Cod Liver Oil

1. Cod Liver Oil Our Number One Superfood! Chris Masterjohn

2. Pliny the Elder, Natural History, 73 ADLichens and Leprosy “Some persons bake dolphin's liver in an earthen vessel, till a grease flows therefrom like oil in appearance: this they use by way of ointment for these diseases."

3. John Hughes Bennett, 1841Treatise on Cod Liver Oil • Introduced systematic use of microscope and study of histology to medical curricula. • Opposed indiscriminate use of drugs, bleeding, and mercury. • Proved the κώνειον used to execute Socrates was hemlock. • First to describe leukemia as a blood disorder. “The Cod liver oil appears to have been used immemorially as a popular remedy for the cure of rheumatism in various countries. In Sweden and Norway . . . Germany . . . Holland . . . Scotland . . .”

4. Scrofula – Tuberculosis of the Lymph Nodes in the Neck • Common blood deficiency underlying scrofula and rickets in children and osteomalacia, gout, and rheumatism in adults. • Cod liver oil was an effective remedy.

5. Heating Cod Liver Oil Destroys Vitamin A But Not Vitamin D Corneal ulceration due to xerophthalmia, prevented and cured by vitamin A.. Bowed and poorly mineralized legs due to rickets, prevented and cured by vitamin D.

6. Cod Liver Oil Decreases the Incidence of Colds One tbsp CLO (15,000 IU A; 2,000 IU D) per day, Dec-March, n=313. Holmes AD, Pigott MG, Sawyer WA, Comstock L. Vitamins Aid Reduction of Lost Time in Industry. Indust Eng Chem. 1932;24:1058-60.

7. Cod Liver Oil Decreases Time Missed From Work One tbsp CLO (15,000 IU A; 2,000 IU D) per day, Dec-March, n=313. Holmes AD, Pigott MG, Sawyer WA, Comstock L. Vitamins Aid Reduction of Lost Time in Industry. Indust Eng Chem. 1932;24:1058-60.

8. Cod Liver Oil Concentrate Reduces Measles Mortality Over Half Ellison JB. Intensive Vitamin Therapy in Measles. BMJ. 1932;2:708-11.

9. Dogs Fed Vitamin A-Deficient Diets Developed Pneumonia Soft bones, partially collapsed lungs, bronchial pneumonia. Olive Oil Soft bones, partially collapsed lungs, free of infection. Butter (A) Well mineralized bones, fully functioning lungs, free of infection. Cod Liver Oil (A+D) Green HN, Mellanby E. Vitamin A as an Anti-Infective Agent. BMJ. 1928;2:691-6.

10. Vitamin A, Not Vitamin D, Protected Against Infection in Rats "The importance of vitamin D has attracted great attention recently, and it has even been suggested that preparations of vitamin D can be safely substituted for cod-liver oil in medical treatment. The work above described shows that this teaching is erroneous, and that, although vitamin D controls, probably absolutely, the calcification of bones and teeth, it has no direct power to promote resistance to infection in the same way as vitamin A. If a substitute for cod-liver oil is given it ought to be at least as powerful as this oil in its content of both vitamins A and D." Infection (tongue, throat, eyes, lungs, GI tract) Vitamin-Deficient Diet (Heated Casein, Rice Starch, Sugar, Olive Oil, Lemon Juice, Mineral Salts) Hastened onset of infection Diet Plus Vitamin D2 Diet Plus D2 and Vitamin A (Dried Cabbage, Butter, or Cod Liver Oil) No Infection Diet Plus Vitamin A No Infection Green HN, Mellanby E. Vitamin A as an Anti-Infective Agent. BMJ. 1928;2:691-6.

11. Vitamins A and D Only Protect Against Colds When Combined 54 “chronic or frequent cold sufferers” aged 7-49 given 9,000-40,000 IU A, 120,000-300,000 IU D, or both, daily Sept-June for three years. Spiesman IG. Massive does of vitamins A and D in the prevention of the common cold. Arch Otolaryngol.1941;34(4):787-791.

