Wednesday, June 30, 2010

Sunshine of Your Love Part 6: Multitasking Your Needs

Doesn't this fish just look inquisitive?  That or hungry...

Today, we further delve into the intricacies of vitamin D by answering the question: Can you meet multiple needs through one source?  

If you remember from our previous installments, vitamin D can be had from different sources:
  • the sun
  • food (especially fish), and
  • supplementation
Supplementation is a slippery slope.  First, we tell you NOT to ingest processed foods, and THEN we say that our current nutritional milleau is insufficient to meet our needs, even if we eat whole foods.  So we are left with a conundrum: eat whole foods and risk deficiencies or eat whole foods and add supplements to meet our evolutionarily-derived needs.

One example of our need for supplementation is with omega-3 fatty acids.  Our ancestors had whole foods raised naturally on unpolluted, richly fertilized earth.  Whole foods of that caliber are increasingly hard to come by and in our modern world you can bet on oil being part of the process, whether to fertilize that soil, process the goods, or transport them.  Our plants and animals are entirely different beings than those we evolved upon.  We've domesticated plants into sugar factories, animals into fat (and thereby fat soluble toxin) delivery systems, and we stripe our foods of their nutrients during processing.  The problem (besides all that reliance on oil, a very finite natural resource) is that our bodies haven't caught up with modernity yet.  They still need a lot of what we can't naturally give them.  One of those things is omega-3 fatty acids.  We thrive on having our omega-3s about equal with our omega-6 fatty acids.  The problem is that while omega-6 fatty acids have become more and more ubiquitous as we consume nuts, seeds, and their oils and processed, grain-fed meats daily, the same can't be said for omega-3s that reside mostly in fish and meat from animals raised as if they were wild.  And even if we only consume the right meats, most of us thrive when given even more omega-3 fatty acids (but the same can NOT be said of omega-6 fatty acids, despite the fact that they are also essential).  So we supplement our omega-3 fatty acids with fish oil, thereby reducing systemic inflammation, improving our heart health, and accelerating recovery to exercise and the rigors of modern life (ex. stress).

The same story exists for vitamin D.  While our equatorial ancestors had no problem getting the sun they needed to produce their vitamin D, we mucked up the process by moving to places not really fit for our skin color, staying inside, covering up, and bathing too much and now most of us don't see midday sun anywhere near the duration we need to get the vitamin D we need from the sun alone.  Most of us can't meet our vitamin D needs from the sun alone, year round.  Okay, so we can eat fortified foods and whole foods that are sources of vitamin D, you say.  That makes two more problems: 1) fortified foods are processed and often don't contain the animal-based vitamin D3 we need and 2) even the whole food sources of vitamin D are a drop in the bucket to meet our needs.  We can't meet our vitamin D needs from food alone.  So what's left? Supplementation or replacement to get the vitamin D we need to thrive.  What are our options?  Well, we can take vitamin D3 gel caps, tablets along with fat, or in liquid form.

Another option exists.  We know we need fish oil for omega-3 supplementation, and we know fish are a good source of vitamin D--so put two and two together and you have the ultimate choice, right?  Not really.  Let me explain.

What About Cod Liver Oil?

Cod liver oil has been named the "Number One Superfood" by the Weston Price Foundation.  Why?  It contains bountiful omega-3 fatty acids, vitamin D, vitamin A (important for vision amongst other things), and small amounts of vitamin K (key in maintenance of bone and blood) in the most concentrated natural source. 

Balancing your fish oil needs with your vitamin D needs is tricky business, especially since those fish oil sources high in vitamin D are also high in vitamin A, which adds another layer to our risk of toxicity.  I love multitasking, but creating a trifecta balance of omega-3, vitamin D, and vitamin A might be more trouble than it is worth.  In fact, cod liver oil has created one heck of a debate in the medical community, polarizing those for and against its use.

