Cod Liver Oil Basics and Recommendations February 9, 2009 By Sally Fallon and Mary G. Enig, PhD 407 Comments Read this in: Français Last updated 2019 Concerns about Fermented Cod Liver Oil Questions and Answers About Fermented Cod Liver Oil JUMP TO: Brand Recommendations – Updated 2019 Once a standard supplement in traditional European societies, cod liver oil provides fat-soluble vitamins A and D, which Dr. Price found present in the diet of primitives in amounts ten times higher than in modernized diets. Cod liver oil supplements are a must for women and their male partners, to be taken for several months before conception, and for women during pregnancy. Growing children will also benefit greatly from a small daily dose. Cod liver oil is also rich in eicosapentaenoic acid (EPA) and docasahexaenoic acid (DHA). The body makes these fatty acids from omega-3 linolenic acid. EPA is as an important link in the chain of fatty acids that ultimately results in prostaglandins, localized tissue hormones while DHA is very important for the proper function of the brain and nervous system. Those individuals who have consumed large amounts of polyunsaturated oils, especially partially hydrogenated oils, who are suffering from certain nutrient deficiencies, or who have impaired pancreatic function, such as diabetics, may not be able to produce EPA and DHA and will, therefore, lack important prostaglandins and necessary fats for the brain unless they consume oily fish or take a cod liver oil supplement. Buy cod liver oil in dark bottles and store in a cool, dark, dry place. Please read Vitamin A, Vitamin D, and Cod Liver Oil: Some Clarifications below for amounts to give to adults and children and for recommended brands. Cod liver oil is easy to take when stirred into a small amount of water or fresh juice. Dr. Price always gave cod liver oil along with high-vitamin butter oil, eXtracted by centrifuge from good quality spring or fall butter. He found that cod liver oil on its own was relatively ineffective but combined with high vitamin butter oil produced eXcellent results. The butter oil contains what he called Activator X, now considered to be vitamin K2, which works synergistically with vitamins A and D (see Chris Masterjohnʼs article “On the Trail of the Elusive X Factor: A Sixty-Year Old Mystery Finally Solved”). Your diet should include sources of vitamin K, such as good quality butter from grass-fed cows and/or high-vitamin butter oil, fat from grass-fed animals, cheeses from grass-fed animals and duck or goose liver, along with cod liver oil. Vitamin A, Vitamin D & Cod Liver Oil: Some Clarifications Several visitors to our website have noted inconsistencies in various statements about vitamin A, vitamin D and cod liver oil. These issues revolve around questions of dosage and safety. Vitamin A Dosage We have pointed out that concerns about vitamin A toXicity are exaggerated. While some forms of synthetic vitamin A found in supplements can be toxic at only moderately high doses, fat-soluble vitamin A naturally found in foods like cod liver oil, liver, and butterfat is safe at up to ten times the doses of water-soluble, solidified and emulsified vitamin A found in some supplements that produce toXicity.(1) Additionally, the vitamin D found in cod liver oil and butterfat from pasture-raised animals protects against vitamin A toxicity, and allows one to consume a much higher amount of vitamin A before it becomes toXic.(1-3) Liver from land mammals is high in vitamin A but low in vitamin D, and should therefore be consumed with other vitamin D-rich foods such as lard or bacon from pasture-raised pigs, egg yolks, and oily fish, or during months in which UV- B light is sufficient to provide one with adequate vitamin D. As a general guideline, we recommend the following doses of vitamin A from cod liver oil, along with a nutrient-dense diet that contains other vitamin A-rich foods: Children age 3 months to 12 years: A dose of cod liver oil that provides about 5000 IU vitamin A daily, obtained from about 1 teaspoon of regular cod liver oil or ½ teaspoon of high-vitamin cod liver oil. Children over 12 years and adults: A maintenance dose of cod liver oil that provides about 10,000 IU vitamin A daily, obtained from 2 teaspoons of regular cod liver oil or 1 teaspoon of high-vitamin cod liver oil. Pregnant and nursing women: A dose of cod liver oil that provides about 20,000 IU vitamin A daily, obtained from 4 teaspoons regular cod liver oil or 2 teaspoons high-vitamin cod liver oil. Please note