Vitamin A (Retinol) (HYG-5551-05)

This fact sheet is one in a series containing information to help you select foods that provide adequate daily amounts of vitamins, minerals, and dietary fiber. The Dietary Guidelines Advisory Committee just released the Dietary Guidelines for Americans 2005 that convey the following nine major messages concerning these topics:

Adequate nutrients within calorie needs

Weight management

Physical activity

Food groups to encourage: fruits and vegetables, whole grains, and nonfat or low-fat milk and milk products

Fat

Carbohydrates

Sodium and potassium

Alcoholic beverages

Food safety

What is the importance of vitamin A?

Vitamin A, a fat-soluble vitamin, plays essential roles in vision, growth, and development; the development and maintenance of healthy skin, hair, and mucous membranes; immune functions; and reproduction.

How much do you need?

Vitamin A is also called retinol. Measurement of the amount of vitamin A is taken in retinol activity equivalents (RAE). Carotene, an orange pigment found in food, is split by the body to become two active units of vitamin A. This is also important when calculating the amount of vitamin A in the body.

The U.S. Recommended Daily Allowance (RDA) for vitamin A is 700 RAE per day for women and 900 RAE per day for men. The U.S. RDA given is for adults and changes for women who are pregnant or lactating; therefore, please consult your healthcare provider for differences.

A good source of vitamin A contains substantial amounts of vitamin A and/or carotene in relation to its calorie content and contributes at least 10% of the U.S. RDA for vitamin A in a serving.

Do Americans get enough vitamin A?

According to recent surveys by the U.S. Department of Agriculture (USDA), the average intake of vitamin A (and carotene) by an American adult is adequate.

How to get enough vitamin A.

Eating a variety of foods that contain vitamin A (and carotene) is the best way to get an adequate amount. Healthy individuals who eat a balanced diet rarely need supplements. In fact, too much vitamin A can be toxic. Select foods that contain excellent to good sources of vitamin A each day.

Good Sources of Vitamin A

Food

Serving Size

RAE

%RDA men

% RDA women

Sweet Potato

1/2 C

1400

155

200

Carrot

1 medium

1015

112

145

Kale, boiled

1/2 C

240

26.6

34.2

Mango

1/2 medium

200

22.2

28.5

Turnip Greens

1/2 C

200

22.2

28.5

Spinach, raw

1 C

185

20.5

26.4

Papaya

1/2 medium

150

16.6

21.4

Red Bell Pepper

1/2 medium

140

15.5

20

Apricot

3

135

15

19.2

Cantaloupe

1/2 C

130

14.4

18.5

Milk, Fat Free

1 C

150

16.6

21.4

Romaine

1 C

70

7.7

10

Egg, large

1

95

10.5

13.5

Milk, whole

1 C

75

8.3

10.7

Tomato, raw

1 medium

35

3.8

5

Broccoli

1/2 C

35

3.8

5

Green Bell Pepper

1/2 C

15

1.6

2.1

Orange

1 medium

15

1.6

2.1

How to prepare foods to retain vitamin A.

Vitamin A can be lost from foods during preparation, cooking, or storage. To prevent loss of vitamin A:

Use raw fruits and vegetables whenever possible.

Keep vegetables (except sweet potatoes and winter squash) and fruits covered and refrigerated during storage.

Steam vegetables and braise, bake, or broil meats instead of frying. Some of the vitamin A is lost in the fat during frying.

What about fortified foods?

Low-fat and skim milk are often fortified with vitamin A because it is lost during processing. Margarine is fortified to make its vitamin A content the same as butter.

Most ready-to-eat and instant prepared cereals are fortified with vitamin A. Fortified ready-to-eat cereals usually contain at least 25% of the U.S. RDA for vitamin A. Cereals vary, so check the label on the package for the vitamin A content for that cereal.

What is a serving?

The amount of vitamin A in a serving depends on the weight of the serving. For example, ½ cup of a cooked vegetable contains more vitamin A than ½ cup of the same vegetable raw, because the cooked vegetable weighs more. Therefore, the cooked vegetable provides vitamin A, just not enough in a ½-cup serving to be considered a good source.

