Why haven't you heard about lipoprotein(a)?

1. July 2010 William Davis (26)
Lipoprotein(a), or Lp(a), is the combined product of a low-density lipoprotein (LDL) particle joined with the liver-produced protein, apoprotein(a).

Apoprotein(a)'s characteristics are genetically-determined: If your Mom gave the gene to you, you will have the same type of apoprotein(a) as she did. You will also share her risk for heart disease and stroke.

When apoprotein(a) joins with LDL, the combined Lp(a) particle is among the most aggressive known causes for coronary and carotid plaque. If apoprotein(a) joins with a small LDL, the Lp(a) particle that results is especially aggressive. This is the pattern I see, for instance, in people who have heart attacks or have high heart scan scores in their 40s or 50s.

Lp(a) is not rare. Estimates of incidence vary from population to population. In the population I see, who often come to me because they have positive heart scan scores or existing coronary disease (in other words, a "skewed" or "selected" population), approximately 30% express substantial blood levels of Lp(a).

Then why haven't you heard about Lp(a)? If it is an aggressive, perhaps the MOST aggressive known cause for heart disease and stroke, why isn't Lp(a)featured in news reports, Oprah, or The Health Channel?

Easy: Because the treatments are nutritional and inexpensive.

The expression of Lp(a), despite being a genetically-programmed characteristic, can be modified; it can be reduced. In fact, of the five people who have reduced their coronary calcium (heart scan) score the most in the Track Your Plaque program, four have Lp(a). While sometimes difficult to gain control over, people with Lp(a) represent some of the biggest success stories in the Track Your Plaque program.

Treatments for Lp(a) include (in order of my current preference):

1) High-dose fish oil--We currently use 6000 mg EPA + DHA per day
2) Niacin
3) DHEA
4) Thyroid normalization--especially T3

Hormonal strategies beyond DHEA can exert a small Lp(a)-reducing effect: testosterone for men, estrogens (human, no horse!) for women.

In other words, there is no high-ticket pharmaceutical treatment for Lp(a). All the treatments are either nutritional, like high-dose fish oil, or low-cost generic drugs, like liothyronine (T3) or Armour thyroid.

That is the sad state of affairs in healthcare today: If there is no money to be made by the pharmaceutical industry, then there are no sexy sales representatives to promote a new drug to the gullible practicing physician. Because most education for physicians is provided by the drug industry today, no drug marketing means no awareness of this aggressive cause for heart disease and stroke called Lp(a). (When a drug manufacturer finally releases a prescription agent effective for reducing Lp(a), such as eprotirome, then you'll see TV ads, magazine stories, and TV talk show discussions about the importance of Lp(a). That's how the world works.)

Now you know better.

How to have a heart attack in 10 easy steps

29. June 2010 William Davis (48)
If you would like to plan a heart attack in your future, here are some easy-to-follow steps to get you there in just a few short months or years:


1) Follow a low-fat diet.

2) Replace fat calories with "healthy whole grains" like whole wheat bread.

3) Eat "heart healthy" foods like heart healthy yogurt and breakfast cereals from the grocery store.

4) Use cholesterol-reducing plant sterols.

5) Take a multivitamin to obtain all the "necessary" nutrients.

6) Take the advice of your doctor who declares your heart "in great shape" based on your cholesterol values.

7) Take the advice of your cardiologist who declares your heart "like that of a 30-year old" based on a stress test.

8) Take a statin drug to reduce LDL and c-reactive protein while maintaining your low-fat diet.

9) Neglect sun exposure and vitamin D restoration.

10) Limit your salt intake while not supplementing iodine.



There you have it: An easy, 10-step process to do your part to help your local hospital add on its next $40 million heart care center.

If you would instead like to prevent a heart attack in your future, then you should consider not doing any of the above.

Kick inflammation in the butt

25. June 2010 William Davis (0)
C-reactive protein, or CRP, is a protein produced by the liver in response to inflammatory signals its receives. Thus, CRP has emerged as a popular measure to gauge the underlying inflammatory status of your body. Higher CRP levels (e.g., 3.0 mg/L or greater) are associated with increased risk of heart attack and other cardiovascular events.

The drug cartel have jumped on this with the assistance of Harvard cardiologist, Dr. Paul Ridker. Most physicians now regard increased CRP as a mandate to institute statin therapy, preferably at high doses based on such studies as The JUPITER Trial, in which rosuvastatin (Crestor), 20 mg per day, reduced CRP 37%.

