Where Did the Vitamin A Go? What Changed in Cereal, Milk and the American Plate

Vitamin A helps build a baby's critical organ systems. As pregnancy goes on, the baby draws on the mother's stores. A woman who starts with marginal reserves is at higher risk of running short [1].

Many women start short. In a national US survey, 27.7% of pregnant women fell short on vitamin A from food alone [2].

The ready-made form has been slipping. Between 2009 and 2018, the preformed vitamin A US adults got from their diets fell about 7% [4]. The food supply points the same way: about 12% less vitamin A per person in 2010 than in 1970, counting food available rather than food eaten, and more of what remains now comes from plant carotenes, which many people convert poorly [3].

Specific foods changed too. Liver and other organ meats have left the dinner table. Americans drink about half the milk they once did, and low-fat milk and yogurt lose vitamin A with the fat. Some well-known breakfast cereals took vitamin A out. Federal guidelines keep passing it over. And a prenatal vitamin may not fill the gap: most contain beta-carotene, the plant form, and we found no study of how well it converts in pregnancy [5].

Put together, we think it's a recipe for disaster, including a higher risk of birth defects. Here's what changed, one piece at a time.

How much vitamin A do pregnant women get from food?

The national survey covered 1,003 pregnant women aged 20 to 40, from 2001 to 2014 [2]. From food alone, 27.7% fell below the estimated average requirement, or EAR. With supplements counted, 15.5% still did [2].

The EAR is a low bar. It's the intake that meets the needs of only half of healthy people [6]. The recommended amount, the RDA, is set higher, to cover nearly all of them: 97 to 98% [6]. So falling below the EAR means falling well short.

Those intakes also count beta-carotene from fruits and vegetables, using the official conversion factor [2]. Many people convert it poorly, so the real gap may be wider [7][8].

Research cohorts with more diverse women found bigger gaps. Among 1,910 pregnant participants, 42% fell short from food alone [9]. Teens aged 14 to 18 fared worst, at 53%. So did women without a high school diploma, at 53%, against 32% of college graduates [9]. Hispanic and Black participants fell short more often than white participants: 49% and 50%, against 33% [9].

The standard blood test for vitamin A, serum retinol, stays level until the liver's stores are nearly gone [10][11]. Under 1% of US women aged 14 to 45 fell below its deficiency cutoff, a line that flags only severe depletion [1][10]. Another 3.5% fell in the insufficient band just above that line [1]. A woman can test normal while her liver stores run low, and her baby draws on those stores through pregnancy [1][11]. So neither figure measures her risk in pregnancy.

Marginal stores matter for fertility, too. In animals, even a milder shortfall harms reproduction. Female rats kept mildly deficient still conceive, but their embryos often die midway through pregnancy [12]. A marginal shortfall may do the same in women, and the standard blood test can't detect it [10][11].

Do Americans still eat liver and organ meats?

Not often. A USDA report says organ meats "do not typically grace Americans' dinner tables" [13]. As Americans came to prefer leaner meat and muscle cuts, demand for organ meats fell [13]. Much of the supply goes abroad. Beef liver led US beef organ-meat exports in 2010, at 31% [13].

That matters because liver, fish, eggs and dairy are the richest sources of preformed vitamin A [14]. No federal survey tracks how much liver Americans eat, so we can't put a number on the decline.

Federal guidelines count organ meats, including liver, as protein foods [15]. The 2015 and 2020 editions don't recommend eating them [15][16]. The newest edition doesn't mention them [17].

Does low-fat milk or yogurt have less vitamin A?

Americans drink far less milk than they used to. In 1970, the average American drank about 0.96 cups of milk a day. By 2019, it was 0.49 cups, about half [18]. Pam sees this most in young women in her practice. Not many of the women she sees drink fluid milk. Many choose nut milks, oat milks or plant-based protein blends instead, while still eating some cheese and butter.

Plant milks vary. Unfortified almond and soy milks list no vitamin A in USDA's database [19]. FDA has set no rules for what a plant milk must contain. Their nutrients vary widely, even within one type [20]. Some popular brands, like Silk almond milk and Oatly oat milk, add vitamin A palmitate, a ready-made form. Others list none in their ingredients [19]. Whey protein powder carries little or none unless the maker adds it [19].

Vitamin A travels in milk fat. Skim off the fat and the vitamin goes with it. Unfortified whole milk carries about 46 mcg of vitamin A per 100 grams. Nonfat carries about 2 [21].

By law, lower-fat milk must have its vitamin A added back, so it is not nutritionally inferior to whole milk [22]. Until 1998, the old standards for lowfat and skim milk required a set level of added vitamin A [23]. Since then, the floor is only whole milk's natural level. Fortifying beyond that became optional [23]. FDA said at the time it saw no evidence dairies would stop [23].

Yogurt is different. Since 2021, lowfat and nonfat yogurt don't have to replace the vitamin A lost with the fat [22]. So milk is the steadier source. Per 100 grams, fortified lower-fat milks carry 55 to 61 mcg of vitamin A. Plain whole-milk yogurt carries 27, and plain low-fat yogurt 14 [24]. Cheddar cheese carries about 337, and butter 684 [24]. A tablespoon of butter makes it a good source.

Light can add to the loss. How much depends on the package, how long the milk sits under the lights, and how much fat it has. In lab tests under bright fluorescent light, the vitamin broke down faster in lower-fat milk. A Cornell study saw measurable loss at 2 hours in nonfat milk, 4 hours in reduced-fat, and 16 hours in whole milk [25]. In an older study, milk sat in clear plastic pouches for up to two days. Whole milk kept 67.7% of its vitamin A, and skim milk kept 4.2% [26].