Food companies label their products according to regulations set by the Food and Drug Administration (FDA). Terms to define a serving of food that has 20% or more of the RDA include: “high,” “rich in,” or “excellent source of” vitamin A. Terms to define a serving of food that contains 10% or more of the RDA include: “good,” “contains or provides” vitamin A. Terms to define a serving of food that contains less then 10% of the RDA include: “enriched,” “fortified,” or “added” vitamin A.

by Jackie Mosure, Dietetic Intern, College of Human Ecology

Vitamin A and Carotenes

I hope you might be able to answer my dietary query. I have recently lost a lot of weight- over 100 lbs. In order to do this, I have been eating loads of carrots, as I need to eat something when I am stressed, which is quite often.
When I recently went to the doctor, they commented that I looked tan / orange. I am, I suppose, eating so many carrots that I am over dosing on beta carotene. I read your Q & A on beta carotene and it was talking about not taking too many vitamin A or beta carotene supplements, but to eat fresh veggies instead. So the question is: is eating loads of carrots bad for me (I probably eat a pound a day)? Do I need to stop completely to get rid of the slight orange tint? How much can I eat and not turn orange? Also, my other veggie of choice is pickled beet root. Will that contribute to my coloring as well? Do I need to stop eating that as well - nightmare! What veggies can I safely eat large quantities of?
I hope you can answer my query. Thank you very much. I enjoyed your Healthy Body Calculator very much, and have recommended it to others.
Hey, big congratulations on the weight loss! You are one success story.
With regards to carrots, yes you can eat so many of them that your skin will turn yellow. One carrot (7 1/2" long) has 2025 RE of vitamin A, which is 203% of your Daily Value. One pound of carrots has 1276% of your RDA for vitamin A. So since you have eaten more than 3 carrots in a day (> 34,000 IU), you have probably saturated your body's ability to store vitamin A over a short time and so it is showing up as an orange tint on your skin. I would suggest you decrease your carrot consumption and increase other low vitamin A vegetables.
Broccoli (1 spear has 232 RE of vitamin A) and other foods high in vitamin A or carotene will do the same, but you would have to eat almost 9 broccoli spears to equal the vitamin A in one carrot. Eat any raw vegetable that you like and try a greater variety. Vegetables higher in carbohydrate and calories like corn, peas, lima beans, winter squash aren't too tastey raw. Try including cauliflower, bell peppers, pea pods, cherry tomatoes and celery and lay off the carrots till the yellow cast to your skin fades. Take a stroll through the fresh vegetable section in your favorite gocery store to find what interests you. Be bold in trying vegetables you've never had like raw jicama.
Is pickled beet root the same thing as pickled beets in your part of the country? If so, they contain 0 vitamin A. Beets may darken your stool, but that is about it. But did you know that 1/2 cup of pickled beets contains 80 calories and 19 gms carbohydrate, mostly as sugar? Don't want to burst your routine if this satisfies your sweet tooth though.
To complete your journey, I would recommend you explore why you eat when stressed. Now that you have been successful at weight loss, do some work on your food behaviors. Don't just continue substituting a low calorie food for high calorie foods when you get stressed. This is difficult work to do poking around in your brain, but you can do it as your self confidence and self esteem is probably stronger now that you have tasted success.

