Lubbock hospitals have reported some measles patients showing signs of Vitamin A toxicity. Here is what you need to know about Vitamin A and measles.

What is Vitamin A?

We all have Vitamin A in our bodies. It helps with our vision, bone growth, cell development and immune system. This vitamin is naturally found in a lot of our food. Vitamin A deficiency is very rare. Most people have one to two years’ worth of Vitamin A stored in our livers!

Less than 1% of people in the United States have a Vitamin A deficiency.

Putting too much Vitamin A into our bodies at once, like with a supplement, can be harmful.

Taking Vitamin A supplements, especially at the dosages some people are recommending on social media, will likely cause Vitamin A toxicity.

A deeper look

Vitamin A is stored in the liver. The liver releases the right amount of Vitamin A into the rest of our bodies as needed. But when there’s too much Vitamin A, our bodies cannot process or store all of it. This can throw many of the body’s systems off. Too much Vitamin A flooding the body can cause vomiting, dizziness, blood clotting issues and liver damage.

For more detailed information about how this works, check out this article.

Toxic doses

Some social media posts recommend doses of Vitamin A that are dangerous.  Even a one-time high dose can be toxic. Our bodies can only handle so much Vitamin A at once.

Main takeaway: You and your child do not need to take Vitamin A, and taking it can cause harm.

Symptoms of Vitamin A toxicity

Acute toxicity happens when someone takes a toxic amount of Vitamin A.

• After 12 to 24 hours of toxic dose: headache, nausea, vomiting, lethargy, blurry vision, muscle and joint aches, dizziness.
• Chronic toxicity happens when someone takes too much Vitamin A over a period of time. These symptoms include:
• Skin lesions, skin lesions, dry and cracked lips, painful joints and muscles, fatigue, depression, anorexia, poor muscle control, alopecia (hair loss), visual impairment, blood clotting issues and liver damage

A deeper look

Where did this misinformation come from?

When someone has measles, their Vitamin A levels decrease. Because of this, people with the measles are sometimes given Vitamin A to make sure they do not develop deficiency.

But taking Vitamin A does not prevent measles. It should not be taken without a doctor’s recommendation.

Main takeaway:

Vitamin A supplements can cause toxicity in people, especially children. Some people urging people to take Vitamin A on social media are recommending doses that are far too high to be safe for children.

Vitamin A should only be taken at your doctor’s recommendation. The most effective and safest prevention against measles is the MMR vaccine. The MMR vaccine has helped keep us safe from measles for decades.

If you have questions about measles, the MMR vaccine or Vitamin A, talk to your doctor.

But, here goes …

Our intestines are full of bacteria that help us to break down food products and whose function has an effect on immunity and possibly allergies. These bacteria can be called “probiotic” organisms.

1.What are probiotic/prebiotic supplements?

Probiotic bacteria can be given as a supplement which can be mixed in with foods, beverages or given as a supplement (similar to a vitamin).

Prebiotics are substances which, when ingested, help to increase the number of probiotic bacteria in the colon. Prebiotics are typically small chains of sugars that humans cannot digest or use. They can be ingested in beverages or nutritional supplements and are even added to some formulas.

2.Are they safe?

Studies suggest that the use of probiotics is safe in healthy infants and children. However, some patients might be at risk:

Children who have abnormal immune systems such as ill preterm babies or children with implanted catheters (or other medical devices) should consult with their doctor because infections have occurred as a result of giving probiotics in these groups. Studies have also shown that adding prebiotics to infant formula is safe.

3.What conditions do they work for?

Infectious diarrhea (stomach bugs)

Some evidence suggests taking probiotics might prevent cases of infectious diarrhea, particularly in day care centers, but the effect is very small. It would take about seven kids taking the probiotic daily to prevent just one case of diarrhea, thus I don’t recommend use of probiotics to prevent diarrhea.

Once diarrhea has started, there’s pretty good evidence that starting probiotics may decrease the time of a child having diarrhea by as much as 40 hours. So it would seem good to provide probiotics at the first sign of infectious diarrhea. The effect was greatest with a probiotic known as Lactobacillus rhamosus GG (LGG).

Antibiotic associated diarrhea

Diarrhea is a common side effect with children who are taking antibiotics. Studies have shown that taking may decrease the child’s risk of developing diarrhea. Once again, the effect is small as it takes seven kids taking the probiotic to prevent one episode of antibiotic associated diarrhea. However, because it only requires the child to take the probiotic during the course of the antibiotic, this seems like a reasonable approach. Treating antibiotic associated diarrhea once it has already started does not appear to be helpful.

4.What conditions might they work for?

Eczema and allergies

Studies have been mixed on the use of probiotics for both prevention of and treatment for allergic diseases (including eczema). One of the major problems is that these diseases often are difficult to study because they are difficult to define and assessment for improvement is often subjective.

