dogma, including in the extreme case the dogma that you think the HED may contain (if any). Experiment with varying the amount of carbs and fats in your meals over an extreme range. Experiment with mixing large amounts of foods together in meals. Eventually try to eat foods that you were previously allergic or intolerant to, like wheat, whole grains, beans, fiber, starches, sugars, dairy, fruits, juices, vegetables, fish, nuts, etc. The goal is to be able to eat everything, literally, not just large amounts of a few foods. The HED encourages you to overcome all dietary dogma, rules, and fear. Find your own Way. By starting with a high degree of dietary freedom, you can eventually attain more.

STOP DIETING, EAT WELL, FEEL GOOD.
DEATH TO DIETS. EAT EVERYTHING.

http://health.groups.yahoo.com/group/High-Everything-Diet/

http://180degreehealth.blogspot.com/2009/03/hamburglars-metabolism.html

http://180degreehealth.blogspot.com/2009/04/plower-vs-force-revisited.html

Jenny Light said...

I strongly question whether the majority of individuals in the US get 7,000 to 8,000 IU of vitamin A per day! I can tell you for fact, that until several years ago, this household did not come anywhere near it! Our veggie sources were basically limited to potatos, green beans, corn, peas and occasionally spinich. My husband and I don't particularily like carrots, but I keep them in the house for my two boys who like to munch them right out of the fridge.

You mention organ meats to most people in this country, and you get all sorts of negative looks and noises! Organ meats are staples in most other countries around the world, and always have been.

How many of you have ever seen the Travel Channel show "Bizarre Foods" with Andrew Zimmern? He travels all over the world and tastes traditional native foods. Anyone who is serious about diet should definately try to catch this, or better yet get the DVD set (season one and two are avalible on Amazon, and season three is upcoming). Organ meats, bugs, fermented foods are all figured prominantly in diets everywhere but here!

Although healthy in every other way, my eldest son was born with multiple vision problems that did not get diagnosed until the end of the 3rd grade, and which have since been corrected with therapy and excellent diet. He has 20/20 vision, but HAD problems with tracking, convergence, depth perception and more. My younger son was born with strabismus (cross eyes) which was successfully corrected with two surgeries.

I can't help thinking that a lifelong difficency in vitamin A on my part, and reliance on a perscription prenatal vitamin for my nutrition during pregnancy contributed strongly to their eye problems (I believe the A source in these vitamins was from beta-carotene)!

Veggies are not enough! Get your A from animal sources too!

Anna said...

I echo Jenny's thoughts on the Vit A deficiency issues, and I also l-o-v-e watching the Bizarre Foods show (my son groans about the show, but he always sits down to watch it with me, too - it must make my cooking choices seem tame in comparison).

The vision problems Jenny describes are very common, I think. I know several school children who have similar tracking problems (not the same as needing corrective lenses) and are receiving (very expensive) vision therapy for it. My own son had similar signs of vision tracking problems throughout kindergarten and first grade and had trouble reading. About halfway through his first grade year, for other reasons, I began gradually changing our family's diet (incl adding Vit A-rich foods). His reading ability greatly improved over the summer before the start of 2nd grade. By mid-third grade, we did not notice any vision tracking problems anymore. I know it could be coincidence and maturity, too, but so many things seem to be resolving throughout the family as we move away from the SAD and processed foods, and into old-fashioned, nutrient-dense foods.

I know a number of people who show signs of subtle Vit A deficiency - follicular hyperkeratosis in kids and young-middle aged adults is quite common, as are complaints of night blindness in 30-40yo adults, etc. Intake of Vit A could be inadequate in some of them, but I also suspect gluten issues that create fat-soluble vitamin malabsorption, too, at least in some cases.

So like iodine consumption, overall, overt Vit A deficiency rates are very low in the US, but mild deficiency is probably much more common than conventionally thought and very easily missed by those not looking for it.

Jenny Light said...

