Basic Description

The term "vitamin A" makes it sound like there is one particular nutrient
called "vitamin A," but that is not true. Vitamin A is a broad group of related
nutrients. Each of these nutrients provides us with health benefits, but
these benefits may be quite different and they may be provided in different
ways. Here is a summary chart showing basic relationships between the
forms of vitamin A.
Vitamin A-Related Nutrients
Retinoids
(found in animal foods)
Carotenoids
(found in plant foods)
retinol Carotenes Xanthophylls
retinal alpha-carotene* astaxanthin
retinoic acid beta-carotene* beta-cryptoxanthin*
retinyl esters gamma-carotene* canthaxanthin

delta-carotene fucoxanthin

epsilon-carotene lutein

zeta-carotene neoxanthin

violaxanthin

zeaxanthin
*Once a food has been consumed, these carotenoid forms of vitamin A
may be converted by the body into retinoid forms under certain conditions.
Retinoids
As you can see in the chart above, there are two basic forms of vitamin A:
retinoids (found in animal foods) and carotenoids (found in plant foods).
These two forms aren't just chemically different - they also provide us with
different types of health benefits. There are some specific immune,
inflammatory, genetic, and reproductive-related benefits of vitamin A that
can only be obtained from the retinoid forms of the vitamin. These retinoid
forms can be especially important with respect to pregnancy and childbirth,
infancy, childhood growth, night vision, red blood cell production, and
resistance to infectious disease. Yet even if we are not faced with any of
these special conditions, each of us needs retinoid forms of vitamin A.
Carotenoids
Like the retinoid forms of vitamin A, the carotenoid forms also provide us
with unique health benefits. Most carotenoid forms of vitamin A function as
antioxidant and anti-inflammatory nutrients. Sometimes specific
carotenoids have a special role to play in the protection of our health. For
example, the only carotenoids found inside the retina of the human eye are
the xanthophylls lutein and zeaxanthin. Anyone needing to focus on vitamin
A benefits related to eye health (for example, prevention of age-related
macular degeneration) would need to develop a meal plan that not only
included foods that were rich in vitamin A, but more specifically, rich in
these two specific carotenoid forms of the vitamin. (Spinach, kale, and
Swiss chard would be examples of foods that are rich in lutein and
zeaxanthin.)
At first glance, it looks like we need to eat both animal and plant foods in
order to get both retinoid and carotenoid forms of vitamin A. In some
instances, that is true. However, in some other instances, it is not. In the
bodies of many individuals, carotenoid forms of vitamin A can be effectively
converted into retinoid forms, therefore providing the physiological
functionality noted above. Alpha-carotene, beta-carotene, and beta-
cryptoxanthin are three carotenoid forms of vitamin A that can be converted
by our body into retinoid forms under certain conditions.
Conversion of Carotenoids to Retinoids
We use this phrase"under certain conditions"to refer to the fact that the
bodies of many individuals may not be well equipped to convert carotenoid
forms of vitamin A into retinoid forms. Many different factors can contribute
to problems with this conversion, including: a person's inherited genetic
tendencies, digestive problems, bacterial imbalances in the digestive tract,
excessive use of alcohol, excessive exposure to toxic chemicals,
imbalanced intake of vitamin A and vitamin D as a result of high-dose
supplementation, and the use of certain over-the-counter and/or
prescription medications. So there is a need for caution here. If you are a
person who avoids animal foods and you are trying to obtain more retinoid
forms of vitamin A by consuming plant foods that are high in carotenoids,
you might get a very large amount of carotenoids yet still be unable to
convert these carotenoid forms of vitamin A into the retinoid form that is
also required by the body for proper physiological functioning.
If you recognize some of the problem factors in the list above as potentially
affecting your own body's ability to convert carotenoid forms of vitamin A
into retinoid forms, we recommend that you consult with a healthcare
provider to determine possible helpful steps. A healthcare provider with
experience in this area may be able to help you improve your digestion,
reduce the impact of medications, lessen your toxic exposure, and balance
the amounts of vitamins A and D in any supplements that you are taking.
Also, while still expensive in the healthcare marketplace, some forms of lab
testingincluding genetic testingmay be available to help you determine
potential vitamin A-related problems.
Two additional important points: (1) if a person's body is effectively able to
convert carotenoids into retinoids, beta-carotene is the best carotenoid for
the body to work with, since in comparison to alpha-carotene or beta-
cryptoxanthin, it takes only half as much beta-carotene for the body to
create the same amount of retinol; and (2) if a person's body is effectively
able to convert carotenoids into retinoids, there may be some advantages
to letting it do so (rather than trying to directly obtain high levels of retinol
from food). Allowing the body to decide about the degree of conversion
may provide more optimal regulation of both carotenoid and retinoid levels.
Researchers have developed a system for evaluating the degree to which
carotenoid forms of vitamin A can be converted into retinoid forms. This
system is based on units of measurement called retinol activity equivalents
(RAE) and retinol equivalents (RE). RAE and RE are yardsticks for
measuring the retinoid-converting potential of carotenoid-containing foods.
The higher the RAE or RE, the greater the potential for conversion of
carotenoids into retinoids.
We created the chart below to help explain how all of these factors are
interrelated.
