No more Lovaza

30. July 2010 William Davis (45)
That's it: I will NEVER ever write another prescription for Lovaza.

I actually very rarely write a prescription for Lovaza, i.e., prescription fish oil. But this was the last straw.

I advised a patient that we've had good success using high-doses of fish oil to reduce lipoprotein(a), Lp(a). 6000 mg per day of the omega-3 component (EPA + DHA) from fish oil reduces Lp(a) in 60% of people after one year. (Recall that Lp(a) is the most aggressive known lipid-related cause of heart disease.)

The two preparations I generally suggest are either the very affordable Sam's Club Members Mark Triple-Strength Fish Oil with 900 mg EPA + DHA per capsule: 7 capsules per day. Another great product (my personal favorite because of its extreme purity--it doesn't even smell like fish oil): Pharmax Finest Pure Fish Oil with 1800 mg EPA + DHA per teaspoon: 3 to 3 1/2 teaspoons per day.

Both preparations work great and are quite affordable, given the high dose. For the Sam's Club preparation, it will cost around $30 per month, while the Pharmax liquid will run around $49 per month.

Well, the woman's husband insisted on a prescription for Lovaza. One Lovaza capsule contains 784 mg EPA + DHA per capsule: 7 to 8 capsules per day.

Here are some prices for Lovaza from online pharmacy discounters:
Prescription Giant: $78.99 for 30 capsules ($2.63 per capsule)
Planet Drugs Direct: $135 for 100 capsules ($1.35 per capsule)

These are lower than the prices I obtained in past by calling local pharmacies in my area, quite a bit lower, in fact.

Filling the Lovaza prescription at Prescription Giant will therefore cost $552.93 to $631.92 per month; at Planet Drugs Direct it will cost $283.50 to $324.00 per month. At local pharmacies, a similar 7 to 9 capsules Lovaza per day will cost upwards of $800 to $900 per month.

The patient's husband insisted on the Lovaza prescription because he knew that his insurance would cover it. When I pointed out that this was a large cost that would have to be borne by others in their healthcare premiums, he said that didn't matter to him.

I hesitated, but ended up writing the prescription for 7 Lovaza capsules per day. As soon as I handed to him, I regretted it. In fact, I am embarassed and angry at myself for having given in.

So I vowed: I will NEVER EVER write another prescription for Lovaza.

I do not believe that we should spread the excessive profiteering of the pharmaceutical industry around on the backs of people who pay their healthcare insurance premiums, just so that a few people, like this selfish couple, can save a few dollars a month.
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Comments (45) -

  • Anonymous

    7/30/2010 4:52:21 PM |

    Amen!  I took Lovaza for a year when my physician gave me a coupon for a monthly supply at $5/month for 12 months.  I obviously stopped when it ran out because of the "real" price.  I've started using CardioTabs (http://www.cardiotabs.com/Omega-3-Fish-Oil/productinfo/OMEGA-EC/) instead on the advice of my physician.  Any feedback on this brand?

  • Anonymous

    7/30/2010 5:17:35 PM |

    What is your opinion about Nordic Naturals DHA?  It contains 450 MG DHA and 90 MG EPA, along with 15 IUs of Vitamin E (alpha tocopherol) in two soft gels.  I've read in many places that fish oil containing more DHA than EPA is superior.

  • Joe D

    7/30/2010 5:19:13 PM |

    Even though Obama and his socialists would vehemently disagree, you make a logical point.

  • Anonymous

    7/30/2010 5:19:14 PM |

    I use Spring Valley brand and it costs me about $11 for a two for one deal (two bottles). 200 capsules per bottle 1000 mg each. EPA + DHA is only 300 per capsule but for the price taking 6 per day isn't a problem. Under $12 every 2 months isn't bad.

  • Pater_Fortunatos

    7/30/2010 5:29:53 PM |

    Hello everybody!

    Well, I see this article refer to a matter of price and less about quality.

    Dr Davis, please, what do you think about NOW Foods suplements?
    Sorry for being offtopic!
    Thanks for your blog, your work changed my life.
    All the best from Romania!

  • Anonymous

    7/30/2010 6:26:43 PM |

    For maximum absorbability, use liquid not capsules or gels, and eat with a high fat meal.

    New research also shows the probiotics in yogurt also help to minimize the oxidation:
    http://www.nutraingredients.com/Research/Yogurt-proteins-could-stabilize-omega-3-enrichment

    as does pollen spore shells (exines)
    http://www.nutraingredients.com/Research/Pollen-spores-could-enhance-omega-3-bioavailability

    A good value for omega-3s is Twin Labs:
    http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

  • David

    7/30/2010 7:50:15 PM |

    Take a look at Trader Joe's odorless omega 3. 90 capsules for less than $9. 1200 mg fish oil 400 mg EPA and 200 mg DHA in each capsule. The only brand I have been able to find with a 2 to 1 ratio of EPA to DHA. And there is no after taste.

