CASE REPORT

Carrot Man: A Case of Excessive Beta-Carotene Ingestion

Randy A. Sansone, MD1,2,3* ABSTRACT

In this case report, the authors describe a
to facilitate his dieting effort. The patient
was diagnosed with constipation, hyper-
Lori A. Sansone, MD4 48-year-old male who complained to his carotinemia, and possible vitamin A tox-
primary care physician of abdominal dis- icity. Following the cessation of excessive
comfort and yellow/orange skin discolor- carrot ingestion, his liver enzymes nor-
ation. Physical examination was normal malized within 1 month. V C 2012 by Wiley

except for some mild mid-abdominal dis- Periodicals, Inc.

comfort (no observed skin color changes).
An abdominal CT scan indicated a colon Keywords: beta-carotene; carrots; diet-
that was full of stool. Laboratory studies ing; liver enzymes
indicated elevated liver enzymes. Upon
further questioning, the patient reported
ingesting 6–7 pounds of carrots per week (Int J Eat Disord 2012; 00:000–000)

ficulty in doing so. In the following case report, the

Introduction
authors describe a previously obese adult male
Overweight, obesity, and dieting behaviors seem to who disclosed an unusual approach to dieting—an
be integral themes in the fabric of American soci- approach that resulted in several unexpected phys-
ety. For example, according to the US National ical findings.
Health and Nutrition Examination Survey in 2003–
2004, 17% of children and adolescents were over-
weight and 32% of adults were obese.1 In addition,
using a survey format in a randomized sample of Case Report
over 38,000 college students, investigators found
that 50% of respondents were attempting to diet.2 Mr. C. was a 48-year-old white male who presented
Finally, in a cross-sectional population-based tele- to his family physician for the evaluation of a swol-
phone survey, 15.2% of adults reported having used len abdomen and periodic yellow-orange discolor-
a weight-loss supplement—8.7% in the past year.3 ation of his skin. In support of his concerns, the
In the context of these statistics, obesity remains patient indicated that others had commented
contributory for a number of medical morbidities about his odd skin color. Symptoms had been pres-
(e.g., diabetes, high blood pressure, cardiovascular ent for 3–4 months. He denied nausea, changes in
disease, joint stress, hyperlipidemia), and abdomi- appetite, vomiting, diarrhea, constipation, melena,
nal obesity has been shown to significantly relate or hematochezia. Mr. C. reported some mild, inter-
to cardiovascular mortality.4 Therefore, attempts to mittent, mid-abdominal discomfort. The patient
lose weight are oftentimes justified, despite the dif- denied any alcohol or drug use. Mr. C. reported
that, during the previous year, he had successfully
lost 100 pounds ‘‘without much effort.’’
Accepted 11 February 2012
At the time of the initial evaluation, Mr. C. was
The views and opinions expressed in this article are those of the
authors and do not reflect the official policy or position of the US 50 8@ and 152 pounds (BMI 5 23.1). On physical
Air Force, Department of Defense, or US Government. examination, vital signs were normal. The patient
*Correspondence to: Dr. Randy A. Sansone, Sycamore Primary appeared well nourished and developed, and in
Care Center, 2115 Leiter Road, Miamisburg, OH 45342.
no acute distress. Overall skin color appeared nor-
E-mail: Randy.sansone@khnetwork.org
1
Department of Psychiatry, Wright State University School of mal and there was no evidence of jaundice or
Medicine, Dayton, Ohio icterus. The cardiorespiratory and neurological
2
Department of Internal Medicine, Wright State University examinations were normal. Examination of the
School of Medicine, Dayton, Ohio
3 abdomen confirmed some distention but no ten-
Department of Psychiatry, Kettering Medical Center, Kettering,
Ohio derness.
4
Department of Primary Care, Wright-Patterson Air Force Base, In the aftermath of the initial examination, the
Dayton, Ohio
patient’s primary care physician ordered a compre-
Published online in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/eat.22015 hensive metabolic panel as well as a CT scan of the
VC 2012 Wiley Periodicals, Inc. abdomen and pelvis to evaluate for the presence of