Top 25 Vitamin A-Containing WHFoods Retinol and Carotenoid
Content*

Food
Total
for All
Form
s
(mcg
RAE)
Retino
l (mcg
RE)
Total
Carotenoid
s (mcg RE)
Beta-
caroten
e (mcg)
Lutein &
Zeaxanthi
n
Lycopen
e (mcg)
1
Sweet
potato
1922 0 3844 23018 0 0
2 Carrots 1019 0 2038 10108 312 1
3 Spinach 943 0 1887 11318 20354 0
4 Kale 885 0 1771 10625 23720 0
5
Mustard
greens
865 0 1732 10360 8347 0
6 Collard 722 0 1444 8575 11774 0
greens
7
Turnip
greens
549 0 1098 6588 12154 0
8
Swiss
chard
536 0 1072 6391 19276 0
9
Winter
squash
535 0 1071 5726 2901 0
1
0
Romaine
lettuce
409 0 819 4912 2173 0
1
1
Bok choy 361 0 722 4333 65 0
1
2
Cantaloup
e
271 0 541 3232 42 0
1
3
Bell
peppers
144 0 288 1494 47 0
1
4
Parsley 128 0 256 1536 1691 0
1
5
Broccoli 121 0 241 1449 1685 0
1
6
Asparagus 91 0 181 1087 1388 54
1
7
Sea
vegetables
81 - - - - 973 - - - -
1
8
Chili
peppers
80 0 160 810 17 1
1
9
Tomatoes 75 0 150 808 221 4631
2
0
Basil 56 0 112 666 1198 0
2
1
Papaya 131 0 262 756 246 5045
2
2
Shrimp 102 102 102 0 0 0
2
3
Eggs 75 74 75 5.5 176 0
2
4
Brussels
sprouts
61 0 121 725 2012 0
2
5
Grapefruit
(pink/red)
59 0 119 706 8 1453

Food
Total
for All
Form
s
(mcg
RAE)
Retino
l (mcg
RE)
Total
Carotenoid
s (mcg RE)
Beta-
caroten
e (mcg)
Lutein &
Zeaxanthi
n
Lycopen
e (mcg)
* All values are listed per serving size as identified on our website. Due to
unavailability of data, content of many other specific carotenoids (for
example, alpha-carotene) is not presented. mcg RAE is microgram retinol
activity equivalents. mcg RE is microgram retinol equivalents. mcg is
micrograms.
To better understand this chart, it's helpful to start with the third column
from the left that is labeled "Total for all forms (mcg RAE)." In this column,
you will notice that the numbers drop lower and lower as you move from
the first food (Sweet potatoes) and proceed down the list. This column tells
you that if you are seeking foods that will provide you with the greatest
potential amount of vitamin A in its retinoid form, you are likely to get the
best results by choosing Food 1 (Sweet potatoes) versus Food 2 (Carrots),
Food 2 (Carrots) versus Food 3 (Spinach), and so on down the list.
Now take a look over at the fourth column in the chart, which is labeled,
"Retinol mcg RE." This column tells you that none of the Top 25 Vitamin A-
containing foods on our website contain vitamin A in its retinoid form! So
how can these foods provide you with the greatest potential for vitamin A in
its retinoid form when they don't actually contain any retinoids? The answer
lies in their unusually high carotenoid content. Provided that your body has
the ability to effectively convert carotenoids into retinoids, you'll actually
end up with more retinoid forms of vitamin A by eating any of these Top 25
Vitamin A foods, even though all of these are plant foods that do not
directly provide any Vitamin A in retinoid form.
We created a second chart below to show you how the animal-derived
foods featured on the website ranked as sources of Vitamin A.
Vitamin A Ranking for WH Animal Foods

Food
Total
for All
Form
s
(mcg
RAE)
Retino
l (mcg
RE)
Total
Carotenoid
s (mcg RE)
Beta-
caroten
e (mcg)
Lutein &
Zeaxanthi
n
Lycopen
e (mcg)
22 Shrimp 102 102 0 0 0 0
23 Eggs 75 74 1 5.5 176 0
26
Cow's
milk
56 55 2 8 0 0
33 Cheese 77 73 4 12 0 0
34 Yogurt 67 66 2 12 0 0
35 Salmon 58 58 0 0 0 0
37
Sardine
s
29 29 0 0 0 0
50 Chicken 7 7 0 0 0 0
61 Turkey 3 3 0 0 0 0
39 Tuna 25 25 0 0 0 0
66 Cod 2 2 0 0 0 0
67 Scallops 2 2 0 0 0 0
not
in
To
p
100
Beef 0 0 0 0 0 0
Not
in
To
p
100
Lamb 0 0 0 0 0 0

Food
Total
for All
Form
s
(mcg
RAE)
Retino
l (mcg
RE)
Total
Carotenoid
s (mcg RE)
Beta-
caroten
e (mcg)
Lutein &
Zeaxanthi
n
Lycopen
e (mcg)
* All values are listed per serving size as identified on our website. Due to
unavailability of data, content of many other specific carotenoids (for
example, alpha-carotene) is not presented. mcg RAE is microgram retinol
activity equivalents. mcg RE is microgram retinol equivalents. mcg is
micrograms.
In this second chart, you'll notice that even though most of our animal foods
contain vitamin A in its retinoid form (as shown by those numbers in the
fourth column which is labeled, "Retinol (mcg RE)," their carotenoid content
is very low (or absent), giving our body very little to work with if it wanted to
convert carotenoids into retinoids. The only exception here would be eggs
and their relatively high content of the carotenoids lutein and zeaxanthin.
