IU vs RAE

Have you noticed a little change on nutrition labels?  Vitamin A used to be listed in IU’s (International Units), but is being changed to µg RAE (Retinol Activity Equivalents).

Apparently Vitamin A is more complex than initially thought. There’s so much more to it than eating carrots for good eyesight!  Vitamin A is still fat soluble. It’s still important for vision. It is also critical for things like immune function and modulating inflammation – especially important if you have an autoimmune disease!  What’s changed is what we know about how Vitamin A is metabolized.

  • animal sources contain pre-formed Vitamin A (retinol & retinyl ester)
  • plant sources contain many different kinds of pro-vitamin A carotenoids, including but not limited to:
    • alpha-carotene
    • beta-carotene
    • beta-cryptoxanthin

Our bodies bio-convert all of these nutrients so that we can use the active form of Vitamin A: retinal (and retinoic acid).  It turns out that what researchers have learned about this process led to the change in units from IU to RAE.  There’s a difference in how nutrients convert depending on their source. Confounding the researchers, when looking at IU’s, foods supposedly containing the same amount of Vitamin A can metabolize to vastly different amounts of usable retinal, which means that there isn’t a simple conversion factor to use to change all IU’s to RAE’s.1 Although we absorb about 70-90 percent of pre-formed vitamin A from animal sources, carotenoids are a different story. Plant-based Vitamin A is not metabolized nearly as well.

Consider two foods that many people consider disgusting:  kale and liver.  Both are good sources of Vitamin A, yet the nutrients look quite different between the old and new units of measure.

Kale (1 C = 67 g) 10,302 IU 515 mcg RAE
Beef Liver (2 oz) 9,600 IU 2,805 mcg RAE

IU’s make it look like kale has more Vitamin A, but when we look at how much retinal our bodies get to use from these foods, a serving of liver has more than five times as much.

Vitamin A & Autoimmunity
For years, some people have suggested that autoimmune diseases are caused by nutrient deficiencies.  Nutrition is especially important to people with autoimmune diseases.  In the case of Vitamin A, we need sufficient amounts for our bodies to work correctly. Unfortunately, sometimes people think that they can just take a handful of vitamin pills instead of eating properly. It doesn’t work that way.  We need to consume plenty of Vitamin A-rich foods if we’re to be as healthy as possible.  Vitamin A is needed to do many things, including:

  • form natural killer cells
  • increase phagocytes to fight infection
  • increase anti-inflammatory cytokines

Why the Change in Units?
The newer research about how bioconversion takes place indicates that some people are not getting nearly as much Vitamin A as they thought since not all IU’s are metabolized the same. Switching to RAE’s is better because it gives us a more accurate picture of the nutrients our bodies actually get to use.

One cup of kale provides 74% of the Recommended Daily Allowance for Vitamin A, while a two ounce serving of liver (because, honestly, who can stand to eat much more than that?) is well over the RDA and nearly to the tolerable upper limit (UL).

Yep, there’s an upper limit.  Just as it is important to get enough Vitamin A, it is also important not to get too much.  Toxicity can result from excessive intake.  Vitamin A toxicity is more common when people are taking supplements, but can happen through dietary intake, too, generally from excessive amounts of liver. I find it slightly ironic that eating too much liver can be harmful to our livers.

Symptoms of toxicity are numerous and can include headaches, dizziness, nausea, joint pain, peeling skin, and in extreme cases coma, or even death. Severity depends on how much Vitamin A was ingested, and how fast. This theory says that symptoms would be more severe for a person who eats 5,000 mcg in one sitting, compared to a person who eats 1,100 mcg three times a day. Am I a terrible person for thinking that anyone who eats 4 ounces of liver shouldn’t be surprised that it makes them sick?

Curiously, excess plant-based Vitamin A is not toxic. The most-reported symptom is orange skin. I know someone whose baby loved carrots and ate so many that his face turned orange.  Skin returns to its normal color when plant-sourced Vitamin A consumption is reduced.