I am a young student presently in the 9th grade. Your site is awesome! I am doing a project in biology class and I chose to do it on vitamin A. Your site was the only one that had some vital information on vitamin A. I was hoping that you could somehow give me some more information on vitamin A. It would be a tremendous help if you could give me some sites with some info on vitamin A. I live in Canada. Thanks for even considering this message.
Hey, thanks.
What is known about Vitamin A at this time is that there are animal sources (retinol) and vegetable sources (carotenes) in foods. Animal sources are about six times more potent than vegetable sources and can be toxic if taken in excess. Because of this, Vitamin A supplements are restricted to carotenes and under limited to under 25,000 IU per pill. One ounce of polar bear liver contains enough Vitamin A (retinol) to kill a person!
Your body uses Vitamin A for growth, healthy skin and cells (epithelial) that line any opening to the body (nose, throat, lungs, mouth, stomach, intestines, vagina and urinary tract) and good night vision. Absorption of vitamin A is dependent on fat from food sources and bile (cholesterol substance produced by your liver and stored by your gall bladder and used to break down fats, seeds and skins). Your body can store two year's worth of Vitamin A in your liver. If you don't eat enough Vitamin A, it can cause blindness or in milder cases, your ability to see or drive at night.
Good food sources are fish oil, liver (pork, lamb, chicken, turkey or beef), eggs, butter and orange or yellow vebetables or fruits. Broccoli is a good source of Vitamin A, but the cholorphyll (green) camoflages the yellow carotene color. If it weren't for chlorophyll, broccoli would be yellow or orange.
Some researchers have found that large amounts of Vitamin A can prevent the development of cancer in epithelial cells and yet other researchers have found the opposite is true. But, if you take large quantities of Vitamin A, your skin and even the whites of your eyes can turn yellow when your body stores for Vitamin A become saturated. If this happens, discontinue the vitamin A supplements and the yellow coloring in the whites of your eyes, palms of your hands and soles of your feet will go away in a few months. If the whites of a person's eyes are yellow and not caused by Vitamin A supplements, they could have liver disease like cirrhosis and should see their doctor immediately.
Hope this info helps your understanding of Vitamin A.
I am taking a vitamin supplement called carotene with 15 milligrams. The label says it can be converted to vitamin A, maximum 25,000 IU Also, I take Stresstabs. Is that too much?
Carotene is a pre-cursor form of retinol vitamin A that your body uses. It is not as toxic as retinol, but at 25,000 IU per day, that is excessive. It equals 4,166 RE of retinol vitamin A. Males (ages 11 to 51+) Recommended Dietary Allowances (RDA) for vitamin A is 1,000 RE and a females (ages 11 to 51+) RDA is 800 RE Why do you feel you need to take more than four times your RDA?
Your RDA of vitamin A could be achieved by eating two or three carrot sticks, one tablespoon of cooked carrots, two tablespoons of cooked winter squash, sweet potatoes or pumpkin, 1/4 cup of dark green leafy vegetables (spinach, beet greens or Swiss chard), 4 asparagus spears, 1/4 cup broccoli, one apricot, 1/2 peach or 1/4 cup cantaloupe. All of these are probably less expensive than your vitamin A pills.
Vitamin A is fat-soluble and is stored in your body along with vitamins D, E and vitamin K. Your body can store up to two years worth in your liver. Levels above 100,000 IU of vitamin A are considered toxic (hypervitaminosis). Loss of hair can occur with megadoses of vitamin A. Excess carotene can cause your skin and the whites of your eyes to turn yellow. I have seen a patient with a jaundice look to their skin and eyes because of excess carotene intake from supplements. Generally, carotene will turn the skin yellow when the intake is above 20 mg per day (about 34,000 IU). The yellow skin tint is most noticeable on the hands and soles of your feet where there is little underlying tissue between the skin and bones. If the carotene supplement is discontinued, the skin will lose the yellow tint.

Your body uses vitamin A for good night vision and for maintaining the health of your epithelial cells. These cells are found in skin as well as lining your respiratory tract and gastrointestinal tract. Research has found that persons who have an adequate intake of vitamin A have a lower incidence of epithelial cancers. Epithelial cells line the lungs as well as the gastrointestinal tract, urinary tract and vagina. Research has not advocated megadosing vitamin A to prevent cancer though. A new Finish research project showed that smokers increased their rate of cancer if they took Vitamin A supplements.
Stresstabs by Lederle are vitamin B complex, C, D and E pills. They do not contain vitamin A. Only your vitamin supplement contains A.
In the early 1980's the FDA restricted the vitamin A content of multivitamin supplements to a maximum of 1,000 RE to limit the possibility of vitamin A toxicity. You can buy vitamin A supplements up to 5,000 RE (25,000 IU).
I would suggest, you discontinue your vitamin A supplements and try eating bright orange or dark green leafy vegetables for vitamin A. Liver is also an excellent source.

