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Case Study: Hypervitaminosis A Following Long-Term Use of High-Dose Fish Oil Supplements

As Grant Genereux points out in his free e-books, fish oil supplements contain undisclosed Poison/"Vitamin A". The man in this case study was taking LOTS of fish oil pills, along with some "unknown" amount of cod liver oil pills.  CLO pills would obviously contribute more Poison/"Vitamin A" to the mix, yet the author chose to focus on the fish oil AND the problem only started resolving upon completely stopping the fish oil pills.  The culprit should seem obvious, and it isn't the CLO pills alone.

Hypervitaminosis A Following Long-Term Use of High-Dose Fish Oil Supplements (full PDF attached below)

The use of fish oil supplements recently has become quite popular as a potential method of lowering plasma lipids, inhibiting platelet aggregation, decreasing blood pressure and increasing plasma HDL levels. 1 However, the consumption of large dosages of these substances may not be without risk, as they may contain relatively high levels of both vitamins A and D. 2 Reported here is a case of hypervitaminosis A secondary to chronic fish oil capsule ingestion alone.

A 35-year-old white man presented complaining of anorexia, nausea, fatigue and mild frontal headache. He had been well until approximately one year prior to presentation when he began to consume between 30 and 50 capsules a day of various commercial fish oil preparations. These principally included Max EPA (R. P. Scherer Company, Clearwater, FL), Pro Mega (Parke-Davis Co, Morris Plains, NJ), EPA-Chol (People's Drugs, Alexandria, VA), Twin EPA (Twin Labs, Rokenkona, NY) and Super EPA (Pharmacaps, Inc, Elizabeth, NJ).

Note that none of the above fish oil supplements are cod liver oil, they are specifically fish oil...between 30-50 capsules a day!

He reported taking no other medications or vitamin supplements during this time, nor did he report high dietary sources of vitamin A. However, it was later found that the patient had also consumed an undetermined number of cod liver oil capsules during that year.

The ASSumption that was made here was that his consumption of a massive amount of fish oil pills was the problem, and that the intake of cod liver oil pills was relatively minor (although would have definitely contributed to the problem. Note below that stopping the FISH OIL capsules is what started his recovery.

Approximately one month prior to presentation he began to notice chronic fatigue and malaise as well as dry and itchy skin. One week prior to admission he began to complain of myalgia, anorexia and nausea and two days prior he began to have episodes of vomiting.

He obviously passed some threshold level of toxicity within that prior month, and again in that prior week.  This is how toxicity works, folks.  The poisoning/toxicity will show up much more only once a certain threshold has been crossed.  Theoretical examples might be the liver's storage capacity for Poison/"Vitamin A" is surpassed, the next one might be that there is not enough Retinol Binding Protein (RBP) to protect the person enough from the continuing onslaught of Poison/"Vitamin A".  All just theories, but it goes along with my saying, "my car worked just fine...until it broke!"

Vital signs showed a blood pressure of 120/80 mm Hg, a respiration rate of 16 breaths per minute, a pulse rate of 80 beats per minute and a temperature of 38.3 degress C orally.

38.3 degrees celsius = ~101 degrees fahrenheit.  This man is running a temperature/fever.  Fevers are one way the body tries to rid itself of Poison/"Vitamin A" toxicity.

On physical examination, he was noted to have diffusely dry skin with fissures around the mouth.

Another term for fissures around the mouth is cheilosis/cheilitis, which is often simply assumed to be a Vitamin B2 deficiency...when in reality it is a classic symptom of Poison/"Vitamin A" toxicity (and the B2 deficiency is likely caused by this as well).

Ophthalmologic examination showed no papilledema. Pulmonary, cardiac and neurologic examinations were unremarkable. Abdominal examination revealed mild hepatomegaly but was otherwise unremarkable. A scan of the liver and spleen showed hepatomegaly with a liver size of 14 cm. The electrolyte, BUN, creatinine, calcium and alkaline phosphatase levels were normal as were the complete blood cell count and urinalysis findings. The SGOT was elevated to 102 IU/L (normal, 10 to 40 IU/L) and the SGPT was 80 IU/L (normal, <40 IU/L). The fasting blood lipid profile showed a total cholesterol value of 215 mgldl, an HDL cholesterol level of 38 mgldl, a LDL cholesterol value of 150 mg/dL and a triglyceride level of 170 mg/dL. A serum vitamin A level was 482 mcg/dL (normal, 30 to 70 mcg/dL).

Note how many of the above examinations were normal...until they get to the scans of the liver and the liver enzyme tests (SGOT and SGPT).  Serum Vitamin A was ~7x higher than the high end of the range!

Most doctors never even consider running serum Vitamin A levels (and wouldn't know proper goals for it anyway!).  Many people are told all their labs are "fine".  Even when people's liver enzymes are elevated, many doctors shrug it off and say it's "no big deal"...when that's the only marker a person might show on "standard" blood tests that points toward Poison/"Vitamin A" toxicity!  Non-Alcoholic Fatty Liver Disease (NAFLD, hepatomegaly, "big liver", anyone?) is an EPIDEMIC worldwide: The global NAFLD epidemic. (!!!).

I'm going to interject another study here about how NAFLD is diagnosed:

Non-alcoholic fatty liver disease: The diagnosis and management

Most subjects with NAFLD are clinically silent and asymptomatic, but can manifest with non-specific symptoms such as right upper quadrant discomfort or fatigue. Liver enzymes are usually minimally perturbed with mostly increased levels of alanine aminotransferase (ALT) [ALT is SGPT, same thing] and gamma-glutamyl transpeptidase [aka GGT, a marker of oxidative stress/damage in the liver]. The diagnosis is often made incidentally in these individuals because of either abnormal liver enzyme levels or radiological features of a fatty liver. In others, NAFLD may be diagnosed either as a result of an unusual appearance of the liver during abdominal surgery or because of persistent hepatomegaly.

