Experts have reiterated that since Tuberculosis (TB) is still a common infection,accounting for millions of deaths annually across the world, there may yet be a role for cod liver oil, an old-time remedy, in the treatment of Tuberculosis.

TB is still a common and life-threatening disease in most parts of the world. And even with modern medicines, the disease can sometimes be difficult to treat, as some strains of TB are becoming resistant to antibiotics. It is a major global problem: an estimated one-third of the world’s population – nearly two billion people – is infected. Nine million people a year develop the active disease worldwide, which kills two million each year.

In 1848, physicians with the Hospital for Consumption and Diseases of the Chest (now the Royal Brompton Hospital in Chelsea) conducted a study involving 1,077 patients with TB. They gave 542 patients thrice-daily doses of cod liver oil in addition to their usual care, and compared them with 535 patients who had usual care alone.

The proportion of patients in each group who improved was similar: 63 per cent in the cod liver oil group and 61 per cent in the comparison group. However, 18 per cent of those in the cod liver oil group had all or nearly all of their symptoms disappeared, compared with only 6 per cent in the comparison group. Also, only 19 per cent of those having cod liver oil got worse or died compared with 33 per cent of those having usual care alone.

In a new review of the study in the British Medical Journal, the researcher who revisited the study indicated that the high vitamin D content of cod liver oil was likely to have played a role in the differences between the groups, considering new knowledge that vitamin D helps the immune system fight infection.

Although, the reduction in deaths due to tuberculosis was generally attributed to enhanced living conditions, and less to overcrowded living, he stated that nutrition was probably as vital too. According to the expert, “it could well be that the widespread use of cod liver oil encouraged by doctors played a significant part.”

Cod liver oil, a pale-yellow liquid, made from cod fish is a rich source of Vitamin D. It is now know to be important in fighting infections, as well as in preventing conditions such as rickets.   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. 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.

The pungent taste of cod liver oil is familiar to many people born in the first half of the 20th century. The oil was liberally used to improve health and treat a variety of ailments, including arthritis and skin wounds. Many children were also given regular doses of cod liver oil to prevent the bone disease, rickets. Rickets is caused by a lack of vitamin D, a nutrient that is plentiful in cod liver oil.

What is more, scientists have found that vitamin D can accelerates recovery from tuberculosis. Researchers in the new study which gives fresh insight into how vitamin D may affect the immune response stated in the journal, The Lancet, that a high dose of Vitamin D during intensive treatment of pulmonary tuberculosis may offer cheap and effective immune system boost against TB

In a trial, 146 patients with drug-sensitive TB were recruited from 10 National Health Service Trusts in London and randomly and evenly assigned to receive either four oral doses of 2.5mg of vitamin D, or a placebo. All participants received standard antibiotic treatment for their condition. The average time to clearance of TB from the lungs among all study participants was six weeks for patients taking standard therapy alone and five weeks for those taking additional vitamin D, although this difference was not large enough to sustain statistical significance.

However, patients who had a particular genetic type of vitamin D receptor were much more vitamin D responsive than others and cleared TB bacteria much more quickly if they received vitamin D in addition to standard antibiotic treatment.

According to the scientists, based on the findings of the study, a single large dose of vitamin D was sufficient to enhance a person’s immunity to the TB germ. This is very significant given the high levels of vitamin D deficiency in people at the highest risk of TB infection, and shows that a simple, cheap supplement could make a significant impact on the health of people most at risk from the disease.

Ironically, cases of TB sometimes arise from people who have already become infected with the bacteria but in whom it lies latent. Nonetheless, the results of the study supports the fact that vitamin D supplementation may prevent reactivation of latent TB, thus the identification of people with latent TB and providing supplements could be an important strategy for tackling the disease.

Vitamin D deficiency is a very common problem in TB patients – a characteristic which may arise due to lack of sunshine in the United Kingdom, or to diets low in vitamin D. Although a diet of oily fish can provide some vitamin D, the main source of the body’s vitamin D comes from exposing the skin to sunlight. It is also possible that TB can cause vitamin D deficiency by a mechanism which is not wholly understood at present.

But the scientists wrote: “The findings of this study show great promise in speeding up the antibiotic treatment of TB for those patients who are receptive to vitamin D. The treatment process is currently very long and can be costly so any headway made in the medical research field for this disease is welcome to improve outcomes for patients.”

Are there other ways to curtail vitamin D deficiency? Population-wide supplementation can be considered by public health planners. For instance, milk and orange juice could be fortified with vitamin D, as in the United States of America and Canada just as margarine is supplemented in the United Kingdom to supplement whatever is tapped from the sun.

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