From the previous part we covered:

Introduction, rationale and context behind this Self-Meta
Brief history, metabolism, and toxicology of Vitamin A
Highlights and summaries of the (2) opposition views against Vitamin A as an essentiality.

In this part two:

Conflicting sentiments (as further Questions)
How this concern relates to Ankylosing Spondylitis

For the next part (3) I will get to cover

Other confounding factors
Conclusion

Once again, this is Live Draft preview, that which I am willing to share all writing as WIP (work-in-progresses). Non-sequitors, mispellings and the like are all laid on the table.

Live-It-Forward,

AW.

Part 2

How does this relate to Ankylosing Spondylitis / “AS”?

For context, Ankylosing Spondylitis (literally meaning ~ “Fusion” [Ankylosing], “Spine” [Spondy] and Inflammation “litis”) affecting mobility amongst individuals, at least those with a confirmed HLA-B27 genetic expression. Believed to be an auto-immune response it mainly stems from derading disc health on the lower spine, which can be exacerbated under prolonged and intense compound movements.

AS as a autoimmune condition is not just affect the spine. Uveitis / eye inflammation, gut health malaise, and psoriasis have all been documented to have close implications to those with AS.

Specifically on eye health, pinks or redness around the sclera (or whites of the eyes) may indicate sign of inflammation thought to be associated with the AS. A study reviewing eleven sources seem to indicate a correlation with lowered Vitamin D intake with severity of the disease.

Due to lack of symptomatic visibility, stigma persists surrounding access to social support circles.

Suffice to say I am very happy to ably manage, with a decade worth of N=1 interventions from SKD, CKD to now CKD+IF. Though I do have to come to terms that at times ~ flares do still occur but rare in terms of frequency.

Following from my last (major and big) Self Meta on Vitamin D ~ convinced me with the research (see here, here, here and here) ~ suggesting that Vitamin D with Calcium, despite mixed concerns on auto-immunity ~ seems protective.

However in this Vitamin A debacle ~ I am met with more, albeit interesting confusion given the following highlights.

Vitamin A appears to have an antagonistic relationship to Vitamin D (Deanna Minich, 2018).
1. This trial (S. Johansson &, H. Melhus, 2009) looking at daily livers intake amongst Scandinavian males finds reduced Calcium intestinal absorption.
Hypercalcemia seems correlated with serum Vitamin A.
1. This case study (Hammid D et al. 2014) examining a modest amount of Vitamin A (7,000 IU “supplementation”, note – not dietary) daily for 10 years on 67 year old senior female ~ appears to support to this hypothesis. But note this is within the context of impaired kidney function. Inconclusive but suspected that due to “osteolytic” effect in response to the prolonged frequency of the vitamin A supplementation.
Serum retinol levels were compared between healthy controls and those with AS (O’Shea, FD, et al. 2007). Interestingly, the researchers noted a decrease in the AS group.
Similarly, a study (Dougados M et al. 1988) comparing multiple conditions (hyperostosis, AS and rheumatoid polyarthritis) found that serum retinol decreased on AS and Rheumatoid polyarhtritis. Interestingly, serum retinol levels increased on the Hyperostosis group.
A single + double blind trial on subjects with AS supplementing with Vitamin E and A found that only Vitamin E appears to be helpful for pain relief (Mahmud Z & Ali SM 1992). Vitamin A interestingly, was found to be as “not effective”.
A Harvard article on Vitamin A suggests correlation between Retinoic Acid status with increase risk of fractures due to more osteoclast (the “erosion” of bone) activity over osteoblast (the “building”) activity in response to Vitamin A status. This further suggests that calcium is being eroded off the bones, and transfers into the serum.

April May 2024 Update: thoughts Vitamin A versus D ~ exclusion and reinclusion self-experiment.

From April to May 2024 I decided to self-experiment effects between increasing and decreasing Vitamin A intake.

Experimental increase of Vitamin A intake from bioavailable sources (DIY chicken liver pate) OVER Vitamin D. In other words, Vitamin A intake/supplementation: increase. Vitamin D intake/supplementation: decrease.
Reinclusion of Vitamin D supplementation (of 10k IU with K2). In other words, Vitamin D intake / supplementation: increase. Vitamin A intake/supplementation : decrease

TLDR; there is some adverse, but manageable effects.