By Joanne Larsen MS RD LD

Vitamin A Supplementation

Vitamin A Supplementation

This tool explains the importance of vitamin A to good health and describes the treatment protocols for vitamin A supplementation in the major instances when this may be necessary: among young children who may have a deficiency of vitamin A or who have been diagnosed with chicken pox or protein energy malnutrition, and among postpartum women. It gives the daily recommended safe intake of vitamin A for children and pregnant and lactating women and the estimated vitamin A concentrations in a variety of common foods. It could be used by teachers in the classroom or by those responsible for health services at the school, and/or to develop parent education materials.
I. Introduction
What is vitamin A?Vitamin A is an essential nutrient needed in small amounts for the normal functioning of the visual system, for growth and development, for the maintenance of epithelial cellular integrity, immune function, and reproduction. It is present in foods such as whole milk, breast milk, butter and liver. In addition, carotenoids—substances that can be converted to vitamin A in the body—are present in red palm oil, yellow and orange fruits and vegetables and dark green leafy vegetables.
Who needs vitamin A?Everybody needs vitamin A to protect his/her health and vision. Women who breastfeed especially need vitamin A to help them stay healthy, and to pass vitamin A to their children through breast milk. Young children need vitamin A after they are weaned to help them to grow, develop normally and stay healthy.
Vitamin A helps to protect our health and vision in several ways:
· Reduced severity of infectionsVitamin A helps to decrease the severity of many infections, such as diarrhoea and measles.
· Increased chances of survivalWhen young children receive the vitamin A they need, they are more likely to survive an infection.
· GrowthVitamin A is necessary for growth. Young children have a special need for vitamin A because they are growing rapidly. Pregnant women need vitamin A to help the growth of their unborn child.
· Sight and the eyesVitamin A is vital for the proper functioning of the eyes. The transparent part of the eye, the cornea through which one sees, is protected by vitamin A. If there is shortage of vitamin A, it may be difficult to see in dim light. A severe shortage of vitamin A may result in blindness.
Vitamin A deficiencyThe body cannot make vitamin A, so all the vitamin A we need must come from what we eat. However, the body stores any extra vitamin A we eat to create a reserve for times of need. When the reserve is low, and we do not eat enough foods containing vitamin A to meet our body’s needs, we say that there is vitamin A deficiency. When there is vitamin A deficiency, many infections are more severe.
Vitamin A supplementsVitamin A solution in capsulesYoung children and women who are not getting the vitamin A they need from the food they are eating can be given a concentrated form of the vitamin like a medicine. This is called vitamin A supplementation. Vitamin A supplementation is given by mouth.
II. How to store vitamin A supplements
Vitamin A supplements are more stable than vaccines. However, air and sunlight will damage the vitamin. Vitamin A in the capsules should:
§ be kept out of direct sunlight§ be kept cool§ not be frozen
Vitamin A supplements do not need a cold chainand need not be stored in a refrigerator.
Unopened, vitamin A supplements will keep their potency under good conditions of storage for at least two years. However, once a bottle containing vitamin A capsules is opened, the capsules should be used within one year.
§ Write the date on the label when you open a new bottle containing capsules, so that you will know when to stop using it.
§ Always check the expiration date printed on the label of the bottles of vitamin A capsules.
§ Storage of the 100,000 IU and 200,000 IU capsules (generally of different colours) should be separate and clearly identified, so as not to mix up the two doses.

III. How to give vitamin A supplements using capsules
Using the capsules
Check the label to determine the dose of vitamin A supplement contained in each capsule.
Check the expiration date on the label.
A health worker or other trained person should administer the dose of vitamin A to the child. Make sure that the child swallows the content of the capsule and does not spit out any drops.
Discard used capsules in the appropriate container.
Cutting the capsules
Open the capsule by cutting across the nipple with a clean pair of scissors.
To avoid finger pricks, do not use pins to open the capsules.
Do not open capsules with your teeth.

Dispensing the capsules
Squeeze the sides of the capsule firmly, and carefully drop all the contents of the capsule into the mouth of the recipient.