Another interesting thing to do while watching "Bizzare Foods" is to "people watch". Look at the inhabitants of these areas and notice body weight, facial structure, teeth. Note if they are eating excess carbs and check out their bodies! Just saw an episode on Hawaii yesterday and there were sooo many obese people! Andrew was talking about the Hawaiian addiction of SPAM eating. They also appear to eat ALLOT of starchy plants!

Seafood is also a MAJOR staple just about everywhere, but again, they eat the organs and especially the heads!

Stephan said...

Bruce, if you're trying to provoke me into deleting your comments, you're getting damn close. I understand that you're frustrated that everyone is not flocking to your new diet philosophy, but you need to get over it. If you want to be part of this community, you're going to have to start behaving like an adult.

Monica said...

Bruce, I'm guessing that since Stephan has tolerated all these comments from you he'll tolerate this one from me.

I don't know you but I've followed your comment on Eades' blog and other blogs. Eades was completely gracious toward you. He told you that if what you were doing was working that he was happy for you and to go ahead and keep on doing it. Your response? To call him a religious fanatic. Not on his blog, but here. That's a priceless display of cowardice and malice, in my opinion. It's no wonder you're not getting the attention you want.

Monica said...

I've been following the interesting exchange on vitamin A.

homertobias, I think I've mentioned taking about a tablespoon of HVCLO daily before, somewhere on this blog or others... In actuality, when I went back and measured, the shallow tablespoon I'm filling is really the volume of a teaspoon. It was silly not to measure more accurately from the outset when I started taking it a year ago. So, I suspect I have not been getting too much vitamin A, but thanks for your concern. On the other hand, I was relying on HVCLO for vitamin D for a long time, which was a bad idea. Hopefully getting vitamin D replete will take care of any vitamin A toxicity I may have experienced.

homertobias said...

Anna,

I always like your coments. They are intelligent and well reasoned. Congratulations on cleaning up your family's diet.

I don't think eye "tracking" problems are necessarily related to Vitamin A deficiency. Nor do I think strabismus is. It's the "rods and cones", the actual seeing apparatus which is Vit A dependent. Also the cornea and it's lubrication are Vit A dependent. Not so much the surrounding eye muscle strength (strabismus) or how the brain tells the eye to move.
Didn't you eat eggs during your pregnancy? I think free range grass fed chicken eggs rich in omega 3's and Vitamin A are an excellent dietary addition for mothers to be. And I bet you ate them during your pregnancies.
I think that iodine may well be another story. There is a NEJM article a few months ago - 20% of americans deficient, especially in the noncoastal areas where the soil does not get enriched with iodine from the sea. Important for thyroid function of course, but also very important and preferentially secreated in breast milk. Most prenatal vitamins didn't contain iodine and those that did often didn't contain the amount listed. There's also data linking postpartum depression with subtle hypothyroidism. Hummmm.
Jennylight
I'm just quoting a textbook that Vitamin A deficiency in developed countries is rare. Subtle Vitamin A insuficiency may be more common though.
All,
You can get your vitamin A level tested. Just ask your doctor. You need to fast. Serum level is best.
Tom
I do have a case report of Vitamin A toxicity, symptomatic, with documented Vitamin D level > 100. Its interesting, but its only a case report.

homertobias said...

One last warning on Cod Liver Oil:

If you must take it, please carefully inspect your brand. Consumerlab found several brands where the listed amount of Vitamin A per teaspoon was very significantly different from the actual content. One brand had twice the amount of A that was listed. Of course, the DHA and EPA in CLO is awesome. I do supplement DHA/EPA just not CLO. Naturaldatabase lists the "average" Vitamin A dose per 20ml as 15,000. If Briggs and Freeman's Textbook "Drugs in pregnancy and Lactation" is correct that the average american consumes 7,000 IU's, you certainly are getting up there on dose, especially if the brand you are using inaccurately reflects its dosage.

Tom said...

Homertobias, I'd be interested to see that case report if you have an electronic copy.

Bruce K said...

