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January 23, 2017

The Small Dangers of Vitamin A Deficiency

Vitamin A deficiency is the number one cause for preventable blindness in children. It’s a clinical condition that’s strongly linked to socio-economic factors, which is precisely what makes it so difficult to combat. Unfortunately, vitamin A deficiency comes with many other health issues, which you can discover below, along what you can do to prevent it.

Vitamin A deficiencyWho Does Vitamin A Deficiency Affect?


According to the World Health Organization, vitamin A deficiency mainly targets children aged between 6 and 59 months. The category most affected is the one living in underdeveloped places around the globe. The most prominent examples are sub-Saharan Africa (about 48% of cases) and South Asia (44% of cases). The World Health Organization went more in-depth with their research on the topic, conducting a study that revealed an overwhelming reality.

Around 250 million people worldwide already suffered from this affliction as of 2013. What’s more concerning is the fact that these numbers didn’t include children exclusively. The organization discovered that plenty of pregnant women living in similar conditions also bore this diagnosis. Between 250,000 and half a million children get down with this sickness annually. After losing their sight, less than half of them survive long after.


In order to determine the areas that are more likely to be affected by vitamin A-related disorders, the World Health Organization panned out in 1994 a classification method. They analyzed every country and gave them ratings of clinical or subclinical, severe, moderate, or mild VAD. As a result, they declared 75 countries as posing a risk of clinical or subclinical risk. Most of them were countries located in Africa or South Asia.

Country Year Age (months) Sample size Prevalence of clinical signs
Bangladesh 1983 4-72 22,355 4.6
India 1988 0-60 na 1.4a
Indonesia 1992 6-72 18,435 0.3
Myanmar 1994 6-60 14,059 0.8
Nepal 1996 6-35 3,386 1.5
Philippines 1993 6-60 5,049 0.4
Sri Lanka 1987 0-48 32,643 0.5
Viet Nam 1988 0-60 23,782 0.6

Prevalence of clinical vitamin A deficiency (VAD) in Asian countries – SOURCE.

The Deficiency In The United States

This health issue is significantly rare in properly developed countries, but that doesn’t automatically remove the risk level. Low-income American families are prone to vitamin A deficiency because of living conditions and limited access to proper dieting. As always, children are the most vulnerable against this ailment.

Symptoms Of Vitamin A Deficiency


This affliction slowly creeps on to you and starts affecting you gradually. There is a good chunk of symptoms that can raise some flags towards the possibility of this ailment’s development. However, most of them are strongly connected to eye health issues.


The term is used to scientifically refer to what we know as “night blindness.” It’s one of the most crucial indicators that vitamin A deficiency is starting to carve its roots in. When suffering from night blindness, the one affected has trouble distinguishing silhouettes in the dark. What really makes night blindness so dangerous is that someone may easily dismiss or not even notice the changes. During daytime, your vision remains normal and the sight difficulties only make themselves known during nighttime or in dimly lit environments.

This is the result of the effect vitamin A deficiency has on retinol and rhodopsin formation. The latter is a crucial pigment that defines the ability of the retina to adapt your eyesight to dark surroundings. This affliction has a historical legacy, having been documented as an ailment that even Ancient Egypt struggled with. To treat night blindness, Egyptians would use drops from a squeezed lamb river, applied directly into the eyes of the patients.


In most instances, keratomalacia is the next step of aggravation of vitamin A deficiency symptoms. Scholars are still debating what the connection between vitamin A and the maintaining of cornea health is. What is known, however, is that a lack of sufficient vitamin A can end up damaging the cornea by leading to anthropic changes. The process itself ends up affecting several components of your eye and eye pigments. Ultimately, the eye gains an opaque appearance, which is the biggest precedent to blindness.

Other Eyesight Issues

Aside from the widely grave aftermaths listed above, vitamin A deficiency can take its toll on your eyesight in several other ways. It can lead to cornea or conjunctiva dryness. You may start developing Bitot’s spots, which implies abnormal cell proliferation of the conjunctiva. In other words, foamy patches start forming across the white of your eye.

“Lack of vitamin A affects the development of goblet cells in the conjunctiva resulting in accumulation of keratin debris. The Bitot’s spots also demonstrate keratinization, irregular maturation, inflammatory infiltration and accumulations of Gram-positive bacilli. Generally seen as triangular spots, the Bitot’s spots usually have the tip laterally and may have a variable surface. These may be foamy and cheesy whitish lesions and are the most common indicator used to estimate VAD in community.” ( SOURCE )

Some other even more extreme effects include corneal perforation and permanent blindness. Unfortunately, blindness isn’t an uncommon conclusion to those affected by VAD.

Other Health Manifestations

You may detect Vitamin A deficiency through other effects on your general health. Skin, fingernails, and hair are particularly vulnerable to low intakes of vitamin A. Your skin and hair will start growing drier and fingernails will be more likely to break frequently.

What Causes Vitamin A Deficiency?

Of course, it’s incredibly important to know what kind of risk we’re subjecting ourselves to if we don’t ensure the necessary intake of vitamin A. In this portion of the article, we’re not going to go into the chemical details of how the vitamin is connected with maintaining proper eyesight. In fact, it would be pretty difficult given that experts are still debating the precise relation.

Rather so, we need to learn about all the things we can do that can potentially trigger a vicious cycle that will tragically result in the development of VAD.

