Treatment Guide

Vitamin A Deficiency in Celiac Disease…Common Before & After Diagnosis

Vitamin A was first identified in 1913 because of its crucial role in vision.  Subsequent discovery of its many other duties show that a deficiency will cause a broad range of health problems.

Vitamin A is not a single compound but actually comprises a fat-soluble family of molecules that includes retinol, retinal, retinoic acid, and retinyl ester. The term vitamin A also includes certain plant carotenoids called provitamin A because they are dietary precursors of retinol.

Vitamin A is essential for normal vision and eyeball health, a properly functioning immune system, gene regulation, reproduction, embryonic development, health and protection of all the tissues that line the body, including skin and mucosa of the lungs, digestive tract, urinary tract, and genital tract, bone metabolism and normal growth and strong teeth in children.


Vitamin A Deficiency

The United States National Institutes of Health recommends testing vitamin A levels in people with celiac disease at diagnosis. This is because vitamin A deficiency is common in celiac disease. Deficiency can result from incomplete digestion, absorption, or metabolism.

Normal absorption of vitamin A first requires digestion, or releasing, from food protein in the stomach. Then it is converted to retinol and bound to albumin protein in the small intestine for transport through the intestinal lining and absorption with fatty acids via the lymph system into the body. In the blood plasma, maintaining proper retinol levels depends on having adequate levels of amino acids and zinc.

Vitamin A deficiency can develop in celiac disease in the following ways. Upper digestive problems, such as low stomach acid, can fail to dissolve vitamin A out of food sources. Protein deficiency impairs absorption transport through the intestinal lining while fat malabsorption impairs vitamin A absorption into the lymph. Finally, the liver cannot mobilize stored vitamin A to maintain adequate blood levels when blood protein and zinc levels are low.

Vitamin A deficiency can persist or develop after diagnosis and treatment with a gluten-free diet if the diet does not include adequate amounts of vitamin A, protein, zinc and fat.

Vitamin A deficiency…

  • Impairs maintenance of eye tissue of the conjunctiva and cornea.
  • Alters visual function of the retina due to depletion of rhodopsin, a pigment located in the rod cells of the retina, needed to distinguish light and dark.
  • Impairs development and maintenance of skin and mucus membranes, resulting in skin thickening and poor defense against infection.
  • Alters immune response, impairing the numbers and responsiveness of white blood cells to bacterial, viral and fungal infections.
  • Alters gene regulation resulting in adverse growth and development of tissues in general.
  • Impairs reproduction for conceiving and producing children and fertility in both sexes, and
  • Impairs bone and tooth growth in children.


Deficiency Symptoms

1. Sight problems:

Nightblindness, or difficulty seeing in dim light such as twilight is the earliest sign.

  • Difficulty adjusting from light area to dark area.
  • Excessive sensitivity to light (photophobia).
  • Blindness


2. Eye problems:

  • Dry eyes (dry, sandy feeling) due to lack of adequate tear production.
  • Eye redness (conjunctivitis).
  • Blepharitis (inflamation of the eyelid).
  • Bitot’s spots following thickening of conjunctiva and lack of tears.
  • Blurry vision due to dryness of cornea.
  • Xerophthalmia develops from softening of the cornea in advanced stage of dryness and thickening and advances to blindness.
  • Cataracts.


2. Skin problems:

  • Dry, rough, scaly skin.
  • Plugged hair follicles, or dry, bumpy skin “goose flesh,” called follicular hyperkeratosis.


3. Low mucus production

  • Dryness in digestive tract, lungs, urinary tract and genital tract.
  • Poor protection against microbe invasion.


4. Digestive problems:

  • Dry mouth.
  • Poor digestion.
  • Indigestion.


5. Immunity problems:

  • Repeat infections such as sinusitis, ear infections, candidiasis, fungal infections, and particularly, respiratory infections.
  • Poor recovery from infections such as flu and colds or sores.