12. Vitamins A and D Proved Toxic Alone But Not in Combination Percentage of Subjects Who Developed Symptoms of Toxicity 54 “chronic or frequent cold sufferers” aged 7-49 given 9,000-40,000 IU A, 120,000-300,000 IU D, or both, daily Sept-June for three years. Spiesman IG. Massive does of vitamins A and D in the prevention of the common cold. Arch Otolaryngol.1941;34(4):787-791.

13. Cod Liver Oil Was Widely Promoted in the 1930s and 1940s From 1926 to 1937 consumption of cod liver oil grew nearly three-fold, from 1.9 million gallons to 5.8 million gallons.

14. Two Worlds Collide: Antibiotics Replace Interest in Cod Liver Oil Prontosil Vitamin A University of Wisconsin, Madison Heinrich Himmler, head of all Nazi police and security forces, touring an IG Farben facility

15. Time Magazine – July 15, 1946“Hardier Germs” “Though bacterial ‘drug-fastness’ is a serious problem for medical researchers, Dr. Molitor believes there is yet no cause for public anxiety. Bacteria do not always keep up their resistance. Some bacteria, as they become drug-resistant, also become less virulent; and new antibiotics are being discovered all the time. The adaptable researchers hope to keep two jumps ahead of the jump-ahead germs.” “Just when the sulfa drugs, penicillin and the other antibiotics seemed to be sweeping most of the bacterial diseases before them, a dark thunderhead of rumor appeared on the horizon—the germs were rallying and fighting back.”

16. Vitamin D Stimulates Production of Antimicrobial Peptides • Cathelicidins and their derivatives are also effective against: • Candida albicans • Streptococcus aureus • Group A Streptococcus (S. pyogenesor GAS) • E. faecalis • Pseudomonas aeruginosa • E. coli • lentiviruses and retroviruses (e.g. HIV) Liu PT, Krutzik SR, Modlin RL. Therapeutic implications of the TLR and VDR partnership. Trends Mol Med. 2007;13(3):117-24.

17. Vitamin A Supports the Epithelial Defense Against Pathogens • Vitamin A also: • Supports Natural Killer Cell Activity • Enhances T Cell Proliferation • Supports Killer T Cell Function • Supports Helper T Cell Activity • Regulates Activation, Proliferation, and Survival of B Cells • Increases Production of Zinc-Dependent Metalloproteinases When vitamin A is sufficient, a living epithelial barrier uses cilia, mucous secretions, and other factors as a first line of defense against pathogens. In vitamin A deficiency, the cells become flattened, filled with keratin, and die. • Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685-98. Goldblatt H, Benischek M. Vitamin A Deficiency and Metaplasia. J Exp Med. 1927;46:699-707.

18. Cod Liver Oil Helps Rheumatoid Arthritis Patients Reduce Medication Double-blind, placebo-controlled, n=54. 2 tsp CLO/day (2700 IU A, 200 IU D, 2.2g n-3) for 9 months. Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C, Ogston S, Nuki G, Belch JJ. Codliver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford). 2008;47(5):665-9.

19. The Many Functions of Vitamin A • Essential to good vision, especially night vision. • Essential to male and female reproduction. • Essential to proper development of organs and tissues. • Aids in the production of steroid hormones. • May protect against asthma. • Supports dopamine signaling; may protect against depression and support focused, goal-oriented behavior. • Protects against kidney stones. • Protects against fatty liver disease. • Protects against oxidative stress and exposure to environmental toxins.

20. Vitamin D May Protect Against the Following Diseases • Rickets and osteomalacia • Hypocalcemia • Convulsions, tetany and heart failure in the newborn • Osteoporosis • Heart Disease • High blood pressure • Obesity • Arthritis • Mental Illness • Chronic Pain • Muscular weakening • Radiation poisoning • Diabetes • Multiple sclerosis • Other autoimmune diseases

21. Functions of the Omega-3 Fatty Acid DHA • Contributes to visual acuity. • Protects against oxidative stress. • Essential to the resolution of inflammation. • In a mouse model of human Alzheimer’s disease, prevented oxidative destruction of important proteins in the brain and prevented cognitive decline.