  • Dave, RN

    7/30/2010 8:09:31 PM |

    I eat omnly grassfed beef and wildcaught salmon. Chicken is pastured. I don't eat grains or vegitable oils. I use coconut oil and tallow for cooking.
    That being said, can one get too much Omega 3?

  • PJNOIR

    7/30/2010 9:41:11 PM |

    Great point about the cost effecting others. Studies ghave shown that fish oil that is too pure is not as good as fish oil with a little bit of "mother" in it. Clean not sterile.

  • Mike

    7/30/2010 11:54:33 PM |

    Huge props to you, Dr. Davis, for admitting regret and posting future accountability by NOT filling scrips for Lovaza.

    Hopefully, the husband of that patient reads your blog.  But I doubt it. Smile

  • Tom C

    7/31/2010 12:20:05 AM |

    Hi Dr. Davis,
    Thank you for living your principles, and, as always, for your candid and unvarnished thoughts.
    Sincerely,
    Tom C

  • mongander

    7/31/2010 1:28:30 AM |

    I take 4 of Sam's Club triple-strength fish oil plus a 1 gram Krill Oil from Puritan's Pride.  The omega 3s, ground flax seed, curcumin, and Jean Carper's Super Osteo Gold have allowed me to jog at age 71 without any joint injury.

  • nightrite

    7/31/2010 2:31:02 AM |

    Assuming no problems with Lp(a) you can reduce the need for so much fish oil by changing your diet to low omega-6 intact.  There is competition between the two essential fats so try to limit foods high in omega-6 first.  Once you've done that you can cut back on all those fish oil capsules. It's probably helpful to take some vitamin E too to prevent potential fatty acid oxidation.

  • Lori Miller

    7/31/2010 4:01:37 AM |

    Thanks for not being part of the problem, Dr. Davis.

    The thing is, some prescription plans have a copay. If the plan of the couple is like mine, they'd have had a $30 copay. It's possible they were only saving $20 a month. For our friends outside the U.S., that'll buy a movie ticket and popcorn for one person. Nine hundred dollars is more than my mortgage payment.

  • Anne

    7/31/2010 6:46:03 AM |

    The real problem is the pharmaceutical industry and not patients who wish for prescriptions or insurance companies. Here in the UK, the last I heard,  Lovaza (marketed under the name Omacor) costs the National Heath Service £50 ($78) per 100 capsules, that is considerably less than what it costs in the US and roughly the same as comparable fish oil omega-3 supplements from health food shops in the UK. This is the pharmaceutical company charging this and it is they who should be brought to account when it comes to over profiteering from patients and insurance companies, imho.

  • David M Gordon

    7/31/2010 1:37:49 PM |

    I've started using CardioTabs instead on the advice of my physician. Any feedback on this brand?

    Not a very good deal, Anonymous.

    Each bottle includes 180 capsules, but a serving size is 3 capsules (to equal 975mg of DHA and EPA). Multiply that serving size by 6 to attain Dr Davis's objective of 6000mg of DHA and EPA per day. This means:
    1) You must ingest 18 (!) capsules/day;
    2) Each bottle of 180 capsules is a mere 10 days supply; which means
    3) 3 bottles/month at a cost of ~$100/month.

  • Dr. William Davis

    7/31/2010 3:23:45 PM |

    Several commenters have asked about specific brands.

    Consumer Lab (www.consumerlab.com) is a great place to start to see what brands have been tested.

    While it is clear that no mercury, PCBs, dioxin, or furans have been measured in any brand of OTC fish oil (slight contamination of cod liver oil, not fish body oils, with PCBs), there are differences in oxidative breakdown products.

    A quick test of oxidation: Smell your fish oil. It should only be faintly fish, not overwhelmingly fishy.

  • homertobias

    7/31/2010 4:22:41 PM |

    Can you give us some references on why 6,000 epa/dha for lp(a) carriers?

  • Metal Wall Art

    7/31/2010 4:30:59 PM |

    Finding a suitable plaques for our home is little hard to do. Your special taste of art and rare places provide it in best quality sometimes become the challenges to do it. But, because of the importance of the plaques you have to find it whatever it takes.

  • Tommy

    7/31/2010 6:33:18 PM |

    What about Weston A. Price suggesting that there is a potential for Omega 3 overdosing as well as the concern from contaminants  in fish oil compared to Cod liver oil due to fish oil being mostly from farmed fish? Also the benefits of Vitamin A and D from taking Cod liver oil rather than fish oil.  Personally I don't use cod liver oil, but should I be concerned about too much fish oil? Have there been long term studies?
    Thanks

    Tommy

  • kellgy

    7/31/2010 6:49:16 PM |

    This is one of the many reasons for our skyrocketing insurance costs. People need to take more responsibility for their own health. Unfortunatley, this concept is in direct conflict with the prevailing trend in our society.