I see this differently. Two strategies drop CRP dramatically, nearly to zero with rare exception: Vitamin D restoration and wheat elimination. Not 37%, but something close to 100%.

Yes, I know it sounds wacky. But it works almost without fail, provided the rest of your life is conducted in reasonably healthy fashion, i.e., you don't live on Coca Cola, weigh 80 lbs over ideal weight, and smoke.

How can something so easily reduced like CRP mean you "need" medication? Easy: Increased CRP means there are fundamental deficiencies and/or inflammation provoking foods in your diet. Correct neither and there is an apparent benefit to taking a statin drug.

Why not just correct the underlying causes?

Life without Lipitor

25. June 2010 William Davis (17)
One of the most common reasons people come to my office is to correct high cholesterol values without Lipitor. (Substitute "Lipitor" with Crestor, simvastatin, Vytorin, or any of the other cholesterol drugs; it's much the same.)

In the world of conventional healthcare, in which you are instructed to follow a diet that increases risk for heart disease and not advised to correct nutrient deficiencies like vitamin D and omega-3 fatty acids, then a drug like Lipitor may indeed provide benefit.

But when you are provided genuinely effective information on diet, along with correction of nutrient deficiencies, then the "need" and apparent benefits of Lipitor largely dissolve. While there are occasional genetic anomalies that can improve with use of Lipitor and other statins, many, perhaps most, people taking these drugs really would not have to if they were just provided the right information.

Anyone following the discussions on these pages knows that wheat elimination is probably one of the most powerful overall health strategies available. Wheat elimination reduces real measured LDL quite dramatically. Provided you limit other carbohydrates, such as those from fruits, as well, LDL can drop like a stone. That's not what your doctor tells you. This approach works because elimination of wheat and limiting other carbohydrates reduces small LDL. Small LDL particles are triggered by carbohydrates, especially wheat; reducing carbohydrates reduces small LDL. Conventional LDL of the sort obtained in your doctor's office will not show this, since it is a calculated value that appears to increase with reduced carbohydrates, a misleading result.

Throw vitamin D normalization and iodine + thyroid normalization into the mix (both are exceptionally common), and you have two additional potent means to reduce (measured) LDL. Not restricting fat but increasing healthy fat intake, such as the fats in lots of raw nuts, olive oil, and flaxseed oil reduce LDL.

While I still prescribe statins now and then, a growing number of people are succeeding without them.

(Note that by "measured" LDL I am referring to the "gold standard," LDL particle number by NMR provided by Liposcience. A second best is measured Apoprotein B available through most conventional labs.)

In search of wheat: Emmer

23. June 2010 William Davis (13)
While einkorn is a 14-chromosome ancient wheat (containing the so-called "A" genome), emmer is a 28-chromosome wheat (containing the "A" and "B" genomes, the "B" likely contributed by goat grass 9000 years ago).

Both einkorn and emmer originally grew wild in the Fertile Crescent, allowing Neolithic Natufians to harvest the wild grasses with stone sickles and grind the seeds into porridge.

Having tested einkorn with only a modest rise in blood sugar but without the gastrointestinal or neurological effects I experienced with conventional whole wheat bread, I next tested bread made with emmer grain.

The emmer grain was ground just like the other two grains, cardiac dietitian Margaret Pfeiffer doing all the work of grinding and baking. Margaret added nothing but water, yeast, and a little salt. The emmer rose a little more than einkorn, but not to the degree of conventional whole wheat.

I tested my blood sugar beforehand: 89 mg/dl. I then ate 4 oz of the emmer bread. It tasted very similar to conventional whole wheat, but not as nutty as einkorn. Also not as heavy as einkorn, only slightly heavier than conventional whole wheat.

One hour later, blood sugar: 147 mg/dl. I felt slightly queasy for about 2-3 hours, but that was the end of it. No abdominal cramps, no sleep disturbance or crazy dreams, no nausea, no change in ability to concentrate.

I asked four other wheat-sensitive people to try the emmer bread. Likewise, nobody reacted negatively (though nobody tested blood sugar).

So it seems to me, based on this small, unscientific experience, that ancient einkorn (A) and emmer (AB) wheat seem to act like carbohydrates, similar to, say, rice or quinoa, but lack many of the other adverse effects induced by conventional wheat.