Aside from children, people that consume lots of low-fat foods are also susceptible. The same applies to those that don’t include enough dark green vegetables, dairy, or liver in their diet. Fat malabsorption as a result of hepatitis or celiac disease can later develop into vitamin A deficiency as well.

Generally speaking, malnutrition and malabsorption are the main sources of vitamin A deficiency. But speaking of malnutrition, here’s something that not many think about. Mothers can greatly decrease the odds of VAD for their children by breastfeeding. You need to be extra careful, though since pregnant or lactating women that suffer from vitamin A deficiency are very likely to pass it down to the child.

A Background Of VAD

18th – 19th Century

The first documented instances of vitamin A deficiency show us that its symptoms can be traced back to as early as the 18th century. Of course, we’ve already established that people of Ancient Egypt suffered from the sight impairments too and tried to cure them with liver juices. However, it was only in late 18th century when scholars started researching the symptoms with medical conviction.

Around that time period, night blindness was a common affliction which posed a lot of issues to the population. Prior to the new discoveries, doctors treated patients with this affliction in a number of relatively primitive curing methods. One particular method involved isolating the patient in a darkened room for roughly one month and treating the eyes with cod liver oil.

Progress eventually came through Hubbenet and Bitot, who took the matter into their own hands and starting delving into the depths of what we now know as night blindness. After research, they concluded with a connection between the ailment and a bizarre manifestation of foamy spots on the white of the eyes. These manifestations would later be known as Bitot’s Spots despite the fact that the initiative of the research was in Hubbenet’s hands. Under the guidance of the two, a new door was opened which welcomed a type of studies. They set the foundation for progress, which would eventually conclude with the discovery of vitamin A and its crucial health implications.

Later, in the 19th century, Magendie would uncover the particularities of nutritional implications in vitamin A deficiency. By restricting the diets of his canine test subjects to sugar and water, he noted the resulting corneal ulcerations.

20th Century

It took several decades of systematic research until the discovery of the specifics of dietary compounds. Studies on laboratory animals unveiled the substances that for a while bore the name “vital amines” until they switched to the term “vitamins.” Hopkins, McCullum, Osborne, and Mendel conducted experiments in which they fed a handful of animals only fats, protein, starch, and inorganic salts.

Compared to the ones that followed a regime which included the necessary vitamins, they encountered difficulties in normal growth rates. Moreover, some harsher side effects could be attributed to this situation too, such as raised susceptibility to infections or even death by overwhelming sepsis. The animals that did survive and live a prolonged life eventually contracted corneal ulceration and ocular inflammation.

While trying to discover ways to prevent and to fight these aftermaths, the researches fed animals accessory factors that can be found in dairy products or cod liver oil. At the end of the routines, McCullum noted the importance of one particularly vital fat soluble which he labeled as A.

Prevention Of Vitamin A Deficiency

One positive, if you will, of VAD is the fact that, technically, it shouldn’t take incredible effort levels to prevent it. However, we can only say this about developed countries. As such, dietary routines aren’t the only factors that weigh considerably in the development of this affliction. Socio-economic circumstances have a say too – and they have a pretty loud voice.

#1 Eating Habits

Despite this, at the end of the day, the simplest way to avoid VAD is through proper dietary habits.

There is a number of foods that are rich in vitamin A and which everyone should include on their plate on a regular basis. For those that have no problem with the consumption of animal products, don’t leave beef liver and eggs out of your diet. The former is an especially considerable source of crucial nutrients.

Plenty of vegetables contain vitamin A as well. Green ones are the most recommended, see spinach, broccoli, and kale for the best examples. Beta-carotene comes hand-in-hand with ocular health, which makes carrots primary players in this race against vitamin A deficiency. Other  healthy foods useful for prevention include sweet potatoes, apricots, butter, or winter squash.

#2 Education Programs

Simply telling one citizen to alter their eating habits to avoid the installment of VAD isn’t of much use in the long run. Naturally, a community that’s riddled with people affected by this ailment is an ineffective community which often blows huge holes in the budget of a country. Labor is considerably more difficult with eyesight issues. And in case the worst-case scenario grows wings, the government will have to gear extra money for assistance for those left blind by VAD.

This is why, whenever we can help it, nutrition tutorials should become the norm, especially in developed countries. At the opposite end, underdeveloped countries suffer from a very particular kind of issue – lack of accessibility. If all the foods we’ve previously mentioned aren’t in the reach of the population, then all education will be for naught if they can’t actually procure these foods.

#3 Health Treatments

While eating habits remain the number one cause for vitamin A deficiency, other illnesses that prevent proper absorption of the nutrients do still exist. Since they vary from case to case, the only way to fight against these afflictions is through communication with your doctor. Establish an eating plan that will prove to be effective and pursue treatments that will allow your body to absorb the vitamin.

A Worrying Conclusion?

There’s really no way to go around this cruel reality: in many cases, vitamin A deficiency is a result of either poverty, lack of education, or lack of accessibility. For this reason, VAD is truly a monstrous affliction, specifically because it’s so easy to prevent. If under these circumstances, it continues to make victims, this only means that the ones affected had and have no means of prevention in the first place.

If you have access to the aforementioned foods and to treatments, prevention is easy. But on a global scale, the causes are deeply rooted in economy, society, and politics.

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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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