Article from Weston A Price - https://www.westonaprice.org/health-topics/vitamin-a-mazing/#gsc.tab=0

DEFICIENT OR SUBOPTIMAL?

Note that these vitamin A experts do not say that “deficiencies” are linked to several diseases. These authors say “suboptimal status.” So what does suboptimal mean?

We live in an industrialized nation where health authorities commonly believe that we don’t have a problem with vitamin A deficien­cy—that deficiencies are limited to the develop­ing world. A few years ago, I testified to the FDA to protest the fact that they were taking vitamin A off the mandatory food labeling requirement and replacing it with vitamin D. The “experts” don’t think vitamin A is that important anymore. Even when vitamin A labeling was required, most of the vitamin A in the foods labeled prob­ably wasn’t true vitamin A but precursors such as beta-carotene, from fruits and vegetables.

The current thinking is that vitamin D is more important than vitamin A. However, we definitely see vitamin A deficiency, even in the United States, and this has been an ongo­ing problem for a very long time. In develop­ing countries where there is often not enough nutritious, high-quality food, true vitamin A deficiency is very common, leading to much blindness. Almost a half million children in the world go blind every year and half of them die within a year of becoming blind. The United Nations and the World Health Organization are actively working on this along with organiza­tions, like the Bill & Melinda Gates Foundation.

In the U.S. we define vitamin A intake in terms of micrograms of “retinol activity equiva­lents.” (See Table 1.) Note that requirements for men are higher than those for women, although for lactation, it increases to 1,200 or 1,300 mi­crograms. The Recommended Dietary Allow­ances (RDA) is actually higher for small infants than children one to three years of age. Babies need more vitamin A as their cells are dividing and growing extremely rapidly. According to the National Academies of Sciences, Engineering, and Medicine, the organization that sets the RDA for all the vitamins, 95.7 percent of the population will meet its needs by taking this much per day.

It is critical to understand that the RDA was set to take care of the nutrient requirements we have for vision. But there are so many other things that vitamin A plays a part in, and experts in the field are right to ask, does the RDA cover everything that vitamin A is required for?

How are we doing in the United States? According to data from the National Health and Nutrition Survey for the years 2009-2012, between 35 and 65 percent of Americans have intakes “below the EAR.” The Estimated Average Requirement (EAR) is different than the RDA, as the EAR is set to meet the needs of half of the population. The EAR is much lower than the RDA—500 micrograms (1,665 IU) for a woman and 625 micrograms for a man (2080 IU). The assumption is that if everyone in the population consumed that much on a daily basis, half of the people would be okay and half would not be getting enough. But the EAR is a very low bar to meet. In fact, 65 percent of the population doesn’t meet the EAR from food alone. That is 65 percent of people who don’t consume enough vitamin A without non-fortified foods. If you add the fortified foods, we are down to 35 percent not getting the amount specified in the EAR.

So, a third of the U.S. population, eating the standard American diet (or whatever they eat) do not get the EAR of vitamin A—and remember that the EAR is a very low bar to meet. For some reason this isn’t consid­ered a national problem. Has anybody heard of this as a problem? We’ve all heard about vitamin D as a problem, but have we heard anything about vitamin A? Now this doesn’t include intake from supplements, and that does make a difference. But if you’re looking just from all foods eaten, 35 percent of people don’t meet that very low EAR number. This is not limited to the U.S. Twenty percent of people in the developed world don’t meet two-thirds of the recommended intake of vitamin A. They also have lower-than-normal blood levels.

You may wonder how you would know whether you are getting enough vitamin A. The first question to ask is whether your diet con­tains any vitamin A-containing foods. If you eat liver once a week, you are probably fine. Historically, people would eat liver about once a week, as there is only so much liver in an animal. You wouldn’t be able to eat liver every day unless it was specifically set aside for you. You’d have to eat it less often than the other parts of the animal, although there are other animal parts that are good sources of vitamin A—such as the eyes. We tend not to eat the eyes in this country but you could put them into soup. The flesh behind the eyes of fish is rich in vitamin A, so fish head soup would be a good source.

Daily consumption of cod liver oil is very important. Its regular consumption started in the 1800s. You can meet your needs of vitamin A with a good-quality cod liver oil daily. A vitamin supplement that con­tains the retinol form of vitamin A with at least 3000 IU per day would also work for most people, depending on the diet, but if you consume liver or cod liver oil, you don’t need to supplement. Another strategy is to consume two to three servings of pastured dairy, two to four egg yolks, and several servings of red and orange vegetables (orange and red work better than green). That may meet your vitamin A needs but not as consistently as liver or cod liver oil.

We also need to remember that vitamin A is one of the most difficult nutrients to absorb and utilize. Both endogenous (inside the body) and exogenous (outside the body) factors affect how we absorb and utilize dietary sources of vitamin A.

An important question to ask is whether you are eating a lot of lean protein. Are you drinking a lot of protein shakes? Are you exceeding one gram per kilogram of lean protein without the fat-soluble vitamins in it? Too much protein will increase your need for vitamin A. Also, are you taking a supplemented amount of vitamin D on a consistent basis, more than 2000 IU per day? And do you consume a high amount of polyunsaturated vegetable oils? All these will increase your need for vitamin A.

Do you eat lots of high-fiber foods or take fiber supplements? These will bind vitamin A and take it out of your body. And what about vi­tamin A from fruits and vegetables? These contain beta-carotene, not vitamin A. Our bodies can convert some of the beta-carotene in our diet into vitamin A, but ironically large amounts of beta-carotene can create compounds that oppose the action of vitamin A at the cellular level. This is unlikely to happen with dietary beta-carotenes, but it is possible with supplements. In addition, some medications, like steroids, will increase your vitamin A needs.