    With the direction our health care industry is going, future costs will become quite prohibitive. In an effort to fight class warfare this new health care system will create a class of those who will be able to afford effective health care while the rest of us who are dependent on the government's version will be left waiting . . . It really is our fault.

  • Anonymous

    7/31/2010 7:33:45 PM |

    What's pathetic about the situation is, if the insurance company would shoulder some of the cost of basic fish oil instead of the prescription Lovaza, everyone in the system would benefit.  The way it is, everyone in the system loses.

  • Anonymous

    8/1/2010 5:31:27 AM |

    I have always used scott emulsion. A couple tbs per day.
    is that one good?

  • Dr. William Davis

    8/2/2010 12:43:50 AM |

    Anonymous about insurance paying for supplement fish oil--

    Yes, a brilliant idea!

    I've had the same idea and wondered why an insurance company didn't just shell out the money to prove for themselves that OTC is every bit as good as the prescription, then encourage their insured to use this instead. It would provide HUGE savings with no downside.

  • Anonymous

    8/2/2010 6:16:54 AM |

    Dr Davis

    with the us treasury printing currency by the boatload if everyone operated with cost savings in mind there would be hyperinflation due to excess money floating in the economy. So government channels try to mop up and circulate as much currency as possible and keep the bottlenecks to a minimum.

    No wonder usa is looking at a consistent high inflation future or maybe hyperinflationary future.

  • Anonymous

    8/2/2010 8:13:20 PM |

    I wonder about oxidation and possible immune system suppression at the 6 gram dose level. Although I suppose in patients with high Lp(a), it's the lesser of two evils. Emulsified fish oil may be worth trying, to see if it decreases Lp(a) even further.

    Eventually Lovaza will go generic, which will be sort of odd, when prescription fish oil potentially could be in the same ballpark as OTC. Not sure how the FDA will make sense of it, unless the dosages are exactly the same... not sure how prescription fish oil ever really made sense really.

  • Anonymous

    8/2/2010 11:42:10 PM |

    Also, don't eat with fiber as this hurts absorption.  

    The following are listed in the ConsumerLab.com report, but I'm not a member so don't know how it rates:

    Twin Labs Mega EPA ( 1 capsule = Epa 550 Mg, Dha 215 Mg )
    http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

    Nordic Natural Ultimate Omega + CoQ10  ( 2 capsules = Epa 650 Mg, Dha 450mg)
    http://www.nordicnaturals.com/en/Products/Product_Details/98/?ProdID=1446

    Green Pastures Fermented Cod Liver Oil and Butter Oil Blend (~139 mg EPA, ~83mg DHA),
    http://www.greenpasture.org/retail/?t=products&a=line&i=fermented-cod-liver-oil

    Vital Choice Wild Salmon Oil (240 mg EPA, 220 mg DHA)
    http://www.vitalchoice.com/product/omega-3-salmon-oil/1000-mg-sockeye-salmon-oil-softgels-180-count

    The nordic product also has 60mg of CoQ10, and 30IU of vitamin E!

  • Anonymous

    8/3/2010 1:41:04 AM |

    Dr Davis as a practicing neurosurgeon and age management doc I write for Lovaza all the time.  At least 75 Rx a month.  Does it bother me?  Yes it does.  But I feel better knowing those who are taking it are being proactive and healthy instead of a dog chasing its tail with his or her PCP.  Everything is relative my friend.  I suggest you focus in on the good because their is bad in everything but if you focus in on the good it magnifies itself.  Keep fighting the battle.  I do. I get more patients off Statins and on Fish Oil and resveratrol than you can imagine.  Love your work and the book.  I have saved lives because of you.  you passed it forward and now I do too everyday.  Dr. K

  • Anonymous

    8/3/2010 3:43:20 PM |

    Presumably, the guy has been paying his health care insurance premiums.  Based on the facts you describ, his insurance covers prescriptions for Lovaza.  Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?

  • Onschedule

    8/3/2010 7:02:28 PM |

    @anonymous who wrote:

    "Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?"

    If we focus only on an insured and his contractual rights under his insurance policy, he should not "have to pay additional money out of pocket..."

    However, that focus is arguably too narrow as it fails to consider the effect on insurance premiums for the rest of an insurance company's policy holders/payers. This is one of the evils of a system that requires citizens to obtain health insurance - it forces other people to subsidize, to use Dr. Davis's example, an expensive prescription when cheaper and equally effective alternatives exist. This is not an isolated example; consider prescription Vitamin D2 vs. D3 supplementation, etc...