Here is the gist of it:

The Vitamin D Council's Dr. Cannell cautioned against cod liver oil since some varieties have such high levels of vitamin A, which can be toxic when you get close to its tolerable upper intake of 10,000 IU for adults (see reference) and leads to birth defects when taken in high dosage by pregnant women.  He contends that our regular diet already generates our vitamin A needs through the carotenoids in our diet (brightly colored veggies).  Finally, excess vitamin A messes with the activation of vitamin D, making it less effective because the two compete for each other's function.  Here is his story.  Bottom line:
As the prevalence of vitamin A deficiency in the United States is apparently much lower than the prevalence of subclinical vitamin A toxicity, we cannot recommend cod liver oil for either adults or children. 
The Weston A. Price Foundation has countered that the levels of vitamin A aren't toxic (until closer to 30,000 IU) because of the natural balance between vitamins A and D in natural food sources, like cod liver oil (especially fermented kinds), and it is only when people are deficient in vitamin D that they run the risk of vitamin A toxicity.  Here is their side of the story.  Their recommendations for vitamin A run 2-5 times greater than the US RDA for children, eight times greater for pregnant women, and four times greater for adults, making their recommended dosage equal to the current upper limit of 10,000 IU.  Their rationale (see article for the citations):
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) 
Furthermore, according to this summary of the controversy, the problem is not with natural sources of cod liver oil that are relatively unprocessed; instead, the problem arises when the oil is processed and the vitamins are added back in at unnaturally potent levels, which can be toxic at high dosage.  

But is even natural cod liver oil safe?  

How Much Do You Need?

To evaluate that, let's do the math.  Here is a handy Whole 9 fish oil calculator that applies Robb Wolf's fish oil recommendations to your personal parameters (body weight and health status) and your fish oil's DHA and EPA stats to generate how much you need to take maintain or improve your health.  It takes less than a minute to find out your personalized dosage.  If you are curious why you need fish oil, read Whole 9's introduction page to the calculator and click on all the links from reputable sources like Robb Wolf, Barry Sears, Poliquin, and Berardi.  The consensus is that you need your fish oil.

However, there are potential side effects as with anything.  The same potential problems from omega-3 supplementation now apply to supplements for omega-3 and vitamin D.  One of these is problems with blood clotting since fish oil naturally thins the blood.  There are precautions not to take fish oil two weeks before surgery and one week after to avoid bleeding complications.  Obviously, don't couple fish oil with blood thinning medication.

Okay, let's play with the calculator and compare some brands to see if they can meet your omega-3 AND vitamin D needs while keeping vitamin A below the National Institutes of Health Tolerable Upper Intake Level of 10,000 IU (yeah, I know, some say it can go much higher, but I'll take the conservative road on this one).  For your vitamin D goals, let's say you don't get outside much and want to follow the 5,000 IU a day for 2-3 months recommendation of the Vitamin D Council.  For your omega-3 needs, let's calculate for a 200lb individual (the default of the calculator) and a 140lb individual using the modifier for "Healthy: Training smart, sleeping well, eating no sugars, grains, dairy or legumes" (i.e. paleo-eaters) (NOTE: if you aren't fully paleo or if you are injured/recovering from an injury, the dosage will be even higher).  Here are some results:

Nordic Naturals Omega-3D Liquid (their product with the highest omega-3 concentration):
EPA: 825 mg
DHA: 550 mg
D3: 1,000 IU
Vitamin A: none
Minimum dosage for Healthy 200lb paleo-eaters: 7 tsp/day; for 140lb paleo-eaters: 5 tsp/day
Conclusion?  EXCEEDS our optimal vitamin D for 200lb paleo-eaters by 2000 IU but MEETS the needs for 140lb-er

Nordic Naturals Arctic-D Cod Liver Oil
EPA: 410 mg
DHA: 625 mg
Vitamin A: 650–1500 IU
Vitamin D: 1000 IU
Minimum dosage for Healthy 200lb paleo-eaters: 10 tsp/day; for 140lb paleo-eaters: 7 tsp/day
Conclusion?  EXCEEDS our optimal vitamin D for both weight classes (by 5000 IU and 2000 IU respectively) and vitamin A for 200lb-ers (by 5000 IU, using the highest possible vitamin A)

