vitamin A & D in cod liver oil and toxicity concerns

[Guest guest]

The typical recommendation for cod liver oil is 1 teaspoon 3 times a

day with a meal. Carlson's is a very high quality fish oil and the

one we dispense from our office.

http://www.carlsonlabs.com/images/supplementfacts/204.gif

1 teaspoon provides 700-1200IU vitamin A, 400IU of vitamin D.

The daily dose under standard treatment guidelines with cod liver oil

is 1200 IU vitamin D and at most 3600IU of vitamin A.

A quick scan of the literature says elevated liver enzymes can be seen

at 25,000IU vitamin A per day and a rare case of liver toxicity after

taking 50,000IU per day over some extended time. To achieve 25,000IU

of A you have to take about 7 times the standard dosage per day of cod

liver oil, and 14 times to match the 50,000 IU it took to cause the

" rare " case of liver toxicity cited in the abstract attached to this post.

If 2000IU vitamin D is being seen as the effective daily dose for

raising serum D levels, then the standard cod liver guideline would

need to be raised to 5 teaspoons per day from 3 -- great for

anti-inflammation, and still the vitamin A would only be 6000IU max.

Vitamin A also has important roles in immune function and tissue

healing. It should not only be viewed as a potential toxin.

[Moderator: CFIDS seem to have a hard time raising vit D level to the optimal

levels, even when taking 10,000 IU/day.

" Our research reveals that vitamin D, at doses equivalent to 2,000 IUs a day, is

not only safe for adolescents, but it is actually necessary for achieving

desirable vitamin D levels, " said Ghada El-Haff Fuleihan, M.D., of the American

University of Beirut-Medical Center, Lebanon "

http://www.sciencedaily.com/releases/2008/05/080527084255.htm and this is for a

very favorable population (adolescent who's skin produces high levels from

sunlight, living near the equator).

The key is patient testing:

" Optimal serum 25(OH)D levels are ***greater*** than 32 ng/mL (80 nmol/L). "

PMID: 18525006, Sep 2008

" for cancer prevention, desirable 25(OH)D levels are between 90-120 nmol/l

(36-48 ng/ml). " PMID: 18348447

As a statistician, I know these ranges are **Thresholds**, that is where for a

population, you can no longer detect deficiency effects. For myself, I rather be

at the 160nmol or 64 ng/ml level. There is no known risks at that level, and I

see the optimal levels are moving up on almost a yearly basis]

Cod liver oil is a safe and effective way to supplement vitamin D.

The risk of vitamin A toxicity appears extremely low in the reasonable

dosages of 3-5 teaspoons per day that I might prescribe for the

vitamin D purpose and for shifting omega 6:3 ratios to a better balance.

Jeff , ND

http://www.truehealthmedicine.com

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Am J Med. 1994 Dec;97(6):523-8.Links

Vitamin A hepatotoxicity: a cautionary note regarding 25,000 IU

supplements.

Kowalski TE, Falestiny M, Furth E, Malet PF.

Gastroenterology Division, Hospital of the University of

Pennsylvania, School of Medicine, Philadelphia.

Vitamin A hepatotoxicity has been reported at doses exceeding

50,000 IU/day. At 25,000 IU vitamin A per day, although elevated liver

enzymes may be seen, hepatotoxicity is rare. We report a case of

severe hepatotoxicity associated with the habitual daily ingestion of

25,000 IU of vitamin A bought as an over-the-counter dietary

supplement. With the general availability of high-dose supplements and

recent literature emphasizing the importance of vitamin A adequacy,

the potential for vitamin A hepatotoxicity may increase. Health

professionals should remain aware of the potential for vitamin A

hepatotoxicity and elicit a vitamin A history in all patients being

evaluated for liver dysfunction.