When Vitamin A status/intake increased, Vitamin D decreased:
detriments / worsening ~ dry/tired eyes, sleep quality and overall stress composure.
When Vitamin A status/intake decreases, Vitamin D increases:
improvements ~ on sleep quality, general eye fatigue improvements .

I would say that the most significant effect is sleep quality. When Vitamin A increased I felt less rejuvenating upon awakening, leading to noticeably increased fatigues throughout the day; hours on end until the afternoons. But supplementing Vitamin D (10k IU per day, usually at night coinciding with my 18:6-20:4 meal intake window) ~ these effects seemed to decrease, or lessen to a degree that is quite noticeable.

On the more subtle and yet more difficult to ascertain is obviously the more extrinsic / environment factors. Obviously, I’d have no control over whether I am staying back late, beyond office hours or (very few occasions) leave at 5PM on the dot. Suffice to say, overall stress composure / QOL quality of life remains difficult to distinguish which Vitamin (A vs D) plays a bigger role.

Obviously not a “controlled” study. But I consider this as data nonetheless in addition and in retrospect to all similar variable intakes of Vitamin A as far as I am able to recall; regardless during carbohydrate allowance days and weekdays 18:6-20:4 low carb with intermittent fasts.

Conflicting Sentiments as Further questions.

So here are a curation of snippets, or should we say, unanswered questions which might be noteworthy for further reading.

Vitamin A interaction with Vitamin D ~ which one is which?

One of many questions pertaining health optimizations, surrounding which key vitamin deficiency(s) play a bigg(er) role to mortality risks.

Vitamin A appears to have antagonist processes to Vitamin D. Mechanism wise, Vitamin A & D appears to compete for the same receptors; suggesting that higher bias of either one, will degrade the other in their utilization. One animal study here appears to have found Vitamin A’s effect directly on calcium absorption. Likewise, Vitamin D council’s (presumably rebranded as “Yippy health“) newsletter dating back in 2017 (captured by Archive.org) detailed a somewhat heated discussion on Vitamin A’s antagonism with Vitamin D; also relating to the use of Cod Liver Oil.

This obviously neccesistates further reading as the relationship appears quite nuanced.

Complete dietary Vitamin A restriction may be impractical.

Despite increasing # of anecdotes concurring with Dr Smith and Grant’s message, so too a few who, despite trialling these extensive exclusion protocols as suggested ~ experienced adverse outcomes. Obviously no names need mentioning, but several insights can be found here.

(minor offtrack) but Important disclaimer: there are many forums whose members do use exact same “handle” or “user names” as my own shortened name and identity ~ be it “Andrew W” or “AW”. I can assure everyone that I am not currently affiliated NOR am I proclaiming I am such-and-such individual(s) residing in these forums. unless explicitly declared that I am such a member. My presence here remains clear for everyone to identify~ be it (thus far) in this website, my own website, and obviously – my youtube channel. I hope this clears any confusions. ~ AW.

Understanding why behind these conflicting outcomes, are obviously difficult to translate for lay reading. Presuming within the safest conclusion that everyone bears an unique response to any exclusion protocols; perhaps the following can derive further reading(s) that may assist at putting things to perspective.

Eliminating all Vitamin A foods can and may predispose deficiencies or inadequacies in another.
Vitamin A still remains throughout history a nutrient praised amongst indigenous and ethnic cultures for centuries.

Eliminating Vitamin A foods can and may also prove challenging as such may invite more problems than they are constructive, or worse – may pose further confusions as a cascading array of unknowns unless one is prepared and very thoroughly patient to assess such a repercussion. For instance foods that are rich in Vitamin A, notably those in animal form (retinyl esters) contain many other non-obligatory essentials. Chiefly among them, eggs ~ containing the much needed pre-methylated choline, are considered vital as it helps in the packaging of Retinol into the RBP / retinol binding protein (48:50).

Should Vitamin A be avoided? (A Self-Meta draft Part 2)