22. 2000 IU Vitamin D In First Year of Life Reduces T1 Diabetes Risk 88% Studied in 12,000 Finnish people from 1996 to 1997. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-3.

23. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

24. Does Vitamin A Increase Mortality? Over 240 pages Only two studies on vitamin A

25. First Study Showed No Significant Effect of Vitamin A on Mortality Moon TE, Levine N, Cartmel B, et al. Effect of Retinol in Preventing Squamous Cell Skin Cancer in Moderate-Risk Subjects: A Randomized, Double-Blind, Controlled Trial. Cancer Epidemiol Biomarkers Prev. 1997;6(11):949-56.

26. Second Study Showed the Number One Cause of Death is Getting Old Subjects Receiving Vitamin A Were on Average 5 Years Older! Murphy S, West Jr. KP, Greenbough III WB, Cherot E, Katz J, Clement L. Impact of vitamin A supplementation on the incidence of infection in elderly nursing-home residents: a randomized controlled trial. Age Ageing. 1992;21(6):435-9.

27. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

28. Does Vitamin A Increase the Risk of Infection in Developed Countries? • One study was conducted in Ecuador; the other was conducted in Indonesia. • Both studies measured serum retinol. • Neither study reported an association between the effect of vitamin A and serum retinol status. • Sempertegui F,, Estrella B, Camaniero V, et al. The Beneficial Effects of Weedly Low-dose Vitamin A Supplementation on Acute Lower Respiratory Infections and Diarrhea in Ecuadorian Children. Pediatrics. 1999;104(1):e1. • Dibley MJ, Sadjimin T, Kjolhede CL, Moulton LH. Vitamin A Supplementation Fails to Reduce Incidence of Acute Respiratory Illness and Diarrhea in Preschool-Age Indonesian Children. J Nutr. 1996;126:434-42.

29. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

30. Vitamin A Intake Tied to Birth Defects, But No More Than in the General Population Multivitamins and fortified breakfast cereals? Watkins M, Moore C, Mulinare J. Teratogenicity of High Vitamin A Intake. N Engl J Med. 1996;334:1197.

31. Vitamin A Supplementation Up to 40,000 IU Tied to Lower Risk of Birth Defects Martinez-Frias ML, Salvardor J. Epidemiological Aspects of Prenatal Exposure to High Doses of Vitamin A in Spain. Eur J Epidemiol. 1990;6(2):118-123.

32. Vitamin A Supplementation Tied to Lower Risk of Major Malformations Mastriacovo P, Mazzone T, Addis A, Elephant E, Carlier P, Vial T. High vitamin A intake in early pregnancy and major malformations: a multicenter prospective controlled study. Teratology. 1999. 59(1):7-11.

33. Two Negative Studies • No association between a multivitamin + 10,000 IU vitamin A and risk of birth defects. Shaw GM, Wasserman CR, Block G. High maternal vitamin A intake and risk of anomalies of structures with cranial neural crest cell contribution. Lancet. 1996;347:899-900. • No association between the use of vitamin A in supplements, fortified breakfast cereal, organ meats, or liver. Mills JL, Simpson JL, Cunningham GC, Conley MR, Rhoads GG, Vitamin A and birth defects. Am J Obstet Gynecol. 1997;177(1):31-6.

34. Limitations of These Studies Epidemiological (observational) studies can be used to generate hypotheses, but experimentation must confirm them. Most of the studies did not differentiate the source of vitamin A. Interaction with vitamin D? Implications Limited to Early Pregnancy (~ 8 wks).

35. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

36. Vitamin A Antagonizes Serum Calcium Response to Calcitriol * p<0.05 vs. placebo ** p<0.01 vs. placebo + p<0.05 vs. vitamin D D A+D PlaceboA Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Miner Res. 2001;16(10):1899-905.