Carlson's Cod Liver Oil with Low Vitamin A
EPA: 110 mg
DHA: 110 mg
Vitamin A: 250 IU
Vitamin D: 100 IU
Minimum dosage for Healthy 200lb paleo-eaters: 45 pills/day; for 140lb paleo-eaters: 32 pills/day
Conclusion?  DOESN'T MEET our optimal vitamin D for either weight class (totals: 4500 and 3200 respectively) and EXCEEDS the upper limit of vitamin A for 200lb-ers (by 1250 IU), and that is a metric crap-ton of pills to take in a day!

EPA: 500-590 mg
DHA: 400-500 mg
Vitamin A: 800-1200 IU
Vitamin D: 2000 IU
Minimum dosage for Healthy 200lb paleo-eaters: 11 tsp/day; for 140lb paleo-eaters: 8 tsp/day
Conclusion?  EXCEEDS the optimal vitamin D for both weight classes (by 17000 IU and 11000 IU respectively--Yikes!) and vitamin A for 200lb-ers (by 3200 IU, using the highest possible vitamin A)

Dr. Ron's Blue Ice Fermented Cod Liver Oil (recommended by the Weston A. Price Foundation as one of the best cod liver oil sources) 
EPA: 150 mg
DHA: 100 mg
Vitamin A: 2500 IU
Vitamin D: 250 IU
Minimum dosage for Healthy 200lb paleo-eaters: 40 pills/day; for 140lb paleo-eaters: 28 pills/day
Conclusion?  EXCEEDS the optimal vitamin D (by 5000 IU and 2000 IU respectively) and vitamin A for both weight classes (by 90,000 IU and 60,000 IU respectively)--OMG!

Looking at the ingredient labels of the other recommended brands shows the same results: too high vitamin A and vitamin D while much too low omega-3, at least according to our calculator.  According to the Weston Price Foundation, cofactors in cod liver oil increase the uptake and usage of vitamins A and D so it's more potent than other sources and you don't have to take as much to get the same results.  That still leaves out omega-3 fatty acids, though, and leads to greater potential for toxicity by the already high levels of vitamins A and D.  Perhaps you don't need as much supplemental omega-3 when your diet is full of pastured, wild-caught, grass-fed animals and fish.  Perhaps you can take some supplemental vitamin A in your diet without adverse side effects.  Perhaps, perhaps, perhaps...  To me, it's a little too iffy.  

Thus, if you are going to get your vitamin D from cod liver oil, you have to make damn sure the ratio of vitamin A to vitamin D does NOT exceed 10:1 and take into account what dosage you need to meet your vitamin D and omega-3 needs--is the vitamin A at that dosage exceeding the tolerable upper intake of 10,000 IU for adults?  Remember, if you are eating plenty of brightly colored veggies, eggs, occasional liver, and good sources of meat and fish, you are likely meeting your vitamin A needs, so keep it's level by supplement as low as possible.  

Bottom line: If you are going to multitask your omega-3 and vitamin D needs, you just might be jumping into the deep end of the pool without your water wings.  

Next up, let's discuss more about supplementation sources:
Sunshine of Your Love Part 7: Supplementation Source

This is NOT medical advice to take vitamin D or any other supplements.  Consult your doctor (and try to educate him/her with this information), do some research, and formulate your OWN plan.


  1. I’ have gone through your article. This is good information to have with me. Liquid Fish Oil is good for health especially for heart related problems. It will improve your emotional health and enhance vitality. Good advice!

  2. Just found your site. Thanks for your very interesting posts on vitamin D. I fully agree with you that we need to put lots of effort and thinking into multitasking our intake of vitamin D and A.

    But wouldn't buying a full-spectrum lamp or going for a tanning session solve this problem?