  • Anonymous

    8/3/2010 7:50:48 PM |

    I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
    Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
      I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
    I can see both sides of the situation. The situation is a grey area.
    I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

  • Anonymous

    8/3/2010 7:51:19 PM |

    I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
    Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
      I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
    I can see both sides of the situation. The situation is a grey area.
    I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

  • stephen

    8/7/2010 6:06:18 AM |

    As a liberal, I say thank you. We can only provide health care for all, if it is affordable. Abusing the system only ensures less and less people will have access to quality health care.

  • Knox

    8/7/2010 3:03:21 PM |

    I love this article.  It makes me gag when I see commercials on TV for Lovaza or Niaspan.  This is one example of what's broken in our healthcare system.

  • Anonymous

    8/8/2010 6:20:11 PM |

    +! on the Trader Joe's omega-3 capsules. They are cheap and they have 50% concentration of combined EPA/DHA. TJ's sells two models of their omega-3 and the other has a lower concentration.

    I'll take Lovaza when it's a free sample. It has a 90% concentration but I think the overall total in Lovaza is not much higher than what is available from the local drug store.

    The only advantage Lovaza could have is that is monitored very carefully for purity and the like. I'm not sure that's much of a concern.

    -- Boris

  • Anonymous

    8/11/2010 4:53:48 PM |

    Are such high doses necessary? 7-8 grams per day of EPA/DHA seems like it would get you well past the desirable 8-10% on the HS-Omega-3 Index (usually only requiting 1-3 grams daily). Is there any need to go beyond 10%?

  • Anonymous

    8/13/2010 4:19:23 PM |

    I take 5-6 TJ omega-3 capsules during the day. Maybe that's a bit much but maybe there is a saturation point? I don't know. I know that omega-3 has cleared my mind, reduced my eye pain, and lowered my blood pressure.

    -- Boris

  • Anonymous

    8/16/2010 4:03:53 AM |

    So glad to hear it. When the ads came on TV, it was just another Big Pharma scam. Take a natural product and package it for mega profits.

  • scall0way

    8/22/2010 10:21:58 PM |

    I finally knuckled under and let my doctor write a prescrption for Niaspan for me - as we were fighting terribly as she was *ADAMANT* that I HAD to take STATINS as my cholesterol was too high (though my HDL was 62 and my triglycerides were 65) and I was flat out refusing. So she then suggested I had to take Niacin.

    I was willing to give Niacin a try as I have seen Dr. Davis talk about it here - and she just sent in the prescription via her computer to the mail-order pharmacy I'm required to use to get my prescription insurance coverage.

    So imagine my SHOCK when I got the online notice that the prescrption had been filled, and I was able to look it up. A 90-day prescription of Niaspan was about $400! I almost fainted, though my patient share was $75 - or $25/month.

    But I still thought it was highway robbery and will never fill the prescription again. If I continue t take Niacin I think it will be Slo-Niacin for me. I'd heard Niaspan was expensive, but had no clue it was that much!

  • Anonymous

    8/27/2010 9:57:38 PM |

    Dear friends,

    On Omega-3 highdoses EPA/DHA ; Minami Nutrition is providing Supecrital extraction (low temperature, and not molecular distillation!!) Omega-3 as well guaranties on purity below the detection limit next provinding a 93% Omega-3 per one softgel or 820 mg EPA/DHA per one softgel. look into www.minami-nutrition.co.uk availabel in the US at Wholefoods.

  • Anonymous

    8/27/2010 10:13:49 PM |

    Some people are worry on too much intake of fish oils. Indeed if you swallow standard fishoils with low levels of EPA/DHA as most US products you may swallow also a lot of saturated fats. Go for 1 softgel a day a softgel tahts provide you almost 1 g Omega-3 or a minimum as 820 mg EPA+DHA per softgel. a lot of brands having high levels of pcb's.(see http://www.cbsnews.com/stories/2010/03/02/health/main6259938.shtml ) be also a ware when mention "per serving" could be 2 to 4 or more softels a day.  Avoid liquid oils as they oxidize fast, as well I'm not in favor of codliver oils as too low on EPA and DHA and to high on vitamin A when taking 500 mg EPA/DHA.

  • Mike OD

    9/21/2010 8:28:53 PM |

    THANK YOU!! For taking a stand where many in your profession will not. We need more of this!

  • Metal Wall Art

    10/15/2010 12:26:58 PM |

    Even the traditional medical community is finally realizing that the omega 3s in fish oil provide some of the best natural health benefits on the planet. Worldwide, the omega 3 supplement market is in the billions of dollars. The drug companies want a piece of the action.

  • fireplace screen

    10/23/2010 6:40:37 AM |

    Great insights about how we can have a healthy lifestyle.Omega 3 is good for the heart that's why many people are eating foods rich in Lycopene.