Modern wheat , Triticum aestivum, contains variations on the "A," "B," and "D" genomes, the "D" contributed by hybridization with Triticum tauschii at about the same time that emmer wheat hybridization occurred. It is likely that proteins coded by the "D" genome are the source of most of the problems with wheat products: immune, neurologic, gastrointestinal destruction, airway inflammation (asthma), increase in appetite, etc. This is consistent with observations made in studies that attempt to pinpoint the gliadin proteins that trigger celiac, the area in which much of this research originates.

If I ever would like an indulgence of cookies or cupcakes, I think that I will order some more einkorn grain from Eli Rogosa.

In search of wheat: Another einkorn experience

23. June 2010 William Davis (6)
Lisa is a trained dietitian. Unlike many of her colleagues, she has "seen the light" and realized that the conventional advice that most dietitians are forced to dispense through hospitals, clinics, and other facilities is just plain wrong. 

I know Lisa personally and we've had some great conversations on diet and nutritional supplements. I told Lisa about my einkorn experience and how I witnessed a dramatic difference between bread made from einkorn wheat and that made from conventional whole wheat. So she decided to give it a try herself. 

Here's Lisa's experience:


This past Friday, June 18th, I conducted my "Einkorn Wheat Experiment".

7 am 
FBG [fasting blood glucose] 97 mg/dl

8 am-9 am 
1 hour high-intensity aerobic workout

10:05 am 
BG 99

10:05 am 
I embarked upon the journey of choking down, I mean enjoying, the hefty piece of Einkorn bread. Wow, was that bread dense!  It was a lot of work chewing. 

10:50 am 
(45 minutes after consumption, wanted to see what BG did a bit before the 1 hr mark)  BG 153

11:05 am 
1hr PP 120

11:35 am 
90 mins PP [postprandial] 113

12:05 pm 
2 hours PP  114 ... at this time I ate an egg & veggie omelet for lunch.

12:50 pm 
BG 100

Before dinner 5:10 pm 
BG 88

I was surprised with the BG of 153. However, it was good to see my insulin response is reactive and decreased BG 33 points in 15 minutes to end up with a BG of 120 1 hr after the bread.  

So, it appears my response is similar. A slight elevation of BG at the 1 hour mark, but not to the degree of conventional whole grain wheat bread.  

Of note, also, was the fact that I cannot remember the last time I ate a piece of wheat bread of this magnitude that did not make me bloated... not at all: No cramps, no brain fog, no headache and, did I mention not bloated?  

I believe you are on to something with tolerance of Einkorn wheat for those of us with wheat sensitivities, in addition to its apparent lower glycemic response.

Along with Lisa, I asked four other people with various acute intolerances (all gastrointestinal) to conventional wheat, i.e., people who experience undesirable effects from wheat within minutes to several hours, to eat the einkorn bread. None experienced their usual reactions.

Obviously, this does not constitute a clinical trial. Nonetheless, I find this a compelling observation: People like myself who generally experience distinct undesirable reactions to wheat did not experience these reactions with einkorn.

Note, however, that einkorn behaves like a carbohydrate. No different, say, from brown rice or quinoa. However, unlike modern whole wheat flour from Triticum aestivum,  in this little experience there were no immune reactions, no neurologic phenomena, no gastrointestinal distress--just the blood sugar consequences.

While this may not be true for all people consuming einkorn, it suggests that primordial einkorn wheat is quite different from modern conventional wheat for most people.

Increased blood calcium and vitamin D

21. June 2010 William Davis (50)
Conventional advice tells us to supplement calcium, 1200 mg per day, to preserve bone health and reduce blood pressure.

Here's a curious observation I've now witnessed a number of times: Some people who supplement this dose of calcium while also supplementing vitamin D sufficient to increase 25-hydroxy vitamin D blood levels to 60-70 ng/ml develop abnormally high levels of blood calcium, hypercalcemia.

This makes sense when you realize that intestinal absorption of calcium doubles or quadruples when vitamin D approaches desirable levels. Full restoration of vitamin D therefore causes a large quantity of calcium to be absorbed, more than you may need. In addition, two studies from New Zealand suggest that 1200-1300 mg calcium with vitamin D per day doubles heart attack risk.

We have 20 years of clinical studies demonstrating the very small benefits of supplementing calcium to stop or slow the deterioration of bone density (osteopenia, osteoporosis). These studies were performed with no vitamin D or with trivial doses, too small to make a difference. I believe those data have been made irrelevant in the modern age in which we "normalize" vitamin D.

