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What is Cod Liver Oil
Cod liver oil is used as a dietary supplement and is available in both liquid and capsule forms.
It is rich in vitamin A, vitamin D, and omega-3 fatty acids; some commercial formulations may contain additional vitamins and nutrients.
The omega-3 content includes two essential fatty acids (EFAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). EFAs are not synthesized by the human body and therefore must be consumed in the diet to prevent EFA deficiency.
However, caution is advised as cod liver oil products may also contain toxic organochlorines, including the pesticides DDT and lindane and polychlorinated biphenyls (PCBs), which are concentrated in the fish liver prior to harvest.
Additionally, high vitamin A and vitamin D concentrations in cod liver oil could lead to hypervitaminosis. Patients should consult a health care provider prior to initiating supplementation for appropriate monitoring and therapy.
As the name implies, cod liver oil is derived from the livers of cod fish. The practice of drinking cod liver oil was started several centuries ago by the fisherman of Scandinavia and Greenland for fortification under cold and harsh working conditions.
In the late 1800s, prior to the addition of vitamin D to milk, cod liver oil was used successfully to treat and prevent rickets.
Currently, fish oil supplements are promoted for a variety of health conditions including hypertriglyceridemia, migraine prophylaxis, psychiatric conditions, secondary prevention of cardiovascular disease, type 2 diabetes mellitus, various nephropathies, and also for inflammatory conditions such as asthma, gingivitis, inflammatory bowel disease, and rheumatoid arthritis.
Although data for most conditions are limited and preliminary, fish oil supplements, including cod liver oil, are ‘Generally Recognized As Safe’ (GRAS) by the FDA. The data are most compelling for the ingestion of fish in the diet to maintain a healthy heart.
The American Heart Association (AHA) recommends eating fish two times per week as a source of lean protein. Until compelling data indicate that fish oil supplements benefit overall cardiovascular health, the AHA does not recommend the use of supplements for this purpose.
In November 2004, the FDA approved a prescription only fish oil supplement capsule Omacor™ (see separate monograph: Fish Oils, Omega-3 Fatty Acids) for the treatment of hypertriglyceridemia.
Indications
- nutritional supplementation
Side Effects
- abdominal pain
- alopecia
- anorexia
- arthralgia
- ataxia
- azotemia
- constipation
- dehydration
- diarrhea
- dysgeusia
- dysmenorrhea
- dyspepsia
- ecchymosis
- elevated hepatic enzymes
- epiphyseal closure
- epistaxis
- eructation
- exophthalmos
- fatigue
- growth inhibition
- halitosis
- headache
- hepatomegaly
- hypercalcemia
- hypercalciuria
- hypercholesterolemia
- hyperphosphatemia
- hypertension
- hyperthermia
- hypervitaminosis A
- hypervitaminosis D
- increased intracranial pressure
- irritability
- jaundice
- lethargy
- leukopenia
- malaise
- metallic taste
- musculoskeletal pain
- myalgia
- nausea
- nocturia
- osteoporosis
- papilledema
- photophobia
- polydipsia
- polyuria
- prolonged bleeding time
- pruritus
- rash
- renal failure (unspecified)
- skin hyperpigmentation
- splenomegaly
- teratogenesis
- tinnitus
- vertigo
- vomiting
- weakness
- weight gain
- weight loss
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- alcoholism
- anticoagulant therapy
- asthma
- biliary tract disease
- bipolar disorder
- bleeding
- breast-feeding
- cardiac disease
- children
- dental work
- diabetes mellitus
- fish hypersensitivity
- gallbladder disease
- hepatic disease
- hepatitis
- hypercalcemia
- hypercholesterolemia
- hyperlipidemia
- hyperphosphatemia
- hypertension
- hypervitaminosis A
- hypervitaminosis D
- infants
- inflammatory bowel disease
- malabsorption syndrome
- migraine
- myocardial infarction
- nephrolithiasis
- obesity
- pregnancy
- pulmonary disease
- renal disease
- rheumatoid arthritis
- sarcoidosis
- schizophrenia
- surgery
- systemic lupus erythematosus (SLE)
- thrombolytic therapy
Interactions
There are no drug interactions associated with Cod Liver Oil products.
