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Case study: "Reversible Hepatotoxicity Associated with Hepatic Vitamin A Accumulation in a Protein-Deficient Patient"

Many important things can be gleaned just from the title of this one:

Reversible Hepatotoxicity Associated with Hepatic Vitamin A Accumulation in a Protein-Deficient Patient

Key terms to catch:  "reversible" and "protein-deficient".

A 62-yr-old white male presented with edema, protein malnutrition, and abnormal liver function. He had ingested from 40,000-50,000 IU of vitamin A per day for 7 yr.

Protein malnutrition.  The body requires dietary protein to make Retinol-Binding Protein (RBP), which is a major part of how the body protects itself against Poison/"Vitamin A".  Not enough protein, not enough RBP, more Poison/"Vitamin A" damage.

Ingesting 40,000 - 50,000 IU of Poison/"Vitamin A" from supplements a day for 7 years, plus whatever he was eating from food, is a guaranteed road to chronic toxicity.

Examination of liver tissue by light and electron microscopy revealed findings characteristic of an excessive accumulation of vitamin A. Liver tissue contained massive amounts of vitamin A (19,000 IU/g); however, both the serum concentration of vitamin A and retinol-binding protein were below normal, and serum RBP was not saturated.

He got the GOLD STANDARD test for chronic Poison/"Vitamin A" toxicity, the liver biopsy. Liver biopsy showed he was MASSIVELY TOXIC.

Oh, but his serum retinol ("blood Vitamin A") and his RBP (protects against VA damage) were both BELOW NORMAL!  Serum RBP wasn't saturated either, which would suggest that he wasn't toxic by that measure either!

He was MASSIVELY TOXIC and two blood tests and one calculated number [(serum retinol / RBP) * 100% = RBP Saturation %] would have said he was "deficient"!!!  Just this one case study should show you how this whole epidemic poisoning has been able to go so far and not be caught.

Most doctors, at best, will only test serum retinol after you beg them to.  Doesn't this case study show you that massive problems could be going on, and your "standard" doctor will COMPLETELY MISS THEM without actually taking a chunk out of your liver?

On a normal diet the patient was able to mobilize hepatic vitamin A, as indicated 71 days later by a repeat biopsy of the liver, which then contained 9000 IU of vitamin A/g.

A "normal" diet cut his liver stores of Poison/"Vitamin A" in HALF in 2.5 months.

Let's be clear about how toxic he was.

  • The normal range the authors state for liver content of Poison/"Vitamin A" is 100-600 IU/gram (see table in paper)
  • When the first biopsy was taken in week 3, his level was 19,600 (~33x higher than the high end of the range!)
  • When the second biopsy was taken in week 12, his level had come down to 9,000 (still ~15x higher than the high end of the range!)

During this time his nutrition improved, serum vitamin A rose, and serum RBP became transiently saturated.

He was lowering his Poison/"Vitamin A" intake.  His "serum Vitamin A rose".  This is one of the greatest examples of lab-demonstrated DETOXIFICATION we may ever come across.

Now, let's get clear about what reducing Poison/"Vitamin A" did to his liver-related enzymes.

  • Albumin.
    • Normal range given as 3.5-5.0 g/dL
    • Week 1: 3.0 g/dL (low)
    • Week 12:  4.0 g/dL (back within normal range).
  • Alkaline Phosphatase.
    • Normal range given as 30-110 IU/L.
    • Week 1: 1075 IU/L (~10x higher than high end of normal)
    • Week 12:  65 IU/L (back within normal range).
  • SGOT (AST).
    • Normal range given as 10-40 IU/L.
    • Week 1: 313 IU/L (~6.6x higher than high end of normal)
    • Week 12:  47 IU/L (slightly high, and his week 10 test was 38 IU/L, back within the normal range).

What I have seen is a common thread in these poisonings is that the lab values come back into line FIRST, but the deeper toxicity symptoms take much longer to fully resolve.  If one has liver blood tests that just won't seem to come back into range, the likelihood of chronic Poison/"Vitamin A" toxicity is quite high for that individual, in my opinion.

The amount of vitamin A ingested by this patient was less than that usually producing recognizable hepatotoxicity, and he had no extra hepatic manifestations of vitamin toxicity, consistent with a low serum vitamin A concentration and a low vitamin A to retinol-binding protein ratio. At presentation he was apparently unable to normally mobilize vitamin A from his liver, which may have been due to an accompanying protein deficiency.

I'm going to summarize the above.  What you EAT or DON'T EAT has a major impact on how easily one develops toxicity.  This man was severely protein deficient AND he ate tons of carotenoid foods AND he took supplements.  There is no surprise he got massively poisoned.

How much poison should/does it take to poison someone?  The only correct answer is...JUST ENOUGH.