So how much is enough, and how much is too much?
According to the current research, dietary needs increase as we grow.  Adult men tend to need more than adult women (probably because they tend to have larger bodies).

Vitamin A Recommendations2

Do you ever wonder if people are just throwing darts at a dart board in making these recommendations?  At least 700 µg RAE every day?! Are they out of their ever-lovin’ minds?  People would have to quit their jobs and spend all their time menu planning & cooking in order to find a way to get that much Vitamin A on a regular basis!

How Do We Get Vitamin A?
We can get some Vitamin A from plants. The best plant sources are bright orange or leafy green.  Carrots and sweet potatoes (but not yams) have the most, followed by foods like kale, turnip greens, dandelion greens, radish leaves, and cantaloupe.

However, the Vitamin A from plants is in the carotenoid forms and isn’t metabolized very efficiently. We’re supposed to get animal sources, too.  If you don’t consume dairy or eggs (which is now recommended by many), that means liver. Beef liver. Chicken liver. Liverwurst. Foie Gras. Braunschweiger. Cod liver oil. Liver is an excellent source of Vitamin A.

Don’t eat too much, because toxicity – mentioned previously – is a real thing. One source recommends limiting liver to six ounces per week, maximum.

From a Vitamin A standpoint, it’s not even necessary to eat that much liver.  We could actually get our entire RDA of Vitamin A by eating half an ounce of beef liver daily.  Or bring back the practice of taking a daily spoonful of cod liver oil.

Liver Nutrients

But don’t get stuck in a rut.  We’re actually supposed to get our nutrients from a variety of sources instead of eating the same thing every day.  The USDA’s FoodData Central website has nutrient information on pork liver, veal liver, lamb liver, turkey liver, goose liver, duck liver, sea lion liver, walrus liver, and even moose liver —  but not elk or deer, which are livers that I actually have access to. Go figure.  Anyhow, what it comes down to is that unless you’re eating a ton of vegetables, you should probably eat liver, but a little bit goes a long way.

If you’re curious about the actual amounts of Vitamin A in veggies:

WahlsXAIP Bright Orange2

 

WahlsXAIP Leafy Greens

By comparison, other veggies don’t have nearly as much Vitamin A2. They do, however, contain other nutrients, so don’t neglect them:

WahlsXAIP Bright Red

WahlsXAIP Bright BlueBlackPurple

WahlsXAIP Bright Green

WahlsXAIP Sulfur-Rich

So there you have it.  Switching the units from International Units to Retinol Activity Equivalents lets us look at nutrient information and know how much Vitamin A our bodies will actually be able to use.

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For Further Reading:

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1Converting from IU’s to RAE’s:

  • For meat and eggs (retinol sources), multiply IU by 0.3 to find mcg RAE
  • For fruits and vegetables with beta-carotene, multiply IU by 0.05 to find mcg RAE
  • For fruits and vegetables with alpha-carotene or beta-cryptoxanthin, multiply by 0.025 to find mcg RAE

2Nutrient info is from the US Department of Agriculture’s FoodData Central website, glycemic load information is from Self’s NutritionData database. Color groups shown are based on Dr. Terry Wahls‘ research, wherein she recommends eating 3C of leafy greens, 3C of brightly colored (try to hit more than one color), and 3C sulfur-rich foods daily. I have omitted nightshades and legumes because they are disallowed in the elimination portion of Wahls and AIP. Legumes didn’t make the re-intro cut for me (not a problem since I’m allergic to soy and probably peas and peanuts), and the only nightshade I really do okay with is tomatoes if they’re organic (but I react to standard store-bought tomatoes). More than you ever wanted to know, but that’s what determined what’s on the lists.

