The Vitamin A Toxicity Epidemic – Dr. Garrett Smith | Episode #150

Published on September 25, 2024 by Mike Roberto | No Comments

Dr. Garrett Smith, known as the Nutrition Detective, joins the PricePlow Podcast to discuss his journey into the world of vitamin A toxicity and its connection to numerous health issues. This is an impactful episode, as we’re learning how damaging this fat-soluble class of molecules is — especially when consumed in excess over time — and how difficult it is to remove from the body.

Dr. Garrett Smith: Vitamin A Toxicity on the PricePlow Podcast

Is there a Vitamin A Toxicity EPIDEMIC? Dr. Garrett Smith joins the PricePlow Podcast for Episode #150 and dives into the dangers and symptoms of Vitamin A toxicity — and how to detox it for better overall health. We also get into the dangers of calcification and joint pain from vitamin D3 supplements, making for a very informative and potentially controversial episode.

Dr. Smith is having tremendous success in supporting those who begin restricting and detoxifying vitamin A, relieving numerous health maladies from basic joint pain and skin conditions to reversing kidney, liver, and thyroid diseases. Followers of his program are also having great success in areas of fertility.

Dr. Smith also shares his views on vitamin D supplementation and its potential negative effects, which is how Mike started to follow him in the first place, having noticed that vitamin D3 (cholecalciferol) supplements were contributing to his joint pain. At the end of the episode, Mike explains that he’s been restricting vitamin A and D since January 2023, with incredible success.

Vitamin A: An extremely toxic family of molecules in excess

The conversation explores the pathway of vitamin A in the body, from its sources in plants to its conversion into retinaldehyde, retinol, and retinoic acids, and the toxicity of all of these molecules. Dr. Smith also explains the liver’s role in filtering toxins and producing bile, as well as the importance of bile in detoxification.

Sadly, there’s no commercially-available lab test to determine vitamin A toxicity, since retinol is kept in a tight homeostatic range in the blood and the rest is kept in the liver, but the men discuss ways to determine that you may be having some subclinical issues without getting a dangerous liver biopsy.

Introducing Toxic Bile Theory

The concept of toxic bile theory is introduced, which is a new paradigm/framework on health and disease that explains how countless diseases are caused when toxic bile damages the liver and leaks into the bloodstream.

Low Vitamin A Diet

Nutrition Detective Logo

Dr. Garrett Smith is known as The Nutrition Detective

The low vitamin A diet includes avoiding organ meats, pork, dairy, eggs, and high vitamin A plant foods. Animal protein sources like red meat and poultry are preferred. The diet also includes white or light-colored plant foods, cooked beans, whole grains like oats and barley, and select fruits like bananas, apples, green grapes, and pears.

In the final part of the conversation, Mike and Dr. Garrett Smith discuss their personal experiences and perspectives on nutrition and supplementation. They touch on finding balance, the role of minerals in the body, and the benefits of removing toxins from the body rather than adding more supplements.

Dr. Smith also shares information about his Love Your Liver Program and the testing and consultation services he offers, and he sells an incredible mineral supplement called Keystone Minerals that Mike gives to his family, as well as a very popular topical magnesium lotion.

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https://blog.priceplow.com/podcast/dr-garrett-smith-vitamin-a-toxicity-150

Video: Learn about the Vitamin A Toxicity Epidemic with Dr. Garrett Smith

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Detailed Show Notes: Dr. Garrett Smith on Vitamin A Toxicity

Detailed Show Notes are in Progress!

  • 00:00 – Introductions

    Mike and Ben welcome listeners to the PricePlow Podcast and introduce their guest, Dr. Garrett Smith, who Mike has followed for nearly two years now.

    Dr. Smith’s background is introduced, focusing on his expertise in health, nutrition, and detoxification. He comes from a background of strength training, having begun weight lifting at age 11. This led to nutrition, and he realized how food affected his health.

    He was a personal trainer, got a degree in physiology and a minor in chemistry and nutrition. He worked in a supplement store, then headed to naturopath medical school.

