Fish oil: The natural triglyceride form is better

2. February 2011 William Davis (43)
If you have a choice, the triglyceride form of fish oil is preferable. The triglyceride form, i.e., 3 omega-3 fatty acids on a glycerol "backbone," is the form found in the body of fish that protects them from cold temperatures (i.e., they remain liquid at low ambient temperatures).

Most fish oils on the market are the ethyl ester form. This means that the omega-3 fatty acids have been removed from the glycerol backbone; the fatty acids are then reacted with ethanol to form the ethyl ester.

If the form is not specified on your fish oil bottle, it is likely ethyl ester, since the triglyceride form is more costly to process and most manufacturers therefore boast about it. Also, prescription Lovaza--nearly 20 times more costly than the most expensive fish oil triglyceride liquid on a milligram for milligram basis--is the ethyl ester form. That's not even factoring in reduced absorption of ethyl esters compared to triglyceride forms. Remember: FDA approval is not necessarily a stamp of superiority. It just means somebody had the money and ambition to pursue FDA approval. Period.

Taking any kind of fish oil, provided it is not overly oxidized (and thereby yields a smelly fish odor), is better than taking none at all. All fish oil will reduce triglycerides, accelerate clearance of postprandial (after-eating) lipoprotein byproducts of a meal (via activation of lipoprotein lipase), enhance endothelial responsiveness, reduce small LDL particles, and provide a physical stabilizing effect on atherosclerotic plaque.

But if you desire enhanced absorption and potentially lower dose to achieve equivalent RBC omega-3 levels, then triglyceride forms are better.

Here are cut-and-pasted abstracts of two of the studies comparing forms of fish oil.

Bioavailability of marine n-3 fatty acid formulations.

Dyerberg J, Madsen P, Moller JM et al. 
Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

The use of marine n-3 polyunsaturated fatty acids (n-3 PUFA) as supplements has prompted the development of concentrated formulations to overcome compliance problems. The present study compares three concentrated preparations - ethyl esters, free fatty acids and re-esterified triglycerides - with placebo oil in a double-blinded design, and with fish body oil and cod liver oil in single-blinded arms. Seventy-two volunteers were given approximately 3.3g of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily for 2 weeks. Increases in absolute amounts of EPA and DHA in fasting serum triglycerides, cholesterol esters and phospholipids were examined. Bioavailability of EPA+DHA from re-esterified triglycerides was superior (124%) compared with natural fish oil, whereas the bioavailability from ethyl esters was inferior (73%). Free fatty acid bioavailability (91%) did not differ significantly from natural triglycerides. The stereochemistry of fatty acid in acylglycerols did not influence the bioavailability of EPA and DHA.
(Full text of the Dyerberg et al study made available at the Nordic Naturals website here.)



Eur J Clin Nutr 2010 Nov 10. 

Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacylglycerides versus ethyl esters.

Neubronner J, Schuchardt JP, Kressel G et al. 
Institute of Food Science and Human Nutrition, Leibniz Universität Hannover, Am Kleinen Felde 30, Hannover, Germany.

Abstract

There is a debate currently about whether different chemical forms of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are absorbed in an identical way. The objective of this study was to investigate the response of the omega-3 index, the percentage of EPA+DHA in red blood cell membranes, to supplementation with two different omega-3 fatty acid (n-3 FA) formulations in humans. The study was conducted as a double-blinded placebo-controlled trial. A total of 150 volunteers was randomly assigned to one of the three groups: (1) fish oil concentrate with EPA+DHA (1.01?g+0.67?g) given as reesterified triacylglycerides (rTAG group); (2) corn oil (placebo group) or (3) fish oil concentrate with EPA+DHA (1.01?g+0.67?g) given as ethyl ester (EE group). Volunteers consumed four gelatine-coated soft capsules daily over a period of six months. The omega-3 index was determined at baseline (t(0)) after three months (t(3)) and at the end of the intervention period (t(6)). The omega-3 index increased significantly in both groups treated with n-3 FAs from baseline to t(3) and t(6) (P < 0.001). The omega-3 index increased to a greater extent in the rTAG group than in the EE group (t(3): 186 versus 161% (P < 0.001); t(6): 197 versus 171% (P < 0.01)). Conclusion: A six-month supplementation of identical doses of EPA+DHA led to a faster and higher increase in the omega-3 index when consumed as triacylglycerides than when consumed as ethyl esters.
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Comments (43) -

  • Flavia

    2/2/2011 2:05:51 PM |

    Thank you for the heads up! Once I exhaust my fish oil, I will switch to the triglyceride form.

    I wanted to drop by and thank you for scaring the sh*t out of me regarding a high wheat carby diet and atenolol.

    My blood pressure seems to be genetic and quite stubborn, but since taking your advice (plus some supplements) I have been able to lower it from 150/100 to around 128/92 and going down.

    Something I have also noticed...my pulse used to be quite high all the time- Around 80-90 (I am 29). Now it is always in the 60s. Could this be due to the supplements? Or low carb? Is this healthy?

  • Anonymous

    2/2/2011 2:27:44 PM |

    Which brands do you recommend?
    I can't find where my cotsco fish oil states which type it is?