that these recommended doses are 2-5 times greater than the U.S. RDA for children, 4 times greater than the U.S. RDA for adults and 8 times greater than the U.S. RDA for pregnant women. The RDA values are based on studies conducted in the general population, which is now recognized to be largely deficient in vitamin D. For a discussion of studies showing that vitamin A consumption up to 30,000 IU per day by pregnant women does not result in a greater risk of birth defects, see Vitamin A for fetal development. This article also describes the vital role played by vitamin A in the development of the fetus. Pregnant women may wish to consult their health practitioner about taking cod liver oil during pregnancy. Individuals under stress or wishing to use cod liver oil to treat a disease condition may take much larger doses, even up to doses providing 90,000 IU vitamin A per day, for a period of several weeks. Vitamin D Dosage Our recommended brands of cod liver oil (see below) will provide with the above recommended dosages for cod liver oil about 500-1000 IU vitamin D for children, 1000-2000 IU vitamin D for adults, 2000-4000 IU vitamin D for pregnant and nursing women and up to 9000-18,000 IU for those taking large amounts of cod liver oil to deal with stress and disease. In 1997, the Food and Nutrition Board of the US Institute of Medicine set the tolerable upper intake level (TUIL) for vitamin D at 2000 IU per day. However, the vitamin D content experts on the Upper Limits Panel objected to this limit, and several prominent vitamin D researchers have called for an upward revision of the limit. EXperiments show that even during the winter with a low vitamin D intake, humans will exhaust stores of vitamin D at a rate of 3000-4000 IU per day, an amount that many people require to maintain optimal levels of the vitamin in the blood. Extensive eXposure to summer sun at mid latitudes naturally produces levels of vitamin D in the blood equivalent to what is attained by supplementing with a continued daily dose of 10,000 IU, suggesting humans are designed to tolerate such large amounts of vitamin D.(4) If you are a lifeguard or spend a lot of time in the sun, you do not need to take supplemental vitamin D; however you still need to consume adequate vitamin A. Animal studies show that even moderate amounts of vitamin D increase the bodyʼs need for vitamin A, whether the vitamin D is provided in the diet or by UV light (2,5). So, if you cut back or eliminate cod liver oil in the summer, be sure to consume plenty of oily fish, liver, butterfat and egg yolks from grass-fed hens to ensure adequate vitamin A. For a discussion of Vitamin D Toxicity, see http://www.vitamindcouncil.org/about-vitamin-d/am-i-getting-too-much- vitamin-d/ This does not mean we do not recommend that some individuals have their vitamin D levels tested. Such testing can be very useful in determining vitamin D status and the effectiveness of cod liver oil or vitamin D supplements. Optimal serum vitamin D levels should be in the range of 30-50 ng/mL (see discussion at [link “Potential Dangers of Vitamin D, page 24 of Spring 2009]). Brand Recommendations – Updated 2019 Most brands of cod liver oil go through a process that removes all of the natural vitamins. The resultant product contains very low levels of vitamin A and virtually no vitamin D. Some manufacturers add manufactured vitamins A and D to the purified cod liver oil and until recently, one manufacturer added the natural vitamins removed during processing back into the cod liver oil. Fortunately, we now have available in the U.S. a naturally produced, unheated, fermented high-vitamin cod liver oil that is made using a filtering process that retains the natural vitamins. The high-vitamin fermented cod liver oil is sold as a food so does not contain vitamin levels on the label. However, after numerous tests, the approximate values of A and D have been ascertained at 1900 IU vitamin A per mL and 390 IU vitamin D per mL. Thus 1 teaspoon of high-vitamin fermented cod liver oil contains 9500 IU vitamin A and 1950 IU vitamin D, a ratio of about 51. Based on these values, the dosage for the high-vitamin fermented cod liver oil is provided as follows: Children age 3 months to 12 years: 1/2 teaspoon or 2.5 mL, providing 4650 IU vitamin A and 975 IU vitamin D. Children over 12 years and adults: 1 teaspoon or 10 capsules, providing 9500 IU vitamin A and 1950 IU vitamin D. Pregnant and nursing women: 2 teaspoons or 20 capsules, providing 19,000 IU vitamin A and 3900 IU vitamin D.