    Dr. Smith has now been practicing for 18 years, and explains many “phases” that everyone goes through, blaming numerous factors for their diseases (heavy metals, carbs, etc).

    The main topic of discussion is revealed: Vitamin A toxicity and its potential effects on health, and how the liver and bile are connected in sickness.

  • 03:45 – Discovering Grant Genereux’s Work on Vitamin A Toxicity

    Dr. Smith mentions a Canadian engineer named Grant Genereux who went through chronic kidney disease, jaundice, and brutally painful eczema. He was heading to dialysis, but then realized that nearly all “eczema foods” were all high in vitamin A! So Grant decided to go on a very low vitamin A diet consisting of just beef/bison, white rice, and beans.

    Grant’s jaundice, eczema, and kidney disease completely went away once he eradicated vitamin A from his diet. He wrote two books, Poisoning for Profits and Extinguishing the Fires of Hell.

    After reading half of Grant’s first book, and connecting vitamin A with many of his patient’s issues, Dr. Garrett Smith realized that he had to change everything he was doing.

  • 06:30 – Reconsidering Vitamin D Supplements (Calcification and Joint Pain)

    This wasn’t the first time Dr. Smith had reversed course on using a vitamin/supplement/nutrient. He did the same thing with Vitamin D3 (cholecalciferol) in 2013, after realizing through his patients’ hair mineral tests that:

    • Vitamin D3 supplements raise calcium levels
    • Vitamin D3 supplements lower potassium levels
    • Vitamin D3 supplements induce hypothyroidism

    Dr. Smith claims to be “one of the most anti-vitamin D supplement people out there”. He doesn’t think it’s good for people.

    He states, if you have a lot of pain:

    1. Get off of the vitamin A supplements
    2. Get off of the vitamin D supplements
    3. Stop eating nightshades (which also contain calcitriol, the active vitamin D)

    Give the above three a chance for a month and watch pain go down.

    Knowing that our listeners may be caught off guard hearing that vitamin D is toxic, Ben asks Dr. Smith to rewind a bit and go deeper.

    While we do need sunlight and ultraviolet light, do we know that it’s through oxidized cholesterol as cholecalciferol? People have been sold an assumption about this, and it doesn’t pan out in the research when you just give cholecalciferol to unhealthy people.

    Vitamin D raises the calcium levels in the blood. It either increases calcium absorption from the gut, or it’s going to take it out of your bones. Men have been shown to have lower bone density after 3 years of vitamin D supplementation.[1]

    Vitamin D overdose induces hypercalcaemia.[2-8] He instructs everyone to look up Vitamin D bone resorption. Ultimately, if you’re stiff in your joints, cracking/popping, increase magnesium (the anti-calcium) and remove vitamin D3. Think about it: X-rays look for calcium. Mammograms look for calcium. Calcification is a problem – most diseases involve it.

    Calcified Tissue International?!

    Hilariously, while looking for citations in these show notes, we found a paper titled “Is high dose vitamin D harmful?” that is published in a journal literally titled “Calcified Tissue International”.[9]

    Dr. Smith isn’t into ingesting fat-soluble (fat-storable) vitamins and/or metabolites. We should let the body control metabolite production.

    So getting patients — and himself — off of vitamin D started helping everyone feel better. He tells a personal story about how he became constipated from his over-dosing of vitamin D.

    The whole point is that this was a mea culpa where Dr. Smith had to reverse course, and it wouldn’t be his last.

  • 15:00 – Improving Health with a Low Vitamin A Diet

    Back to Grant Genereux’s work, despite being a doctor, Dr. Smith was still having issues with BPH (benign prostatic hyperplasia — enlargement of the prostate gland), insomnia, lower back pain, and a bit of psoriasis. Urinary and prostate issues at age 25 were certainly concerning given the fact that his dad had died of prostate cancer.

    After taking vitamin A out of his diet (but not to the extreme that Grant goes), avoiding eating liver at all costs, and stopping vitamin A / beta-carotene supplements, his health began to greatly improve. And so did his patients who also followed this recommendation.