Should hypercalcemia develop, it is not good for you. Over long periods of time, abnormal calcium deposition can occur, leading to kidney stones, atherosclerosis, and arthritis.

Until we have clarification on this issue, I have been advising patients to take no more than 600 mg calcium supplements per day. I suspect, however, that the vast majority of us require no calcium at all, provided an overall healthy diet is followed, especially one that does not leach out bone calcium. This means no foods like those made with wheat or containing powerful acids, such as those in carbonated drinks.

Heart health consultation with Dr. Joe D. Goldstrich

20. June 2010 William Davis (3)
Cardiologist, nutritionist, and lipidologist, Dr. Joe D. Goldstrich, is a frequent contributor to the Track Your Plaque Forum, where we discuss the full range of issues relevant to coronary health and coronary plaque reversal.

I have come to value Dr. Goldstrich's unique insights, especially in nutrition. Formerly National Director of Education and Community Programs for the American Heart Association and a physician at the Pritikin Center, his dietary philosophy has evolved away from low-fat and towards a low-carbohydrate focus, much as we use in Track Your Plaque. Like TYP, Dr. Goldstrich is always searching for better answers to gain control over coronary health. His unique blend of ideas and background has helped us craft new ideas and strategies. Dr. Goldstrich has proven especially adept at understanding how to incorporate new findings from clinical studies in our framework of coronary atherosclerotic plaque management strategies.

Dr. Goldstrich is offering to share his expertise with our online community. If you would like a one-on-one phone consultation with Dr. Goldstrich, you can arrange to speak with him at his HealthyHeartConsultant.com website.

Wheat aftermath

16. June 2010 William Davis (18)
Following my 4 oz whole wheat misadventure that yielded the sky-high blood sugar of 167 mg/dl, compared to einkorn wheat's 110 mg/dl, I suffered through a 36-hour period of misery.

After I obtained the blood sugar of 167 mg/dl, I biked hard for one hour. This yielded a blood sugar back down in the 80s. I felt spacey in the ensuing few hours, as well as a little queasy. However, about 12 hours later, I awoke with overwhelming nausea along with that hypersalivating thing that happens just prior to vomiting. It did not come to that, but persisted all through the following day.

The next morning, I could barely concentrate. Trying to read a study (admittedly on the complex topic of agricultural genetics), I had to read each paragraph 4 or 5 times. Abdominal cramps and a bloated feeling also developed, though I was able to eat.

The 2nd night was filled with incredibly vivid dreams and intermittent sleeplessless. I awoke about 5 times through the night, but periods of sleep were filled with detailed, colorful dreams. I dreamt that a large corporation was secretly trying to gain control over the world's water supply, and I snuck onto a complex underwater vessel that was exploring and mapping the coastline of the Great Lakes in preparation. Weird.

I recognized these odd feelings as various facets of wheat intolerance, since they were all reminiscent of feelings I used to experience before I removed wheat from my diet. They were amplified and compressed, likely because I had been wheat-free for so long.

The odd thing is that, despite the modest blood sugar effect of my einkorn experience, none of the gastrointestinal or neurologic effects of wheat developed. So far, two other people with acute gastrointestinal wheat sensitivities have consumed our einkorn bread, also without reproduction of their usual symptoms.

Einkorn contains gluten, though the structure of the many gluten proteins of einkorn differs from that of the wheat bread I consumed, an example of modern Triticum aestivum. 14-chromosome einkorn carries what biologists call the "A" genome, while Triticum aestivum has the combines genomes of 3 plants, the combination of the A, B, and D genomes. It is the D genome that contains the genes coding for the most obnoxious, immunogenic forms of gluten.

So einkorn may not be entirely benign, but it is a good deal less obnoxious than modern Triticum aestivum.

I am awaiting the reports from a few other people on their experiences.

In search of wheat: Einkorn and blood sugar

14. June 2010 William Davis (32)
There are three basic aspects of wheat's adverse health effects: immune activation (e.g., celiac disease), neurologic implications (e.g., schizophrenia and ADHD), and blood sugar effects.

Among the questions I'd like answered is whether ancient wheat, such as the einkorn grain I obtained from Eli Rogosa, triggers blood sugar like modern wheat.

