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Vitamin A-induced cholestatic hepatitis treated with ursodesoxycholic acid
https://pubmed.ncbi.nlm.nih.gov/17924304/
We report a case of intrahepatic cholestasis due to chronic vitamin A supplementation. A 70-year-old woman was admitted to the hospital for jaundice and reduced nutritional and general status with a 2-month history of increasing cholestasis. Some years previously she had suffered from breast and ovarian cancer with subsequent surgery and chemotherapy. Chemotherapy was terminated one month before elevated serum transaminase activities and cholestatic serum markers were noted. Following the chemotherapy, supportive care included weekly vitamin A injections (100 000 IU per injection). Liver biopsy showed an acute toxic liver injury with focal parenchymal necrosis, sinusoidal lesions, inflammatory infiltrate (round cells, macrophages), and activation and proliferation of stellate cells. The hepatic vitamin A concentration was found to be significantly elevated. There were no signs of intrahepatic metastasis or liver cirrhosis. Treatment with ursodeoxycholic acid rapidly improved the cholestasis and led to a total recovery after three weeks
Full article can be found on sci-hub: https://sci-hub.do/10.1055/s-2007-963342
Notably the patient, with 3-4 times greater what is considered normal liver retinol levels, had normal retinol levels in the blood
The patient was given 100,000 IUs of retinol palmitate per week for 10 weeks following chemotherapy before developing symptoms, her gallbladder had been removed over 20 years ago because of gallstones
The patient was treated with the bile salt ursodeoxycholic acid, UDCA, which lead to 'total recovery' after 3 weeks, however a subsequent liver biopsy was not performed
The paper also noted that retinol unbound from the RBP could be toxic to cellular membranes, something that Grant has written about
I wonder if the detox-setback condition has anything to do with cholestasis, suboptimal bile flow, does anybody have experience supplementing UDCA or TUDCA?
Garrett Smith is currently approaching this with using probiotics to reduce secondary bile acids, and foods (like rye) that nurture those beneficial strains. Tartaric acid (grapes) comes into play, also. He also previously and continues to recommend soluble fiber to bind toxic bile to eliminate. He definitely attributes detox setbacks cycles to cholestasis. I have classic presentation of cholestasis, that is evident in retrospect of my history prior to low A diet, but the deep itching started as i added more total fiber as psyllium.
@kurtis I tried 3 bottles of TUDCA with zero result.. I was really disappointed especially because it was expensive as fuck.. I think Rachel is right. I was avoiding soluble fibers and ate low FODMAP diet for a long time and I think it was a big mistake.. I should push through bloating, gas, skin issues and keep eating things like oats to keep detoxing..
@kurtis yes when I have some headache, bloating, gas probably from endotoxin I take tsp of activated charcoal. Always works great.. I also can't eat soluble fiber from pectin like legumes, apples etc.. They give me crazy constipatin and bloating, but I can eat oats and mushrooms with beta glucan. Psyllium husk is also ok, but slows down transit time too much.. Definitely try gluten free oats and mushrooms and psyllium is also good option..
How much fat do you all eat, and what kind?
I've always thought that fat consumption should be an important part of excreting vA because of its control over bile release, and I continue to wonder if those that have problems during the detox, such as cholestasis, are not turning over the bile fast enough because they are limiting fat consumption?
I've stuck with a muscle meat and fat carnivore diet for 8 months trying to detox vA and I don't believe I've run into cholestasis problems. I do, however, get bile acid diarrhea all the time, which is no fun at all (see my recent post for more info). I'm not sure I would recommend my approach to others at this point. But I do think it's working and I think it might be preventing some of the issues posed by the high fiber / low fat approach. I've tried using various binders, including fiber, and they just seem to make my GI problems worse and sometimes aggravate other detox symptoms as well.