  • Chris P

    10/28/2010 4:16:06 PM |

    Vitacost.com has their own brand of fish oil, NSI Mega EFA® Omega-3 EPA & DHA.  At 6000mg EPA/DHA a day (10 capsules) in a 240 cap container for $22, that comes out to be $27.50 per month.  And they often have 10% off sales, like right now till 10/31/10.  My personal experience with them has been good, their NSI brand has been high quality, and I rarely find a better price elsewhere.  I'm currently taking 6000mg EPA/DHA daily.

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Wheat hip

10. August 2010 William Davis (39)
You've heard of wheat belly. How about wheat hip?

Recall that the innocent appearing wheat belly is actually a hotbed of inflammatory activity beneath the surface. The visceral fat of the wheat belly, i.e., fat kidneys, fat liver, fat intestines, fat pancreas, produces abnormal inflammatory signals, such as various interleukins, tumor necrosis factor, and leptin. These are the inflammatory signals that create insulin resistance and diabetes, heart disease, hypertension, and cancer.

These same inflammatory mediators are able to enter the joint spaces, such as those in your hips, knees, and hands. This leads to osteoarthritis, the exceptionally common form of arthritis that affects 1 in 7 Americans. In particular, the level of leptin in joints mirrors that in blood, a phenomenon that has been associated with joint destruction.

The previously widely-held notion that arthritis is simply a wear-and-tear phenomenon due to the mechanical stress of excess weight is proving to be an oversimplification. Arthritis is also part of the carbohydrate-driven, weight-increasing, inflammatory condition of insulin resistance or metabolic syndrome.

Throw into this cytokine storm the fact that glycation, i.e., glucose modification of proteins, also causes cartilage destruction. The cells of human cartilage lack the ability to divide, so the cartilage cells you had at age 18 are the cartilage cells that you will hopefully still have at age 80. However, high blood sugars (glucose) glycate the proteins in cartilage. (Wheat raises blood glucose higher than almost all other foods, higher than a Milky Way bar, higher than a Snickers bar.) The process is irreversible and cumulative. Because cartilage has next to no capacity for repair or regeneration, it becomes brittle. Over years, it essentially crumbles, leading to the "bone on bone" that prompts conversations about total hip and total knee replacement.

So that ciabatta or blueberry muffin in your mouth takes you a step or two closer to joint destruction via heightened inflammation arising from the visceral fat of the wheat belly, worsened by glycation of high blood sugars after carbohydrate consumption.

My solution: Lose the ciabatta.

Men's lingerie is on the second floor

7. August 2010 William Davis (33)
Consume wheat products, like poppyseed muffins, raisin bagels, and whole grain bread, and you trigger the 90- to 120-minute glucose-insulin cycle.

Blood glucose goes way up (more than almost any other known food), triggering insulin release from the pancreas. Glucose enters cells as a result, blood glucose plummets. You get hungry, shaky, and crabby, reach for another wheat or other sugar-generating food to start the roller coaster ride all over again.

Repetitive insulin triggering grows this thing I call a "wheat belly," the protuberant, hang-over-the-belt fat you see everywhere nowadays. Wheat belly fat is really visceral fat. Visceral fat means you have fat kidneys, fat intestines, fat pancreas, and fat liver, all causing the belly to protrude in the familiar way we've all come to recognize.

Visceral fat is special fat. Unlike the fat in the backside, thighs, or arms, visceral fat triggers inflammatory responses that are evident in such measures as tumor necrosis factor, interleukins, and leptin, as well as drops in the protective hormone, adiponectin.

Visceral fat also, oddly, triggers estrogen release. Estrogen triggers growth of breast tissue. That's why females with wheat bellies have up to four-fold (400%) greater likelihood of breast cancer.

Men also experience excess estrogen from the visceral fat wheat belly, causing "man boobs." This B-cup phenomenon means that inflammation is raging beneath the surface, all due to this thing you're wearing around your waist.

I wasn't aware until recently that male breast reduction surgery is a booming business growing at double-digit rates. So are special clothes to help men conceal their expansive breasts.

Perhaps the USDA is in cahoots with Playtex.

10,000 units of vitamin D

3. August 2010 William Davis (47)
Joanne started with a 25-hydroxy vitamin D level of 23 ng/ml--severe deficiency.

What made this starting value even worse was that it was drawn in August after a moderately sunny summer spent outdoors. (Last summer, not this summer.) It therefore represented her high for the year, since vitamin D levels trend lower as fall and winter set in. This suggests that her winter level was likely in the teens or even single digits. In addition, note that, at age 43, Joanne has lost much of her ability to activate vitamin D in the skin.

So I advised that she take 6000 units of an oil-based gelcap per day, a dose likely to generate the desired blood level, which I believe is 60-70 ng/ml.

Four months later, her 25-hydroxy vitamin D level: 39.9 ng/ml--still too low. So I advised her to increase her dose to 10,000 units per day. Several months later, her 25-hydroxy vitamin D level: 63.8 ng/ml--perfect.

