Is Eating Liver More Effective Than Supplementation? (Episode 629)

Full Transcript: Episode 629

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 629.

Vitamin A intake is a very touchy subject. It is so interesting how much conflicting information there is about vitamin A. But when you dig into the research about vitamin A and its role in reproduction and fertility, it’s really astounding that vitamin A doesn’t make its way front and center into nearly every fertility conversation.

For many years on the podcast, I’ve been talking about the importance of eating liver and finding ways to incorporate it into your diet, not just because of the vitamin A. Make no mistake, liver is not a vitamin A supplement. Liver is a food that is rich in a variety of nutrients, including vitamin A, nutrients like choline and zinc and folate and B vitamins and iron and selenium. It really goes on and on. But vitamin A is significant in liver.

Liver is the most significant and accessible source of retinol, vitamin A in its safest form and most absorbable form. Today we’re going to dive into a study that looks at this in a different way.

One of the challenges when you’re wanting to find research on liver and liver consumption is that there are few, if any, studies that have ever actually had participants just eat liver and study that. To look for a study where they’re just studying liver specifically is a little bit harder to find. You often find studies that are examining populations and their intake. You can look for studies that are doing nutrient analysis and identifying different deficiencies. And you may find large data sets where you’re just kind of examining how people eat in general, and they may have a subset of people who happen to eat liver, and then you may be able to derive some results from that.

But it’s a little bit more rare to find a study where they specifically are having the participants eat liver. The study that we’re looking at today is not that either, but there are a few studies available where you have a population who does eat liver consistently and they study those populations and kind of tell you what’s going on. That’s what we are going to be looking at today.

Today’s study actually examined liver intake in 24 to 59-month-old children from an impoverished South African community. The titles are always really long with these studies, but this study is really interesting because it does give us some insight into how impactful even regular but inconsistent liver consumption can be in an impoverished nation. The study looks specifically at children — basically children age two to just under five — and they’re looking at the impact of liver consumption.

The reason that they’re looking at this population in particular is because this population is known to be impoverished and therefore undernourished. They’re looking at a few different factors, but they’re looking at how — indirectly — how successful food fortification programs have been to actually add vitamin A into the food supply and other initiatives that have been designed to actually give children vitamin A periodically, and comparing it to liver consumption.

It’s addressing a lot of different factors, but it does give us some insights into liver consumption and its impact on vitamin A intake. A few things just to consider as we get into talking about the study.

There’s an underlying assumption, naturally, that if you have an impoverished community who are undernourished, then it would make sense — you would think that population would necessarily be more likely to be deficient in vitamin A also, because the whole thing is: if you’re not even getting enough to eat, if you’re impoverished and undernourished, you should be much more likely to be deficient in vitamin A among other nutrients.

But a previous study — so this study that we’re talking about today is actually a follow-up to a previous study — found that just under 6% of preschool children in this area were actually vitamin A deficient, despite the fact that they were stunningly underweight. Again, on its face, these children are very undernourished and underserved and impoverished, and their families are known to be of a lower socioeconomic status in this area. Yet only just under 6% were actually deficient in vitamin A.

This was something that kind of confounded the researchers. They were like, well, this doesn’t make sense. Obviously it goes contrary to what we would think. These researchers then went in and did a study to try to figure out what is going on. Why are these children who are obviously underweight and clearly undernourished — how are they still getting sufficient vitamin A?

The researchers looked at vitamin intake from liver consumption, the National Food Fortification Program — they have actually fortified bread and various different types of grains with certain nutrients, particularly and including vitamin A — as well as a national vitamin A supplement program that is intended to provide a high dose of this nutrient every six months to all of these children.

A few points really stood out to me. The first one is that the researchers found that liver alone — without any additional supplementation, even with food fortification — liver intake alone in these children provided more than 100% of the required daily amount. I think that is not necessarily surprising when you understand the nutrient density of liver. That was one of the key findings of this paper.

The estimated average requirement of vitamin A sits somewhere between 700 to about 900 IUs for children between the ages of 1 and 8. It varies a little bit, but that gives you an idea of the average. But when children were consuming liver, even just — the children in the study who were consuming liver, not necessarily every day, but their average daily intake from their regular, but not necessarily daily liver intake exceeded that. They were getting a little bit over a thousand IUs per day on average based on what they reported.