IV. Giving vitamin A supplements to children
Dosing schedule
Step 1: ScreeningFrom the age of six months, children should be screened to determine eligibility for a dose of vitamin A at all immunization and other health contacts. Eligibility can be determined by checking the immunization or child health card for the last date of vitamin A supplementation. Vitamin A supplements can be safely given at the same time as vaccines.
Step 2: DosingThe schedule for giving vitamin A supplements to young children to prevent vitamin A deficiency is shown in Table 1.
Table 1: Vitamin A Dosing Schedule to Prevent Vitamin A DeficiencyCHILDREN 6 TO 59 MONTHS OF AGEAgeDoseFrequencyChildren: 6-11 months100,000 IU (30mg)Once every 4-6 monthsChildren: 12-59 months200,000 IU (60mg)Once every 4-6 months
Instruct the parent to return with the child for the next appropriate dose of vitamin A supplement. (The health worker may want to give the parent a piece of paper showing the next date of vitamin A supplementation.)
Route of administration of vitamin A supplements:Vitamin A supplements for prevention of vitamin A deficiency are given by mouth. Vitamin A supplements presented in capsules should never be given by injection.How often do you need to give vitamin A supplements?Vitamin A supplements give protection against vitamin A deficiency for a period of 4 to 6 months. Therefore, it is recommended to give a vitamin A supplement every 4 to 6 months to young children who do not receive the amount they need from their food.
Labelling of vitamin A supplements:Preparations of vitamin A supplements are labelled in international units, often shortened to IU. Preparations also may be labelled in milligrams (mg) or micrograms (mg). Always check the manufacturer’s instructions.
Contraindications to giving vitamin A supplements:There are no contraindications to giving vitamin A supplements to children.
Side effects:Usually there are no side effects. However, sometimes a child may eat less for a day, or there could be some vomiting or headache. Advise the mother/parent that this is normal, that the symptoms will pass and that no specific treatment is necessary.
V. Giving vitamin A supplements to mothers
Dosing schedule
Step 1: Screening· Pregnant women and women of child-bearing age: Pregnant women, or women of childbearing age who may be in the early stages of pregnancy without knowing it, should not be given large dose vitamin A supplements (over 10,000 IU). Large dose vitamin A supplements given early in pregnancy may damage the unborn child.
· Women up to six weeks postpartum: It is only safe to give large dose vitamin A supplements (over 10,000 IU) to women of childbearing age within six weeks after delivery. At this time, there is almost no chance that the mother is pregnant.
Vitamin A supplements given to a lactating mother will increase vitamin A levels not only in her own body reserves but also in breast milk and therefore her breastfed newborn.
Step 2: Dosing:Mothers should receive vitamin A supplementation in two doses. The first dose of vitamin A should be provided immediately after delivery of the child at a health facility or during the first postnatal contact with a health worker, and a second dose should be given at least 24 hours after the first dose and within six weeks after delivery. Supplements may also be given daily or weekly in low doses during the first six months after delivery.
Table 2: Vitamin A Dosing Schedule to Prevent Vitamin A DeficiencyWOMEN UP TO SIX WEEKS POSTPARTUMFrequencyTimingDoseFirst dose
Second doseImmediately after delivery
24 hours after the first dose, within 6 weeks after delivery200,000 IU (60mg)
200,000 IU (60mg)Or, DailyUp to six weeks after delivery10,000 IU (3mg)Or, WeeklyUp to six weeks after delivery25,000 IU (7.5mg)
VI. Assuring adequate vitamin A to infants through breastfeeding
When a lactating mother has sufficient vitamin A stores, she passes vitamin A through breast milk to her child and ensures its adequate vitamin A status.
Mothers should breastfeed their children for the first six months exclusively, i.e., without giving other foods or liquids. After six months, mothers should introduce complementary foods but continue to breastfeed for up to two years.
Promote exclusive breastfeeding during the first six monthsand explain the benefits of breastfeeding for both the mother and child.
Advise mothers on how to breastfeed adequately.

Some breastfeeding recommendations are as follows:
§ Mothers should start breastfeeding shortly after delivery (within the first hour).§ Mothers should be instructed on the proper attachment of the child to the breast.§ The child should be breastfed as often and as long as he/she wants, day and night, up to every 2½ to 3 hours or between 8 to 12 times a day.§ Mothers should not give their children any food or drink, including water, other than breast milk during the first six months. Feeding bottles and pacifiers should not be used.§ Mothers should consume a balanced diet and drink sufficient liquids in order to ensure a good milk supply.Frequent breastfeeding is desirable because it stimulates adequate breast milk production to meet the daily requirements of the child.