  • TedHutchinson

    2/2/2011 2:28:02 PM |

    In case anyone else uses Nature's Answer, I've just contacted their customer services who say
    " This product IS the triglyceride form.
    Thank you,
    Ellen Kamhi PhD RN"
    At $14.95 from Iherb 16 fl oz it's good price and tastes fine.
    CODE WAB666 saves $5 off initial IHERB purchase. Maybe cheaper elsewhere but IHerb ship cheap to UK.

  • Dr. William Davis

    2/2/2011 3:21:47 PM |

    Hi, Flavia--

    Those are all positive changes, including the drop in heart rate. It reflects a reduction in adrenaline. A reduction in heart rate is a powerful marker for overall health.


    Anon-

    Costco is the ethyl ester. It is a fine brand, just less well absorbed, of course.

  • Anonymous

    2/2/2011 4:03:36 PM |

    I have some vitamin D gelcaps and they smell like fish. Are these oxidized too?

  • Michael

    2/2/2011 4:19:33 PM |

    You say not "overly oxidized" at one point in the post.  

    I am generally concerned about the fish oil I buy being oxidized.  There is a brand of fermented fish oil which purports to avoid this problem of oxidation with storage.  

    Is it your position that concerns about oxidation are sometimes (or at least mine) are overblown?  Or that the oxidation that occurs with normal storage etc. is acceptable?

  • Jack

    2/2/2011 4:26:08 PM |

    Hi Dr Davis,

    If I eat high omega-3 wild salmon once a week, high omega-3 wild sardines once a week, grass pasture butter with 225mg of naturally occurring omega-3 per serving, and organic eggs that have a bit in there as well, do you think I am getting enough for a healthy ratio? I also take the Green Pastures FLCO and HVBO blend.

    I do not eat ANY vegetable oils, ever. I only use coconut oil and ghee to cook, so my O6 intake has got to be pretty low.

    What are your thoughts on being able to obtain adequate levels of healthy omega-3 from foods where it is naturally occurring?

    Thanks,
    Jack Kronk

  • Anonymous

    2/2/2011 4:29:17 PM |

    Dr. Davis (or others): Based on what you say, since my fish oil brand is silent on what kind, I'm assuming it's the ethyl ester form.  But, I just wanted to check to see if anyone knows for sure: the brand I've been using is Carlson ("The Very Finest Fish Oil"), liquid form in a bottle - not the capsules.

  • Anonymous

    2/2/2011 5:01:52 PM |

    I take the Carlson lemon cod liver oil. Is their any disadvantage to this over fish oil?

  • Anonymous

    2/2/2011 5:13:20 PM |

    What about Krill oil?

  • Flavia

    2/2/2011 6:00:08 PM |

    Dr. Davis said: "Those are all positive changes, including the drop in heart rate. It reflects a reduction in adrenaline."

    No wonder every time I take my BP at Walmart my pulse is higher!!

  • Anonymous

    2/2/2011 7:01:13 PM |

    Where does krill oil fit into this?

  • Might-o'chondri-AL

    2/2/2011 7:18:24 PM |

    Natural Factors omega-3 is ethyl ester processed form.

  • Lucy

    2/2/2011 7:21:44 PM |

    Dr. Davis,

    Can you comment on the recommended dose for an ApoE 3/4 like me?  I've been told by a BHL educator not take any, but I don't like the idea of that.  I was thinking I may try just 500-600mg/day.  Of course, I've been using Kirkland's which apparently is less bioavailable anyway...

  • Vin Kutty

    2/2/2011 10:53:27 PM |

    As a nutritionist who's worked in the fish oil industry for 20+ years, I may be able to add some insight.

    Yes, Triglyceride (TG) and Re-esterified triglyceride (rTG) forms are better absorbed than the Ethyl Ester form (EE). At least in the short term. And the Phospholipid (PL) form is roughly 50% better absorbed than rTG.

    Then why don't we all take PL form found in Krill oil? Well, there isnt much Omega-3 in Krill to begin with. And the PL-bound Krill Omega-3 are very temperature sensitive, so you won't see anyone concentrating it.

    BTW, the folks at Neptune Krill Oil have some unpublished data that shows the difference between TG and EE diminishes to insignificance over time.

    TG form is natural, no need for pre-conversion before absorption. That does not mean that your body won't use EE. It will. Just requires another step. It's just that TRUE natural TG is not very concentrated. Usually about 30% Omega-3 or so. Anything above 50% is likely to be EE. But most EU nations only allow TG form, so if you want a concentrated fish oil, you jack it up to 60 or 70% as EE and then re-esterify it. Additional process and can be done, but it will cost you. I'm currently working with some 90% rTG material. This raw material is 10 to 20X more expensive than what goes into Walmart brand fish oil.

    I'm guessing (but it's a good guess) but more than 95% of fish oil studies are done on EE form. So all the benefits you've read about don't go out the window if you are taking EE instead of TG. Forget Lovaza, next-gen EPA-based drugs like Epadel, Epanova and still-pending AMR-101 are all EE.