So I conducted a simple experiment on myself. On an empty stomach, I ate 4 oz of einkorn bread. On another occasion I ate 4 oz of bread that dietitian, Margaret Pfeiffer, made with whole wheat flour bought at the grocery store. Both flours were finely ground and nothing was added beyond water, yeast, olive oil, and a touch of salt.

Here's what happened:

Einkorn wheat bread:

Blood sugar pre: 84 mg/dl
Blood sugar 1-hour post: 110 mg/dl

Conventional wheat bread
Blood sugar pre: 84 mg/dl
Blood sugar 1-hour post: 167 mg/dl

The difference shocked me. I expected a difference between the two, but not that much.

After the conventional wheat, I also felt weird: a little queasy, some acid in the back of my throat, a little spacey. I biked for an hour solid to reduce my blood sugar back to its starting level.

I'm awaiting the experiences of others, but I'm tantalized by the possibility that, while einkorn is still a source of carbohydrates, perhaps it is one of an entirely different variety than modern Triticum aestivum wheat. The striking difference in blood sugar effects make me wonder if einkorn eaten in small quantities can keep us below the Advanced Glycation End-Product threshold.
 
A little bit of fish oil

A little bit of fish oil

5. November 2006 William Davis (12)

The British National Health Service (NHS) has announced that, in light of the substantial data documenting that omega-3 fatty acid intake from fish reduces likelihood of cardiovascular events by around 40%, that Brits discharged from hospital following a heart attack should be "prescribed" 1000 mg of prescription fish oil per day.

Hardly a revolutionary concept. Part of the timidity of the British NHS seems to relate to the potential cost to the government, since apparently much of the cost will be borne by the government-subsidized health system.

But prescription fish oil? Why prescription fish oil? Prescription Omacor, one capsule per day, costs around $70 (U.S.) per month. If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form.

Omacor is clearly more concentrated. But is the prescription form better--more effective, more purified, less contaminated, etc.? I have seen no independent verification of this. Of course, manufacturers make all sorts of claims. The only independent, unbiased testing I'm aware of comes from organizations like Consumer Reports and www.consumerlabs.com. Omacor has not been compared to non-prescription fish oil in any of their analyses. Head-to-head comparison of Omacor to nutritional supplement fish oil is unlikely to come from Solvay, the manufacturer of Omacor. Drug companies powerfully resist head-to-head comparisons, fearing it will not play out in their favor. Let the public remain ignorant and hope marketing conquers all.

Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.

Nonetheless, despite the filthy politics and under-the-table dealings, some good comes out of the NHS's action: broader recognition of the power of fish oil. Perhaps when a British patient or an American patient gets discharged with a prescription for Omacor, the patient will take the initiative and go to the health food store instead and save him (or his insurer) $67.50 per month.

For your coronary plaque control program and control and/or reversal of your heart scan score, we start at 4000 mg per day of standard fish oil, providing 1200 mg per day of omega-3 oils. This amount as a nutritional supplement costs only a few dollars a month. And you have the satisfaction of not only taking a powerful step for your health, but also not enriching the overflowing pockets of drug companies.
Tags :

Comments (12) -

  • Anonymous

    11/6/2006 4:30:00 AM |

    Many of the non distilled forms of Fish oil seem to specify varying amounts of cholesterol contamination , + saturated fat etc.  In the pharmaceutical or distilled types most of the fat content is accounted for by the omega-3 content while in most over the counter types you will find varying amounts of additional fat and cholesterol specified. (Nature Made for example has the following:
    Per 2 Softgels: Calories 25 (Calories From Fat 20); Total Fat 2.5 g (Saturated Fat 1 g; Polyunsaturated Fat 1 g; Monounsaturated Fat 0.5 g); Cholesterol 25 mg; Protein 2 g; Fish Oil Concentrate 2400 mg (Omega-3 [EPA] Eicosapentaenoic Acid 360 mg; Omega-3 [DHA] Docosahexaenoic Acid 240 mg); Gelatin (Non-Bovine); Glycerin; Water; Tocopherol.

  • Bix

    11/6/2006 11:35:00 AM |

    Will insurers cover Omacor?  I don't know...

    If so, I know a number of people who would go get a script today.  The out-of-pocket costs for supplements just aren't in some people's budgets.  But I agree with you, it's a shame the system is designed to support such blatant profit for so few people.

  • Anonymous

    6/16/2007 4:10:00 PM |

    Omacor is a prescription drug and it is covered by my insurance. I pay $90 for a three-month supply, that is four capsules a day for a total of 360 capsule. It is also covered by my flexible spending account, so that saves me about 30% tax. I effectively pay about $63 for three months. So the cost per capsule is about 17.5 cents.

