Quote from Tricky on September 3, 2024, 11:50 pm

This is Wavy Gravy, posting a final update in case it benefits anyone.

Based on commonly cited nutrition databases, my diet has been extremely low in Vitamin A for 4 years now. 

Reason for trying LVA

I began a LVA diet because I had symptoms in line with those reported for Vitamin A toxicity following years of consuming multivitamins, cod liver oil (fermented and non-fermented), desiccated liver capsules, fresh liver, kidney, eggs, dairy, and enough beta carotene from fresh vegetables to give me carotenemia (orange-hued skin) for more than a year.  Due to lack of consistent correlation between serum levels and symptoms of toxicity in the scientific literature, I never bothered to test my serum VA levels.  Nevertheless, I am extremely confident that most of my symptoms stem from VA toxicity based on my history of intake, changes in symptoms in response to a LVA diet, and likely predisposition to adverse effects of considerable VA consumption from living at high latitudes for 30 years (minimal sun exposure and presumably minimal Vitamin D production).

My LVA Diet

My version of a LVA diet has been a carnivorous one with intermittent trials of other foods and supplements.  I began transitioning to a plant-free diet before deciding to do LVA, so there was a period of several weeks where I was essentially on a High VA plant-free diet before starting a LVA plant-free diet.  I experienced a rapid onset of new symptoms (nausea, diarrhea, headaches, etc.) after starting a LVA plant-free diet that I did not experience during my few weeks on a HVA plant-free diet; therefore, I attribute these symptoms mostly to the removal of VA from the diet rather than the removal of plants.  However, I had been consuming large amounts of oxalates along with VA for years, many of my symptoms are in line with oxalate toxicity, and I had signs of oxalate clearance (the most diagnostic of which was cloudy urine) not long before transitioning to a plant-free diet, so it is quite possible that some of the symptoms I have experienced on a LVA diet are the result of oxalate clearance rather than VA clearance.

With a base of 1.5 to 3 pounds of meat per day (beef > rabbit > lamb > pork > salmon > caribou > chicken/turkey) and supplemented fat (lamb tallow > beef tallow), I have intermittently reintroduced the following for short periods of time (usually just one at a time, always organic and/or locally grown under “organic” conditions):

- white sushi rice (soaked, rinsed, boiled in extra water then drained; up to 1 Cup measured dry per day)

- rolled oats (soaked in ACV, rinsed, boiled; up to ½ Cup measured dry per day)

- parsnip (peeled, boiled in extra water then drained; up to multiple cooked cups per day)

- potato (peeled, pressure cooked in extra water then drained; up to multiple cooked cups per day)

- fruit (avocado, zucchini, blueberries, strawberries, banana, apple, orange, lemon, peach, pineapple; peeled when possible)

- shredded coconut (up to 6 Tbsp per day)

- sugar (sucrose, dextrose; up to 2 Tbsp per day)

- honey (up to 1 Tbsp per day)

- eggs (up to 3 per day)

- butter (up to 4 Tbsp per day)

- supplemental fiber (psyllium, acacia, cellulose; up to 1 Tbsp per day)

- binders (charcoal, bentonite clay, GI Detox product; up to 1 tsp per day).

I’ve also experimented with just about every nutritional supplement possibly related to VA metabolism, usually by Pure Encapsulations, Thorne, or NOW brands (aiming for purity and quality):

- All the B vitamins, both individually (often in multiple forms), and in a complex (methylated forms where applicable)

- C (Ascorbic acid powder, buffered and non-buffered)

- D3

- E (Alpha Tocopherol from sunflower seed oil)

- K2 (multiple forms)

- Calcium (citrate)

- Magnesium (citrate, glycinate, malate, chloride, oxide)

- Potassium (citrate, chloride)

- Sodium (citrate, chloride)

- Zinc (glycinate, picolinate, sulfate)

- Copper (glycinate, sulfate)

- Selenium (citrate)

- Molybdenum (glycinate)

- Iodine (Lugol’s)

- Boron (sodium)

- Chromium (chloride)

- Manganese (glycinate, sulfate)

- Lithium (orotate)