Chronic hypervitaminosis A is rarely reported in adults.

Hopefully you can see that the reasons why it is "rarely reported".  Because the less-invasive blood test measurements are not used well by the medical field.  "Rarely reported" can also mean "we really suck at finding it".

When recognized, the toxic state is accompanied by a history of excessive vitamin A intake, usually in the form of vitamin A capsules,

"Usually" is not always.  It happens with foods too, all the time.  I've shown this other places on this blog-forum.  Wait until you see what this guy actually WAS eating.

and is characterized by signs and symptoms which include

When we go through this admitted symptoms of Poison/"Vitamin A" toxicity, you should realize that if you only had ONE of them, that may be your indicator of this epidemic, hidden problem.  No one has all of them!

 loss of hair,

Know anyone with hair loss or hair thinning or excessive hair fall?

dry skin,

Know anyone with dry skin?

pruritis,

Know anyone who is often itchy?

cheilosis,

Know anyone with painful cracking and inflammation at the corners of their mouth?

gingivitis,

Know anyone with irritation, redness, swelling, and/or bleeding of the gums?

headache,

Know anyone suffering from headaches?  This includes ALL types of headaches, including migraines!

anorexia,

Know anyone, including children, who just don't seem to have an appetite or eat as much as they should?

fatigue,

Know anyone who's TIRED? Heard of Chronic Fatigue Syndrome (CFS)?

muscle and bone pain,

Know anyone whose joints hurt?  Know anyone whose bones ache?  Heard of fibromyalgia?  Heard of myalgic encephalomyelitis (ME)?

and an elevated serum concentration of vitamin A (l-6).

NO!  They just showed you that one can be MASSIVELY TOXIC in their liver with LOW Vitamin A on their blood tests!!!  This is where it is either stupidity, ignorance, bias, or a plan to continue hiding Poison/"Vitamin A" toxicity from the public at large.

We're going to get into his diet.  Make sure to look at what he was EATING, and then think what is being pushed on us as "healthy":

Admission history revealed that he had been taking several vitamin supplements while restricting the variety of food sources in his diet for 7 yr. A subsequent detailed dietary history (Methods) determined that until 1 yr before admission he took up to 20,000 IU of vitamin A/day in capsule form and ingested approximately 30,000 IU of vitamin A/day from dietary sources. The ingestion of substantial amounts of sweet potatoes, carrots, peaches, tomatoes, and dessicated beef liver accounted for this high dietary vitamin A intake. One year before admission he reduced the vitamin A in his diet to approximately 15,000 IU/day but, increased vitamin A taken in capsule form to 25,000 IU/day.

Chronic Poison/"Vitamin A" toxicity is a disease of ACCUMULATION over time.  The sources doesn't matter, the outcome will be the same.

He denied symptoms of vitamin A toxicity including headache, hair loss, dry skin, or painful extremities. He also denied alcohol ingestion or the use of any drugs other than furosemide. His diet was also estimated to contain 570 mg of cholesterol (nl, 500-1000 mg/day) and 230 pg of vitamin K (nl, 300-500 kg/day).

People denying they have this problem because they don't have the "typical symptoms" is why they are going to continue suffering.

On discharge the patient was placed on a diet low in vitamin A (4000 IU/day) and with adequate protein and calories to increase protein stores (120 g protein/day; 3000 Cal/day).

This gentleman was down to 121 pounds at 5' 9" tall (very thin, "wasted" was the term they used).  120 grams of protein at 121 pounds of bodyweight is a gram per pound, that's a lot more than he was eating!

He followed this diet reasonably well, although occasionally he would succumb to a desire for foods rich in vitamin A which raised his intake to 20,000 IU/day.

Read here about Poison/"Vitamin A" withdrawals and addiction.  It's very real.  That should make people think twice about it...people don't get addicted to healthy things.

During his course, both serum vitamin A and RBP slowly rose. By the tenth week serum vitamin A reached its highest level. Retinol-binding protein was saturated at this point, but both serum vitamin A and the vitamin A/RBP ratio subsequently fell, and peripheral vitamin A toxicity never appeared.

This is DETOX happening!  Serum retinol can be thought of how quickly the tissues (including the liver) are dumping the stored Poison/"Vitamin A" into the blood so that it can come back around to the liver and kidneys to be processed again.  The increase in RBP saturation means the body was getting the nutrients it needed to make RBP and keep it bound up (protecting the tissues).

This study was done in 1982.  The number of Poison/"Vitamin A" sources since then has increased.  The presence and use of compounds that slow down proper Poison/"Vitamin A" metabolism/detox has greatly increased.  All of these things are addressed on the Poison/"Vitamin A" and Glyphosate Detox Program.

Dr. Garrett Smith, the "Nutrition Detective"
Licensed Naturopathic Physician (NMD) in Arizona
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