VII. Vitamin A supplements in treatment of measles
Children with measles infection should be provided high dose vitamin A supplementation. Administration of vitamin A to children at the time of measles diagnosis decreases both the severity of disease and the case fatality rate. Children who live in areas where measles is a common infection should also receive vitamin A supplementation as a preventative measure.
Dosing:
— The first dose of vitamin A should be administered on the day of measles diagnosis, with the exact dosage depending on age.— The second dose should be administered the following day.— When the mother is not able to return for the second dose, she should be given the vitamin A supplement to administer at home.
Table 3: Vitamin A Treatment Schedule During Measles:CHILDREN 0 TO 59 MONTHS OF AGEAgeFirst DoseImmediately on diagnosisSecond DoseNext dayChildren: 0-5 months50,000 IU (15mg)50,000 IU (15mg)Children: 6-11 months100,000 IU (30mg)100,000 IU (30mg)Children: 12-59 months200,000 IU (60mg)200,000 IU (60mg)

VIII. Vitamin A supplements in treatment of severe protein-energy malnutrition
Children with severe protein-energy malnutrition (PEM) are at increased risk of having or developing vitamin A deficiency. Any child with severe malnutrition, showing visible wasting or oedema of both feet, should be given a high dose of vitamin A supplement immediately on diagnosis and referred to the hospital for treatment.
High dose vitamin A supplements should only be administered to children who have not already received vitamin A supplementation within the last four weeks.
Dosing:
— A single high dose of vitamin A supplement, according to age, should be given to children with severe malnutrition immediately on diagnosis.
Table 4: Vitamin A Treatment Schedule During Severe Protein-Energy MalnutritionCHILDREN 0 TO 59 MONTHS OF AGEAgeDoseFrequencyChildren: 0-5 months50,000 IU (15mg)One doseChildren: 6-11 months100,000 IU (30mg)One doseChildren: 12-59 months200,000 IU (60mg)One dose

IX. Assuring sufficient vitamin A through food sources: Dietary diversification
A variety of foods should be eaten every day. Vitamin A can be derived from meat, fish, milk and dairy products and plant foods. Carotenoids, precursors that change into vitamin A in the body, are present in dark green vegetables and orange-coloured fruits and vegetables.
— Vitamin A from animal sources and breast milk is better utilized by the body than carotenoids from plant sources.— Introduce fruit and vegetable home gardens to have better access to a variety of vitamin A-rich foods.— Consume preserved, dried and fortified foods when fresh fruits and vegetables are temporarily unavailable in order to assure a diverse diet year round.
How to prepare foods to increase vitamin A intake:
§ Cut, shred or grind vegetables into small pieces.§ Add a small amount of oil or fat to the meal (½ to 1 teaspoon), preferably canola oil, corn oil or sunflower oil, during mixing and preparation.§ Boil or steam vegetables for a short period of time, preferably with a lid on the pot.§ Avoid long cooking of vegetables under high temperatures.§ Consume foods immediately after preparation, not allowing them to sit for extended periods of time.§ Store fresh fruits and vegetables in a cool and dry place without exposure to sunlight.§ Sun-dry fruits and vegetables as a method of storing and preserving them.
The recommended safe intake levels to meet the vitamin A requirements for infants and children and pregnant and lactating women are indicated in Table 3. Pregnant and lactating women need to consume foods containing sufficient vitamin A for both mother and child.

Table 5: Daily Recommended Safe Intake of Vitamin AINFANTS AND CHILDREN µg RE/day0-6 months 3757-12 months 4001-3 years 4004-6 years 4507-9 years 50010-18 years (male or female) 600ADULTS µg RE/dayPregnant women 800Lactating women 8501 µg RE (Retinol Equivalents) = 3.33 IU vitamin ASource: FAO/WHO, Geneva, 2000
Table 6 indicates the estimated vitamin A concentrations in a variety of common foods.
Table 6: Common Foods and their Estimated Vitamin A ConcentrationsFOOD UNITS µg REMature breast milk (>21 days postpartum)a 500 µg RE/LBeef liver, raw 100g 10,503Carrot, raw 100g 2,813Sweet potato, mashed 100g

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