Low Vitamin A

 - May Worsen Iron Deficiency Anemia 

Heather Mackie, MS, RD, LD 

As a bariatric surgery patient, you have more than likely heard about iron deficiency and how your risk for iron deficiency anemia increases after surgery.  If not, check out our article, “Iron Deficiency After Bariatric Surgery.”  However, did you know that low vitamin A may play a role in your resultant iron level?

It is not uncommon for someone to experience vitamin A deficiency at the same time as an iron deficiency.  This could be due to inadequate intake of both nutrients or to a relative deficiency of one or the other (1).  In fact, it appears vitamin A deficiency may worsen iron deficency anemia.  It has been reported that vitamin A has the ability to alter iron metabolism (2).

One of the earliest studies in humans reported that subjects fed a vitamin A-deficient diet developed anemia even though they were getting adequate iron.  The anemia improved with vitamin A supplementation, but not with iron supplementation in this study (1).  

Does Vitamin A Supplementation Help?

Vitamin A supplementation has been shown to help iron deficiency anemia and improve iron nutritional status among children and pregnant women (2,3).  However, specific studies have not been completed in bariatric surgery patients. 

The combination of supplemental vitamin A and iron appears to reduce iron deficiency anemia more effectively than supplemental iron or vitamin A alone (4). 

One study in vitamin A deficient children reported vitamin A supplementation resulted in an increase in hemoglobin, hematocrit, and serum iron (1).  All of these parameters indicate an improvement in the childrens’ iron status, which suggests the potential relationship between vitamin A and iron. 

Results from several studies of vitamin A and iron suggest that separate from correcting iron deficiency, improving vitamin A status will increase the body’s ability to use iron (1). 

In summary, the available research at this time suggests that vitamin A deficiency is often associated with iron deficiency anemia and vitamin A supplementation may have a beneficial effect on iron status.  However, it is important to remember that iron deficiency is the main cause of iron deficiency anemia and vitamin A cannot resolve a severe underlying iron deficiency by itself.  

For bariatric surgery patients, this means if you have an iron deficiency, it is important to continue taking your bariatric-specific multivitamin along with any iron supplements recommended by your physician.  Talk to your bariatric healthcare team to be sure that your bariatric-specific multivitamin includes the appropriate level and formulation of vitamin A in order to reduce your risk of vitamin A deficiency and iron deficiency anemia.  Your bariatric surgeon may also request to check your iron levels along with your vitamin A status.

*Proper supplementation should be viewed as an individualized regimen based upon each patient’s individual medical history, laboratory studies, and current medication use.  Patients should follow the instructions of their bariatric surgery healthcare team.  Patients should be sure to follow-up with their bariatric surgery healthcare team at frequent intervals as recommended by their team and stay up-to-date with requested laboratory studies.



  1. International Vitamin A Consultative Group.  Vitamin A and Iron Interactions.  Available online at: www.ilsi.org/Publications/IVACG_vitA_iron_interactions.pdf.  Accessed May 9, 2016.
  2. Semba RD, Bloem MW.  The anemia of vitamin A deficiency: epidemiology and pathogenesis.  Eur J Clin Nutr.  2002;56(4):271-281.
  3. Allen LH.  Iron supplements: scientific issues concerning efficacy and implications for research and programs.  J Nutr.  2002;132(4 Suppl):813S-819S.
  4. Suharno D, West CE, Muhilal, et al.  Supplementation with vitamin A and iron for nutritional anemia in pregnant women in West Java, Indonesia.  Lancet.  1993;342(8883):1325-1328.