Since neither lutein nor zeaxanthin can be converted by the body into
retinoids, however, the presence of these carotenoids does not help eggs
move up on our ranking list (although they still do not do too badly at
number 37 out of more than 125 foods).
We'd like to end this description with four key take-away points:
There are two basic forms of vitamin A (retinoids and carotenoids)
and both forms provide unique health benefits.
If your body is able to effectively convert carotenoids into retinoids,
you don't have to eat animal foods in order to obtain retinoid forms of
vitamin A that are essential for health. If your body is unable to do
this conversion effectively, you'll either need to include animal foods
in your meal plan or obtain retinoid forms of vitamin A through dietary
supplements.
Many factors can compromise the body's ability to convert
carotenoids into retinoids, including: genetic tendencies, digestive
problems, bacterial imbalances in the gut, excessive alcohol use,
excessive exposure to toxins, imbalanced intake of vitamin A and
vitamin D in supplement form, and use of over-the-counter and/or
prescription medications.
Some Vitamin A health benefits will require you to eat foods that are
rich in specific carotenoids. A great example is eye health and the
unique role of two specific carotenoids (lutein and zeaxanthin) in the
health of our eyes.
Role in Health Support
How does vitamin A support health?
Retinoid Forms
While vitamin A is best known for its vital role in vision, the retinoid forms of
this vitamin also participate in physiological activities related to the immune
system, inflammatory system, maintenance of epithelial and mucosal
tissues, growth, reproduction, bone development, creation of red blood
cells, and production of spermatozoa (male reproductive cells). In food,
retinoid forms of vitamin A typically appear as retinyl esters. The body is
typically able to convert these retinyl esters into metabolically active forms
of vitamin A including retinol, retinal, and retinoic acid.
Vision Support
The human retina contains four kinds of photopigments that store vitamin A
compounds. One of these pigments, called rhodopsin, is located in the rod
cells of the retina. Rhodopsin allows the rod cells to detect small amounts
of light, and, thus, plays a fundamental role in the adaptation of the eye to
low-light conditions and night vision.
Retinal, the aldehyde form of the vitamin, participates in the synthesis of
rhodopsin, and in the series of chemical reactions that causes visual
excitation, which is triggered by light striking the rod cells. The remaining
three pigments, collectively known as iodopsins, are found in the cone cells
of the retina and are responsible for day vision.
Support of the Immune and Inflammatory Systems
Throughout the body, but particularly in our digestive tract, vitamin A plays
a key role in support of immune and inflammatory functions. Our digestive
tract can get exposed on a daily basis to potentially unwanted substances
(like pesticide residues in food), as well as unwanted micro-organisms (like
certain kinds of bacteria). Our immune and inflammatory systems are
designed to help prevent us from being harmed by these events.
For example, in order to help neutralize unwanted bacteria and other micro-
organisms, our immune system has the ability to make and release
antibodies that can block their activity. Our immune and inflammatory
systems also have "braking" function that prevents them overreacting.
Recent research has shown that vitamin A plays a key role in both of these
protective processes. Scientists now know that the T cell and B cells of the
immune system cannot be correctly synthesized without vitamin A, nor can
immune responses be effectively activated without participation of vitamin
A. Interestingly, whenever we undergo an increase in whole body
inflammation, our cells also increase their conversion of vitamin A in its
retinol form into a second form called retinoic acid. This conversion
required participation of two enzymes (alcohol dehydrogenase and
retinaldehyde dehydrogenase). The inability of our cells to make this
vitamin A conversion is now believed to be a risk factor for increased
susceptibility to infection, as well as for poor response to vaccination.
Researchers believe that vitamin A may be equally important for our
immune and inflammatory "braking" system, in which our cells are
prevented from becoming overreactive. Since some aspects of food allergy
can be related to our immune system's overreaction to food proteins,
optimal intake of vitamin A may turn out to be important for lowering risk of
certain types of food allergy.
Cell Growth Support
Vitamin A is required for normal cell growth and development. Although the
mechanisms by which vitamin A promotes cell growth and development are
not yet fully understood, it is known that retinoic acid is necessary for the
synthesis of many glycoproteins, which control cellular adhesion (the ability
of cells to attach to one another), cell growth, and cell differentiation. For
example, the production of red blood cells in our bone marrow (through a
process called hematopoiesis) is a process that is known to require vitamin
A in the form of retinoid acid. As described in the previous paragraph,
retinoic acid can be synthesized in our cells from the retinyl esters found in
food, and it takes two enzymes (alcohol dehydrogenase and retinaldehyde
dehydrogenase) in order for this synthesis to occur. Researchers are
actively investigating the link between this enzyme system and cell growth
and believe that problems with synthesis of retinoic acid may hold the key
for understanding a wide range of problems related to human growth and
development.
Other Roles for Vitamin A
It is also known that vitamin A is essential for reproductive processes in
both males and females and plays a role in normal bone metabolism. In
addition, some of the most cutting-edge research in the field of genetics
has been examining the role of vitamin A (in the form of retinoic acid) in
regulating genetic events. Vitamin A is also known to be required for proper
production of sperm (through a process called spermatogenesis).
Carotenoid Forms
Preventing Vitamin A Deficiency
Until late in the 20th century, the functions of carotenoids were discussed
only in terms of their potential to act in the same way as retinoids. From
among the more than 600 carotenoids known to exist in plant foods, only
three carotenoids - beta-carotene, alpha-carotene, and beta-cryptoxanthin -
were designated as "provitamin A" carotenoids that could be converted by
the body (under the right circumstances) into retinoids. Intake of these
three carotenoids is still regarded as extremely important in preventing
deficiency of vitamin A in its retinoid forms.
