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Myth: Serum Retinol is not a useful measurement of subclinical VA toxicity
Yes isn't it , I read it frequently ! I still have a few questions , he would definitely been not in good health with so much Retinol storage , his liver function was not good at all , yet his mobilization was super fast ? How ? He was placed on furosemide 40 mg a day . furosemide is sold under the brand name Lasix , it is a loop diuretic medication . I have taken high doses after a very high dose treatment of dexamethazone . I remember I had lots of edema ( my weight shot up from a 52 kg to 70 kg in a few months and with lasix it went down in two months, came to my original weight ( came with cramps as well , no fun ! ) My question is when he had A toxicity ( paper is about that ) why was he given furosemide? ( not recommending antidiuretic at all but recalling my experience , I took it under supervision of my neurosurgeon)
He also ate a high protein diet , one gram per pound of his weight .
the most surprising fact is he ate around 4000 IU of A food all the time yet his detox was so fast , This makes me think whether doing too much ( soluble fibre, charcoal ) is putting a lot of pressure on the organs . Yes , he still had a lot in him but my guess is as his liver function got better maybe his liver would handle it better ? I think if there was a serious issue even after 12 weeks it would have been mentioned in this paper , so much effort was put in it , with biopsies done
I read Dino's notes many times , in fact saved them , his recovery plan about the woman is mostly water , sunlight , adequate calories , breathing ,only those minerals one is deficient in . She recovered quickly too , and her levels came down .
I wonder if lots of water would act as a diuretic too ?
Does anyone know (or has an idea on topic) if Isotretinoin serum levels (for those who have taken Accutane long time ago) would appear in serum retinol test (blended with it's measurement)? I mean, is serum retinol test reliable for evaluation of eventual circulating levels of Accutane's remains? @ggenereux2014 @tim-2 maybe ?
Hi @grapes,
A serum retinol test is not useful for measuring isotretinoin levels. The basic vA tests are usually designed to measure retinol that’s bound up in the holo-RBPs. Whereas, only research type tests are going to specifically measure Retinoic Acid (RA) / (Isotretinoin) .
More importantly, any RA taken in (say via accutane) will have very quickly moved out of serum and been absorbed by tissue cells. Once inside the cell the RA will then get bound up in a CRBP and also bind to the RNA / DNA where it is going to remain until the cell dies. Of course, most endogenous RA production originates from processes within the cell too, and therefore that RA never makes it into serum. Thus, only very tiny amounts of endogenous RA are ever going to be detectable in serum.
I also think that the regular vA serum levels tests are not very meaningful. These tests are just going to mostly reflect the level of RBPs. For a lot of people their RBP value is going to go up as they start consuming more protein, and possibly also due to their liver starting to reverse its accumulation of retinyl esters.
Additionally, I think that knowing the amount of RA a person has bound up in tissues, and cell structures is also not useful. That’s because there is almost nothing we can do to change that. However, we might be able to do something to help cells to more safely catabolize RA. So, I think that in addition to the near immediate damage that Isotretinoin causes, the long-term concern is the ongoing damage being caused by the depletion / lack of detoxification enzymes and other resources needed to combat our dietary sources of vA and RA.
Thank you for the answer @ggenereux2014 ,
That's a pity the only test we have being unreliable. I was reflecting on my experience, I was following very low vitamin A diet for 2 years and my serum retinol levels tests were consistent with it, in lowish range after 1 year, and about 50% below the minimum after 2. However my symptoms didn't follow at all linear reduction. It looks more like while I was on the diet it helped because I was avoiding some irritant foods, but when I'm off the diet (still quite low vitamin A) there is no more this benefit. So (in the case the test is somewhat meaningful) that leaves me with two hypothesis
- retinol from food source went dow, but I still have high toxicity from stored isotretinoin (it should be in liver cause I don't have visible body fat)
- my symptoms are due not to remaining isotretioin toxicity, but to the damage it (or other things) have done. I'm thinking of leaky gut, or disturbed detoxification. (like detoxification enzymes you mention).
@are Yes the results being volatile is a possibility too. To know for sure the testing should be more extensive, and that's impossible for us simple patients to do. For me I felt like it wouldn't be good to stay on the rice/beef diet for more time, my iron levels went too high. Blood donation wouldn't be a good option being underweight. I also saw worsening in some areas. I still avoid high vitamin A foods though.
@are I agree it’s frustrating not having a good marker for progress. Serum retinol seems to correlate with detox rate I think until body fairly depleted. I’m now looking at worsening symptoms and/or new symptoms as detox progressing at a rate which is too much for my body. I’m currently feeling worse so am asking myself what have I changed? What do I need to support? I’ll let you know when I’ve come up with the answer!! My aim is a slow detox that doesn’t overwhelm the body. I’m seeing any new symptoms as a clue to a bottleneck. This is just me. Some people seem to want to go fast & push through. Some people are better detoxers.
How I speed up detoxification of retinoic acid:
- Vitamin C (cabbage, potato, supplementary amount optional from half a Berocca)
- Vitamin E (I get it from almond milk)
- There is a patented cure for Hypervitaminosis A which contains a few of the B vitamins (beans, meats, potato, cabbage, whole grains, egg yolks, mushrooms, supplementary amount optional from half a Berocca)
- High UVB sunlight (I live in a subtropical location with good sunlight year round)
- Meat, eating a range of meats including chicken, pork and fish helps to get plenty of K2 and zinc
- Cabbage is very good as it is high in K1 but low vA
- Smoking, I smoke one Manitou organic cigarette per day (highly controversial but the number one way to deplete retinoic acid)
It hasn't given me any negative effects, just feels good. I put it in the same category as getting some sun and doing exercise haha.
Btw, with regard to hair growth this is a very interesting paragraph:
These studies demonstrated that retinoids have a major impact on theca cell androgen production and steroidogenic enzyme gene expression. This effect was observed with atRA and 9-cis RA as well as retinol, suggesting that theca cells are capable of converting retinoid precursors to biologically active retinoids. The differential response of CYP17, CYP11A1, and STAR gene expression to retinoids in normal and PCOS theca cells further suggest that PCOS cells may have intrinsic differences in their ability to respond to retinoids as well as synthesize retinoids. Therefore, it is possible that stimulation of androgen production by retinoids may contribute to ovarian hyperandrogenism in PCOS. In general, the pathways involved in cell-specific retinol and retinoid metabolism are not well known, particularly within the ovary. Further studies are necessary to determine the pattern of expression of enzymes involved in retinol metabolism/retinoid synthesis in ovarian cells and their functional significance in retinoid action in PCOS.
https://academic.oup.com/jcem/article/90/8/4858/2838533
This confirms what I've suspected which is that Hypervitaminosis A can lead to hirsutism, MPB and excess sebum production by upregulating androgen production. Yuck.
Quote from tim on February 23, 2021, 8:57 amFurther studies are necessary to determine the pattern of expression of enzymes involved in retinol metabolism/retinoid synthesis in ovarian cells and their functional significance in retinoid action in PCOS.
I probably could have been diagnosed with PCOS if I had tried.
It IS hard to go on like this (long term), and not know what the status is, and several people have posted lately about it.
It's a commentary on the world as it is right now that more research isn't being done with this idea. (no one will get rich off of this idea and it's not covid lol)
And also commentary on how adamant people are that veggies are good, LOL. My family and friends know I've tried so many special diets, but this one, out of all, gets the weird looks. Sure, drop meat! Drop bread! Drop fats! Drop dairy! but God help us DON'T DROP VEGGIES!!!!