6. Reproductive problems:

  • Impairment of sperm formation in males.
  • Spontaneous abortion in females.
  • Impaired development of embry


7. Failure to grow, or growth retardation, is the most common sign in children.


Food Sources of Vitamin A in Animals

Excellent: Liver, chicken giblets, oysters, cod, halibut.

Good: Milk, cheese, butter, eggs and other fish.


Food Sources of Vitamin A in Plants (Carotenoids)

Very good: Carrot juice, sweet potato with peel, pumpkin, carrots.

Good: Dark green leafy vegetables such as spinach, collards, kale, beet greens, turnip greens.


Recommended Daily Dietary Allowances for Vitamin A:



Children 1 to 3 years: 600 micrograms (2,000 IU)

Children 4 to 8 years: 900 micrograms (3,000 IU)

Children 9 to 13 years: 1,700 micrograms (5,666 IU)

Males and females 14 to 18 years: 2,800 mcg (9,333 IU)



Males add females 19 years and older: 3,000 mcg (10,000 IU)

Pregnant and breastfeeding females 18 and older: 2,800 mcg (9,333 IU)

Pregnant and breastfeeding females 19 and older: 3,000 mcg (10,000 IU)


Getting Your Daily Intake

In addition to consuming foods rich in vitamin A and carotenoids as a part of your healthy diet, consider taking a multivitamin containing up to, but not more than, 100% RDA in order to make up for any shortfall. Do not give vitamin A or any other supplement to a child without the advice of your doctor.

If you take medicine, there is a potential for side effects and interactions with all supplements. Discuss your optimum dose of vitamin A with your doctor.

Drugs that are used to reduce cholesterol also alter vitamin A in the body. Drugs that increase blood levels of vitamin A include Lescol, Mevacor, Provachol and Zocor, while those that interfere with vitamin A absorption include Cholestyramine and Colestid.

Contraceptives may increase blood levels of vitamin A. Neomycin, an antibiotic, may decrease the absorption of vitamin A.


Impact of Storage, Processing, and Cooking

Vitamin A is unaffected by light, heat and usual cooking methods. It is destroyed by oxidation (exposure to air), drying, very high temperatures and ultraviolet light. Keep food wrapped to protect it from air and sunlight.


Nutrient Interactions

Excessive vitamin A may interfere with vitamin K absorption.



Persistent high doses of vitamin A (not carotenoids) of over 14,000 IU in infants or 33,000 IU in adults overcomes the liver’s ability to store it and can produce toxicity. Children and people with kidney failure are at high risk of toxicity and should always inform their physician of any supplement use. Excessive alcohol consumption increases toxicity. Toxic effects of vitamin A (in the form of retinoic acid) exceeding 10,000 IU when used as a supplement by pregnant women or as the active ingredient in acne products like Accutane have been shown to cause malformations such as spina bifida in their developing fetuses.

Symptoms of vitamin A toxicity include dry lips is an early sign, followed by dryness of the nasal tissues.  Later signs include dryness, redness, scaling, and peeling of skin, hair loss and nail fragility. Other symptoms can include vomiting in infants and children, headache, nausea, bone pain, fractures, fatigue and muscle pain.

For More Information Visit The Gluten Free Works Health Guide.



1. Cleo J. Libonati. Recognizing Celiac Disease, Fort Washington, PA, USA: GFW Publishing, 2007.


2. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition, & Diet Therapy, 10th Edition. Philadelphia, PA, USA: W.B. Saunders Company, 2000.


3. National Acadamies Press


Author Information: Cleo Libonati, RN, BSN
Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease. She can be reached by E-mail.

About Cleo Libonati, RN, BSN

Avatar photo
Cleo Libonati, RN, BSN is CEO and co-Founder of Gluten Free Works, Inc. and She is the author and publisher of the highly recommended celiac disease reference guide, Recognizing Celiac Disease.


  1. Thank you very much for this information! I’ve been gluten free for several years, but I suspect that I have been deficient in vitamin A for most of my life thanks to gluten. I was told that follicular hyperkeratosis was genetic, but now, after reading your article, I wonder if mine can be corrected with vitamin A. I will get tested to find out what my levels are.