    Fast forward to 2024, Dr. Smith has been restricting vitamin A consumption for six years, and Grant recently celebrated ten years with extremely little vitamin A consumption.

    The onslaught of vitamin A is fierce. We get it from:

    • Cosmetics
    • Supplements (beta-carotene, cod liver oil, liver pills)
    • “Eat the rainbow”
    • Eggs
    • Dairy

    Note: Mike will later point out some of the data on beta-carotene, cod liver oil supplementation, and heavy egg consumption that shows a lot of increased disease.

    The toxicity can get handed down via pregnancy. The more toxic someone becomes, the slower their detoxification is. One thing not mentioned here that we missed is how glyphosate slows retinoid metabolism as well![10-12]

  • 19:30 – Vitamin A and Carotenoids

    Ben gets to interject and ask a bit more about Vitamin D, but also asks a general question — are all carotenoids bad?

    Dr. Smith first says that there is no such thing as a zero vitamin A diet. It would be too unhealthy, there are just not enough foods and they’d have no other nutrition. He doesn’t think carotenoids are necessary, he’s not convinced it’s essential. FDA doesn’t really support any health claims with them.

    In general, it’s just a math problem — we want the amount we’re ingesting to be less than the amount we’re excreting.

    Dr. Smith will later state that there is no animal-based vitamin A in the world without carotenoids first. Provitamin A carotenoids (beta-carotene, alpha-carotene, and β-cryptoxanthin) are the precursors.

  • 23:15 – More on Vitamin D, Sunshine, and Health Effects

    Back to vitamin D, another general issue: are studies talking about levels, or are they talking about cholecalciferol consumption? Dr. Smith agrees that someone with higher vitamin D levels and isn’t supplementing will have better health.

    However, there are numerous reviews showing that vitamin D supplementation doesn’t have that many net benefits and the research shows unconvincing, mixed results, with very little in terms of outcomes in terms of bone mineral density, fractures, mortality, and disease.[1,8,9,13-22] For instance, higher blood vitamin D levels often leads to lower bone mineral density,[18,22] contrary to popular belief.

    Those who eat carotenoids have been known to turn orange,[23-25] and liposuction patients who try to “eat healthy” have fat that looks orange. There are also recently-discovered genetic conditions that could make hypercalcaemia worse.[26,27]

    What does sunshine do? Dr. Smith claims that it oxidizes vitamin A, and that his patients get less sunburnt over time.

    Vitamin A and D are also antagonistic to each other.[28] So are we “vitamin D deficient”, or are we really vitamin A toxic?!

    But the big issue is when we start supplementing metabolites. These are fat-soluble, fat-storable molecules! More is not better. The liver is forced to store these!

    He then makes fun of a prominent doctor (Dr. Ken Berry) who said that the liver doesn’t store toxins,[29] which is verifiably false and has been known for a very long time.[30-32]

  • 27:45 – What is Vitamin A? The Biochemistry of Vitamin A and Carotenoids

    Mike notes that the FDA allows for a lot of things to be labeled as Vitamin A:[33,34]

    • Beta-Carotene / β-carotene
    • Alpha-Carotene / α-Carotene
    • β-cryptoxanthin
    • Retinol / all-trans-Retinol / “Vitamin A”
    • Retinaldehyde / “retinal” / all-trans-retinal / vitamin A aldehyde
    • Retinoic acid / tretinoin / all-trans-retinoic acid / Vitamin A acid / (sold as Retin-A)
    • 13-cis-Retinoic acid / Isotretinoin / (sold as Accutane)
    • 9-cis-retinoic acid / Alitretinoin / (sold as Panretin, used in chemotherapy)

    The first three, beta-carotene, alpha-carotene, and beta-cryptoxanthin are the “plant vitamin A” — these are provitamin A molecules that get converted into retinaldehyde, which gets converted into retinol, what we really consider vitamin A.[30,35-37]

    Note that beta-carotene, the most prominent provitamin A carotenoid, gets converted into two retinaldehyde molecules.[38,39] Further, the scientific community often hides the retinaldehyde’s molecule’s identity as a toxic aldehyde by calling it “retinal”.

