For years, I have recommended cod liver oil as a dietary supplement
to support healthy vitamin D levels. However, based on more recent
findings, I am updating my recommendations regarding cod liver oil, as
it may not serve you as well as previously believed.

My previous recommendation was based on the fact that cod liver oil
contains vitamins D and A in addition to healthy omega-3 fats. These
vitamins are essential for most everyone who cannot get regular sun
exposure year-round.

But more recent research has discovered that the ratios of these two
vitamins may be of paramount importance in order to extract optimal
health benefits, and unfortunately, modern cod liver oil does not
supply these vitamins in healthy ratios to each other.

What You Need to Know About Vitamins A and D in Cod Liver Oil

At least 2,000 genes, or nearly 10% of your genes, have been
identified that are directly influenced by vitamin D, which in turn
impact a wide variety of health issues, from preventing the common cold
and flu to inhibiting at least 16 different types of cancer. There’s
even evidence linking vitamin D to the process of brain detoxification
of heavy metals such as mercury.

Widespread vitamin D deficiency has also been strongly linked to the
childhood epidemics of autism, asthma, and diabetes, both type 1 and 2.

Vitamin A, which is essential for your immune system just like
vitamin D, is also a precursor to active hormones that regulate the
expression of your genes, and they work in tandem.

For example, there is evidence that without vitamin D, vitamin A can be ineffective or even toxic. But if you’re deficient in vitamin A, vitamin D cannot function properly either.

There are many problems with modern cod liver oil but one of the
primary ones is that there is no standard definition of what
constitutes cod liver oil. Manufacturers are free to add or subtract as
much vitamin A or D as they see fit. In fact cod liver oil was
discovered in the sewers of England several hundred years ago by
starving children who drank it and scientists noticed they did not get
rickets. Cod liver oil is in fact a highly processed food that was
never consumed by humans prior to this.

Primary Justification Why You Should AVOID Cod Liver Oil

There have been two recent meta-analyses done. The first one showed
that people who took vitamin A supplements in cod liver oil, or in
supplements, had an 18 percent increase in death rates. The other study
showed that unlike third world countries where vitamin A
supplementation appears to decrease infections, vitamin A
supplementation in developed countries like the U.S. actually increases
infections.

The researchers believe this is due to massive nutritional
deficiencies in the third world because most of their calories are from
grains and they simply don’t have an opportunity to consume as many
fresh fruits, vegetables, butter, eggs and other vitamin A containing
foods that those in the developed world do.

In fact current research could not find any vitamin A deficiency at
all, but approximately 5% had vitamin A toxicity. The converse is true
in the third world where vitamin A toxicity is virtually unheard of,
yet vitamin A deficiency is pervasive.

Additionally new research has shown that vitamin D protects against
cancer. But a paradox was found as those with higher vitamin D levels
did not seem to have this benefit. A bright Harvard researcher
carefully analyzed the data in the study that showed this and found
that when he removed the people with high vitamin A and vitamin D
levels, those with normal vitamin A levels and high vitamin D levels
continued to have reduced risk of colon cancer. So those that did not
take vitamin A had the protective effect from higher levels of vitamin
D.

Other research is now showing a connection between high levels of
vitamin A and osteoporosis. In fact many Scandinavian countries that
regularly supplement with cod liver oil have rampant osteoporosis even
though they are getting adequate amounts of oral vitamin D.

Dr. John Cannell, head of the Vitamin D Council, along with 15 other researchers, recently released an article “Cod Liver Oil, Vitamin A Toxicity, Frequent Respiratory Infections, and the Vitamin D Deficiency Epidemic” in the November issue of Annals of Otology, Rhinology and Laryngology.
In this paper Dr. Cannell raised questions about the efficacy of cod
liver oil due to its highly variable and frequently excessive amount of
vitamin A. Typically modern cod liver oil contains far less vitamin D
than it used to, due to the deodorization process used today which
removes much of this essential nutrient.

Dr. Cannell and other prominent researchers believe the vitamin A
contained in most cod liver oil is excessive, and can reduce the
effectiveness of vitamin D by inhibiting the binding of its active form
to your DNA, effectively preventing its ability to regulate the
expression of your vitamin D-responsive genes.

The Weston Price Foundation, of which I am an advisory member, holds
a contradictory view. They believe vitamin D can only effectively
target genes when its “partner receptor” is activated by vitamin A. If
vitamin A is absent, certain molecules called co-repressors bind to the
receptors and prevent vitamin D from functioning. It is their position
that cod liver oil is still a highly recommended supplement.

After reviewing the evidence, I am personally convinced that there
is sufficient vitamin A in the current American diet to facilitate
sufficient vitamin D activation. This does not appear to be the case in
third world countries, where cod liver oil, or some other preformed
retinol supplement, would still be useful.