  2. Gluten-free folks may want to consider gardening if they are not already doing so. Most fruits, vegetables and herbs contain Vitamin A and other nutrients as well, whereas the Vitamin A found in animal foods may be inferior, if bioavailable at all in many cases due to casein intolerance, indigestibility, bacteria contamination or other problems with animal foods. The book of Daniel in the Bible gives us a hint about the importance of eating vegetables and greens in our diet, as does the book of Genesis.

  3. Some of the hints to do that are to drink distilled water only. Eat more vegetables, fish, and gluten totally free grains for instance brown rice and millet. Consume plain yogurt that provides live yogurt cultures.

  4. Karen lielkalns

    Thank you for the information. My TPN team just asked me to start taking 10 000 units per day. It sometimes gives me an upset stomach, a feeling of being unwell. It doesn’t last long. Wondering if anyone has experienced this? Oh and I take it with food. Thanks again

  5. wow. This author is dangerous. Retinoids are likely the main culprit behind celiac, and she has mistaken vitamin a toxicity symptoms as deficiency symptoms

    • Avatar photo

      Well, she’s received endorsements from Harvard, Columbia, University of Chicago, etc. She’s also successfully diagnosed hundreds of patients. While there have been a few small mouse studies where retinoic acid seems to be linked to celiac disease type effect, deficiency of vitamin A is common in celiac disease. The symptoms listed are the symptoms of the deficiency. Vitamin A is a fat soluble vitamin, and if your intestines are not absorbing fat properly, you will not absorb vitamin A. The chances you are miraculously ingesting and absorbing too much vitamin A are remote at best. If you are trying to say vitamin A is triggering celiac disease in the millions of people suffering from it, whether diagnosed or undiagnosed, you are way, way off. The vast majority of people are nutrient deficient, not nutrient sufficient.

      • Aziz Rodan Sarohan

        Celiac disease and Type-I diabetes are two interesting diseases among autoimmune and inflammatory diseases, and they are actually two diseases that are prototypes for the autoimmune pathogenesis mechanism in order to solve such diseases. Of these, what triggers the pathogenesis and inflammation in celiac disease is antigens such as gluten and gliadin, which cause chronic immune stimulation in the body. These antigens chronically stimulate the immune system, depleting retinoic acid stores and causing vitamin A deficiency. Vitamin A deficiency and vitamin D deficiency (unsaturated long chain fatty acids) are held responsible for autoimmune pathogenesis. Immune dysregulation develops in vitamin A deficiency. In vitamin A deficiency, the number of regular T cells that provide immune tolerance and self-tolerance decreases, and the number of effector Th17 cells, which cause inflammatory cytokine release and trigger chronic inflammatory diseases, increases.
        There is also vitamin A depletion in type-I diabetes. But here, as in Celiac disease, the cause is unclear. most likely a virus with tropism to pancreatic tissues. The common point between this disease is the targeting and destruction of a cell or group of cells by the immune system. Intestinal epithelial cells in celiac islet beta cells of the pancreas that secrete insulin in Type-I diabetes. After the clinical picture progresses in celiac, the absorption of vitamin A from the intestines is also impaired. In this way, a vicious circle is formed and vitamin A deficiency is deepened. In other words, vitamin A deficiency in celiac is both a cause and a result.
        For details, see my work below.
        Sarohan, St. Rodan. “COVID-19: endogenous retinoic acid theory and retinoic acid depletion syndrome.” Medical hypotheses 144 (2020): 110250.
        Sarohan, Aziz Rodan, et al. “A novel hypothesis for COVID-19 pathogenesis: Retinol depletion and retinoid signaling disorder.” Cellular signaling 87 (2021): 110121.

  6. Vitamin A deficiency isn’t something that’s talked about a lot, but for those that have certain conditions like Celiac disease, getting your daily intake in can’t be stressed enough. Great info shared!

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