Immunocompromised in the Age of COVID-19

So that I am able to walk and lead a somewhat normal life instead of being confined to a wheelchair, I take medicines which have numerous side effects, one of which is to suppress the immune system.  When exposed to germs, my immune system is less able to fight disease than it did before I took these medicines.  I look perfectly normal, and unless I tell you about my medical condition, you would not know that I’m not perfectly healthy.

I have dealt with this situation for a dozen years now, and am frankly tired of people who have become experts by watching the news and reading online blurbs for a few months telling me how to protect myself.

Guess what?  I have gotten quite adept at protecting myself from inconsiderate people who go out into the community when they are sick, spreading their germs when they ought to be home recuperating.

  • I carry hand sanitizer and use it after interacting with people. I’ve done this for eleven years.
  • When I enter a grocery store, I wipe down the handle of the cart with one of the wipes that are available in a little stand at the door (they’ve been there for years, but suddenly other people are discovering them). I dispose of that wipe and grab a second one to use on my hands after I’ve selected my produce.  I grab a new wipe in the meat department after I’ve put meat in my cart.  I sanitize my hands after I get to my car.  This is not new.  I’ve done it for years.
  • I eat nutritious foods instead of junk. That means I usually cook at home instead of going out to eat.  You’d be amazed at what a difference it makes.  Really.  There is a ton of medical info about the link between nutrition and health.
  • If I go somewhere and someone shows up sick, I distance myself. Depending on the situation, I have been known to suggest that the sick person ought to go home and stay in bed instead of getting everyone else sick – and after that, I make a point of inquiring if that person is healthy before gatherings, explaining that I don’t associate with people who won’t stay home when they’re sick. It makes the point quite well and raises awareness within the entire group, which results in people calling and saying they can’t make it when they’re contagious, which results in everyone being healthier.
  • If I attend a meeting, I carry sanitizing wipes (Clorox, Lysol, etc.) and clean the table where I’m sitting to reduce my exposure to germs. I don’t make a big show of it; it can be done unobtrusively, and there are people who have talked with me while I’m cleaning the table who don’t realize that’s what I’m doing.
  • I have given up some activities, such as teaching Sunday school, because the germ exposure is too great.
  • I do my grocery shopping in off-hours, so there aren’t as many people around, thus limiting my potential exposure.

Other people have different strategies depending on their needs.  When my daughter was in college, she carried Clorox wipes in her backpack and always wiped down her desk/chair in every classroom.  I talked with a teacher once who taped a line on the floor around her desk, and kids in the class knew that if they had a cold, they had to stay outside that line.  The point is that people who need to protect themselves already know how to do so. There are many invisible illnesses similar to mine. You might be surprised at how many people are on immunosuppressing medications.  We find ways to cope.

The current situation means that it’s no longer socially acceptable to be out in public when you’re sick, and I think that’s a good thing.  But I should not have to stay home when I am not contagious just because it will assuage your conscience and make you feel virtuous, as if you’re protecting me.  Decisions about how I protect myself should be a private matter between me and my doctor.

Grocery Shopping is different now. There used to be only 2-3 people in the store in the mornings.  Now, the parking lot is half-full at 7 a.m. when the store has special shopping hours set aside for those who are at-risk.  Didn’t all these people care about germ exposure before?  I like the idea of one-way aisles, not so much for social distancing, but for the improvement in traffic flow.  I’ve heard that some stores police the entrance and ban people not wearing masks, but have not encountered that myself.

Churches in my state are preparing to begin meeting again.  And while I understand that church leaders have a difficult task with voices coming at them from every side, sometimes I wonder if they’re bothering to listen to any of those voices, or if they’ve already made up their minds and don’t want to be confused by the facts.  Frankly, I am fed up with people who know nothing about being immunocompromised telling me what to do.  I research on reputable medical sites, and take medical advice from my physicians, not from pastors.

Recently our church leadership made an announcement, which I’m guessing they think is compassionate, but is not. It is offensive.

When we do come back, I want you to know that we will follow the CDC guidelines.  We need to do that.  We need to make sure we are doing our part, that we are a good witness to the people in and around us, and even in our community. 