Saying I should get medical tests is an "appeal to authority." There's no reason that I should have to get any tests done when I don't believe in medical treatment or doctors, except in the case of emergencies. You are imposing a false standard of proof to ask me for medical tests. The proof that I'm healthy is my ability to eat foods I couldn't eat in the past without having any reaction, as well as many other benefits that I have described.

You see, I practice pan-critical rationalism and so does Matt and so do most of our readers. Even before I knew what it was, I practiced it. I read Max More's paper on Pan-Critical Rationalism about 15 years ago when he first published it.

http://www.maxmore.com/pcr.htm

Here are some shorter articles which can give you an introduction to the ideas of Pan-Critical Rationalism. Basically, you reject ALL "appeal to authority." My only authority is myself. Matt's only authority is himself. And the same goes for everyone else who belongs to HED.

http://en.wikipedia.org/wiki/Pancritical_rationalism
http://clublet.com/c/c/why?PanCriticalRationalism

We don't try to impose dogma on others. We are open to all possibilities and we are open-minded, curious, questioning, rational, and inquisitive by nature. We are willing to question and criticize all ideas, even the HEAD itself. This idea is implicit in the precepts of the HEAD, because I state in #7:

"These guidelines are simply a frame-work for getting started. In the long run, you should try to become more flexible. The goal is a total freedom from diet dogma, including in the extreme case the dogma that you think the HED may contain (if any). Experiment with varying the amount of carbs and fats in your meals over an extreme range. Experiment with mixing large amounts of foods together in meals. Eventually try to eat foods that you were previously allergic or intolerant to, like wheat, whole grains, beans, fiber, starches, sugars, dairy, fruits, juices, vegetables, fish, nuts, etc. The goal is to be able to eat everything, literally, not just large amounts of a few foods. The HED encourages you to overcome all dietary rules, dogma, fears, and limitations. Find your own Way. By starting with a high degree of dietary freedom, you can eventually attain more."

Hence, nobody can say that the HEAD is a "religion" of closed-mindedness. On the contrary, it's a religion of complete and total rationality and open-mindedness, whereas the dogma of low-carb and gluten avoidance and other things is a closed-minded religion. The HEAD is based on PCR implicitly. People who are open to the idea are pan-critical rationalists, even if they have no idea what that word means.

Jenny Light said...

Homertobias:

I think you were addressing me and not Anna regarding my two pregnancies and my sons former eye problems!

Thinking back, I would say I ate eggs just very occasionally when carrying both boys (up til 2 months ago, I was a chronic cereal eater for breakfast all of my life!). I now average 2 eggs per day, and occasionally up to 4.

Regarding iodine, I was a refined salt user (with added iodine) at that time. We now use Celtic Sea Salt exclusively (for the past 7.5 years). When I remember to do so, I eat one sheet of toasted Nori seaweed per day which has 80% of the RDA for iodine.

We ate margarine and drank skim milk when I was pregnant with my eldest (the one with the tracking problems etc), and used butter and whole milk with my youngest.

I would probably describe my former vitamin A deficiency as minor, as I have never had a problem with night blindness.

I wish I would have known then what I know now! Unfortunately, trusting that a prenatal vitamin will correct improper nutrition is the American way today.

There is no way on God's green earth that I got enough vitamin A per day during pregnancy.

BTW, My sons are now 13 and 9!

Coyote said...

Well I just want to add my little anecdotal evidence of the safety of vitamin A.

I went to a doctor of osteopathy in Florida back in 1987. His name was Dr. Mittlestadt. He played golf everyday around noon in the Florida sun but he didn’t have any age spots on his skin. When he asked me to guess his age I said “around 65”, when he told me he was 80 years old I was very surprised. He had me feel of his skin, it was very smooth and he also had very few wrinkles on his face. At age 80 he was still practicing medicine full time, so what was his secret?