Colic

Some early data suggested that probiotics might be helpful for infants with colic. This is also very difficult to study as definitions for colic are wide and varied. It’s hard to even know if colic is a real, definable illness or just a baby that cries a lot. Further information and studies would be necessary in order to fully recommend probiotic use.

5.What’s next?

As we learn more about the normal bacteria that live in our intestines and how variation of the amount and type might contribute to disease, I’m hopeful that we’ll continue to see conditions for which probiotics are safe and effective.

That's one of the most common questions I get while doing my AMAs on our Willow Park Pediatrics Facebook page. 

The answer I give, most of the time, is - nothing.

Here's a few points about vitamins. Short and simple.

1. If your kiddo eats a well-rounded, healthy diet, they don't need a daily vitamin. This means meats, milk, veggies, fruits, and whole grains daily.
2. If your kiddo has a "bad day" - a.k.a. a chicken-nugget, mac-and-cheese kinda day, offer a simple chewable children's multivitamin that day.
3. Limit your child's milk intake to 20-24 ounces or less per day. While we love the calcium and Vitamin D in milk, it hinders the absorption of other vitamins, like iron, and fills kids up so they don't eat the other foods they are supposed to eat.
4. Large doses of certain vitamins can actually be harmful. Be careful of natural websites/naturopaths who claim "megadoses" of vitamins can cure ailments. Be especially careful with kids, as there is lacking research about this and some bad side effects can happen.
5. If your child is a vegan or a vegetarian, or allergic to milk, they need a daily vitamin. Talk to your pediatrician about this.
6. Certain medical conditions require vitamin supplementation. Think food allergies, GI tract disorders like celiac and Crohn's, and endocrinologic (hormone) problems. Talk to your doc.
7. Vitamins can have SIDE EFFECTS! Yes! Vitamins! For example, B vitamins are associated with night terrors and nightmares. Other vitamins can cause nausea, dizziness, vomiting, headaches. They're similar to medications, folks - yet not as strictly regulated by the FDA - and you have to be careful with them.

Cook Children's published a good article about vitamins a few years ago. Check it out!

Hugs,

Dr. Diane

About the Author

We give vitamin K supplementation as an injection in babies following birth to prevent a condition called Hemorrhagic Disease of the Newborn. This devastating condition was, prior to the institution of the supplementation, a significant contributor to infant death, which ravaged society in the pre-twentieth century period. Vitamin K is necessary to make the clotting system in humans work properly. It basically allows clotting factors to be turned on so they can work correctly. As children and adults, we get most of our vitamin K from our diet (eat your green vegetables!) and surprisingly from bacteria, which normally live in your intestines. These bacteria process the components of food which we don’t, and produce the vitamin as benefit to us.

This vitamin dissolves in fat so adults generally store it well. Infants however do not have a good storage or supply of the vitamin. The placenta does not transmit it to the infant well and breast milk has very little vitamin K in it. Newborns also have no bacteria in their intestines to produce the vitamin; so, the end result is, without good storage of this vitamin, infants are at risk for severe bleeding problems. While this can present in the first week of life as bruising and bleeding from the umbilical cord stump, the most devastating effect is bleeding inside the brain which can occur up to 12 weeks after delivery.

Most of this bleeding risk can be avoided with an injection into the muscle of vitamin K at the time of birth. This provides a source of this valuable vitamin to tide the baby over until intestinal bacteria build up enough to produce the vitamin for the baby. As far as dietary sources, breast milk does not encourage the bacteria which produce this vitamin to grow well. Formula is supplemented with vitamin K, but importantly the different sugars in the formula do encourage the bacteria to develop, but it takes time.

Parents often hear stories about the vitamin K injections causing side effects, particularly a risk for cancer later in life (this was related to an old version which had a chemical called phenol in the formulation and never proven even when it was in there), worsening jaundice (again an old formulation used in the mid -twentieth century) and possible liver damage (which can happen from a large overdose, but highly unlikely with the standard amount given to infants).

Some have proposed alternatives methods as the safest and most effective means to administer vitamin K, generally giving the vitamin by mouth to the baby. The big problem with this strategy is absorption of the vitamin is not guaranteed in infants so we have to give a large dose for a long time to do this. With high doses over a long time you do run the risk of getting too much vitamin K and causing liver problems. There are no commercial liquid forms of this drug, so often the injection solution is just fed to the infant. Over the counter vitamins K pills are not well absorbed at all and there is no certainty in these preparations how much vitamin K the infant will get. In a misguided effort to protect their baby from harm, parents end up exposing them to much more risk.

The American Academy of Pediatrics does not recommend oral supplementation, because it has significant risks compared to the simple vitamin K injection, which has proven both safe and very effective to prevent this condition for decades.

About the author

Donald Beam, M.D., is a hematologist and the medical director for the Life After Cancer Program at Cook Children's. Learn more about the Hematology and Oncology Progam at Cook Children's today.