And I want to say this:  if you are medically vulnerable or fragile, please, you’re gonna need to stay home for the live-stream at first, for a little while.  We just need to be careful.

We need to be careful?  Is there a mouse in your pocket?   am already careful.  My presence is not going to make anyone else sick.  The presence of other healthy people is not going to make me sick.  Wouldn’t it make more sense to tell sick people that they need to stay home?

Since when do we announce to people that they aren’t welcome in our churches?  I feel like I’ve been told that I’m not wanted, and that despite my dozen years of experience in living life immunocompromised, suddenly the ignorant opinions of people who know nothing about it matter more than people who actually know about the situation.

Furthermore, this is discrimination.  The CDC doesn’t merely talk about those who are medically vulnerable.  What they talk about is those at increased risk.  Are we going to have bouncers instead of greeters at our church doors, telling fat people that they need to stay home?  Having a BMI over 40 lands you on the at-risk list.  Will the bouncers be asking for ID, carding people and turning away everyone over 65? They’re on the at-risk list.  There is no excuse for singling out those with medical conditions and telling us that we need to stay home.  Either say nothing, or include everyone who is at risk.

The pastor’s statement tells me that the people making these pronouncements have not actually read the CDC’s website, because the CDC is quite clear that they are not telling people what to do or issuing directives to churches.  It’s not legal for them to do so.  The CDC offers “general considerations” and allows churches to make their own choices.  Shouldn’t pastors do the same and allow congregants to make their own choices?  The CDC recommends offering options (not mandating them).  Dictating that one small subset of the at-risk population needs to stay home is vastly different from offering options to all those who are at-risk and letting people decide for themselves.

CDCandTheChurch

Credit: CDC Website

We are adults, not two-year-olds.  Allow people to exercise some personal responsibility.  People with no experience and no qualifications need to quit dictating how others ought to protect themselves from germs.  People who are immunocompromised have multiple doctors they can consult about this issue, and are perfectly capable of protecting themselves.  I’ve been sick less in the past dozen years of being immunocompromised than I ever was when I was “healthy” because I pay more attention to preventing the spread of disease.  Let’s quit pretending that people are somehow safer at home.  Don’t tell people they aren’t welcome in church.

If you are immunocompromised, then talk to your doctor about what steps you need to take.  Do not get your information from google or instagram or news reports.  There are a number of articles, both for physicians and patients, in the COVID-19 section of Up-to-Date‘s website.  According to Up-to-Date, rheum patients on immunosuppressants are not at increased risk from Covid-19.  Other reputable sites include American College of Rheumatology and  European League Against Rheumatism.  I especially like Johns Hopkins‘ list of what patients can/should do and not do.  Nowhere does any medical site tell healthy patients to stay home.  That’s politicians practicing medicine without a license. Grocery stores, churches, and other places setting policies need to allow people to consult their doctors and make their own decisions. Stop listening to politicians for medical advice.

Why is it politically incorrect to tell people that they’re wrong?

Recently someone posted a video, essentially saying that everyone needs to wear a mask so that she feels safe and respected. Her partner does, so the whole world should, too.

No.

First, it is incredibly selfish for one individual or group to say that the whole world needs to change to accommodate them.  Count me as one immunocompromised person who does not want everyone wearing masks. I would not dream of expecting the rest of the world to cater to me.

Second, before 2020 we already knew a lot about masks and how they do/don’t work.  More has been learned in the past few months.  If you feel safer by making everyone wear masks, then you’re not paying any attention to the facts.  If you want to wear an N95 mask to protect yourself, go for it (and I would when going to a doctor’s appointment), but the rest of the world shouldn’t have to put their health at risk just to give you a false sense of security. There are risks to wearing masks.

Telling the whole world that they need to wear a mask to accommodate your unique needs is astonishingly self-centered.  It’s not all about you.