- Glycine

- Taurine

- Lysine

- Inositol

- CoQ10

- Lactoferrin

- Phosphatidylcholine (from soy)

- Yes “Parent” Essential Fatty Acids

- OmaPrem Fatty Acid complex from green mussels

- Melatonin

- Betaine HCL with Pepsin

- Cerule StemEnhance Ultra (AFA + Spirulina extract)

- Probiotics (MegaSpore line, AOR, Seed)

Summary of results on a LVA diet

Put simply, it’s been a total shitshow, literally and figuratively.  One of the first and most lasting things that happened after reducing VA intake was the sudden onset of profuse watery diarrhea, which soon began to burn horribly.  There was often a bright yellow liquid in the diarrhea that I’d never seen previously in my life (and I’d had diarrhea-predominant IBS for 15 years at that point, so I’d seen a lot of diarrhea for comparison).  I eventually concluded that this was most likely due to bile acid malabsorption but am still unclear on the most likely mechanism for this (direct inflammatory effects of retinoic acid on the intestines, or effects of retinoic acid on bile acid production and/or uptake in the ileum, possibly via effects on FXR and FGF19?).  However, retinoids being yellowish in color, I cannot exclude the possibility that VA was responsible for the color.

Over several years, the explosive watery diarrhea gradually transitioned to more formed loose stools that still frequently burn on evacuation.  The yellow color is rarely present anymore, but there is often an orange color instead, frequently accompanied by mucus.  I suspect the yellow color (which is accompanied by more painful burning) is primary bile acid that has been minimally degraded by colonic bacteria, whereas the orange is secondary bile acid acted upon by colonic bacteria.  Speeding up colonic transit with magnesium and insoluble fiber tends to lead to less colonic gas production and more painful watery yellow diarrhea, presumably due to lack of bacterial action.  Reducing fat intake sometimes reduces these problems, but not entirely, and I have become intermittently constipated while maintaining a high level of fat intake, so there appears to be something that rapidly affects bile acid output and/or uptake (assuming bile acids are what causes my diarrhea).  Based on my records, the substances most correlated with a temporary reduction in my GI symptoms are melatonin (3 mg or more), ascorbic acid (350 mg or more), fructose-containing foods, and VA containing foods like butter and eggs.  Some types of fiber and binders seem to reduce the watery nature of the stool, but they usually don’t stop it from burning on evacuation and they often make the situation worse by prolonging the painful transit of offensive substances through the colon (this tends to result in a unique sort of lower back soreness I’d never experienced before).

The other appallingly bad outcome of being on a LVA diet has been severe gum recession.  There have been several distinct periods where parts of my gums have suddenly become inflamed and I can feel them rapidly separate from the teeth, leaving a pocket behind that never reattaches.  The episodes of rapid gum recession seem to correlate with fiber intake, moreso in association with fat intake such as when eating shredded coconut or taking supplemental fiber while eating a high fat diet.  The most recent episode followed consumption of zucchini (peeled and baked) from my garden.  Fiber seems to worsen my symptoms from multiple angles without any clear benefits.

In general, I seem to have developed far more symptoms of VA toxicity after I stopped consuming it: dry/flaking/peeling/burning skin, irritated mucous membranes, sore throat, nose bleeds, headaches, nausea, cherry angiomas and thread veins, joint pain, gum recession, etc. (see a table of symptoms below for more details).  To me, this suggests a surge of toxicity from retinoic acid akin to taking retinoid pharmaceuticals like isotretinoin.  Most of these symptoms have lessened over the 4 years of LVA, but many are still present to a degree that continues to cause significant debilitation.  Virtually none of the dietary or supplemental trials I’ve done have made any lasting improvements in my symptoms, and they have often made them worse.  The only ones that seem to partially alleviate symptoms (ascorbic acid, melatonin, fructose, and foods containing VA) do so temporarily, mostly by minimizing the burning bowel movements and associated GI problems; when I stop consuming these things I tend to get a resurgence of burning and/or watery diarrhea.  I suspect fructose and VA intake alleviate symptoms by slowing the conversion of stored VA to retinoic acid.  Ascorbic acid and melatonin are both antioxidants that may be helping by reducing inflammation.  There is some very scant evidence to suggest they may slow conversion of VA to retinoic acid via effects on dehydrogenase enzymes, but ascorbic acid seems to be reasonably well associated with improvements in ethanol clearance, which suggests it may enhance VA clearance, if it has any effect.