The big takeaway was that just by consuming liver, having it as part of the diet in a pretty consistent but not necessarily daily fashion, resulted in these children exceeding that minimum daily requirement of vitamin A consumption from food.

This particular community was impoverished. They looked at their income levels, they looked at all these different factors, and an estimated about 93% of the households in this community were consuming liver, and about 85% of the children were eating it. About 68% of the children consumed liver at least once a month, and then about 15% ate it once a week or more.

In this community, they’re actually eating liver quite a bit. It’s part of their regular routine. And when they even looked across the year to see if it varied in season, it actually was pretty consistent throughout this time.

Another interesting finding is that one 70-gram portion of liver — equivalent to about the size of a deck of cards — covers a child’s vitamin A needs for nearly one month. If you’re curious about what kind of liver this particular community was eating, they were actually eating sheep’s liver. Sheep farming was kind of a predominant industry in the area. A single 70-gram portion of sheep’s liver contains approximately — let’s say — 18,000 IUs, just a little bit over 18,000 IUs of vitamin A.

Based on the requirements, especially for children of that age range, even just consuming that amount of liver one time in a month actually met their vitamin A needs for that duration of time, approximately. And that was in line with their liver consumption in this community. Most children in this community were actually eating liver maybe once or twice a month, but that was sufficient to meet their vitamin A needs without any further supplementation.

This brings me to another point, which I think is really interesting. It’s almost like a catch-22. These families were not eating liver because they were health conscious. The researchers found that actually the poorest households ate the most liver, and those were the ones who then were also most protected against deficiency when they were looking at vitamin A.

The liver intake was inversely related to socioeconomic status. Put another way, the poorer the family, the more likely they were to eat liver because liver was cheaper. It’s a survival thing. They’re not eating liver because they’re listening to this podcast and they’re like, this is great for fertility. They’re eating liver because they can’t afford to buy the more expensive cuts of meat.

Once they looked at these different relationships — the higher the education level, the lower the liver consumption would be. Because, of course, the higher the education level, the more opportunities they might have for different kinds of work, and that would allow them to buy different kinds of food. What these families are doing out of necessity is paradoxically helping their children to avoid severe deficiency in a variety of areas.

Just an interesting fact from the study: sheep farming was the main industry in this particular area, and liver was the affordable protein with about 700 grams of liver costing about the same as a loaf of bread.

The researchers say, quote, “The paradox in this community is that children from households that are socioeconomically more vulnerable had a higher intake of liver and therefore were less likely to be vitamin A deficient,” end quote.

Another point I think is particularly something to consider. I had mentioned earlier that the government had implemented a vitamin A supplement program where every six months their aim was to provide a higher dose supplement to then prevent deficiency, because they’ve obviously identified that vitamin A deficiency is very significant in this area. But the government supplementation program failed to reach most of the children in the area.

When they actually researched based on the study results, the majority of children actually were not getting that supplement every six months. Only about 37% of children received a supplement in the six months before the study. And this is consistent with the national average of just about 43%. Less than half of the children in the area are really getting this supplement based on this kind of national intervention to try to reduce deficiency.

This paper is suggesting that obtaining these key nutrients from food is more optimal.

I had also mentioned that there was a food fortification program — they’re putting these nutrients in the bread and things like that. What they were finding was that it was helping. It certainly is helping and providing some additional nutrition, especially because according to the researchers, bread was consumed very regularly. But either way, it still wasn’t as effective as liver. And even with the fortification, the average consumption was less than what would be ideal for the children who were not consuming liver.

There are obviously a lot of implications to the study. I had a thought, even as I was kind of talking through this on the podcast, which is: let’s say that now they identify liver as a health food full of all these nutrients. What if that just drives the price up and makes it so that the families of poor socioeconomic status can no longer even afford it? There are so many different factors here.

I feel like this highlights something. As someone who comes from a background where our family did eat liver, it was a regular thing that we were eating. I don’t think the primary reason for eating it was because it was considered nutritious, at least not back then when I was a kid or when my parents were children. It was what was available and there were ways to cook it where people would enjoy it. But it was a food that was consumed regularly.

What these families are doing out of necessity is paradoxically resulting in the poorest families having the lowest levels of deficiency because this is what they were eating. And of course, they weren’t eating it constantly. The average child was eating it once or twice a month.