Antioxidant, Anti-Inflammatory, and Immune-Enhancing Activity
In recent years, carotenoids have received a large amount of research
attention as potential anti-cancer and anti-aging compounds. These
potential functions of carotenoids are closely related to their antioxidant and
anti-inflammatory activity. Importantly, virtually all carotenoids provide
antioxidant and anti-inflammatory benefits (even though it's only a handful
of carotenoids that can be converted into retinoids).
Promoting Proper Cell Communication
In addition to their antioxidant and immune-enhancing activity, carotenoids
have shown the ability to stimulate cell-to-cell communication. Researchers
now believe that poor communication between cells may be one of the
causes of the overgrowth of cells, a condition that eventually leads to
cancer. By promoting proper communication between cells, carotenoids
may play a direct role in cancer prevention.
It is also believed that carotenoids participate in female reproduction.
Although the exact function of carotenoids in female reproduction has not
yet been identified, it is known that the corpus luteum contains a very high
level of beta-carotene, suggesting that this nutrient plays an important role
in reproductive processes.
Summary of Food Sources
What foods provide vitamin A?
Retinoids forms of vitamin A are provided by animal foods, including the
following WHFoods: cow's milk, shrimp, eggs, salmon, halibut, cheese,
yogurt, scallops, sardines, tuna, cod, and chicken.
Carotenoid forms of vitamin A are provided by most of the fruits and
vegetables on our WHFoods list. Please see the Basic Description section
above for a list of the Top 25 plant foods rich in carotenoids.
Nutrient Rating Chart
Introduction to Nutrient Rating System Chart
In order to better help you identify foods that feature a high concentration of
nutrients for the calories they contain, we created a Food Rating System.
This system allows us to highlight the foods that are especially rich in
particular nutrients. The following chart shows the World's Healthiest Foods
that are either an excellent, very good, or good source of vitamin A. Next to
each food name, you'll find the serving size we used to calculate the food's
nutrient composition, the calories contained in the serving, the amount of
vitamin A contained in one serving size of the food, the percent Daily Value
(DV%) that this amount represents, the nutrient density that we calculated
for this food and nutrient, and the rating we established in our rating
system. For most of our nutrient ratings, we adopted the government
standards for food labeling that are found in the U.S. Food and Drug
Administration's "Reference Values for Nutrition Labeling." Read more
background information and details of our rating system.
World's Healthiest Foods ranked as quality sources of
vitamin A
Food
Serving
Size Cals
Amount
(mcg RAE)
DRI/DV
(%)
Nutrient
Density
World's
Healthiest
Foods Rating
Sweet Potato 1 medium 180.0 1921.80 213.53 21.4 excellent
Carrots 1 cup 50.0 1019.07 113.23 40.7 excellent
Spinach 1 cup 41.4 943.29 104.81 45.6 excellent
Kale 1 cup 36.4 885.36 98.37 48.6 excellent
Mustard Greens 1 cup 36.4 865.90 96.21 47.6 excellent
Collard Greens 1 cup 62.7 722.00 80.22 23.0 excellent
Beet Greens 1 cup 38.9 551.09 61.23 28.3 excellent
Turnip Greens 1 cup 28.8 549.00 61.00 38.1 excellent
Swiss Chard 1 cup 35.0 535.85 59.54 30.6 excellent
Winter Squash 1 cup 75.8 535.36 59.48 14.1 excellent
Romaine Lettuce 2 cups 16.0 409.37 45.49 51.2 excellent
Bok Choy 1 cup 20.4 361.16 40.13 35.4 excellent
Cantaloupe 1 cup 54.4 270.56 30.06 9.9 excellent
Bell Peppers 1 cup 28.5 144.03 16.00 10.1 excellent
Parsley 0.50 cup 10.9 128.04 14.23 23.4 excellent
Broccoli 1 cup 54.6 120.74 13.42 4.4 very good
Asparagus 1 cup 39.6 90.54 10.06 4.6 very good
Sea Vegetables 1 TBS 10.8 81.05 9.01 14.9 very good
Chili Peppers 2 tsp 15.2 80.05 8.89 10.5 very good
Tomatoes 1 cup 32.4 74.97 8.33 4.6 very good
Basil 0.50 cup 4.9 55.91 6.21 22.9 very good
Papaya 1 medium 118.7 131.10 14.57 2.2 good
Shrimp 4 oz 134.9 102.06 11.34 1.5 good
Eggs 1 each 77.5 74.50 8.28 1.9 good
Brussels Sprouts 1 cup 56.2 60.45 6.72 2.2 good
Grapefruit 0.50 medium 41.0 59.33 6.59 2.9 good
Cow's milk 4 oz 74.4 56.12 6.24 1.5 good
Green Beans 1 cup 43.8 43.75 4.86 2.0 good
Watermelon 1 cup 45.6 43.24 4.80 1.9 good
Leeks 1 cup 32.2 42.22 4.69 2.6 good
Apricot 1 whole 16.8 33.70 3.74 4.0 good
Cilantro 0.50 cup 1.8 26.99 3.00 29.3 good
Celery 1 cup 16.2 22.67 2.52 2.8 good
World's Healthiest
Foods Rating Rule
excellent
DRI/DV>=75% OR
Density>=7.6 AND DRI/DV>=10%
very good
DRI/DV>=50% OR
Density>=3.4 AND DRI/DV>=5%
good
DRI/DV>=25% OR
Density>=1.5 AND DRI/DV>=2.5%
Impact of Cooking, Storage and Processing
How do cooking, storage, or processing affect vitamin A?