My health outlook after 4 years of LVA

For lack of better explanations (and I’ve tried hard to come up with alternatives), I still appear to be metabolizing excess stores of VA, possibly located in peripheral tissues of the body and the nervous system rather than just the liver.  My experience suggests the metabolism of retinol to retinoic acid can indeed cause lasting and possibly irreversible harm, which is line with the side effects reported for isotretinoin and other retinoid pharmaceuticals.  With all my self-experimentation, I have found absolutely nothing that consistently prevents damage from occurring on a LVA diet after a history of eating a HVA diet.  The only fix I am mildly optimistic about for some of the damage I’ve incurred (namely terrible gum recession) involves stem cell regeneration, possibly enhanced by supplementation of lithium and products like Cerule StemEnhance Ultra.  Exercise may also be helpful in part because of its effects on stem cell proliferation.

My current conclusions on dietary choices for VA elimination

I’ve been carefully documenting my LVA diet using an app, which enables me to look for correlations between food and supplement intake and some of my clearly identifiable symptoms (headache, diarrhea, and other GI symptoms).  My current conclusion is that a diet of skeletal meat and fat from beef or other ruminants is sufficient and likely optimal for eliminating VA from the body, and for living an optimally healthy life in general.  Fiber and binders are not necessary for eliminating excess VA or other metabolic waste products from the body, as evidenced by people following plant-free diets for 5-10+ years who are in optimal health.  In some instances, fiber may enhance rates of elimination of waste products ejected in the bile, and in other instances it may worsen it.  I remain open to the idea that fiber and other binders may enhance VA elimination, but I would never make a blanket recommendation for fiber consumption; more often than not, I would advise against it because of the physiological costs incurred (impeded nutrient absorption, effects on intestinal transit, inflammatory effects to intestinal lining).  Other binders like charcoal and clay also have their place, but I would seriously question the benefits of their long-term use in most cases.

I suspect the majority of xenobiotic plant compounds slow the metabolism of VA through their effects on Cytochrome P450 enzymes.  Consuming spicy foods, herbal teas, and anti-microbial herbal products like Biocidin all appeared to improve my GI symptoms temporarily, followed by a resurgence of diarrhea about 24-48 hours later, although consistent correlational patterns have been exceedingly rare or difficult to identify despite my careful record keeping.

Based on my food trials, the amount of retinol in just 4 Tbsp of butter and possibly as few as 3 chicken eggs, if consumed on a daily basis, may be sufficient to slow/stop the metabolism of stored retinol to retinoic acid.  I’ve drawn this conclusion based on the sudden worsening of symptoms upon initial removal of VA from my diet, and similar patterns observed after removing butter (and eggs, to a lesser extent) following short-term reintroduction.  Butter and eggs are excellent foods in many respects, but their routine consumption is probably contraindicated for someone who has excess stores of VA, particularly if that person is willing to eat sufficient amounts of meat/fat to reach the quantities of choline and other nutrients found in eggs.

It seems clear that everyone would benefit from avoiding ethanol, methanol, and fructose.  I am less sure of the impacts of consuming glucose-forming carbs on VA elimination.  What I can say with certainty is that I crave and am satisfied by fat in a way that far exceeds any desire for or satisfaction from carbs, and I say this after happily eating a ridiculously high carb diet for most of my life. 

Based on current evidence and my knowledge as a professional biologist, the hypothesis that humans evolved as fat-based carnivores with minimal carb intake prior to widespread agriculture is far better supported than any opposing hypothesis.  Optimal health is most likely to follow from living in a manner that is consistent with our evolutionary history and evolved physiology.  Therefore, ruminant meat + fat is clearly the baseline diet that applies most broadly to the human species, even in modern times.  That being said, some people are able to tolerate carbs and plant compounds better than others, and some people clearly live long, healthy lives eating predominantly carbs for energy, so the consumption of carbs does not in itself preclude good health in many people.

