Vitamin D Newsletter

Newsletter

Vitamin A for cancer and acne

Eric from Scotland writes: 


Isotretinoin is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy.

Dr. Cannell: Thanks for all your work on Vitamin D, I have been supplementing with vitamin D and also found a doctor who will test get my blood levels regularly. I am wondering, does the vitamin A drug, Isotretinoin, compete similarly to vitamin A with vitamin D receptors?

Isotretinoin is often prescribed for inflammatory skin conditions; it is supposed to shrink the sebaceous glands and act as an anti-inflammatory, therefore helping acne and rosacea. Do you think it can have similar negative effects as retinol on Vitamin D usefulness? I am quite concerned after reading your February Newsletter: "Vitamin D, Vitamin A, and Cancer".

Many people might be taking or have taken Isotretinoin for acne and I would greatly appreciate your insights on the effects of Accutane (even low doses like 2.5mg/day) on Vitamin D.

Dr. Cannell replies:

For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/mL. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D.

Isotretinoin, or 13-cis-Retinoic Acid (Accutane in the USA), is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy. It may have the same effects on the vitamin D receptor as other retinols. It certainly interferes with vitamin D metabolism1.    

For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/mL. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D.

In 1938, Dr. Merlin Maynard showed vitamin D helped acne more than one of the most effective treatments of all time, x-ray treatment. You can download his entire paper for free2.

Dr. Maynard wrote beautifully: There is probably no skin disease of greater importance to the human race than acne. It is undoubtedly our commonest skin disease, and it is rare that any individual reaches maturity without having had it in one of its phases. It is a disease of considerable economic importance, as the disfiguring scars of a severe case are never completely obliterated. It is also a disease of youth. It attains its most noxious form at the time the individual first has to earn his own living. It is undoubtedly responsible for many failures in getting business positions. It is also the basis for inferiority complexes and discouragement in young people.

Dr. Maynard published a long case series. In his earlier days, he used x-ray treatment for acne, but when he started using viosterol (vitamin D2) he stopped using x-ray treatment. In reviewing his cases, he found x-ray treatment led to favorable results 48% of the time but vitamin D did so 76% of the time; he used between 5,000 and 14,000 IU per day. Vitamin D3 may work even better than D2, if acne patients take adequate doses, like 10,000 IU/day with frequent 25(OH)D levels.

In summary, Dr. Maynard said: I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patients' viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, 'Never felt better.'

In 2008, the mechanism of action of vitamin D in the skin was the subject of a lengthy review3.

Theoretically, rosacea should not respond to vitamin D, just the opposite, but readers have told me it does. However, if you have been on Isotretinoin, it may take months or years for the excessive vitamin A to get out of your system. The excess vitamin A may continue to compete for the vitamin D's receptors attention and, until the vitamin A is gone, one may not see the full effects of vitamin D. By the way, just ask any acne patient if their acne gets better after a week of sunning at the beach.


Susan from Australia writes: 

Dr. Cannell: Why are you against vitamin A? People need to take all vitamins for good health.

Dr. Cannell replies:


As far as vitamin A, the question is, do we get enough in our diet? The answer appears to be that we do, maybe way too much due to widespread food fortification and the use of vitamin A supplements, vitamin A in multivitamins, and cod liver oil.

The body needs all vitamins for good health but this hardly means one has to take all vitamins as supplements for good health. A balanced diet with varied food consumption, including vegetables, seeds and nuts, cold water fatty fish, dairy, red meat, and fruit, will supply almost all needed vitamins with the absolute exception of vitamin D, and possible exception of magnesium, zinc, potassium, and vitamin K2. Remember, nature never intended you to put vitamin D in your mouth; Nature intended you to make it in your skin.

As far as vitamin A, the question is, do we get enough in our diet? The answer appears to be that we do, maybe way too much due to widespread food fortification and the use of vitamin A supplements, vitamin A in multivitamins, and cod liver oil. Beta-carotene is fine but if your multivitamin says retinyl acetate or retinyl palmitate, 5,000 IU, do not take it.

The problem of widespread vitamin A toxicity is so perverse; it includes the monkeys and apes we use in experiments, perhaps those we keep in our zoos. Drs. Joseph Dever and Sherry Tanumihardjo, of the University of Wisconsin, reported that liver biopsies of such primates show evidence of liver damage from the vitamin A. The reason is that way too much vitamin A is added to primate chow4.    

This is an excellent paper for other reasons. Dr. Dever reminds us that blood retinol levels are useless to detect either vitamin A deficiency or vitamin A toxicity, and that the rate limiting step (how the body controls vitamin A levels) occurs with an enzyme in the intestine (carotenoid monooxygenase). The body simply makes the amount of retinol needed from orange-colored vegetables and fruit, but does not make retinol if you do not need it. That is why you can turn yourself yellow by drinking large amounts of carrot juice but you apparently cannot make yourself vitamin A toxic by doing so.

When you take retinyl acetate or retinyl palmitate, or cod liver oil, you bypass this intestinal regulatory system and dump preformed retinol into a closed system that has no good way of getting rid of it. This also explains why many studies from developed countries (where vitamin A toxicity is common) show one does not make much retinol from carotenoids, while studies from underdeveloped countries (where vitamin A deficiency is the rule) show that one does make it.

In 2008, Dr. Anthony Mawson of the University of Mississippi discussed evidence that taking vitamin A, especially during pregnancy, may account for some of the aggressive disorders (like ADHD, irritability, and conduct disorders). In fact, he discusses the numerous case reports associating vitamin A, including Accutane, with aggression5.    

I am no friend of the "lots of all vitamins" crowd. Take what you need and leave the rest, and the only way to know what you need is to do an accurate dietary evaluation of what you are eating.

Page last edited: 05 November 2010

References

  1. Rødland, O. Aksnes, L. Nilsen, A. Morken, T. Serum levels of vitamin D metabolites in isotretinoin-treated acne patients. Acta Derm Venereol. 1992; 72 (3): 217-9.
  2. Maynard, M.T.R. Vitamin D in acne: a comparison with X-ray treatment (Full-text PDF). California and Western Medicine. 1938; 49 (2): 127-32.
  3. Schauber, J. Gallo, R.L. The vitamin D pathway: a new target for control of the skin’s immune response? (Full-text PDF). Exp Dermatol. 2008 Aug; 17 (8): 633-9.
  4. Dever, J.T. Tanumihardjo, S.A. Hypervitaminosis A in experimental nonhuman primates: evidence, causes, and the road to recovery. Am J Primatol. 2009 Oct; 71 (10): 813-6.
  5. Mawson, A.R. On the association between low resting heart rate and chronic aggression: retinoid toxicity hypothesis. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar; 33 (2): 205-13.