Retinoid Forms
Preformed vitamin A is relatively stable in the animal foods that contain it.
Ordinary handling, storage, and cooking methods for these foods will
usually be sufficient to preserve the content of preformed vitamin A. (Most
preformed vitamin A is found in the form of retinyl esters.)
In the case of milk, preformed vitamin A in the form of retinyl palmitate has
been added to the milk based on U.S. Food and Drug Administration (FDA)
fortification requirements. The vitamin A in fortified milk can be damaged by
sunlight. In research studies, about 8-31% of the retinyl palmitate in fortified
milk is lost following one day of sunlight exposure. As long as milk is stored
in the refrigerator in an opaque container (either darkly tinted green or
brown glass, or thick solid-color plastic, or waxed cardboard), loss of retinyl
palmitate from light exposure should be negligible. (Due to the light
sensitivity of retinyl palmitate, we do not recommend packaging in clear
glass or clear plastic.)
Carotenoid Forms
The jury is still out regarding the impact of cooking and processing on
carotenoids in food. High-carotenoid foods like carrots typically have the
vast majority of their carotenoids occurring in all-trans form. While this form
can provide excellent health support, it is not as readily available to the
bloodstream or to our cells as another form called the cis form. The cooking
of a plant food decreases the total amount of all-transcarotenoids found in
the food, but it also increases conversion of many all-trans carotenoids into
their more available cis form. As a net result, some studies show better
support of carotenoid levels in the blood after consumption of a cooked
plant food product (like tomato paste) than a non-cooked plant food product
(like fresh tomatoes). In the case of tomatoes, the carotenoid of greatest
interest has been lycopene, and several studies have shown better support
of blood lycopene levels from cooked and processed tomato products
versus fresh tomatoes. However, other factors may have played an
important role here, including the breaking apart of cells in the tomato
during processing. The crushing of the tomato cells may have made the
cell contents more readily available for digestion and metabolism and
thereby improved blood levels of tomato constituents, including lycopene. If
this sequence of events played a key role, it gives all of us a very good
reason to eat slowly and do an outstanding job chewing our food (including
tomatoes). Thorough chewing could accomplish the same result as
industrial processing, i.e., breaking open of most tomato cells and providing
us with easier access to their nutrients.
Retinoid and Carotenoid Forms
Preliminary research has shown an unwanted impact of food irradiation on
both retinoid form and carotenoid form vitamin A. At least one researcher
has found a decrease of about 12% in total vitamin A content of chicken
feed following irradiation at 20 kGy (kilogray). In this same study, the
decrease in beta-carotene following irradiation was approximately 25%. We
would like to note that there is very little research at this point on the
nutrient impact of commercial food irradiation, and that the jury is still out
on the impact of this food practice on vitamin A quantity and/or quality.
Risk of Dietary Deficiency
What food practices might lead to a dietary deficiency of vitamin A?
Retinoid Forms
In the United States, about two-thirds of all vitamin A intake from food
comes in the form of retinyl esters found in animal products. Butter,
cheese, eggs, and organ meats like liver are among the top 10 sources of
vitamin A for U.S. adults. Persons who seldom consume any of these foods
may be a greater risk of vitamin A deficiency.
One plant-based group of products - the ready-to-eat cereals - are also
found within the top 10 sources of vitamin A retinoids because these
cereals have often been fortified with vitamin A in the form of retinyl
palmitate. The vitamin A in fortified cereals is very likely to have been
obtained from a synthetic, non-animal source. However, since it is possible
for this vitamin A to have be derived from an animal source, persons who
are trying to avoid animal products should contact the cereal manufacturer
to make sure that the cereal's retinyl palmitate was produced synthetically. .
Outside of the Unites States, dietary deficiency of vitamin A in its retinoid
form is common in many non-industrialized countries, and it is associated
with the high incidence of blindness, viral infections, and child mortality.
Carotenoid Forms
Carrots, tomatoes, leafy greens, sweet potatoes, and margarines colored
with beta-carotene are found in the top 10 provitamin A-containing foods in
the U.S. However, since U.S. adults eat relatively small amounts of
vegetables in general, foods containing provitamin A in carotenoid form
only account for about one-third of all dietary intake of vitamin A.
U.S. adults who take vitamin A supplements have a much lower rate of
deficiency than non-supplement users. However, even when vitamin A from
food and supplements is added together, about one-third of all U.S. adults
still fail to get the vitamin A they need.
If regular intake of green leafy vegetables or brightly orange- or red-colored
vegetables like carrots, tomatoes, sweet potatoes, or red bell peppers in
not part of your meal plan, your risk of carotenoid deficiency is increased.
Similarly, if you do not regularly consume orange-, red- or pink-colored
fruits like watermelon, cantaloupe, papaya, and pink grapefruit, you are
also likely to have increased risk of carotenoid deficiency. If these types of
vegetables and fruits are both missing from your routine diet, you'll need to
add foods from these groups if you want to lower your chances of overall
vitamin A deficiency.