Symptom	Prior to LVA	During LVA	Comments
Vertigo / Dizziness	Seldom 10 --> 5	Almost never 1	Have had spells of vertigo that last up to 24 or 48 hours, typically beginning upon waking up and rolling over or sitting up in bed.  Have not been able to determine whether it is a CNS problem or peripheral problem (e.g., Benign Positional Vertigo).  Also had persistent slight dizziness before starting LVA.  Both decreased overall on LVA, possibly due more to clearing of oxalates than VA.
Nystagmus / Myokymia	Constant 10 --> 6	Constant 6	Have had constant sensation of vibration in vision (e.g., staring at borders of objects with high contrast leads to obvious quivering of those borders).  ENT observed nystagmus in association with vertigo, but general problem persists in absence of vertigo.  Was unable to get diagnosis from ENT, ophthalmologist, or neurologist.  Seems likely to be muscular in origin.  No obvious change on LVA.
Headache	Monthly 5	Weekly 8	Headaches focused around temples increased in frequency and severity initially after starting LVA and gradually became less frequent and severe, but still common (one per week on average).
Tinnitus	Frequent 10 --> 5	Intermittent 5 --> 1	Primarily a ringing or constant tone that occurs in one ear at a time and lasts from seconds to hours.  Decreased overall on LVA, possibly due more to clearing of oxalates than VA, although had one awful night after 3 years on LVA when I was temporarily deaf in one year for several hours, then subsided over the next 24 hours.
Night Sweats	Never	Intermittent 10 --> 0	After several months on LVA began to have occasional night sweats so badly that I would soak the bed.  It was disgusting.  Seems to have stopped after 3 years of LVA.
Nighttime Mental Disturbances	Intermittent 5	Intermittent 10 --> 1	Difficult to describe mental sensations that occur only in the middle of the night when trying to sleep.  Decreased in frequency and severity to the point of being almost non-existent after 3.5 years on LVA.
Nighttime Nasal Blockage / Dry Throat / Post-Nasal Irritation	Never	Intermittent 10 --> 3	Blockage of a single nasal passage began occurring in association with other nighttime disturbances on LVA, typically after 3AM.  It can occur to either nasal passage but only one at a time and will be the same one for the duration of a nightly episode.  Disappears by early morning, never occurs during the day.  Can typically blow some mucus out of the blocked nostril but that doesn’t fix the blockage.  Not correlated with side-sleeping.  Have also had very sticky post-nasal mucus form at the top of the throat in the night, and the sensation of a dry throat during the night.
Oily Burning Eyelids	Never	Intermittent 10 --> 1	Started immediately upon initiating LVA.  Eyelids looked and felt oily during the day, particularly upper eyelids.  Fissure formed on upper eyelids, which then cracked and bled overnight.  This improved pretty quickly over the first few months on LVA and is almost non-existent now, but I have recently gotten a milder resurgence of the burning sensation after 4 years of LVA.
Wiry / Curly Eyebrows	Never	Progressive 7	Noticed at some point after starting LVA that individual eyebrow hairs were becoming curled and would stick out at strange angles.  They keep growing back like this after being plucked.  The number of these has gradually increased during LVA.
Dry Eyes	Never	Intermittent 10 --> 1	Started not long after initiating LVA.  In general, lubrication was not an issue, but eyes were easily irritated by dust and I felt as though I could not get the dust out owing to lack of tears.  Very gradually improved and is now fairly rare.
Dry / Flaking Skin	Never	Constant 8 --> 5	Started not long after initiating LVA.  Some areas are much more noticeable than others (scalp, between toes) where there is visible flaking.  Slight improvement but still very much present after 4 years on LVA.
Skin Tags (Small)	Never	Rare 1	A few nearly translucent skin tags have come and gone intermittently around my armpits years after starting LVA.
Nasal & Throat Irritation	Never	Constant 10 --> 1	Started immediately upon initiating LVA.  Nasal passages became extremely sensitive to cold/dry air.  Going outside in winter could be very painful without a face covering.  Gradually dissipated and is now almost non-existent.