Most Cod Liver Oils Have Excessive Vitamin A (Preformed Retinol)

However, even the Weston Price Foundation acknowledges that there
are dangerous versions of cod liver oil out there, even from some
highly reputable companies like Nordic Naturals, which produces a cod
liver oil that is clearly excessive in vitamin A as it only has 3 to 60
units of vitamin D per tablespoon but between 150 and 12,000 times as
much vitamin A.

It’s a delicate balance.

Both vitamins are essential to obtain optimal health benefits,
however, the ratios can become dangerously unbalanced — much like the
omega-3/omega-6 balance, which has become inversed in our modern diet.

Nearly all brands of cod liver oil provide a token amount of vitamin
D, typically a mere 400 to 1,200 IU of vitamin D per tablespoon but
anywhere between 4,000 to 30,000 IU of vitamin A. This is clearly
inappropriate. About the lowest ratio I have seen is ten times as much
vitamin A as vitamin D but, as I stated above, it can be as high as
12,000 times as much vitamin A.

First of all, this is clearly an insufficient amount of vitamin D
for even the smallest child. This is in part due to the government
recommendations, which are FAR too low to offer any health benefits;
the recommended daily dosage being no more than 200 to 600 IU,
depending on age. Meanwhile, researchers have since established that
the therapeutic dosage is anywhere between 2,000 to 10,000 IU per day,
depending on your weight and other factors, such as skin color and
level of regular sun exposure. (Some people may require, and can safely
take, as much as 20,000 IU daily.)

Consuming such high amounts of vitamin A as contained in cod liver
oil and most multi-vitamins, while not getting nearly enough vitamin D,
combined with the fact that most people are deficient in vitamin D to
begin with, could potentially cause vitamin A to become toxic.

The concern Dr. Cannell and the other researchers have is that
vitamin A in cod liver oil is excessive and actually antagonizes
vitamin D by inhibiting the binding of its active form to DNA and thus
preventing its ability to regulate the expression of vitamin
D-responsive genes.

The Weston Price Foundation’s strong belief is that vitamin A is not
at all toxic but is necessary for optimal vitamin D function. However
they believe there is sufficient vitamin A in the diet of most
Americans, especially if they are taking a multivitamin. In the third
world this is not the case and they would likely benefit from vitamin A
supplementation.

The Weston Price Foundation does not agree with Dr. Cannell’s
conclusion that cod liver oil itself may cause vitamin A toxicity,
however they also do not recommend taking any cod liver oil that is low
in vitamin D. Yet even their recommendations, in my opinion have far
too low amounts of vitamin D to be clinically useful. But more
importantly it appears that the high amounts of vitamin A may limit the
effectiveness of vitamin D even if more is taken in addition to that
received in the cod liver oil.

Although it’s still unclear exactly what the balance should be, Dr.
Cannell and most of the prominent expert researchers in this area
believe that the ratios of these two essential nutrients likely should
be reversed from those typically seen in cod liver oil, as you need far
greater amounts of vitamin D as opposed to vitamin A.

After carefully reviewing the arguments on both sides of the issue I
am convinced that Dr. Cannell’s approach is far more likely to be
consistent with producing high levels of health and decreased illness.

My Revised Cod Liver Oil Recommendations

As the prevalence of vitamin A deficiency (which would benefit from
cod liver oil) in the U. S. is much lower than the prevalence of
subclinical vitamin A toxicity, while most everyone suffers from
vitamin D deficiency, I no longer recommend taking cod liver oil for either adults or children.

You’re likely getting the vitamin A you need if you regularly
consume fresh vegetables high in this nutrient, such as sweet potatoes,
carrots, cantaloupe, and other colorful fruits and vegetables, and
butter especially, if obtained from grass fed cows.

Although you can obtain Vitamin D from your diet, it is very
difficult, and I believe it is very unnatural. It is my strong belief
that we were designed to obtain virtually all of our vitamin D from
exposing appropriate areas of our skin to sunshine. If this is not
possible, the next best choice would be exposure to UVB rays from safe
tanning beds, and if that is not possible then one should resort to a
high quality vitamin D3 supplement.

As it stands, it is my strong belief that you’re simply not
getting the appropriate balance of vitamin A to vitamin D from cod
liver oil, which is why I believe it is best to avoid it.

Please note that this new recommendation does NOT apply to
either fish oil or krill oil, as neither of them contain the vitamins A
or D, but rather are excellent sources of essential omega-3 fats.
EVERYONE still needs a regular high quality source of these absolutely
essential and vital nutrients.

Another potential point of confusion is that beta carotene is
not a concern, as that is PRE vitamin A. Your body will simply not over
convert beta carotene to excessive levels of vitamin A. So taking beta
carotene supplements is not going to interfere with vitamin D.