One final deficiency note: recent research has shown a relationship
between very low birthweight infants (LVBW) and deficient vitamin A intake
by the mother. Since these studies looked at blood levels of retinol in the
mothers rather than their food intake, we don't know whether low blood
levels were the result of poor carotenoid intake from plant foods, poor
retinoid intake from animal foods, or a combination of the two. If you're a
woman who is considering pregnancy or who is already pregnant, it's
especially important consume foods that are rich in vitamin A. These foods
could be plant foods rich in provitamin A, animal foods rich in preformed
vitamin A, or both.
Other Circumstances that Might Contribute to
Deficiency
What other circumstances might contribute to a deficiency of vitamin
A?
Both Retinoid and Carotenoid Forms
Since carotenoids and retinoids are fat-soluble nutrients, vitamin A
deficiencies involving either carotenoids or retinoids may be caused by a
diet that is extremely low in fat and/or the presence of medical conditions
that cause a reduction in the ability to absorb dietary fat, such as pancreatic
enzyme deficiency, Crohn's disease, celiac sprue, cystic fibrosis, surgical
removal of part or all of the stomach, gall bladder disease, and liver
disease.
In addition, chronic diarrhea caused by gastrointestinal infections and/or
intestinal parasites may contribute to deficiency of vitamin A in either
carotenoid or retinoid forms. Viral infections, including the measles, can
decrease retinoid-form vitamin A. In addition, exposure to certain toxic
chemicals (for example, polybrominated biphenyls and dioxins) can
enhance the breakdown of retinoid-form vitamin A by the liver.
In this section about "Other Circumstances That Might Contribute to
Deficiency," it's also important to remember that while carotenoid forms of
vitamin A can be effectively converted into retinoid forms inside the bodies
of many individuals, this conversion process does not always take place in
the way that we would like. Many different factors can contribute to
problems with conversion of carotenoids into retinoids. These factors
include: a person's inherited genetic tendencies; digestive problems;
bacterial imbalances in the digestive tract; excessive use of alcohol;
smoking; excessive exposure to toxic chemicals; imbalanced intake of
vitamin A and vitamin D as a result of high-dose supplementation; and the
use of certain over-the-counter and/or prescription medications.
Inadequate intake of protein can also contributes to retinoid-form vitamin A
deficiency (see further explanation in the section on Nutrient Interactions).
Relationship with Other Nutrients
What relationship does vitamin A have to other nutrients?
Retinoid Forms
The transport and utilization of vitamin A is dependent upon several vitamin
A binding proteins. Because a sufficient dietary intake of protein is required
for the manufacture of these binding proteins, inadequate protein intake
may result in vitamin A deficiency. In addition, adequate intake of dietary fat
and zinc is necessary for the absorption and utilization of vitamin A.
The relationship between retinoid forms of vitamin A and vitamin D status
has become an area of special research interest. Recent studies suggest
that effects of vitamin D deficiency are worsened by high supplemental
intake of vitamin A (in retinoid form). Preliminary studies have shown that
when blood levels of vitamin D fall below 50 nM/L (nanomoles per liter),
higher supplemental intake of retinol (defined as intake above 2,000
micrograms per day) can worsen problems related to vitamin D deficiency
(like bone health). After being consumed in retinol form, vitamin A can be
converted by the body into retinoic acid. This retinoid acid, in turn, can
stimulate formation and activity of osteoclast cells that then work to remove
minerals from bone. Similarly, high doses of retinoic acid also seem to be
able to suppress the activity of osteoblast cells, which help deposit minerals
into the bone. We'd like highlight the fact that all of these studies on vitamin
A and vitamin D involve dose levels of retinoid-form vitamin A not available
from food but only from supplements. But if you're among the 34% of all
U.S. adults who take supplements containing both vitamin A (in retinoid
form) and vitamin D, you may want to consult with a healthcare practitioner
about the best ratio of vitamin A and vitamin D for you.
Alongside of this research trend showing exacerbation of vitamin D
deficiency following higher intake of supplemental vitamin A is a second
research trend showing the helpfulness of vitamin A in support of vitamin D
metabolism. This second research trend has made it clear that receptors
on our cell membranes for vitamin A (called retinoid X receptors, or RXR)
and receptors on our cell membranes for vitamin D (called VDR receptors)
actually combine in our cells to produce an VDR/RXR form. (In more
technical terms, vitamin A is said to "recruit coactivators" that are needed
for expression of vitamin D receptors, and the form of vitamin A needed to
assist with vitamin D metabolism in this situation is 9-cis-retinoic acid.) We'll
need many future research studies to eventually clarify the relationships
between vitamin A and vitamin D, and the exact ramifications for our food
choices.
Like its potential interference with vitamin D metabolism, excess retinoid-
form vitamin A may also interfere with the metabolism of vitamin K, a fat-
soluble vitamin necessary for blood clotting. Like the vitamin A-vitamin D
relationship, however, "excess" in this case does not apply to the amount of
retinoid-form vitamin A provided by everyday amounts of animal food.
Carotenoid Forms
Recent studies have shown the ability of beta-carotene to improve the
availability of two mineralsiron and zincfrom grains. In one lab study,
the addition of 2.5 grams of cooked carrot containing 200 micrograms of
beta-carotene to a 10-gram portion of cooked rice resulted in a 50%
increase in the availability of iron from the rice. In everyday practice, you
would need to consume one medium-sized cooked carrot (about 50 grams)
along with each cup of cooked rice (about 195 grams) in order to achieve
this same nutrient ratio. Similarly, this same addition of beta-carotene was
able to increase the availability of zinc in the cooked rice by about 35-40%.