However, on hearing that she was taking 10,000 units vitamin D per day, Joanne's primary care physician was shocked: "What? Stop that immediately! You're taking a toxic dose!" So Joanne called me to find out if this was true.

No, of course it's not true. It's not the dose that's toxic, but the blood level it generates. Although it varies, vitamin D toxicity, as evidenced by increased blood calcium levels, generally does not even begin to get underway until at least 120-130 ng/ml, perhaps higher. Rarely, a dose of 2000 units per day will generate a level this high. In others, it may require 24,000 or more units per day to generate such a high level.

So it's not the dose that's toxic, but the blood level of 25-hydroxy vitamin D it generates.

Provided you and/or your doctor are monitoring 25-hydroxy vitamin D blood levels, the dose is immaterial. It's the blood level you're interested in.

No more Lovaza

30. July 2010 William Davis (45)
That's it: I will NEVER ever write another prescription for Lovaza.

I actually very rarely write a prescription for Lovaza, i.e., prescription fish oil. But this was the last straw.

I advised a patient that we've had good success using high-doses of fish oil to reduce lipoprotein(a), Lp(a). 6000 mg per day of the omega-3 component (EPA + DHA) from fish oil reduces Lp(a) in 60% of people after one year. (Recall that Lp(a) is the most aggressive known lipid-related cause of heart disease.)

The two preparations I generally suggest are either the very affordable Sam's Club Members Mark Triple-Strength Fish Oil with 900 mg EPA + DHA per capsule: 7 capsules per day. Another great product (my personal favorite because of its extreme purity--it doesn't even smell like fish oil): Pharmax Finest Pure Fish Oil with 1800 mg EPA + DHA per teaspoon: 3 to 3 1/2 teaspoons per day.

Both preparations work great and are quite affordable, given the high dose. For the Sam's Club preparation, it will cost around $30 per month, while the Pharmax liquid will run around $49 per month.

Well, the woman's husband insisted on a prescription for Lovaza. One Lovaza capsule contains 784 mg EPA + DHA per capsule: 7 to 8 capsules per day.

Here are some prices for Lovaza from online pharmacy discounters:
Prescription Giant: $78.99 for 30 capsules ($2.63 per capsule)
Planet Drugs Direct: $135 for 100 capsules ($1.35 per capsule)

These are lower than the prices I obtained in past by calling local pharmacies in my area, quite a bit lower, in fact.

Filling the Lovaza prescription at Prescription Giant will therefore cost $552.93 to $631.92 per month; at Planet Drugs Direct it will cost $283.50 to $324.00 per month. At local pharmacies, a similar 7 to 9 capsules Lovaza per day will cost upwards of $800 to $900 per month.

The patient's husband insisted on the Lovaza prescription because he knew that his insurance would cover it. When I pointed out that this was a large cost that would have to be borne by others in their healthcare premiums, he said that didn't matter to him.

I hesitated, but ended up writing the prescription for 7 Lovaza capsules per day. As soon as I handed to him, I regretted it. In fact, I am embarassed and angry at myself for having given in.

So I vowed: I will NEVER EVER write another prescription for Lovaza.

I do not believe that we should spread the excessive profiteering of the pharmaceutical industry around on the backs of people who pay their healthcare insurance premiums, just so that a few people, like this selfish couple, can save a few dollars a month.

This is your brain on wheat II

29. July 2010 William Davis (24)
In the original Heart Scan Blog post, This is your brain on wheat, I discussed how opioid peptides (i.e., small proteins that act like opiates such as heroine or morphine) that result from digestion of wheat cause unique effects on the human brain, particularly addictive behaviors. I also briefly reviewed how elimination of wheat has been shown to reduce auditory hallucinations and other psychotic behaviors in a subset of people with paranoid schizophrenia.

These two phenomena, addictions and schizophrenia, are most likely the result of exorphins that cross the blood-brain barrier. Exorphins--exogenous morphine-like compounds--can be blocked by opiate-blocking drugs like naloxone and naltrexone. Naloxone is used in hospitals to reverse morphine or heroine overdoses; naltrexone is being repackaged into a weight loss drug, since blocking wheat-derived exorphins reduces appetite. (Yes: The USDA tells us to eat more wheat, the drug industry sells us the antidote.)

There's another way that wheat can affect the brain and nervous system: immune-activated damage.

This is similar to the effect seen in celiac. There's even overlap with some of the antibody markers used to diagnose celiac, like the anti-gliadin antibodies and the anti-endomysium antibodies.

The most common immune neurological syndrome consequent to wheat consumption is cerebellar ataxia, a condition in which an immune response causes damage to the Purkinje cells of the cerebellum, the portion of the brain responsible for balance and coordination. This results in stumbling, incoordination, incontinence, and eventually leads to reliance on a cane or walker and wearing a diaper. Average age of onset: 53 years. A shrunken, atrophied cerebellum can be seen on an MRI of the brain.

