The Natural Connection

Long before the invention of erythromycin or penicillin for the treatment of respiratory infections, there was cod liver oil. Many people in these parts of the swamp remember lining up side by side each day alongside their brothers and sisters to take a big gulp of the nasty, bilious yellow-green goop. 

“If you were complaining of a queasy stomach, it was Black Draught or castor oil”, one survivor says. “But for everything else, it was cod liver oil. I still want to run and hide under the kitchen table when I smell it!” Some enterprising company tried to fool children into thinking it was peppermint candy by putting it in a mint flavored syrup once, but that only proved to make it more nauseating. 

Prior to the national passion for fortified foods, cod liver oil gained favor and reputation among the medical community for it’s high concentrations of Vitamins A and D. Pediatricians recommended its use to mothers as a prevention for rickets, caused by calcium and Vitamin D deficiency. Vitamin A deficiency is known to cause immune deficiencies, increased respiratory infections, and blindness. Cod liver oil, a rich source of both of these vitamins, seemed “good for whatever ailed you”. 

In recent decades, the benefits of fish oil supplements in the prevention of coronary heart disease, skin disorders, and macular degeneration has fueled the sales of cod liver oil supplements to aging baby boomers who now prefer to take their fish liver oils in capsules rather than liquid. Unlike Black Draught and castor oil, which while still available are not at the top anyone’s Favorite Health Food Item list, cod liver oil supplements have enjoyed continued popularity. 

The cod liver oil craze (if one could call it that) is not confined merely to this country. Many European nations, in particular the Scandinavian countries, consume amounts vastly greater than our population does. In 1998, medical researchers in Sweden were surprised to learn that hip fractures were higher in both men and women who consumed the highest amounts of Vitamin A in the form called retinol, which is found in cod liver oil and dairy products. The beta-carotene form of Vitamin A, found in green and yellow vegetables, did not appear to be associated with hip fracture. 

A follow-up study done at Harvard and published in the recent January 2, 2002 issue of the Journal of the American Medical Association confirms that excess amounts of Vitamin A (retinol) from supplements indeed appears to be related to higher rates of hip fractures in women. The study looked at the retinol intake of over 72,000 women from food and supplements for 18 years. Patients with an average Vitamin A consumption greater than 3,000 micrograms per day had 48% more fractures than those consuming 1,250 micrograms per day or less. 

Based on this research, the Institute of Medicine recently reduced its Recommended Daily Allowance (RDA) of Vitamin A for women to 700 micrograms or 2,3000 IU, approximately one-half of the previous RDA. Many over-the-counter products contain the older, higher, RDA levels. 

It is now recognized that through consumption of fortified dairy and cereal products, along with supplements containing high amounts of Vitamin A, such as cod liver oil and multi-vitamin preparations, it is possible for Americans to consume large enough quantities of Vitamin A to put themselves over the limit of safe levels, and at risk for brittle bones and fractures. Other symptoms of Vitamin A toxicity include joint aches, abdominal pains, skin rashes, mouth ulcers, and hair loss. The cause can be difficult to determine, as these complaints are also similar to those in Vitamin A deficiency. 

Until more is understood about the risks and benefits of Vitamin A supplementation, it may be best to error on the side of safety. Stay away from the cod liver oil pills, and reach for the Black Draught. 

For further information on Vitamin A, contact The Natural Connection, c/o Dr. Pauline Bellecci, PO BOX 777, Waycross, GA 31501 or visit our on-line Patient Education Library at www.swampdocs.com 

©2000-2003 Pauline M. Bellecci, MD