This man had a "clinically silent" liver, elevated ALT/SGPT AND elevated AST/SGOT, and an enlarged spleen AND liver upon scanning!

He had NAFLD by all indications.  Gosh, do you think all these things might be connected?

The patient's fish oil supplements were discontinued and his symptoms gradually disappeared by the end of one week.

He stopped the fish oil, his symptoms went away. NAFLD doesn't go away in a week.  Six months of heavily restricting ALL sources of Poison/"Vitamin A" would likely do it.

Followup at one month showed resolution of his dry skin and hepatomegaly and the vitamin A level was 68 mcg/dL.

They said above that his symptoms were gone after one week...yet they mentioned that only after one MONTH was the dry skin resolved.  I'm guessing that they didn't do another scan on his liver at this time, they just palpated it (physical exam). Note that earlier in the paper they first found "mild hepatomegaly" on palpation, while the scan caught both an enlarged liver and and enlarged spleen.  Obviously, the physical exam is not as sensitive as their scans, and the hepatomegaly could still be there, just less.

Also, the serum Vitamin A just barely squeaked into the "normal" range for back then (30-70 mcg/dL, 1990).  The recent LabCorp "normal" range for 20-39 year olds is 18.9–57.3 mcg/dL, so he was still hypervitaminotic/toxic based on more recent numbers.  After a month of no fish oil, he was still 3x higher than I want people to be.  He was not out of trouble by a long shot, in my opinion.

The fasting blood lipid profile at that time showed a total cholesterol level of 212 mg/dL, an HDL cholesterol value of 38 mg/dL, an LDL cholesterol level of 138 mg/dL.

He stopped all that fish oil and his cholesterol levels didn't really change at all.

Hypervitaminosis A is a well described clinical entity which has usually been observed following the chronic ingestion of vitamin A supplements. 3,4 It has been reported that as little as 10,000 IU of vitamin A intake daily may be sufficient to cause symptoms of hypervitaminosis. 4

People have NO idea how easy it is to get WAY more than 10,000 IU per day from foods alone.

Patients usually present complaining of fatigue, irritability, dry itchy skin, loss of body hair, headache, myalgia, low-grade fever, anorexia and vomiting. 3

Maybe you or someone you know is (any combo of these, or even just one):

  • low energy / fatigue
  • irritable (depressed, frustrated, grumpy)
  • dry skin and/or itchy skin
  • losing their hair or hair thinning
  • headaches (any type, including migraines)
  • muscle pain
  • recurring low-grade fevers
  • lack of proper appetite
  • nausea and/or vomiting without obvious cause

Those first six issues are a major part of what is walking into every doctor's office, every day, around the world.  This is the epidemic of Poison/"Vitamin A" toxicity exacerbated/aggravated by glyphosate/Roundup stopping the normal breakdown of Poison/"Vitamin A" in the liver.

Hepatomegaly often is present on physical examination, presumably due to an accumulation of vitamin A in the liver.

Think NAFLD, discussed above.

Vitamin A toxicity results when the transport system for vitamin A from the liver to the peripheral tissues is overtaxed and free retinal and/or retinoic acid interact with cell and organelle membranes. 5

Poison/"Vitamin A" is toxic.  Free retinal is toxic.  Retinoic acid (think chemical peel, because that's what it is) is toxic.  The only savior your body has against it is RBP...if Poison/"Vitamin A" is not bound to RBP or if your liver can't make enough, then the true toxic nature of Poison/"Vitamin A" is unleashed on the system.

Concentrations of vitamin A in plasma over 300 mcg/dL are considered diagnostic of the condition. 6

This doesn't make sense.  If the "normal" range they went by was 30-70 mcg/dL, why would the diagnosis of "hypervitaminosis A" have to start at 300???

Fish oils in various forms recently have been the subject of considerable media attention, principally due to their reported ability to prevent the development of coronary artery disease. It is interesting to note, however, that the patient's massive intake of fish oils did not significantly alter his blood lipid picture, and actually caused an increase in his LDL level. Similar findings during periods of fish oil intake were reported by Harris et al. 7 Some of the available commercial fish oil preparations (especially those containing large amounts of cod liver oil), may contain significant amounts of vitamin A. 1,2

Fish oil is a farce and is hurting people (this article shows it, even without talking about the Poison/"Vitamin A" problem: Why Fish Oil Fails: A Comprehensive 21st Century Lipids-Based Physiologic Analysis.  Yes, the paper was retracted due to a competing interest of the author.  That doesn't mean that the REFERENCES used in this paper are any less legitimate, I'd suggest looking at them.

When used at the recommended dosages (usually six capsules a day), these agents are relatively safe. However, the quantity of fish oil capsules taken by this patient far exceeded the dose usually taken or recommended. The case reported here suggests that an increase in episodes of hypervitaminosis A may occur owing to the ovezealous use of fish oil supplements by individuals wishing to lower their risk of developing coronary artery disease.

Maybe fish oil capsule aren't as safe as you were led to believe, due to other unannounced components present in Poison/"Vitamin A".

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Dr. Garrett Smith, the "Nutrition Detective"
Licensed Naturopathic Physician (NMD) in Arizona, home of the Love Your Liver program
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