  • Dr. Davis

    6/16/2007 5:50:00 PM |

    Don't kid yourself:

    You may pay $63 for a prescription out of pocket, but you and society pay a far larger price of $240 per month through increased health insurance costs. All of us ultimately bear the higher price. In this instance, all the excess profits go into Omacor's pockets, thanks to the brainwashing of the public and physicians.

  • Anonymous

    11/22/2007 4:03:00 AM |

    Its amazing that Physicians, who lead their life using medicines and treatment protocols which are based on clinical research, discourage the use of the only truely clinically proven, regulated, prescription Omega 3 acid available.  The benefits of this product extend far past its triglyceride lowering effects, which makes it a product that should be considered for positive health as well as disease treatment.  The clinical studies are horrifically expensive, a natural based product is unpatentable, therefore making whomever is willing to put millions of dollars into making sure the clinical background is well tested, take a large risk. Copycat, unproven, dietary supplements (by the way which are monitored by the same people who monitor kit kats and gatoraid)make unsubstantiated claims. Shouldn't the developers and companies of this pharmaceutical product be  repaid, profit, and also be supported enough to continue the clinical research and development of such products.  If only the worlds medications were made up of more natural based solutions I believe we would be much more satisfied and less at risk of side effects from strictly chemically "isolated" molecules.  Omacor (which is now Lovaza) provides a glimpse of what practitioners have been looking for, a natural based prescription medication, effective, clinically proven to lower triglycerides similarly to other available therapies (with less expected drug to drug interactions or adverse events) and controlled so it is easier to recommend and use by health care professionals.  What is the sociatal cost of frequent LFT's, myopathy, rhabdo, Drug to Drug interactions from 145 fenofibrate?  Not the POOLED representation of Adverse events in the PI, that my good Doctor is trickery.  The 48mg might be more innocuous, but the 145mg is still risky and even recently had many other interactions and warnings added.  That is still considered a good drug, effective, possibly safer than the alternative of no treatment, but it does say to mind the "risk benefit ratio" which is thrown to hell when products like Omacor (Lovaza) come to market proven to work without expected side effects.  You might want to rethink how you see the companies and industries that develop the future of medicine.  No one is perfect, nor totally disclosed, however this product is certainly a step in the right direction and should be supported, not stiffled.

  • Dr. Davis

    11/22/2007 2:26:00 PM |

    Anonymous--

    I think you may have missed the point of the post.

    I was not bashing Omacor/Lovaza because it is fish oil. I have been using fish oil for years with excellent results, preparations that work wonderfully and cost around $3 per month.

    Now, there's a fish oil that costs $130+ per month? Purer? I would like to see side-by-side comparisons; I have seen no such thing. There are over-the-counter, highly purified preparations available without prescription and for less than a tenth of the cost of Omacor/Lovaza.

    I agree that fish oil in some form should precede the use of fibrates like Tricor. I rarely use Tricor, even though much of my cardiology practice has evolved into a lipid consulting practice.

