ASK BONNIE for March 2003

Question #1:

I'm worried about vitamin A toxicity after hearing it on the news. What are your thoughts? 

Answer #1:

Yes, vitamin A can be toxic at high doses. Although, the press has irrationally stirred up fears and misguided the public without adequately explaining the do's and don'ts of vitamin A intake. This is one of the most concise and easy to understand explanations I have found:

Distinguishing between Carotenoids and Vitamin A 

While carotenoids and vitamin A serve similar functions, there are some key differences that exist, such as the way these nutrients are metabolized and stored in the body, as well as the source from which they are derived. Vitamin A is found in animal-based foods such as liver, dairy, and fish oil, and is referred to as pre-formed vitamin A (1,2). Readily absorbed (up to 90%) (1), pre-formed vitamin A is converted to retinyl esters and then stored primarily in the liver to be used, as needed, for supporting healthy vision, epithelial cell growth, and the immune system (1,2). The majority (95%) of pre-formed vitamin A is stored in the liver and the rest in adipose tissue (1,2). 

Carotenoids, on the other hand, are found only in plant-based foods. There are more than 560 carotenoids that have been isolated in nature (1,2), the most well known being beta carotene, lycopene, lutein, zeaxanthin, beta cryptoxanthin, and alpha carotene (1,2). Alpha carotene, beta carotene, and beta-cryptoxanthin are the only carotenoids that can be converted into vitamin A and are referred to as pro-vitamin A carotenoids (1,2). The most biologically active of the group is beta carotene (1,2). These carotenoids are the pigment molecules in fruits and vegetables that account for colors ranging from bright yellows to deep reds (1,2). Pro-vitamin A carotenoids are not as easily absorbed (as little as 3%) as pre-formed vitamin A (1,2). The bioavailability of pro-vitamin A cartotenoids and conversion into vitamin A is highly unpredictable and can be affected by many factors including dietary fat intake, bile salt concentration, presence of other food components, whether or not the food was cooked, and even the farming and cultivation methods used (1,2). The carotenoids that are absorbed are generally stored in the adipose tissue under the skin and in the liver. When the body is low on pre-formed vitamin A, stored carotenoids are then released from adipose tissue and sent to the liver where they are converted into the vitamin A-active compounds retinyl esters, retinol, and retinoic acid, collectively called retinoids (1,2). Because the body converts carotenoids only as it needs, a vitamin A-related toxicity from carotenoid consumption has not been reported to date. 

Vitamin A supplementation from either pro-vitamin A carotenoids or pre-formed vitamin A has been shown to support healthy vision and immune function. In general, most adults can safely take up to 25,000 IU of pre-formed vitamin A per day (3,4). For women who could become or are pregnant, less than 10,000 IU per day is advised. The most common dose recommendation for carotenoids (mainly beta carotene) is 25,000 IU or less; however, up to 100,000 IU per day may be used (5).

References: 
1.) Wardlaw, Kessel. Perspectives in Nutrition 5th ed. McGraw Hill, New York 2002. 
2.) Whitney EN, Cataldo CB, Rofes SR. Understanding Normal and Clinical Nutrition 5th ed. Wadsworth Publishing Co., 1998. 
3.) Wiegand UW, Hartmann S, Hummler H. Safety of vitamin A: recent results. Int J Vitam Nutr Res 1998;68:411­6. 
4.) Bendich A, Langseth L. Safety of vitamin A. Am J Clin Nutr 1989;49:358­71. 
5.) Bendich A. The safety of beta-carotene. Nutrition & Cancer 1988;11(4):207-14. 

Question #2:

My eight-year old daughter has recently been diagnosed with acid reflux. How would you address her problem if we brought her in to see you? I realize it is a bit of a guessing game.

Answer #2:

This does not have to be a guessing game. There are three major causes of Acid Reflux among children/teens:

1) If true allergies exist, we have a one-time blood test to identify 120 possible food reactors.

2) Food Sensitivities usually are the cause of the problem. We have an ELISA test that can detect over 100 of these possible offenders.

3) A yeast overgrowth caused by a high carbo/high sugar/low protein diet often causes reflux, especially if the individual has consumed antibiotics in the past year.

We can also detect the cause(s) of reflux with a two week elimination diet. Before deciding which avenue would be the best way to discover the reasons for your daughter's acid reflux, I recommend a standard blood test and an appt with me to look at symptoms, family history, bloodwork, and her current diet.

If you would like to make an appt, please call our main office at 847-498-3422 so that they can give you details.

It is not shocking that doctors prescribe antacids like candy to infants and young children without looking for cause(s) of the problem. In the last five years, the rate of prescription meds for acid reflux among children has risen by over 600%!

Question #3:

My daughter gets a rash on her face whenever she eats something with Yellow 5 or 6, Red 40 or Blue Lake. Could the dyes be causing it or is it her imagination?

Answer #3:

How could a rash be her imagination? She has a salicylate reaction and those items are high in salicylic acid. No healthy food items contain these dyes - only junk foods. I know this because my own daughter and grandson have this problem and find it easy to find dye-free foods.


Question #4:

Does calcium contribute to kidney stones?

Answer #4:

Calcium does contribute to kidney stones if improperly absorbed. Calcium, if not absorbed properly, circulates throughout the body and deposits itself in many unwanted locations, such as the heart (calcification of arteries), kidneys (stones), urinary tract (crystals), etc.

This is something she would want to monitor. The Metagenics Cal Apatite w/boron is supremely absorbed. Although, the best way to make sure you are not spilling calcium is for to take it with Magnesium Glycinate and Cod Liver Oil (provides bioavailable vitamin D). I can recommend a brand for both. Taking away from meals, preferably when waking and before bed are ideal times. This should help with absorption.

Have a happy, healthy day.

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