    Most fish oils, if not all, sold at retail stores are EE. Because it is cheaper. Specialty and online sources are your best bet for TG and rTG.  Go to 3rd party testing IFOS website and look under product type - it will tell you if it is EE or TG. http://www.ifosprogram.com/ifos/consumerreport.aspx

    Issues with the Dyerberg study: 1) 2 weeks is way too short a duration to figure this out. 2) they did not compare TG oil to a placebo (corn oil?). Instead, they compared it to EE. Comparison to placebo would have put things in perspective. The Neubronner paper addresses this issue.

  • Anonymous

    2/2/2011 11:19:46 PM |

    As I understand it, part of the tradeoff involves potency and how much EPA/DHA you can pack into a capsule. Ethyl esters are going to be more "compact" than trigylceride chains. I take Life Extension brand, and I honestly don't know which form it is. Perhaps it is the ester form. I get 3600 mg of combined Omega 3 activity from six capsules a day. If the trigyleride form would mean 10 or 12, I don't know that the trade is worth it in money or hassle. I know some of these other brands like Pharmax are supposed to be good, but I draw the line at doing "shots" of unencapsulated fish oil!

    As an aside, does anyone have any suggestions for me? I'm 40, pretty close to ideal weight, non diabetic and I still struggle with high TG, now 292 even with fish oil and 1 gram a day of IR niacin... Not a big wheat eater either although I do have a nasty breakfast cereal habit.

  • Ned Kock

    2/2/2011 11:40:30 PM |

    It is worth noting that as little as 38 g of sardines provide more "net" O3, of the "good" type, than 2 fish oil softgels: bit.ly/gsaJI3.

  • Anonymous

    2/3/2011 1:00:28 AM |

    Dr Davis

    do you know which is the best KOsher fish oil?
    most of brands have vegetarian capsules, but there is a liquid one from Nutri-supreme research

  • Davide Palmer

    2/3/2011 3:21:31 AM |

    Thank you, thank you. At least there are some honest doctors (as Dr. Davis) who are not robots and don't view the FDA's stamp of approval as divinely authoritative and perfect.

  • Rick

    2/3/2011 3:53:04 AM |

    Just to check: Are triglyceride forms always in bottles? Or can we also get them in capsules?

  • Anonymous

    2/3/2011 5:02:07 AM |

    While exploring this subject I came upon this article which clearly expands on the difference between TG and EE fish oil forms.

    http://www.ascentahealth.com/health-science/science-articles/fish-oil-triglycerides-vs-ethyl-esters-as-nature-intended

  • Donald Kjellberg

    2/3/2011 6:09:27 AM |

    Rick said...
    "Just to check: Are triglyceride forms always in bottles? Or can we also get them in capsules?"

    To say it lightly, I prefer to get them off the back of my fish like wild caught salmon but especially with sardines like Ned referred to since the mercury content is extremely low to nonexistent.

    Also, it may be more beneficial consuming supplements naturally in whole foods, if you can get enough. That in itself is not an easy endeavor. Don't get me wrong, I do take my fish oil capsules especially when consuming high 6:3 ratio foods but am trying to incorporate more nutrient dense foods that contain known rich supplement content.

    It would be nice to see more research addressing synergistic effects of nutrients in foods like Dr. Price's findings regarding fermented cod liver oil and high vitamin butter oil.

  • Dr. William Davis

    2/3/2011 3:02:12 PM |

    Hi, Jack--

    No, not even close.

    It also depends on why you take fish oil and/or obtain omega-3 fatty acids and whether or not you have coronary atherosclerotic plaque, among other things.

  • Jack

    2/3/2011 3:16:28 PM |

    The only brand of canned salmon/tuna and canned sardines I eat is from Wild Planet. I am not affiliated with them and this is not an advertisement, but they really seem to do the whole process perfectly. They also do not add any vegetable oil or water. They have very low mercury content and very high natural omega-3 content. The omega-3 in their tuna is even higher than the salmon. Also, they explain the importance of low mercury and how it all works.

    Have a look at their site:

    Wild Planet

    cheers,
    Jack Kronk

  • Davide Palmer

    2/3/2011 4:34:05 PM |

    I often wonder if krill oil is an even more superior source of DHA and EPA simply because they come within the matrix of phospholipids. Phospholipids, of course, are what makes up our cell membranes, making krill oil extremely bio-available to the cells. I guess we will have to wait for tests to confirm.

  • Sara

    2/3/2011 7:11:36 PM |

    The triglyceride form is too expensive for me.
    I'll pop an add'l ethyl ester gelcap daily and be done with it.

  • Rick

    2/3/2011 10:06:10 PM |

    Does the same caveat apply to krill oil or to seal oil?

  • Anonymous

    2/4/2011 1:35:33 PM |

    Great Detailed discussion of fish oil
    Can someone please dumb it down for me and just recommend a few brands?

  • John Townsend

    2/4/2011 7:17:46 PM |

    Dr. Davis:

    I'm curious to know where GNC's so-called "Triple Strength Fish Oil"
    product ranks. It comes in a softgel form, each capsule containing EPA+DHA strength of 900mg. It has only a slight hint of fishy-ness in taste. It's not clear to me from the bottle label whether it's in a triglyceride form. I'm not necessarily an advocate of GNC products which are not generally a bargain by any means, but have been satisfied with their quality.