There are a lot of implications here then for fertility. One of the reasons I wanted to cover this paper is because it does show us a number of different things. Simply consuming liver once or twice a month — the levels would be a little bit different for adults, but even if, as an adult, you found a way to consume liver, let’s say twice a month, once every other week, every month you try to buy some liver and you try to make some pate and you try to include it — this study shows that the consumption of liver regularly, but not daily, helps you to meet the requirements of vitamin A because liver is such a significant source of it.

It’s not something that has to necessarily be consumed every single day. But of course, for those of us who don’t consume it every single day or even once a month, or who don’t like to eat it, or if it was not part of your family or you don’t like the taste, then we certainly live in a time where we can consume liver via supplementation. We can get our liver in via desiccated liver capsules, and it’s the same. It’s just in a different form. It’s freeze-dried. It’s the same type of approach, just in a different format. It does have the same benefits.

This is part of a bigger conversation in my writings, in the books, in Real Food for Fertility, in The Fifth Vital Sign. When you look at the data on women who are trying to conceive, or pregnant women, or women postpartum, there are a lot of nutrients that are commonly deficient or just commonly insufficient — meaning it’s common that women are not getting enough of these key nutrients. Vitamin A deficiency is extremely common among pregnant women and women who are postpartum. As few as 20% of women enter pregnancy with sufficient iron stores. Over 93 to 95% of the women that they surveyed were not eating sufficient choline.

When we look at nutrient status, I’m of the perspective that we should be looking at the most efficient way to achieve what we need to be achieving. We’re all busy. We live in a really interesting time. My clients typically are juggling all kinds of different things depending on their life stage.

One of the most efficient ways to consistently meet a lot of these nutritional requirements — especially the requirements that we require for fertility, for healthy and regular ovulation, to prepare for pregnancy, to ensure that our preconception nutrient stores are where they need to be, to support us during pregnancy, to work towards building a healthy baby, and postpartum when we have just birthed a human being and our nutrient stores are typically the lowest — liver is by no means the only food that we should be incorporating, but we really should be paying attention to it.

There’s a reason why it’s often called nature’s multivitamin and it is just this incredible source of these key nutrients. One of the reasons is because our liver is where our body stores these nutrients. One of the reasons why you can have a vitamin A supplement program where they go in and give a high dose of vitamin A to children every six months is because we store vitamin A in the liver. That is why a child could have a serving of liver once a month and have sufficient vitamin A for that entire month.

Not all supplements work that way, but vitamin A is a fat-soluble nutrient similar to vitamin D, where that’s one of the reasons why they can do things like that. Because when we consume vitamin A, our body does store it. And that’s one of the reasons why just finding a way to incorporate liver on a regular basis — whether it’s via desiccated liver capsules or whether it is by buying liver, cooking it, and making sure you’re eating it at least a couple of times a month — that is the reason why doing that alone can significantly improve your choline intake, vitamin A, all of these different nutrients.

To close today, I just wanted to mention a couple of the takeaways that the researchers actually had after going through all of this data. One of the biggest takeaways was that liver, just as a food, just as part of the diet, was sufficient to meet vitamin A requirements even without supplementation or food fortification programs. I feel like that is a really interesting takeaway. It just shows you again how jam-packed this superfood is with nutrients.

Another takeaway from this study in particular was that liver alone provided enough vitamin A to meet the requirements of these children, even though they were still impoverished and undernourished. This doesn’t solve the whole problem. There’s obviously a long way to go. But if you’re already struggling with a variety of challenges just related to the realities of the situation in this community, then access to liver and having that be a part of the diet — that is certainly protecting this community from the additional issues that would arise from the situation.

I think it also highlights that when you’re looking at the challenges of these impoverished communities, they might be thinking: if we just fortify the food with vitamins and if we address nutrient deficiencies, then that’s also going to address these other issues. But I think it also highlights that this is a bigger issue than just putting vitamin A in bread when you have a community that is undernourished and impoverished. There are just so many different takeaways from this study.

If you can think of someone who would benefit from hearing today’s episode, if you’ve been having conversations about key nutrients, nutrient deficiencies, pregnancy preparation, then feel free to share this episode. You will find today’s episode on my website, fertilityfriday.com. And you can also look in your podcast player and share the links in there. I hope you have a wonderful week or weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.