37. Low Serum Ca2+ Increases PTH, Leading to Bone Resorption

38. The 25(OH)D Level that Maximally Suppresses PTH Is Considered Ideal Chapuy et al. Osteoporosis Int. 1997;439-443.

39. Vitamin A Does Not Antagonize Calcitriol Suppression of PTH * p<0.05 vs. placebo ** p<0.01 vs. placebo + p<0.05 vs. vitamin D APlacebo DA+D

40. Vitamin A Does Not Increase Bone Resorption PlaceboAD/A+D

41. Vitamins A and D Only Protect Against Colds When Combined 54 “chronic or frequent cold sufferers” aged 7-49 given 9,000-40,000 IU A, 120,000-300,000 IU D, or both, daily Sept-June for three years. Spiesman IG. Massive does of vitamins A and D in the prevention of the common cold. Arch Otolaryngol.1941;34(4):787-791.

42. Vitamins A and D Proved Toxic Alone But Not in Combination Percentage of Subjects Who Developed Symptoms of Toxicity 54 “chronic or frequent cold sufferers” aged 7-49 given 9,000-40,000 IU A, 120,000-300,000 IU D, or both, daily Sept-June for three years. Spiesman IG. Massive does of vitamins A and D in the prevention of the common cold. Arch Otolaryngol.1941;34(4):787-791.

43. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

44. Do Americans Consume Too Much Vitamin A? • Four percent of obese Wisconsin residents have elevated retinyl esters, a sign that the liver’s capacity to store vitamin A is overloaded. • Vitamin D mobilizes vitamin A from the liver. • Half of all Americans and 80% of African Americans have deficient levels of vitamin D. Obese people are three times more likely to have low vitamin D than non-obese people.

45. Most Americans Consume Too Little Vitamin A • According to the Third National Health and Nutrition Examination survey (NHANES-III), half of all Americans consume less than the RDA for vitamin A and over a quarter consume less than half the RDA. • The RDA for vitamin A is much lower than the amount found in traditional diets and the doses used to lower the risk of infection in controlled trials conducted from 1920-1940.

46. Recent Myths Circulated About the Vitamin A in Cod Liver Oil • Vitamin A Increases Mortality • Vitamin A Increases the Risk of Infection • Vitamin A Causes Birth Defects • Vitamin A Antagonizes Vitamin D • Americans Consume Too Much Vitamin A

47. How Much Cod Liver Oil? • Used ¾ tsp high-vitamin CLO with ¾ tsp butter oil concentrate in children with tooth decay. • Wrote that the butter oil helped him reduce the dose of CLO to one free of toxicity. • Recommended storing CLO in small bottles to minimize exposure to oxygen. “Cod-liver oil can be given in moderate doses without injury and to great advantage. Seldom, however, should a child be given more than a teaspoonful a day for extended periods, because of toxic effects that often develop.” ‒ Letter to Nieces and Nephews

48. John Hughes Bennett, 1841Treatise on Cod Liver Oil • Many peasants would take 1/2-1 pint and repeat 4-8 days until cured. • Medical men would give 2-4 tbsp to adults and 1-3 tsp to children. • Topical use, including drops in the eye when appropriate, can augment internal use. • Long term excessive use of cod liver oil in some patients could lead to: • Gastrointestinal symptoms including atrophy • Itchy skin eruptions • Excessive evaporation from the skin • Excessive menstrual bleeding “It is now also well known that in many cases where the patient has taken it uninterruptedly for six or seven months, nausea, vomiting, loss of appetite, or other derangement of the digestive functions have arisen . . . It has been observed that the digestion has become gradually more and more deranged, and that even atrophy was thus occasioned.”

49. Polyunsaturated Fatty Acids (PUFA) Are Essential in Small Amounts Essential fatty acid deficiency cured by: • Lard – 0.44% PUFA • Liver – 0.12% PUFA • Methyl linoleate – 1% • Methyl arachidonate – 0.33% Burr GO, Burr MM. A New Deficiency Disease Produced by the Rigid Exclusion of Fat From the Diet. J Biol Chem. 1929;LXXXII(2):345-67. Turpeinen O. Further Studies on the Unsaturated Fatty Acids Essential in Nutrition. J Nutr. 1938;15(4):351-66.

50. Cod Liver Oil is Rich in EPA and DHA, but not in AA