  • Timothy Johanek

    2/5/2011 3:24:53 PM |

    I am a Technical Representative from Carlson and the following fish oils are all TG or rTG form:

    -EPA Gems

    -Super DHA Gems

    -MedOmega Fish Oil 2800

    -All Mothers and Kids products

    -All Very Finest Fish Oil products

    -All Cod Liver Oil products

    -All Salmon Oil products

    -Smart Catch softgels

    -CalaOmega liquid (calamari oil)


    The following products are EE:

    -Super Omega-3 Gems

    -Elite Omega-3 Gems

    -CalaOmega Softgels (calamari oil)

    -CalaDHA Sofgels (calamari oil)

  • Anonymous

    2/6/2011 2:08:07 PM |

    "struggle with high TG, now 292 even with fish oil and 1 gram a day of IR niacin... "

    1grm just is not high enough in my opinion.  I take 2grms of Now brand Niacin and had a 30% reduction in my Trigs. At C$7 for 100 x 500mg tablets it is a cheap treatment. somewhere between 2-3grms is the level required but you can check studies at www.lipidsonline.org.

    btw.  just wanted to announce that my latest HDL is 50 !  I started with a reading of 28 and had been on a low fat no meat diet for years. Added meat, reduced wheat and other grains over the last 6 months. I guess I am a convert.
    Trevor

  • omega3tron

    2/6/2011 7:28:10 PM |

    It is nothing more than just another market gimmick -

    http://www.doctormurray.com/index.php?option=com_content&view=article&id=52:the-ethyl-ester-vs-triglyceride-form-of-fish-oils

  • Bob Savage

    2/6/2011 7:59:46 PM |

    Timothy Johanek,  Do you have any reference to independent test that proof Carlson's products in TG/rTG form?

  • Anonymous

    2/7/2011 5:31:15 PM |

    I'm also interested if Dr. Davis can comment here or in one of his articles about the proper dosing for Apo 3/4 people.

    I do notice that lowish doses (1 g or less) doesn't seem to affect my LDL much negatively. However, if I go high, say 3g EPA/DHA or so, then my LDL tends to rise... and it's not the particle size thing giving a false high reading, as it's measured by VAP.

    Somewhat oddly, I have noticed that the EE form causes this rise more often than the TG form, but that could be coincidence.

    And for those interested:

    Barleans (orange, low dose): TG
    (high dose): EE
    Minami (EE, except for MarineEPA)
    Nordic Naturals: rTG
    Meg3: Can be either, but unless specified, it's EE
    Epax: rTG
    Carlson has both forms, as mentioned here
    Coromega (rTG Epax oil (I think))
    Natural Factors: EE

    And pretty much all cheapo store brands are EE.

    Krill oil does absorb better than fish oil, as found in a recent study. However, it's like a 50% or so improvement only (at best), and due to price differences between fish/krill, it doesn't make much economical sense. If the esterified astaxanthin provides a specific benefit, then maybe it's worth it... but no data showing it's the EPA/DHA in krill.

  • Weierstrass

    2/9/2011 5:01:13 AM |

    That's good news on the Carlson's. I really don't understand why anyone uses fish oil capsules. You get a much better deal with the fish oil in bottles; I order mine online, 4 or 5 bottles at a time.

  • Anonymous

    2/9/2011 1:09:17 PM |

    Which brands of Fish Oils doesn't use Soy Bean oil?

  • Timothy Johanek

    2/9/2011 10:46:31 PM |

    Bob Savage,

    I'm not aware of any third party tests that have been done.  I am certain that I am correct though because I write the spec sheets.

    A quick test to see whether an oil is EE or not is to put it on polystyrene (styrofoam) because EE will dissolve it but TG will not.  And before anyone gets nervous, this has nothing to do with how EE oils affect your body (unless you eat or are made of styrofoam that is).

  • farseas

    2/21/2011 6:29:36 PM |

    Hi readers.  With all this talk about O3 and fish oil I thought that I would chime in with my experience.  I had a heart attack about 1.5 years ago and got a stent placed in one of my arteries.

    Since then I have been taking Walmart fish oil because it was so cheap.  My chest pains gradually receded after my heart attack and I was doing really great for awhile.  I was actually working pretty hard, doing aerobics for about 30 minutes and lifting weights for about 20 minutes.  My weight on a low carb diet went from 305 to 260 so far.

    I have been on Plavix but my cardiologist told me I could back off from it slowly, so I started taking 6 capsules of Walmart fish oil, 400mg VE, 1000 mg VC, 325 mg aspirin, and only half a 75 mg Plavix.

    Then, I went to Walmart and got a new supply of fish oil-h/wheat.jpg">

    However, wheat has grown to occupy an enormous part of diet, partly because of the "high-fiber" trickery that causes us to believe that wheat is healthy, but also, I'm convinced, because of wheat's hunger factor.


    A reader of the The Heart Scan Blog recently made this comment:

    I discovered this blog and Dr. Davis' TYP program at the beginning of September. I have relatively successfully cut carbs and grains from my diet thus far.

    Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

    I have also been very surprised at the significant reduction in my appetite. I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too. But it has.

    A few weeks ago, I attended a party catered by one of my favorite Italian restaurants and got myself offtrack for two days. Then it took me a couple of days to get back on track because my appetite returned.