The authors of this study speculated that beta-carotene may have been
able to form a complex with the minerals to help maintain their solubility
and also to help prevent their getting bound together with phytates in rice
that would otherwise be able to lower their absorption. While this study was
lab-based and not conducted on real people eating real food, we look
forward to future studies that may show the ability of beta-carotene content
in our plant foods to improve the availability of minerals in those foods like
iron and zinc.
Risk of Dietary Toxicity
What food practices might lead to a dietary toxicity of vitamin A?
Retinoid Forms
It is almost impossible for ordinary intake of animal foods to result in
vitamin A toxicity. Foods simply do not contain enough preformed vitamin A
to expose us to toxicity-producing amounts.
Here are some numbers to provide you with a concrete example. When
chronic vitamin A toxicity occurs, it typically involves many months of daily
intake of vitamin A in retinoid form in amounts exceeding 14,000 IU (4,200
mcg RE) in children and 25,000 IU (7,500 mcg RE) in adults. Let's compare
that amount to the largest amounts found in food. At 135 mcg RE of retinol
per cup, cow's milk is the animal food on our WHFoods list that ranks
highest in retinol content. As you can see, an adult would have to consume
over 55 times this amount every day over a period of several months in
order to reach the toxicity level described above.
While vitamin A toxicity can be a problem for our health, it comes from
improper use of retinoid-containing supplements, not from our diet. Most
causes of vitamin A toxicity are due to accidental ingestion of supplemental
doses exceeding 660,000 IU (200,000 mcg retinol equivalents) and
330,000 IU (100,000 mcg retinol equivalents) by adults and children,
respectively.
In 2000 the National Academy of Sciences (NAS) set Tolerable Upper
Intake Levels (ULs) for preformed vitamin A. These recommendations were
designed to help prevent excessive amounts of supplemental intake by the
general public, not to discourage intake of foods high in retinoid forms of
vitamin A. Here were the recommendations of the NAS for maximal intake
of retinoid-form vitamin A
Children 3 years or younger, 600 micrograms (2,000 IU) of preformed
vitamin A (retinol) per day
Children 4-8 years, 900 micrograms (3,000 IU) of preformed vitamin
A (retinol) per day
Children 9-14 years, 1,700 micrograms (5,666 IU) of preformed
vitamin A (retinol) per day
Teenagers 14-18 years, 2,800 mcg (9,333 IU) of preformed vitamin A
(retinol) per day
Adults 19 years and older, 3,000 mcg (10,000 IU) of preformed
vitamin A (retinol) per day
Pregnant or lactating women 18 years or younger, 2,800 mcg (9,333
IU) of preformed vitamin A (retinol) per day
Pregnant or lactating women 19 years or older, 3,000 mcg (10,000
IU) of preformed vitamin A (retinol) per day
Carotenoid Forms
A telltale sign of excessive consumption of beta-carotene is a yellowish
discoloration of the skin, most often occurring in the palms of the hands
and soles of the feet. This condition is called carotenodermia and is
generally considered to be reversible and harmless. Excessive
consumption of the carotenoid lycopene can cause a deep orange
discoloration of the skin. Like carotenodermia, lycopenodermia is generally
considered reversible and harmless.
High intake of carotenoid-containing foods or supplements is not
associated with any specific toxic side effects. As a result, the Institute of
Medicine at the National Academy of Sciences did not establish a Tolerable
Upper Intake Level (UL) for carotenoids when it reviewed these compounds
in 2000.
Disease Checklist
What diseases might have a special connection with vitamin A?
Retinoid forms of vitamin A may play a role in the prevention and/or
treatment of the following health conditions:
Acne
AIDS
Alcoholism
Atopic dermatitis
Cataracts
Cervical dysplasia
Cystic Fibrosis
Diabetes
Dry Eyes
Fibrocycstic breast disease
Hyperkeratosis
Impotence (Lack of sperm production)
Inflammaotory bowel disease
Kaposi's sarcoma
Leukoplakia
Measles
Osteoarthritis
Otitis media (ear infection)
Poor vision
Premature Delivery
Psoriasis
Thyroid disorders
Ulcers
Vaginitis
Varicose veins
Viral infections
Carotenoid forms of vitamin A may play a role in the prevention and/or
treatment of the following health conditions:
Acquired Immunodeficiency Syndrome (AIDS)
Age-related macular degeneration
Angina pectoris
Asthma
Cataracts
Cervical cancer
Cervical dysplasia
Chlamydial infection
Heart disease
Laryngeal cancer (cancer of the larynx)
Lung cancer
Male and female infertility
Osteoarthritis
Photosensitivity
Pneumonia
Prostate cancer
Rheumatoid arthritis
Skin cancer
Vaginal candidiasis
Public Health Recommendations
What are current public health recommendations for vitamin A?
Public health recommendations for vitamin A can be confusing due to units
of measurement. Food and supplement labels present vitamin A content in
terms of the Daily Values (DVs). The DVs were established in 1993 by the
U.S. Food and Drug Administration (FDA) and are measured in IU
(International Units). However, about 20 years earlier (in 1974), the
National Academy of Sciences (NAS) had already established its own set
of public health recommendations, setting vitamin A requirements in terms
of micrograms retinol equivalents (micrograms RE, or mcg RE). In 2001,
the NAS changed this measurement standard from mcg RE to mcg RAE
(micrograms retinol activity equivalents). Today, you might find public
health recommendations using all three units of measurement: RE, RAE,
and IU.