The package matters too. Two Greek studies kept milk under fluorescent light for a week. In paperboard cartons, it lost 15 to 16% of its vitamin A [27][28]. Milk in clear plastic bottles lost 31% [27]. Milk in thin clear or white plastic pouches lost half or more [28]. Thicker, opaque white-and-black plastic did as well as cartons or better [27][28]. LED store lighting did far less damage than fluorescent light in another study [29]. Clear glass lets light through too, though we found no study measuring vitamin A in glass bottles.

Fat matters for plant vitamin A as well. Salads eaten with full-fat dressing delivered more carotenoids into the blood than salads with reduced-fat dressing [30]. Adding avocado to a salad raised beta-carotene absorption 15.3-fold [31].

We found no study measuring what the low-fat era did to Americans' vitamin A levels overall. The mechanisms are documented, and they all point the same way.

Is there less vitamin A in breakfast cereal?

Several well-known cereals now carry less vitamin A, or none. USDA keeps a database of the ingredient lists food makers send in [32]. Older records and labels for Kellogg's Corn Flakes, Frosted Flakes, Rice Krispies and Raisin Bran list vitamin A palmitate [32]. That's preformed vitamin A, the ready-made form. Their recent records list no vitamin A at all [32].

Special K went another way. It swapped vitamin A palmitate for beta-carotene, the plant form your body has to convert [32]. Some people convert it poorly [7][8].

In 2012, each of these cereals listed 10 to 15% of the Daily Value for vitamin A per serving [33]. The records don't show the year each recipe changed. It falls somewhere between about 2018 and 2023. We found no company statement explaining why.

Cheerios still adds vitamin A. Gram for gram, though, it now carries about 57% less than its 2018 label showed [34].

The label rules changed in the same years. In 2016, FDA made vitamin A optional on the Nutrition Facts label, saying deficiency is now rare [35]. A food with only its own natural vitamin A, like eggs or cheese, no longer has to list it [36]. So shoppers often can't see how much it holds. A food with added vitamin A still must list it [36]. On a cereal box, then, a missing vitamin A line means the maker most likely added none. The label also doesn't have to say how much is retinol and how much is beta-carotene [36]. The Daily Value for vitamin A also fell, so the same printed "10%" now means less vitamin A [36]. A modeling study by General Mills scientists compared the same printed 10% before and after [37]. Per 100 grams of cereal, the vitamin A behind that 10% fell by more than half [37].

Fortification was never universal. Among cereals US households bought in 2017, only 51% were fortified with vitamin A [38].

Fewer people eat cereal now, too. On a given day, 24% of adults ate it in 2009 to 2010. By 2015 to 2016, 19% did [39]. Children fell from 41% to 36% between 2003 and 2016 [40].

For the adults who ate it, cereal mattered. It supplied 27% of their day's vitamin A, or 37% counting the milk [39]. One model of US adults removed cereal fortification [41]. The share below the requirement rose from 46.8% to 54.8% [41]. The consumption and modeling studies come from General Mills scientists or industry nutrition consultants. They show cereal was a big vitamin A source for the people who ate it.

Does cooking or processing destroy vitamin A?

Cooking costs less than you might think. Across 269 foods and cooking methods in USDA's tables, the typical loss is about 10% [42]. Most cooked beef and chicken keep about three quarters. Dried fruit keeps about half [42].

The bigger documented losses come from drying, from skimming fat, and from light on low-fat milk.

What do federal dietary guidelines say about vitamin A?

The 2015 to 2020 Dietary Guidelines named vitamin A as underconsumed [16]. They stopped short of calling it a nutrient of public health concern [16].

The 2020 to 2025 edition named four nutrients of concern: calcium, potassium, fiber and vitamin D [15]. Its pregnancy guidance highlights folate, iron, iodine and vitamin D [15]. Vitamin A isn't mentioned for pregnancy.

The 2025 to 2030 edition lists iron, folate and iodine as pregnancy priorities [17]. Vitamin A appears for breastfeeding and for vegan diets. It doesn't appear for pregnancy [17].

What does losing vitamin A from the food supply mean for pregnancy?

Each change looks small on its own. Together they strip sources of preformed vitamin A from the American plate, with little federal attention. Pregnancy is when a woman's stores matter most.

That's why we call it a recipe for disaster. The birth defect evidence runs in two directions, too little and too much. The last post in this series lays out both sides.

This is part 1 of a four-part series on vitamin A. Still to come:

• Is Your Prenatal Vitamin Missing Vitamin A?
• Plant vs. Animal Vitamin A: Why Beta-Carotene Isn't Retinol
• Vitamin A in Pregnancy: The Risks of Too Little and Too Much

Where can I learn more about vitamin A and fertility?

Pam Schoenfeld, MS, RD, LDN, a registered dietitian and co-author of this post, joins the Save the Uterus Club this week. Her members talk, "Vitamin A: Critical for Female Fertility," is Thursday, October 22, at 3 PM Eastern, live online. Pam will share her approach and her references.

Save your spot for the talk. Or join the Save the Uterus Club, RRM Academy's community, for the full session library. If you're planning a pregnancy, come together. Vitamin A is a question for both of you.

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Dr. Naomi Whittaker is a board-certified OBGYN. Pam Schoenfeld is a registered dietitian who has written about vitamin A for a decade. This article is educational and is not medical advice or a substitute for care from your own clinician.

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