Cod Liver Oil vs TB

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In a feature article in the Christmas 2011 edition of the well-known British Medical Journal, Professor Emeritus Malcolm Green revisited an 1848 study looking at the potential benefits of Cod Liver Oil in the treatment of Tuberculosis.[1]

In the study, carried out by physicians at the Hospital for Consumption, Chelsea (now the Royal Brompton Hospital), 542 patients with consumption (tuberculosis) received standard treatment with cod liver oil. These patients were compared with 535 ‘control’ patients who received standard treatment alone (without cod liver oil).[2]

While improvement rates were similar in the two groups, the disease was stabilised in 18% of the patients given cod liver oil, compared with only 6% of those in the control group. Deterioration or death occurred in 33% of patients given standard treatment alone, but in only 19% of those given cod liver oil, a reduction of 14%.

‘Stabilisation and reduction of death greater in the CLO group’

The 542 inpatients with consumption treated with cod liver oil, were given a dose of 1 drachm (3.6 ml) three times a day, gradually increased, in some few cases up to 1.5 ozs (42 ml) per dose.

It was observed that one of the most striking effects of the use of cod liver oil is an increase in the patient’s weight. A gain in weight occurred in 70%, a loss in only 21% and in 9% the weight remained stationary. However, the weight changes in patients in the control group were not recorded, so this observation remains anecdotal.

Professor Green says that some children are still given cod liver oil today and perhaps this relates back to the late 19th and early 20th centuries when cod liver oil was widely used to treat and prevent tuberculosis.

He adds that the steady fall in tuberculosis deaths in the late 19th and early 20th centuries is often attributed to better living conditions. While a reduction in overcrowded living might have reduced transmission, Green believes improved nutrition was probably as important. “It could well be that the widespread use of cod liver oil encouraged by doctors played a significant part,” he writes.

Cod liver oil is a rich source of Vitamin D, which we now know is important in fighting infections, as well as preventing conditions such as rickets, says the author.

He says: “A role for vitamin D in combating tuberculosis gives a rational basis for sunshine therapy, which was widely practised for patients in sanatoriums before chemotherapy became available, as vitamin D is synthesised in the skin when exposed to the sun. Patients were put out on their beds to lie in the sun in summer and winter, and many were sent to Switzerland and other sunny countries for treatment.” He adds that today many patients who develop TB in the UK are found to be Vitamin D deficient.[3]

The author concludes:

Tuberculosis is still a virulent and common infection, accounting today for some 3.5 million deaths worldwide.[4] The emergence of multidrug resistant bacilli is of increasing concern.[5] It could be that vitamin D supplements will again have a role in combating this terrible killer, possibly in some subsets of those patients with vitamin D deficiency through diet or relative lack of sunshine.[6]

References


[1] Green M; Physicians from the Hospital for Consumption and Diseases of the Chest, anonymous and long deceased. Cod liver oil and tuberculosis. BMJ. 2011 Dec 20;343:d7505. doi: 10.1136/bmj.d7505. View Full Paper

[2] Hospital for Consumption and Diseases of the Chest. The First Medical Report of the Hospital for Consumption and Diseases of the Chest, presented to the Committee of Management by the Physicians of the Institution. J Churchill, 1849, pp. 31-41.

[3] Usrtianovski A, Shaffer R, Collin S. Prevelance and associations of vitamin D deficiency in foreign-born persons with tuberculosis in London. J Infect2005;50:432-7 View Abstract

[4] Bryder L. Below the magic mountain—a social history of tuberculosis in twentieth century Britain. Clarendon Press, 1988, p. 7.

[5] Veen J. Drug resistant tuberculosis: back to sanatoria, surgery and cod liver oil? Eur Respir J 1995;8:1073-5. View Full Paper

[6] Martineau AR, Timms PM, Bothamley GH, Hanifa Y, Islam K, Claxton AP, et al. High-dose vitamin D3 during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial. Lancet2011;377:242-50. View Abstract

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