If you need to make conversions between these different units of
measurement for vitamin A, here are the rules you must follow:
In the RE and RAE measurement systems, 1 microgram of retinol is
equivalent to 1 RAE/1 RE while 1 RE is equal to 6 micrograms of beta-
carotene or 12 micrograms of alpha-carotene or beta-cryptoxanthin.
Additionally, 1 RAE is equal to 12 micrograms of beta-carotene or 24
micrograms of alpha-carotene or beta-cryptoxanthin, and 1 IU is equal to
0.3 micrograms of retinol, 0.6 micrograms of beta-carotene, or 1.2
micrograms of alpha-carotene or beta-cryptoxanthin. (Please note that the
word "microgram" is commonly abbreviated as "mcg.")
When converting between these two units of measure, 1 retinol equivalent
(or RE) is equal to 3.33 International Units (or IU) of preformed vitamin A.
In 2000, the National Academy of Sciences established the following
Adequate Intake (AI) levels for consumption of vitamin A by infants:
Males and females 0-6 months: 400 mcg (1,333 IU)
Males and females 7-12 months: 500 mcg (1,666 IU)
In 2000, the National Academy of Sciences established the following
Recommended Dietary Allowances (RDAs) for consumption of vitamin A by
children and adults. (Please note that the acronym "RAE" used below
stands for Retinol Activity Equivalents, and the abbreviation "mcg" stands
for micrograms.)
Males and females
Vitamin A
Vitamin A is a fat-soluble vitamin.
Two different types of vitamin A are found in the diet. Preformed vitamin A is
found in animal products such as meat, fish, poultry and dairy foods. The other
type, pro-vitamin A is found in plant-based foods such as fruits and vegetables.
The most common type of pro-vitamin A is beta-carotene.

Vitamin A is also available in dietary supplements, usually in the form of retinyl
acetate or retinyl palmitate (preformed vitamin A), beta-carotene (pro-vitamin A)
or a combination of preformed and pro-vitamin A.
Function
Vitamin A helps form and maintain healthy skin, teeth, skeletal and soft tissue,
mucus membranes, and skin. It is also known as retinol because it produces the
pigments in the retina of the eye.
Vitamin A promotes good vision, especially in low light. It may also be needed for
reproduction and breast-feeding.
Retinol is an active form of vitamin A. It is found in animal liver, whole milk, and
some fortified foods.
Carotenoids are dark-colored dyes (pigments) found in plant foods that can turn
into a form of vitamin A. There are more than 500 known carotenoids. One such
carotenoid is beta-carotene.
Beta-carotene is an antioxidant. Antioxidants protect cells from damage
caused by substances called free radicals. Free radicals are believed to
contribute to certain chronic diseases and play a role in the aging
processes.
Food sources of carotenoids such as beta-carotene may reduce the risk for
cancer.
Beta-carotene supplements do not seem to reduce cancer risk.
Food Sources
Vitamin A comes from animal sources, such as eggs, meat, fortified milk, cheese,
cream, liver, kidney, cod, and halibut fish oil. However, all of these sources --
except for skim milk that has been fortified with Vitamin A -- are high in saturated
fat and cholesterol.
Sources of beta-carotene include:
Bright yellow and orange fruits such as cantaloupe, pink grapefruit, and
apricots
Vegetables such as carrots, pumpkin, sweet potatoes, and winter squash
Other sources of beta-carotene include broccoli, spinach, and most dark
green, leafy vegetables.
The more intense the color of a fruit or vegetable, the higher the beta-carotene
content. Vegetable sources of beta-carotene are fat- and cholesterol-free.
Side Effects
If you don't get enough vitamin A, you are more likely to get infectious diseases
and vision problems.
If you get too much vitamin A, you can become sick. Large doses of vitamin A can
also cause birth defects.
Acute vitamin A poisoning usually occurs when an adult takes several hundred
thousand IUs of vitamin A. Symptoms of chronic vitamin A poisoning may occur
in adults who regularly take more than 25,000 IU a day. Babies and children are
more sensitive to vitamin A, and can become sick after taking smaller doses of
vitamin A or vitamin A-containing products such as retinol (found in skin creams).
Large amounts of beta-carotene will not make you sick. However, increased
amounts of beta-carotene can turn the skin yellow or orange. The skin color will
return to normal once you reduce your intake of beta-carotene.
Recommendations
The best way to get the daily requirement of essential vitamins is to eat a wide
variety of fruits, vegetables, fortified dairy foods, legumes (dried beans), lentils,
and whole grains.
The Food and Nutrition Board of the Institute of Medicine -- Dietary Reference
Intakes (DRIs) Recommended Intakes for Individuals of Vitamin A:
Infants (average intake)
0 - 6 months: 400 micrograms per day (mcg/day)
7 - 12 months: 500 mcg/day
The Recommended Dietary Allowance (RDA) for vitamins is how much of each
vitamin most people should get each day. The RDA for vitamins may be used as
goals for each person.
Children (RDA)
1 - 3 years: 300 mcg/day
4 - 8 years: 400 mcg/day
9 - 13 years: 600 mcg/day
Adolescents and Adults (RDA)
Males age 14 and older: 900 mcg/day
Females age 14 and older: 700 mcg/day
How much of each vitamin you need depends on your age and gender. Other
factors, such as pregnancy and your health, are also important. Ask your doctor
what dose is best for you.
Alternative Names
Retinol; Retinal; Retinoic acid; Carotenoids