International Journal of Eating Disorders 00:0 000–000 2012 1

BETA-CAROTENE

a mass. The CT results indicated normal findings not affected, as in jaundice (an indicator of he-
with the exception of, ‘‘stool. . . throughout the patic disease).
entire colon. . . raising the concern for constipa- In addition to discoloration of the skin, Mr. C. had
tion.’’ The laboratory studies, including albumin an elevation in liver enzymes. On rare occasion, ele-
and protein, were normal except for an elevation in vated levels of beta-carotene have been associated
two liver enzymes: alanine aminotransferase (ALT; with changes in the livers of humans.8 These types
98 U/L; normal range 24–63 U/L) and lactate de- of changes have also been empirically documented
hydrogenase (LDH; 260 U/L; normal range 100– in animal studies.9,10
190 U/L). Despite the conversion of beta-carotene to vita-
During a follow-up appointment approximately min A, excessive ingestion of beta-carotene is not
2 weeks later, the patient disclosed eating 6–7 typically associated with vitamin A toxicity. How-
pounds of carrots per week for a period of months. ever, this patient may have also had some mild
Due to his skin discoloration and the elevation in vitamin A toxicity due to high exposure over a
liver enzymes without other contributory etiologies lengthy period of time. A single 7½ inch carrot has
(e.g., hepatic disease), the patient was diagnosed 8,666 IU of vitamin A, which is nearly twice the
with hypercarotinemia, possible hypervitaminosis daily value or recommended daily allowance. More
A, and constipation. The patient was advised to than three carrots per day is likely to saturate the
curtail his excessive ingestion of carrots. One body’s ability to store vitamin A. While acute toxic-
month after the initial evaluation, follow-up liver ity is unlikely (i.e., a single dose of more than
enzyme studies were normal. 660,000 IU), mild chronic toxicity (10 times the
daily values) may have been present. Signs and
symptoms of chronic vitamin A toxicity include dry
skin, nausea, headache, fatigue, irritability, hepato-
Discussion megaly, and alopecia. In some cases, hepatotoxicity
may lead to cirrhosis. Symptoms possibly related to
The use of carrots to aid in dieting efforts has been vitamin A toxicity in this patient were abdominal
previously recognized and documented by clini- discomfort (possibly also due to constipation) and
cians in the field of eating disorders.5,6 For exam- mild liver enzyme elevation.
ple, in an Italian study, the prevalence of caroteno-
derma (i.e., yellow-orange discoloration of the skin
due to beta carotene) was 21% in a consecutive
sample of 24 patients with eating disorders.7 How- Conclusion
ever, the prevalence rate in the US is far lower and
the presented case is somewhat unusual in that the Dieters remain creative in their attempts to lose
subject was a middle-aged previously obese male weight. In this case, the excessive ingestion of
who also evidenced an associated rare elevation in carrots was the elected dieting method. While
liver enzymes. hypercarotinemia has been referred to as a marker
Beta-carotene is a constituent of carrots as well for disordered eating,11 it may also occur in routine
as other fruits and vegetables (e.g., squash, canta- dieters. To our awareness, this behavior and symp-
loupe, pumpkin, sweet potatoes). It is the most tomatic manifestation has not been reported in a
common carotenoid in the normal human diet. noneating-disordered individual. Clinicians need
Beta-carotene is also called ‘‘provitamin A’’ because to be aware of the possible excessive ingestion of
it consists of two molecules of vitamin A, which carrots, particularly in the presence of localized
become hydrolyzed and released during excursion yellow-orange skin changes in the nasolabial folds,
through the gastrointestinal tract. There is no rec- palms of the hands, and soles of the feet.
ommended daily allowance for beta-carotene.
Excessive ingestion of beta-carotene may cause
an orange-yellow discoloration of the skin (partic-
ularly in the stratum corneum), sweat, and
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2 International Journal of Eating Disorders 00:0 000–000 2012

 SANSONE AND SANSONE

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