Irritation along Side of Nose	Never	Intermittent 7 --> 1	On numerous occasions after starting LVA, one or both sides of my nose have become itchy where the nose meets the cheeks.  There has often been a very thin, straight red line paralleling the contour of the nose in these areas coincident with the sensation of irritation/itchiness.  It reminds me of a poison oak rash, or possibly a herpetic sore that is elongated.  The itching and red line typically last 24-48 hours before disappearing.
Nose Bleeds	Seasonal 5	Intermittent 7 --> 3	I’ve had nose bleeds in winter for most of my life, but the frequency increased dramatically after starting LVA.  They continue to happen intermittently, but have generally decreased in frequency.
Severe Gum Recession	Very Slight 1	Progressive 10	Severe, progressive gum recession started after 6 months on LVA.  This is the worst thing that happened to me on LVA.  Acute inflammation/recession on some upper molars has occurred several times, apparently in association with shredded coconut consumption.  In general, the most noticeable periods of recession have occurred after eating fiber.  The dentist says my gums do not look inflamed, although they bleed slightly more easily than “normal”.  There is minimal sign of bone loss.  I do not have bruxism or clenching problems.  I do not have TMJ problems.  What is causing this?!
Sore Palatal Rugae	Constant 8	Constant 8 --> 5	Front roof of mouth constantly feels like it’s been burned by hot food, has improved slightly on LVA.  Seems correlated with gum recession.
Rapid Plaque Accumulation	Never	Constant 9 --> 2	Plaque began accumulating on my teeth much faster after starting LVA.  There has often been a chunk of very sticky plaque on the face of a front tooth (where saliva pools) that appeared suddenly in less than 24 hours.  I had never seen anything like this before LVA.  I had to start using a metal dental pick to clean it off, a toothbrush wasn’t sufficient.  The plaque seems to have finally subsided after 3.5 years of LVA.
Onycholysis	Never	Constant 8 --> 5	Distal end of fingernails started separating from underlying tissue after 12 months on LVA.  Progressively worsened to about 3 mm, then improved very slightly but is currently not changing.  Also happened on toes to a lesser extent.
Thin / Brittle Nails	Never	Intermittent 10 --> 3	Started around beginning of LVA, worsened considerably for a while on LVA, then generally became almost non-existent although I have recently experienced very soft/thin nails on a few fingers again after 3.5 years on LVA.
Nail Beading / Ridging	Never	Intermittent 7 --> 1	Started around beginning of LVA, worsened considerably for a while on LVA, then became almost non-existent.  A few nails still occasionally show slight beading.
Receded / Lost Cuticle	Never	Constant 7 --> 4	Started around beginning of LVA, worsened considerably for a while on LVA, and has gradually improved.  Noticeably worse on fingers that get used most (right hand thumb>index>middle).
Cherry Angiomas	Rare 1	Intermittent 5 --> 1	Noticed small, flat red spots appear after a while on LVA.  They seem to have come in a few distinct waves, possibly associated with supplementation of thiamine.  They appear to be cherry angiomas and not petechiae.  Most are on my torso, but there are some on my face/eyelid, neck, and legs.  I haven’t noticed new ones in a while, but it can be hard to see them because most are 1 mm or less.
Thread Veins / Broken Capillaries	Never	Intermittent 5 --> 1	Noticed some small thread veins had appeared around my ankles and scattered around other parts of my body after a while on LVA.  I don’t notice new ones appearing anymore, but it can be hard to see them.
Easy Bruising	Never	Intermittent 5	At some point after starting LVA I noticed I seem to be bruising much more easily.  This may have improved slightly but is still an issue.
Dysfunction of the Belch Reflex	Frequent 8	Intermittent 5 --> 1	I experienced an inability to relieve the sensation of the need to burp well before starting LVA.  It feels like I am producing a burp, with air moving up throat, accompanied by gurgling sounds and sensation of air escaping at the top of the esophagus, but it never actually provides relief and the process repeats over and over with discomfort in the upper chest/throat.  This occurs very infrequently now.
Sensation of Lump in Throat	Never	Seldom 5 --> 0	Likely related to muscle cramping, which was present before going LVA but seems to have intermittently worsened on LVA.
Muscle Cramping	Constant 7	Constant 8	The tendency toward muscle cramping was present before starting LVA, but seems to have intermittently worsened on LVA.  Cramping never happens during aerobic activity like cycling, running, or skiing.  It readily occurs when holding some static positions (as in stretching/yoga).  Most common in my flanks and toes/bottoms of feet, but has happened almost everywhere at some point.