He was a big proponent of vitamin A supplementation in high doses. He personally had supplemented vitamin A 150,000 units per day for 47 years! His blood levels of vitamin A were normal. He had even
taken as high as 1 million units a day for a period of two months. He routinely prescribed the 150,000 units per day amount to his patients. Young children in the 2 or 3 age group would receive 5,000 units 2x per week and gradually increase as they became teenagers.

Now I wouldn’t want to try his lifelong experiment myself, but I do think vitamin A toxicity is way overblown.

By the way, there are two studies I know of on the use of high dose vitamin A per day, one is a short term study of 6 weeks, the other is a long term study of 12years.

The first one had 25,000 iu/day: http://jn.nutrition.org/cgi/content/full/132/6/1169

The second one had a total vitamin A consumption of between 16,369-24,318 iu/d:
http://www.ajcn.org/cgi/content/full/69/4/656

Anna said...

Your post came out on my last day in London and I was able to locate a copy at a UK online used bookseller for a very reasonable £20 (but they wouldn't ship to the US, so my SIL took delivery of it and then re-mailed it to me); the book arrived this week. Looks like it was withdrawn from the University Of London's library stacks. It's in very good condition (for a book from the 30s) and has a few notations here and there in blue pencil.

What a treasure (and it has a wonderful sort of tobacco-like "old book" fragrance that is a bit intoxicating). I can't believe how this very relevant research is ignored/forgotten by the contemporary medical and dental professions.

Thanks for bringing Mellanby's book to the light of day, Stephan. It's a great pairing with Price's work.

Stephan said...

Anna,

It does dovetail nicely with Price's work. I still haven't been able to find a reasonably priced copy.

Stephan said...

Coyote,

Thanks for the story and the references. I think it's interesting all the anecdotal reports I've heard about the effect of fat-soluble vitamins on skin quality. Vitamins A and K2 in particular seem to improve skin quality in many people, including myself. There's actually data that K2 influences collagen production in the skin, and vitamin A clearly has an important role there as well.

Bekki said...

I know this post is getting on in age now, but I just now came across it. I wanted to put myself forth as a guinea pig, of sorts, as I am currently pregnant and supplementing with CLO and extra vitamin D3. I had my D levels tested about 6 months ago, and scored a 43. I want to be in the 60s, to help with an autoimmune issue I have and also just for glowing health. :-) My D3 has 4000 IU, and I take one every day. I'm not getting much sun this summer because it's just too stinkin' hot, but once it cools down again, I'll be out there getting my daily sun therapy. My CLO offers 7,000-10,000 IU of vitamin A per day, and I'm perfectly comfortable with that.

Oh, and I would certainly hope that any woman who was self-directed enough to research nutrition on the internet would never think to sue someone for promoting a nutritional idea on their blog. It's up to each of us as individuals to decide what we do with the information we read. Warning Stephen that he ought to have a lawyer seems like overkill.

Oh, for what it's worth, I *have* had signs of insufficient vitamin A. Night blindness, keratosis pilaris, mild eczema, and very sensitive skin. I'd personally prefer to get at least 20,000 IU per day, but can't really afford that much of the good CLO.

Ryan Koch @ Health Matters to Me said...

Hey Stephan,

I know I'm waaaaaay late on this discussion, but I'm doing some research for a presentation and am wondering about what Mellanby means by "cereals" when he says that that the Kikuyu ate mainly this food as their diet. Does this mean they were eating refined grains (i.e. white flour) or their traditional diet of whole grains?

Here's the quote I'm referring to:

The high incidence of bronchitis, pneumonia, tropical ulcers and phthisis among the Kikuyu tribe who live on a diet mainly of cereals...

Stephan said...

Hi Ryan,

By "cereals", Mellanby meant grains. He was talking about their traditional foods, not processed grains.

His hypothesis was that a diet lacking in vitamin A was conducive to infection. He also felt that grains may interfere with vitamin A status when eaten in large amounts, as they also antagonize vitamin D (due to the phytic acid). As far as I know, no one has found the substance that antagonizes vitamin A, if one exists. They may just have been deficient in A because they weren't eating many animal foods.