  • Biomed007

    11/24/2007 3:53:00 PM |

    I guess my point is specifically, if you support $3 fish oils and their use, will those companies obediently go out and do the clinical studies that you need to feel secure to treat your patients?  Business and price per product does not come cheap.  The studies done, the missed compounds, the intergration into a patented item, the production, and the standards and guidelines all factor into the price of a product.  I just believe it to not only be unfair to recommend that patients use other than the proven product (unless there is no alternative) but also bad business sense.  If there is not loyalty or ethical appreciation to the developers and testers of these pharmaceutical products, who will then develop medicine?  I believe it would be futile to compare regular fish oil to Lovaza, just as it would be futile to compare most other drugs head to head.  The difference between relative/ actual and clinical vs. theraputic significance is very hard to show.  However, the dosing (4per day vs 8 t0 15 of reg fish oil), the purity (excursions from storage parameters render the compound less or ineffective = lack of controled standards)the purity (many manufactures are continuously being warned from FDA about the consistancy of product) and the lack of attributable cause data linking other less pure concentrations to actual clinical outcomes are all reasons that a seasoned medical professional like yourself should support the use of Lovaza instead of Fish oil capsules whenever possible.  I do know there are studies in europe about dosing regimin vs. clinical lipid results.  I would expect that at 8-15 fish pills per day the outcome results would be similar, however more variation and much more fat and omega 6's per pill.  Compliance would be less than optimal, outcome would be less than optimal, and with any alternative prescription that provides confidence in all variable and clinical aspects, this should be commended and supported whenever possible rather than talking about "brainwashing the public and physicians."  I wish someone would figure out that for every product that is developed, tested, and brought to market there are 20 other products that are in some stage of development and fail to be approved.  If EACH drug that comes to market costs approx $1.2 billion dollars (Tufts CSDD 2006), how much do you think is lost with the other 10-20 drugs that fail to gain approval?  Somewhere between 100 and 500 million PER FAILED DRUG!  Multiply that times the 10-20 that failed and you have approximately  6,000,000,000 (6 billion dollars).  With that said, it takes a lot more than just actual production cost to reimburse for past, present, and future research and development, business expenses, and of course profits to keep the company developing key breakthrough products.  All I am saying is that I understand and commend you for using an agressive alternative therapy addition in your patients to increase their health and hopefully life.  I do however believe that there is a blame game in medicine created or exacerbated by insurance companies that leads to finger pointing about medical necessity and cost.  People look towards trimming expenses in all places, however if drugs like Lovaza (not just fish oils) are not appreciatively embraced by practitioners and supported/ recommended whenever possible, there will be no more drugs or better yet, alternative large scale studies done on this kind of unpatentable compound because physicians assume similarities and switch to a compound like Dietary supplements.  Sorry, Ill step down from my soap box now, however this is definitely a sore spot for me.

  • Dr. Davis

    11/24/2007 4:18:00 PM |

    Do you work for a pharmaceutical manufacturer?

    Is it the same sort of economics that allows the founder/CEO of Kos Pharmaceuticals to cash out for $2.3 billion in personal payout, followed by the company raising the price of Niaspan?

    The answer, in my view, is not to gouge the public with extravagant drug prices, but to support non-profit-seeking research.

  • Anne

    2/5/2009 4:47:00 PM |

    Dear Dr Davis,

    I had to comment on this old blog as I am in the UK. Up until yesterday I was buying omega-3 fish oil from my health food shop, an amount to give me 2250 mg per day, that is 1125 mg EPA and  750 mg DHA, and it was costing me in the region of £25 per month. I have a bicuspid aortic valve with moderate stenosis and talking about omega-3 fish oils with my cardiologist he suggested that I be prescribed Omacor instead. The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it Smile

    I would love to have some studies, though, which show the positive effect of omega-3s on coronary calcification.

    Anne

  • Anonymous

    3/12/2009 8:11:00 PM |

    Anne said, "...my cardiologist...suggested that I be prescribed Omacor...The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it Smile".
    I left hospital a month ago with a prescription list that included Omacor but when I visited my NHS GP for a repeat prescription I was told that I could buy this item for myself, over-the-counter. :-(

  • futurepharmer

    10/13/2009 4:37:26 PM |

    "If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form."

    Lovaza capsules contain >80% purified EPA and DHA (465 mg and 375 mg, respectively), which are purified from fish oil.  The other oils are fish oils, and could possibly be omega-3s.  You must take at 2-4 for triglyceride lowering (at least one for CV risk reduction in AVD patients).  

    I don't know about any specific manufacturers OTC, but I do know that typical products contain 120mg DHA and 180mg EPA per GRAM of capsule. This means that only 30% have been confirmed to be the beneficial oils.  What else is in there?  This is why Lovaza does not have a fishy aftertaste, but OTC ones do.  Also, look how many you would have to take to equal the DHA and EPA in Lovaza.  It is not ANY fish oil, but specifically DHA and EPA that is necessary for CV benefit.

    Alpha linoleic acid MUST BE ACTIVATED to give CV benefits, and humans only activate 10% of alpha linoleic acid, so products claiming to have a ton of omega 3s using this compound are giving their values of omega-3s via a technicality (alpha linoleic acid is "technically" an omega-3).  

    This is not to mention the whole issue of herbal/supplement companies basically able to put anything in a capsule as long as it isn't harmful, REGARDLESS of what they say it is.  The FDA just doesn't care to watch these companies much.  

    Therefore, if I had the money, I would go Lovaza, but I am a cheap @$$ and would rather go with a USP Verified OTC product and take my chances Smile

  • buy jeans

    11/3/2010 6:16:42 PM |

    Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.

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