Problem: Most people with central nervous system damage caused by wheat do not have any intestinal symptoms, like diarrhea and abdominal pain, the sort of symptoms usually associated with celiac disease. It means the first sign of wheat-induced brain damage may be bumping into walls and wetting your pants.

There's no such thing as a "no-carb" diet

27. July 2010 William Davis (24)
When I tell patients how I advise a wheat-free, cornstarch-free, sugar-free diet on the background of a low-carbohydrate diet, some people ask: "But can I live on a no-carb diet?"

Well, there's no such thing as a "no-carb" diet. Low-carb, yes. No-carb, no.

Here are the carbohydrate contents of various "low-carb" foods:

Gouda cheese--3 oz contains 1.65 grams carbohydrates
Mozzarella cheese--1 cup contains 2.89 grams carbohydrates
Walnuts--4 oz (56 nuts) contains 2.96 grams carbohydrates
Almonds--4 oz contains 1.38 grams carbohydrates
Sour cream--one-half cup contains 3.31 grams carbohydrates
Red wine--3.5 oz glass contains 2.69 grams carbohydrates
Eggplant--1 cup cooked contains 8.33 grams carbohydrates
Green pepper--1 medium-sized raw contains 5.52 grams carbohydrates
Cucumber--1 medium contains 4.34 grams carbohydrates
Tomato--1 medium contains 4.82 grams carbohydrates

(Nutrition data from USDA Nutrient Database)

In other words, foods thought to be "low-carb" actually contain a modest quantity of carbohydrates.

Such modest quantities of carbohydrates may not be enough to trip your blood sugar. But add up all the "low-carb" foods you consume over the course of a day and you can easily achieve 30 grams or more carbohydrates per day even without consuming any higher carbohydrate foods.

Why doesn't your doctor try to CURE diabetes?

21. July 2010 William Davis (88)
Imagine you have breast cancer. You go to your doctor and she says, "As your pain worsens, we'll help you with pain medication. We'll fit you with a special bra to accommodate the tumor as it grows. That's all we're going to do."

"What?" you ask. "You mean just deal with the disease and its complications, but you're not going to help me get rid of it . . . cure it?"

It would be incredibly shocking to receive such advice. Then why is that the sort of advice given when you are diagnosed with diabetes?

Say you go to the doctor. Lab values show a fasting blood sugar of 156 mg/dl, HbA1c (a reflection of your previous 60 days average glucose) of 7.1%. Both values show clear-cut diabetes.

Your doctor advises you to 1) start the drug metformin, then 2) talk to the diabetic teaching nurse or dietitian about an American Diabetes Association (ADA) diet.

The ADA diet prescribed encourages you to increase carbohydrates and cut fats at each meal and maintain a consistent intake so that you don't experience hypoglycemic (low blood sugar) episodes. You follow the diet, which causes you to gain 10-15 lbs per year, increasing your "need" for diabetes medication. You doctor adds Actos, then Januvia, then injections of Byetta.

Three years and 34 lbs later, you are not responding well to the drug combination with blood sugars rarely staying below 200 mg/dl. You've developed protein in your urine ("proteinuria"), lost 30% of your kidney function, and you are starting to lose sensation in your feet. So the doctor replaces some of your medication with several insulin injections per day.

This formula is followed millions of times per year in the U.S. So where along the way did your doctor mention anything about a "cure"?

Adult diabetes is the one chronic disease that nobody cares to cure. Treat it, maintain control over blood sugars, but cure it? Most physicians say it's impossible.

The tragedy is that diabetes is a curable condition. I've seen it happen many times. Physicians dedicated to curing diabetes like low-carb expert, Dr. Mary Vernon, have cured it countless times. Dr. Eric Westman and colleagues have been building the case for the carbohydrate-restricted cure for diabetes with studies such as this. In this last study, of the 8 participants on insulin + medications at the start of the study, 5 no longer required medications at the close of the study--they were essentially non-diabetic.

I tell patients that diabetes, in fact, is a disease you choose to have or not to have--provided you are provided the right diet and tools. Sadly, rarely are diabetics told about the right diet and tools.

That's why Cadbury Schweppes has been a major contributor to the American Diabetes Association, as are other processed food manufacturers and the drug industry, all who stand to profit from maintaining the status quo.

The cure? Eliminate or at least dramatically reduce carbohydrates, the foods that increase blood sugar.

Note: If you have diabetes and you are taking any prescription agents, such as glyburide, glipizide, insulin, and some others, you will need to discuss how to manage your medications if you reduce carbohydrates. The problem is finding a doctor or other resource to help you do this.

LDL pattern B

18. July 2010 William Davis (17)
Here's a Q&A I stumbled on in the Forum of MedHelp, where people obtain answers from presumed health "experts."