    Check out Jimmy Moore's website for lots of ideas about variations of foods to try. The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg. Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

    I find myself thinking about lunch not because I'm really hungry but out of habit.

    The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.


    I, too, have personally experienced this effect. I also was skeptical. It made no sense. How can whole grain bread increase appetite? I don't know what it is about wheat products that make them especially powerful triggers of appetite. I think that it probably goes beyond glycemic index, perhaps some other component besides taste.

    But if you want to seize control over appetite, elimination--not reduction--but elimination of wheat, as well as other processed carbohydrates, can really change the way you approach food. (Interestingly, The Wheat Foods Council estimates that the average American eats 144 lbs of wheat flour per year; they argue that it should be increased 210 lbs per year!)

    Eliminating wheat products is also an effective tool in the Track Your Plaque program for raising HDL, reducing triglycerides, reducing small LDL, and reducing both blood sugar and blood pressure. And it can be among the most effective ways to control appetite, since eliminating wheat also eliminates its hunger factor.

    Foods to consider to take up the calorie slack when eliminating wheat: cheese (fermented, of course, for vitamin K2 content); eggs, as our reader pointed out; other lean proteins like lean red meats, fish, chicken, turkey; more liberal use of healthy oils like olive and flaxseed; plenty of raw nuts and seeds; soy milk and tofu. Obviously, the center of your diet should remain vegetables.

Our friends at Liposcience

26. October 2007 William Davis (6)
A number of Track Your Plaque Members are still outraged at LabCorp's failure to convey the results of page 2 of the NMR Lipoprofile, as provided by Liposcience, Inc., the testing laboratory that actually performs the test. We've gotten an audience at both Liposcience and LabCorp, though no real progress in obtaining this information has yet been made.

Anyway, that's not what I'd like to focus on. Despite the tremendous aggravation created by this incomprehensible glitch, NMR Lipoprofile remains, in my view, the best way to discover hidden sources of risk for heart disease and the most powerful way to develop a coronary plaque/heart scan score control program.

We could do without NMR, but I think that we'd pay a price in effectiveness. We'd be, in effect, driving blindly when it comes to certain lipoprotein patterns. Some abnormalities, like intermediate-density lipoprotein (IDL) and LDL particle number, are superior to similar measures (like apoprotein B and direct LDL) and yield priceless information that is simply not obtainable as reliably by any other method.

I've had my share of negative experiences with the marketing director and the staff at Liposcience, but it's the vision of company founder and inventor of the technology, biochemist Dr. James Otvos, that should continue to shine. Dr. Otvos' ingenious technology to fractionate plasma proteins has provided an advantage for coronary plaque reversal and reduction of CT heart scan scores that no other method can provide as well.

For a useful discussion on basic lipoprotein science, listen to the discussion provided by Dr. William Cromwell of Liposcience by clicking on the graphic below:

Condensed Taubes

26. October 2007 William Davis (15)
For anyone looking for a quick glimpse at Gary Taubes' provocative arguments on the detrimental health effects of the current carbohydrate-crazed world, take a look at the CNN post of an interview of Taubes at CNN. (Thanks, Fanatic Cook, for pointing this out.)

In his book, Good Calories, Bad Calories, Taubes, a science reporter, manages to deftly and systematically disarticulate the entire argument for the low-fat approach to nutrition that has dominated conventional advice for the last 30+ years.

The book is impressively detailed and well-thought through. If you would like an introduction to the nutrition world according to Taubes, take a look at the CNN video, which permits him to provide a quick, condensed version of his ideas. Even when debating the issue with physicians, Taubes' arguments shine through as a voice of reason, cutting through the flabby and tired arguments that have been proven misguided by the experience of those around us.

Fast-forward information

24. October 2007 William Davis (11)
The internet has accelerated the conversation in health . . . enormously.

The discussions we have in Blogs, places like the Track Your Plaque Forum, and websites have accelerated the exchange of information and ideas so much that it is making traditional "official" sources of information IRRELEVANT.

Dr. John Cannell's unfailingly interesting and insightful comments in his most recent Vitamin D Newsletter brought this issue to mind. In his discussion of the vitamin D needs of pregnant women and his frustration with the failure of the National Institute of Health to take action despite the evidence, he states:

Whenever you see a child with asthma, diabetes or autism, just think: American Medical Association, American Pediatric Association, Institute of Medicine, Centers for Disease Control, National Institutes of Health, or Food and Nutrition Board.

Dr. Cannell is upset with the misguided advice of these agencies for mothers and babies to totally avoid sun while failing to provide advice on vitamin D supplementation, a combination of unhealthy factors that will increase the incidence of both type I and II diabetes, childhood asthma, and perhaps even childhood autism.

But this got me thinking: Here we are listening to a very credible source in Dr. Cannell, who has proven a discriminating judge of the evidence, along with vitamin D experts like Tufts University's Dr. Michael Holick, who has written a book on vitamin D (The UV Advantage: The Medical Breakthrough that Shows How to Harness the Power of the Sun for Your Health) ; University of Toronto's Dr. Reinhold Vieth, whose wonderful webcast on vitamin D was certain to convince you of many aspects of this nutrient's vital importance in health (unfortunately, it must have been taken off the hosting server, since I can no longer locate it); among others.