Muscle Twitching	Constant 9	Constant 9	Experienced incessant muscle twitching before starting LVA and it has continued unabated on LVA.  Has occurred in almost every muscle group I can think of.
Tremor / Shakiness	Intermittent 5	Intermittent 7	Low-level sensation of trembling across body and inability to hold hands completely still has been relatively persistent before and during LVA.  Sensation of having low blood sugar and being shaky despite having normal glucose levels began during LVA and has worsened over time, feels like reactive hypoglycemia, seems to be best described as postprandial adrenergic syndrome but it’s limited to shakiness and the sensation of being fatigued.  Seems somehow related to protein and carb intake.
Fatigue	Constant 6	Constant 5	Persistent fatigue before and during LVA.  Can still exercise for extended periods and have excellent muscle tone, but it is much harder than it should be and I never feel “light on my feet”.  Body feels kind of like it’s full of lactic acid, but exercise is actually most difficult during the first few minutes of exertion and then becomes easier after several minutes of aerobic output.  Cramping never happens during aerobic activity but will readily occur when holding certain stretched positions (as in yoga).
Afternoon Stomach Ache	Never	Intermittent 9 --> 3	Sometime after starting LVA I began to have a dull ache in the stomach around dinner time, bad enough to force me to lie down.  It only happens between around 5PM and 8PM.  It feels as though my stomach is generating too much acid, which is supported by the fact that some burping often follows.  Dissipates after 30-60 minutes.  Seems more likely to happen if I drink multiple cups of water on an empty stomach.  Has lessened in intensity over time.
Burning Diarrhea / Bile Acid Malabsorption	Intermittent 8	Frequent 11 --> 5	Extremely urgent watery diarrhea started around initiating LVA.  I’m talking seconds to reach a toilet, unable to hold it in.  Diarrhea soon began to burn horribly.  Often happened in the middle of the night, causing me to jump out of bed and run to toilet.  Frequency of watery diarrhea has decreased to almost never after 3.5 yeas of LVA, but I continue to intermittently get loose stools that burn.  It is most likely due to bile acid malabsorption, which I’m guessing is somehow caused by VA metabolism and retinoic acid circulation.  Fiber and binders worsen this condition.
Intestinal Gas in Middle of Night	Intermittent 3	Constant 10	Gas starts accumulating in colon between 11PM and 3AM with gurgling sensation in lower right quadrant.  Typically becomes uncomfortable enough that I have to get up and move around to release it.  Seems to be directly related to bile acid malabsorption, most likely from bacteria deconjugating bile salts in the colon.
Transient “Paralysis” of Distal Colon Muscles / Sphincter	Never	Intermittent 10 --> 6	Inability to pass accumulated gas in the distal end of the colon, but can often force it out by pressing abdomen very firmly.  Almost always occurs after 2AM and stops by 11AM.  Probably related to both bile acid malabsorption and muscle problems.  Closest description I could find in literature is “ileus” (aka pseudo-obstruction).
Yellow / Orange Leachate from Stool	Never	Frequent 10 --> 3	Started around initiating LVA.  Happens regardless of stool consistency, but yellow is strongly associated with burning watery diarrhea.  Yellow or orange color rapidly leaches from the stool into the toilet water and seems to be located mostly on the outside of the stool.  Rarely see pure bold yellow anymore but orange is common, including orange-colored mucus in stool.  Differences in color may be from primary (yellow) vs. secondary (orange) bile acid.  I also had some very green stool early on LVA, which I presume was due to bile.
Light-Colored Waxy Stool	Never	Intermittent 10 --> 3	Started not long after initiating LVA.  Probably a consequence of bile acid malabsorption.  Consistency appears similar to tallow, which I have eaten a lot of on LVA so it could partially be unabsorbed fat.  However, it usually does not float like fat would, and it comes and goes despite little change in the diet, so it seems unlikely to simply be fat malabsorption.  Light-colored stools seem to be associated with faster colonic transit times.