Question:

My VAP test results in July 07 identified an LDL Pattern B.
Overall results:
Total 150
HDL 75
LDL 61
Trig 60
HDL-2 17
LP(a) 6.0
LDL Pattern B

Medications:
Lipitor 10mg
Zetia 10mg
Altace 10mg
Atenolol 50mg
Plavix 75mg
Aspirin 81mg

I had several heart attacks which resulted in CABG performed May 2000. I am a 53 year old white male , 6'1", 190 pounds, exercise every day, watch my diet and feel great. Everything looks OK except my LDL Pattern B. Is there any therapy to improve the Patten B?

Answer from CCF, MD:
Your results indicate an LDL pattern B, which generally indicates small atherogenic LDL particles which may cause increased risk for CAD. However, there are several problems with LDL patterning: 1) its unreliability (of LDL pattern testing ), 2) unclear clinical evidence regarding regarding the usefulness of LDL patterns and particle size. The majority of evidence regarding the progression of atherosclerosis is with LDL lowering and to an smaller extent HDL raising.

All available clinical evidence shows that any particles in the VLDL, IDL, or LDL range are atherogenic, and there is no evidence that whether belonging to pattern A or B one is more atherogenic than others.

Subclass studies have proliferated over the last few years, but many of these studies were funded or subsidized either by suppliers of the assays as a method to expand their use and move them into mainstream practice, or by pharmaceutical companies in an attempt to claim some advantage over other therapeutic agents.
Thus, current data on LDL subclasses are at best incomplete and at worst misleading, suffering from publication bias, and now given the recent results of the Ensign et al. study, unreliable.

Your LDL, and HDL are at goal. The Lpa level is still not clearly linked as a modifiable risk factor for CAD, although elevated levels are now know to be linked to stroke.

Continue with your present treatments: aspirin, plavix, ateonol and altace are all essential medications.


Wow. The extent of ignorance that pervades the ranks of my colleagues is frightening.

Contrary to the response, LDL particle size assays are quite reliable and accurate. I've performed many thousands of lipoprotein assays and they yield reproducible and clinically believable results. For example, eliminate wheat, oats, cornstarch, and sugars and small LDL drops from 2400 nmol/L to 893 nmol/L (NMR)--huge drops. If repeated within a short period of time, the second measure will correspond quite closely.

The data are also quite clear: Small LDL particles (i.e., "pattern B") are a potent predictor of cardiovascular events. What we lack are the treatment trials that show that reduction of small LDL results in reduced cardiovascular events. The reason for this is that small LDL research is not well-funded, since there is no prescription drug to treat small LDL, only nutritional means. Niacin (as Niaspan) is as close as it comes for a "drug" to reduce small LDL. But diet is far more effective.

Given the questioner's fairly favorable BMI of 25.1 and his history of aggressive heart disease, it is virtually certain that he has what I call "genetic small LDL," i.e., small LDL that occur on a genetically-determined basis (likely due to variants of the cholesteryl-ester transfer protein, or CETP, or of hepatic lipase and others).

Ignoring this man's small LDL will, without a doubt, consign him to a future of more heart attacks, stents, and bypass. Maybe by that time the data supporting the treatment of small LDL will become available.

What increases blood sugar more than wheat?

15. July 2010 William Davis (38)
Take a look at these glycemic indexes (GI):


White bread 69
Whole wheat bread 72
Sucrose 59
Mars bar 68
White rice 72
Brown rice 66


I've made issue in past of whole wheat's high GI--higher than white bread. Roughly in the same glycemic league as bread are shredded wheat cereal, brown rice, and a Mars candy bar.

With few exceptions, wheat products have among the highest GIs compared to the majority of other foods. For instance:


Kidney beans 29
Chick peas 36
Apple 39
Ice cream 36
Snickers Bar 40


Yes, by the crazy logic of glycemic index, Snickers is a low-glycemic index food.

While I do not believe that low GI makes a food good or desirable, since low GI foods still provoke high blood sugars, small LDL particles, trigger glycation, and other abnormal phenomena, they are clearly less obnoxious than the items in the first list.

Take a look at this list:

Cornflakes 80
Rice cakes 80
Rice Krispies 82
Rice pasta, 92
Instant potatoes 83
Tapioca 81



Starches that are dried and/or pulverized, such as cornstarch, potato starch, rice starch, and tapioca starch (cassava root) will increase blood sugar even more than wheat. Foods with these starches have GI's of 80-100.

Cornstarch, potato starch, rice starch, and tapioca starch: Sound familiar? These are the main starches used in "gluten-free" foods. A hint of the high GI behavior of these dried starches is seen in the GI for cornflakes of 80.

So remember: Wheat-free is not the same as gluten-free. Gluten-free identifies junk carbohydrates masquerading as healthy because they don't contain one unhealthy ingredient, i.e. wheat.