    “There is no vitamin A anywhere — animal, retinol, retinoic acid — without carotenoids first.”

    Other similar molecules, like lutein and zeaxanthin are not provitamin A — they don’t break down into retinaldehyde, although they do activate the “retinoic acid receptor”, or RAR.[40]

    Dr. Smith doesn’t like the term “retinoic acid receptor” though, because it can be stimulated by many compounds, not just retinoids and carotenoids. It can even be stimulated by nothing![CITATION] There are over 7500 retinoic acid receptor agonists – a very promiscuous receptor.

    Back to beta-carotene, it gets chopped into two retinaldehyde molecules — and anyone who knows nutrition knows that aldehydes are not good for us (acetaldehydes cause hangovers, formaldehyde, etc). It can go backwards into retinol, or forwards into retinoic acid:[37]

    Vitamin A Metabolism

    Retinol gets stored in the liver fat as retinyl esters. Why? To get it out of the blood. If you have too much in the blood, free retinol is known to be extremely toxic. It’s stored because we can’t get rid of it fast enough.

    Then you get into the retinoic acids, which can be excreted in various ways:[41]

    1. Retinoic acid / tretinoin / all-trans-retinoic acid / Vitamin A acid / (sold as Retin-A)
    2. 13-cis-Retinoic acid / Isotretinoin / (sold as Accutane)
    3. 9-cis-retinoic acid / Alitretinoin / (sold as Panretin, used in chemotherapy[42])

    Below is a more detailed image:[41]

    Vitamin A Food Metabolism

    If you ever hear the list of accutane side effects, it’s downright awful, ranging from IBS[43-45] to headaches[44-46] to depression,[43,47,48] to suicide ideation and attempts![43,47,49-51] It also causes horrific birth defects (teratogenic).[43,52-55]

    Retin-A isn’t much better, with studies showing significantly increased mortality![56,57]

    And if you eat beta-carotene, you do get elevated levels of 13-cis-Retinoic acid / Isotretinoin / Accutane.[41,58]

    Taking Retin-A and Accutane are such disasters because they’re metabolites — like vitamin D3 supplementation, ingesting metabolites forces the body to deal with something it would have previously had control over.

  • 35:15 – Retinoic Acid Toxicity – A Deadly Chemical Peel

    Dr. Smith explains how toxic retinoic acids are — they are used as chemical peels, dissolving the top layers of skin. These are actually called “controlled wounds” for the skin![59] It’s dissolving cells. It comes out of the bile in your food, and causes tons of the intestinal problems we talk about — leaky gut, for instance.

    When you ingest the food, the retinoic acid you metabolize will inhibit the amount of future retinoic acid produced in the body.[60] This is a cautious, negative feedback loop. While this does slow down detox, it protects you from further toxicity.

    But if you take retinoic acid as a medicine directly, you override that feedback loop. And you can get stuck here without a lot of work. For example, Dr. Smith sees patients who have had dry eyes from Accutane for thirty years.

    Then there’s the big veteran’s study, giving them Retin-A for their faces. They shut the study down because so many veterans were dying![56] And they had already filtered out the veterans who thought they were going to die.

    You can absolutely get vitamin A toxic through the skin.

    Ben then asks about how much Accutane gets created when eating vitamin A foods, Mike points to the two metabolic studies cited above.[41,58]

    By taking retinoic acids, your body cannot send it backwards (see the pathway maps above), so all it can do is slow down the ALDH (aldehyde dehydrogenase) enzyme that would create more of it. But this slows down all detoxification!

  • 41:30 – Assessing Vitamin A Toxicity, a Scientific Catch-22

    The two commercial lab tests available to us are serum vitamin A and retinol binding protein 4 (RBP-4, what binds to vitamin A), but these do not indicate toxicity! Serum retinol is kept in a tight homeostatic range,[61-65] and RBP-4 follows with it (and sometimes goes down if your zinc and protein levels are too low).