We all have access to this information. They are providing discussions on the topic that have long ago made the comments of "official" agencies like the FDA or the Institute of Medicine's Food and Nutrition Board (charged with setting RDA's for vitamins) irrelevant. While information is conveyed at lightning speed through internet media sources, discussion boards, and chats, the committees of "experts" often sit on their hands, fearful of speaking out, often themselves unfamiliar with the scientific literature or the conversations being conducted, not uncommonly having hidden agendas of their own that might interfere with their impartiality.

Information on health (and other subjects, as well) is being conveyed to the interested public faster and faster. The FDA, the USDA, the Food and Nutrition Board, the American Heart Association are increasingly being viewed as behind the times. They often also provide tainted information. Among the most glaring examples of biased information is the Heart Association's endorsement of "heart healthy" products in its Heart Check Mark program, including Cocoa Puffs, Cookie Crisp cereal, and Berry Kix, pure unadulterated junk foods thinly veiled with the Heart Association stamp of approval. Or the American Diabetes Association failure to speak out on the increasing penetration of carbohydrate and sugary junk foods in the American diet, while maintaining relationships and funding from its number one financial contributor, Cadbury Schweppes, the number one candy, soft drink, and snack manufacturer in the world.

The collective knowledge we are gaining through our own efforts will supplant the mis-information provided by official agencies. Just as Wikipedia represents collective knowledge on a broad range of topics, such a collective wisdom will develop in health, as well.

America: The world’s diet laboratory

23. October 2007 William Davis (14)
Low-fat, low-carb, high-protein, Pritikin, Ornish, Atkins, South Beach, Sonoma, Sugar-Busters, Weight Watchers, vegetarian . . . Have Americans tried them all?

We’ve witnessed the relative success of diet habits in selected regions world-wide: the longevity of the Japanese on a spare soy and fish-based diet; the reduced heart disease incidence of the French despite an indulgent food-centered culture; the extreme heart disease-free lives of the Cretan Greeks.

Contrast this with the startling failure of the American diet experiment: We’re all (speaking for the collective whole) fat, diabetic, and miserably mired in the diseases of obesity. We’ve experimented with every possible iteration of diet from grapefruit or cabbage only, to calorie deprivation (a al Weight Watchers), to restricting this or that element of diet. The “official” organizations have made their contributions, as well: the American Heart Association’s Therapeutic Lifestyle Changes (formerly Step I and II diets), a program eerily similar to what Americans are already eating and resulting in failure; the American Diabetes Association diet, incomprehensibly embracing carbohydrates when they are the root of the nutrition-habit-gone-wrong that caused the disease in the first place; the USDA and their Food Pyramid, encompassing a design that contains the germ of wisdom but is so heavily overweighted in grains that it is a sure-fire way to increase weight and heart disease were you to follow their recommendations.

What have we learned from our grand experiment, our nationwide misadventure in nutrition?

I believe that we’ve learned how not to eat: Processed snack foods, meals delivered in a fast-food setting with the offer to “super-size” your order, make-believe food ingested in your car eaten for the sake of staving off the inevitable hunger pangs. Few would argue that these are certain paths to obesity and poor health.

Certainly, if we’ve learned how not to eat, can we extrapolate just how to eat? And not just for weight loss, since most diets focus just on that, but on health, particularly heart health?

If Americans have so far failed to learn the lessons of the nutritional world, we certainly have not failed at talking about it. From books to blogs, websites, information gurus to infomercials, we certainly celebrate the capacity to share our experiences, our grief over our nutritional “misfortune,” despite a world of plenty.

Yet we swim in a sea of information. Can we sift through the chaff to discover the essential truth?

Let me articulate an extreme (extreme meaning closer to the truth, I hope) interpretation of nutritional wisdom:

--If it requires a label or nutritional analysis, reject it. The wondrous green pepper, or bottle of olive oil, for instance, require no such qualifications. Some exceptions: milk, yogurt, cottage cheese (unless, of course, you purchase straight from a local producer). I am always impressed with the contortions and frustrations people experience trying to decipher labels. Ironically, the healthiest foods don’t even require labels.

--If it is ingested in a rush, it’s likely to add to poor health. True food is meant to be consumed at leisure, not in haste to satisfy some irrational, unthinking impulse.

--Search for natural, whole foods. Natural, whole foods require no marketing. You pay a premium for a company to adorn a product with glitz, glamour, and appeal. Repackage Cocoa Puffs as chocolate flavored, round overly-processed wheat flour, sans marketing spin, and what is left? Processed foods are?intentionally?addictive. They are added to, modified, high-fructose corn syruped, etc. to increase desirability, but also create addiction. Eliminate them just as a smoker eliminates cigarettes.

--A corollary to the above issue: purchase foods that appear as if you had grown it or raised it yourself. If you were to grow corn in your backyard garden, you would eat it on the cob or some similar way. You would not grind it, pulverize, process it, nor serve it as cornstarch and add to a pile of chemicals to make breakfast cereal. Eat foods in their natural state, not the highly processed food-product that requires a colorful package and advertising to sell.

--Don’t keep bags of chips, boxes of breakfast cereal and crackers, frozen dinners, all “just in case.” Don’t allow yourself that opportunity because you will more than likely seize it. An alcoholic who keeps a secret bottle of gin hidden in the cabinet is well aware that it’s there and will eventually give in to impulse.

--When you eat meat, try to find free-range, organic products. Even better, purchase from a local producer who you trust.

--For anyone with patterns like low HDL, small LDL, high triglycerides, and blood sugar >100 mg/dl, following a diet that is as free of wheat products as possible will yield enormous benefits. Wheat is a part of all breads, virtually all breakfast cereals, pretzels, crackers, bagels, cookies, cupcakes, pancakes, waffles, etc. Going wheat-free is also a surprisingly effective weight loss strategy.

That’s just a few thoughts. The approach we use in the Track Your Plaque program helps achieve weight loss, but also helps correct lipoprotein patterns, often dramatically.

Many diets have failed to keep pace with the changing nutritional habits of Americans. In 1960, we ingested close to zero high-fructose corn syrup. We’re now approaching 80 lbs per year per American. Breakfast cereal in 1950 consisted of a handful of products, eaten intermittently; today, it is a staple with enough products to fill a modern supermarket’s entire aisle. Meats have changed, thanks to the factory farm phenomenon feeding its animals corn in inhumanely restricted conditions, a dietary shift for livestock that has modified the fat composition to something far different than 50 years ago, not to mention the antibiotics and other chemicals used to accelerate growth and fight off infection from the artificial, overcrowded conditions.

The American nutritional shift, along with rampant obesity, have also caused a relatively new cause of coronary heart disease to explode: small LDL particles. The contribution of small LDL has been enormously underestimated, since most physicians don’t know what it is, don’t know how to check for it, and don’t know what to do with it. Yet it has emerged as the number one cause for heart attack and heart disease nationwide.

Stay tuned for our rewritten New Track Your Plaque diet to be released as a Special Report on the www.cureality.com website in future.

Dr. Jarvik, is niacin as bad as it sounds?

20. October 2007 William Davis (5)
A popular health newsletter, Everyday Health, carried this headline:

A Cholesterol-Busting Vitamin?
Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter?
Find out how niacin can help reduce choleseterol.

At doses way above the Recommended Dietary Allowance — say 1,000–2,500 mg a day (1–2.5 grams) — crystalline nicotinic acid acts as a drug instead of a vitamin. It can reduce total cholesterol levels by up to 25%, lowering LDL and raising HDL levels, and can rapidly lower the blood level of triglycerides. It does so by reducing the liver’s production of VLDL, which is ordinarily converted into LDL.


I'd agree with that, except that it is rare to require doses higher than 1000-1500 mg per day unless you are treating lipoprotein(a) and using niacin as a tool for dramatic drops in LDL. But for just raising HDL, shifting HDL into the healthy large class, reducing small LDL, and for reduction of heart attack risk, 1000-1500 mg is usually sufficient; taking more yields little or no further effect.

But after that positive comment comes this:

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.


Strange. After a headline clearly designed to pull readers in, clearly stating niacin's benefits, the article then proceeds to scare the pants off you with side-effects.

But look to the side and above the text: Ah . . . two prominent advertisements for Lipitor, complete with Dr. Robert Jarvik's photo. "I've studied the human heart for a lifetime. I trust Lipitor to keep my heart healthy."

Niacin bad. Lipitor good. Even celebrity doc says so. Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

Who is Dr. Jarvik, anyway, that he serves as spokesman (or at least figurehead) for this $13 billion dollar a year drug? Of course, he is the 1982 inventor of the Jarvik artificial heart, surely an admirable accomplishment. But does that qualify him to speak about heart disease prevention and cholesterol drugs?

Jarvik has never--never--actually prescribed Lipitor, since he never completed any formal medical training beyond obtaining his Medical Doctor degree, nor has he ever had a license to practice medicine. He does, however, continue in his effort to provide artificial heart devices, principally for implantation as a "bridge" to transplantation, i.e., to sustain a patient temporarily who is dying of end-stage heart failure.

So where does his expertise in heart disease prevention come from? It's beyond me. Perhaps it was the thousands of dollars likely paid to him. That will make an "expert" out of just about anybody.

Robert Bazell, science reporter, for CNBC, made this report on the Jarvik-Lipitor connection in his March, 2007 report, Is this celebrity doctor's TV ad right for you?

Mr. Bazell writes:

On May 16, 1988, an editorial in the New York Times dubbed the artificial heart experiments, “The Dracula of Medical Technology.”

“The crude machines,” it continued, “with their noisy pumps, simply wore out the human body and spirit.”

Since then, in a series of start-up companies, Jarvik has continued his quest to make an artificial heart — as have several other firms. One competitor recently won FDA approval to sell its device for implantation in extreme emergencies.

Perhaps Jarvik’s chances of success with another artificial heart account for his willingness to serve as pitchman for Pfizer. I inquired, without success, to find the going rate for a semi- celebrity like Jarvik to appear in such ads. Thomaselli of Advertising Age said whatever it is, it is “infinitesimal” compared to Pfizer’s expenditures of $11 billion a year on advertising, much of it for Lipitor.