    The only way to truly assess toxicity is a liver biopsy[61,66] or radioactive tracers[67-69] – most people don’t want to do either of these. The vitamin A simply stays in your liver, where routine blood tests won’t detect it.

    Dr. Smith mentions a case study where a patient had liver problems, his serum retinol was only 17 or 18 (anything under 20 is considered “vitamin A deficiency”), so his doctors ordered a liver biopsy and his liver stores were through the roof.[70] They gave him a “normal diet” and he was able to normalize serum retinol and RBP and begin mobilizing it again. The doctors also point out that protein deficiency was also holding him back.[70]

    Serum retinol is simply not good to test.

  • 45:15 – What is the Liver, and What is Bile?

    Dr. Smith claims that this is the most overlooked part of medicine. Many people think of it as a sort of “detox organ”. The liver definitely makes tons of proteins, but that’s not the goal of this conversation.

    1. The liver is a filter. By definition, a filter takes something out of something else, and the liver does exactly that. It takes stuff out of the blood.
    2. The liver is a sewage processing plant. It takes compounds and turns them into other compounds.

      Those compounds are not always less toxic, though. Sometimes, through biotransformation, it creates compounds that are further intoxifying (common example being acetaldehyde being more toxic than alcohol when you drink).

    3. The liver stores endproducts, at least until they can be disposed of. In the research, you’ll see the word “accumulate”, not “store”.

    The above three points are Dr. Smith’s concerns in terms of liver function and health.

    So how does the liver excrete the processed and stored end products? It puts them into the bile. People seem to think that the liver makes things “magically disappear”, but it needs to be removed — often via urine, stool, sweat, etc. Using the skin as a detox organ can be quite damaging.

    The bile is the most toxic fluid in your body[71] – it’s how your liver gets rid of its waste. Your liver poops bile into the intestines, you need to poop that all out in your stool. But around 95% of bile acids recirculate back to the liver.[72]

    Since you can’t get rid of 100% of toxins right away, it’s paramount that you stop ingesting toxins in the first place.

  • 50:00 – Toxic Bile Theory

    This brings us to “toxic bile theory”, a term that Dr. Smith coined to describe a new paradigm on health and disease.

    Not mentioned in the podcast, but this was originally pioneered by a researcher named Anthony Mawson who published several papers, connecting modern diseases to bile “spillover” from the liver into the serum, from flu to glioma to gulf war syndrome to rubella to the disease state known as “COVID”.[73-77] He actually first made the connection in 2009 when looking at chronic aggression and low resting heart rate from retinoid toxicity.[78]

    In general, toxic bile theory states that when the liver becomes cholestatic (cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired), the bile ducts get damaged and the bile begins to “spill over” into the bloodstream. This liver damage is often (but not always) caused by excess retinol stores, but can also be from copper toxicity, vaccine injury, and several other things like excess fructose and/or seed oil metabolites (more toxic aldehydes).

    Vitamin A toxicity has been shown to cause cholestasis.[79]

    So if you’re in this state, and bile is flowing where it should not be, leading to the various manifestations of vitamin A toxicity (headaches, joint problems, fatigue, skin conditions, etc.. more are described below), then what do you do?

    1. Facilitate removal
    2. Provide nutrients (particularly minerals) to help protect itself and run detoxification

    The above two are the basis of what Dr. Smith works on.

    Mike backs things up to make sure it’s all clear, and the guys dig a bit deeper into bile and stool. One manifestation of cholestasis is constipation. Dr. Smith discusses a study where constipated individuals have less bile in their stool than normal, who have less than those with diarrhea.[80]

    Having less bile coming out makes it more concentrated, making for a terrible negative feedback loop.

  • 55:45 – How to Generally Fix the Problem

    So how do we turn that negative feedback loop into a positive one?

    1. Stop putting the toxins in. Stop intoxing before you worry about detox.

      The biggest debate is what is a toxin. Dr. Smith clearly believes is that the fat soluble vitamin A family is a main culprit.

    2. Start supporting removal

      Dr. Smith likes soluble fiber, but you have to watch your amounts, start slowly, and use ones that agree with you. He likes psyllium husk, SunFiber, beta-glucan, apple pectin, beans, oats, barley.

      Research shows that apples are the healthiest fruit — it has a white flesh, not yellow, low in vitamin A, and the pectin is very beneficial. It’s a bold claim, but there happens to be a ton of research on apples.[81-93]

      Activated charcoal is also a big part of Dr. Smith’s program, and we joke that it’s basically completely unknown in America, while Europeans know it quite well. It’s a great detox ingredient with several benefits.[94,95] Charcoal soaks up bile,[96] but doesn’t trigger more bile, so taking too much can lead to constipation.

    Preferably, we detox through the stool. But if toxic bile gets into the bloodstream, the kidneys get hit next (this is what caused Grant Genereux’s problems), and after that, it’s generally the skin.

  • 1:02:15 – Vitamin A Toxicity and Subclinical Vitamin A Toxicity Symptoms

    Since we’re not going to get a liver biopsy to determine vitamin A toxicity, how do you know if you’re potentially toxic or subclinically toxic? Mike asks this, segueing from the skin discussion above, since skin problems are most common.

    Once you understand toxic bile theory above, you realize that the symptoms could be anything. However, skin issues, gut issues, and eye issues are the most common signs of vitamin A toxicity. There’s also anxiety, depression, and lethargy.

    The best overall chart of symptoms is actually to look at the list of accutane side effects,[43] shown on this image:

    Isotretinoin (Accutane) Side Effects

    “Overs” vs. “Unders”

    People generally get overweight and insulin resistant, but there are some people who get very underweight. The latter of these two — chronically underweight — is actually worse. You will see these two patterns on lab tests, too. Dr. Smith calls the people who run high as “overs”, and the people who run low/underweight as “unders”. 95% of the people he sees are overs.

    LDL cholesterol — the “bad cholesterol” — carries retinol.[30,97,98] Dr. Smith sees that LDL is often high on vitamin A toxic individuals, and the research shows that LDL (low density lipoproteins) are forced to carry retinol when RBP-4 production breaks down.[97,98] This has been known for over 50 years: LDL does a very poor job of retinol transport compared to RBP-4, leading to highly damaging effects from these poorly-bound retinyl esters.

    Triglycerides also go up when high vitamin A is given to animals or humans.[99-102] Note that Accutane also causes triglycerides to go up.[103,104] Take it away and it goes back down.

    Then there are the commonly-measured liver enzymes, ALT, AST, GGT, Alkaline Phosphatase (ALP), lactate dehydrogenase. Yet these numbers don’t always manifest even when there are liver function problems. Researchers and doctors call this “silent liver disease”.[105]

    People who were born jaundiced have a lot of liver problems, Dr. Smith states that this very often vitamin A toxicity. Mike mentions that he had heard this on Smith’s Nutrition Detective Livestreams on YouTube, relating a personal story and how this revelation was a foundational learning moment in his life.

    But a jaundiced baby isn’t a death sentence, it just means you started from behind — it can be fixed.

    Skin color changes are also signs of vitamin A toxicity. Mike jokes about the well-known case study, “Carrot Man”,[24] which describes a man with carotenemia.[25] This also happens in Zambia, a country that is over-fortified with vitamin A — the children turn orange during mango season.[106]

    Once the skin turns orange, the research indicates that this is basically hypervitaminosis A.[106]

Detailed Show Notes are in Progress!

Where to Follow Dr. Garrett Smith (@NutriDetect on Twitter)

Thank you very much to Dr. Smith for spending the time to educate our audience.

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About the Author: Mike Roberto

Mike Roberto

Mike Roberto is a research scientist and water sports athlete who founded PricePlow. He is an n=1 diet experimenter with extensive experience in supplementation and dietary modification, whose personal expertise stems from several experiments done on himself while sharing lab tests.

Mike's goal is to bridge the gap between nutritional research scientists and non-academics who seek to better their health in a system that has catastrophically failed the public. Mike is currently experimenting with a low Vitamin A diet.

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References

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