Why spend so much marketing Lipitor?

Because Lipitor is only one of six drugs in the class called statins that lower cholesterol. Many cardiologists say that for the vast majority of people any one of these drugs works just as well as the other. Two of them, Mevacor and Zocor, have already lost their patent protection so they cost pennies a day compared to $3 or more a day for Lipitor.

In 2010, when Lipitor loses its patent protection, it, too, will cost pennies a day, and Pfizer will no longer need Dr. Robert Jarvik.



So, is niacin so bad after all? Or is this Everyday Health report just another clever piece of advertising for Pfizer?

Is niacin as bad as it sounds?

20. October 2007 William Davis (0)
A popular health newsletter, Everyday Health, carried this headline:

A Cholesterol-Busting Vitamin?
Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter?
Find out how niacin can help reduce choleseterol.

At doses way above the Recommended Dietary Allowance — say 1,000–2,500 mg a day (1–2.5 grams) — crystalline nicotinic acid acts as a drug instead of a vitamin. It can reduce total cholesterol levels by up to 25%, lowering LDL and raising HDL levels, and can rapidly lower the blood level of triglycerides. It does so by reducing the liver’s production of VLDL, which is ordinarily converted into LDL.


I'd agree with that, except that it is rare to require doses higher than 1000-1500 mg per day unless you are treating lipoprotein(a) and using niacin as a tool for dramatic drops in LDL. But for just raising HDL, shifting HDL into the healthy large class, reducing small LDL, and for reduction of heart attack risk, 1000-1500 mg is usually sufficient; taking more yields little or no further effect.

But after that positive comment comes this:

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.


Strange. After a headline clearly designed to pull readers in, clearly stating niacin's benefits, the article then proceeds to share the pants off you with side-effects.

But look to the side and above the text: Ah . . . two prominent advertisements for Lipitor, complete with Dr. Robert Jarvik's photo. "I've studied the human heart for a lifetime. I trust Lipitor to keep my heart healthy."

Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

Who is Dr. Jarvik, anyway, that he stands as the spokesman (or at least figurehead) for this $13 billion dollar a year drug. Of course, he is the 1982 inventor of the Jarvik artificial heart, surely an admirable accomplishment. But does that qualify him to speak about heart disease prevention and cholesterol drugs? Jarvik has, never actually prescribed Lipitor, since he never completed any formal medical training beyond obtaining his Medical Doctor degree, nor has he ever had a license to practice medicine. He does, however, continue in his effort to provide artificial heart devices, principally for implantation as a "bridge" to transplantation, i.e., to sustain a patient temporarily who is dying of end-stage heart failure.

So where does his expertise in heart disease prevention come from?

Omega-3 fatty acids: Frequency vs. quantity

20. October 2007 William Davis (8)
I believe I have been observing an unexpected phenomenon: When it comes to fish oil and omega-3 fatty acids, the frequency of dosing may be as important, perhaps more important, than the actual dose.

First of all, why advocate omega-3 fatty acids from fish oil? There’s a list of lipid/lipoprotein reasons, including reduction of triglycerides and triglyceride-containing particles (VLDL, intermediate-density lipoproteins), reduction of small LDL, and increase in HDL. There’s also solid benefit in reduction of heart attack risk, reduction in death from heart attack, and reduction in stroke. There are also anti-inflammatory benefits and improvements in mood, reduction in depression.

Fish oil is a crucial ingredient in the Track Your Plaque program. I am honestly uncertain of just how much success we would give up if fish oil were NOT a part of the program, but I am unwilling to find out. The data are simply too compelling to not include omega-3 fatty acids from fish oil. Of course, supplementation of omega-3 fatty acids assumes greater importance in a modern world in which your food has become terribly depleted of the omega-3 fraction of oils. (Cultures that rely heavily on fish or wild game probably would not benefit to the same extent, since these foods contain omega-3 fatty acids.)

But I believe I have observed a curious effect over the past year or two. With the proliferation of many different preparations of fish oil that provide seemingly endless choices—low-potency fish oil, high-potency fish oil, paste forms of fish oil like Coromega, liquids such as Carlson’s, etc.¾I’ve observed that frequency of dosing may exert as much of an effect as the dose.

For example, someone might take the basic, low-potency preparation like Sam’s Club that contains 180 mg EPA and 120 mg DHA per capsule, four capsules per day. That yields a total of 1200 mg EPA and DHA per day. This is our minimum dose that provides the basic heart attack-reducing effect, though with modest effect on triglycerides and associated patterns.

Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?

Curiously, no. What I have observed, however, is that more frequent dosing may provide a larger effect. The least effective dosing is once per day; twice per day is far more effective. Three times per day¾though cumbersome¾provides even greater effect.

So, which is more important: dose or frequency?

I can’t say for certain, since my observations are informal and have not been obtained by a formal statistical analysis of our data. That will come with time.

For the present, suffice it to say that, if you are struggling with suppression of patterns like increased triglycerides, IDL, or low HDL, then at least twice- or three-times-per-day dosing might be worth considering, even before you increase the dose further.

Best: Greater dose, or higher-potency preparation, combined with higher frequency.