Dr. Davis, would like your thoughts on the Trader Joe's brand Omega-3 Fatty Acids:
1200 mg Fish Oil
400mg EPA
200 DHA
Thanks,
Chris O

I use Pharmax Finest Pure Fish Oil with Essential Oil of Orange from the TYP Marketplace.  I take 1 tablespoon per day to help reduce Lp(a).  Is it better to take this dose at one time or divide it through the day?

In Iceland where I come from we have a really high quality fish oil called Lysi.

In my opinion liquid form is the only real way to take it, with caps you have to take a ridiculous amount to reach the same amount as in a tablespoon.

Plus you have no way of knowing if the fish oil caps are spoiled except to chew them, often they're not even refridgerated in the supermarket.

I remember from an earlier thread that spacing the dose out over the day works better than a big dose once daily. That makes sense, given that you are trying to alter some liver metabolism that goes on around the clock. I've been using the Life Extension capsules, six a day, for several years with pretty good results. It gets my TG from 400+ to about 170. I'm hoping the gram a day of regular niacin I've been taking for a few months helps further and gets my HDL out of the sewer (27). I'll know that in a few days...

Nice tasting Liquid fish oil brand, 1 teaspoon=
1,500 mg EPA
+ 750 mg DHA
----
= 2,250 mg EPA + DHA
+   380 mg other Omega 3
-------
= 2,630 mg. Omega 3/teaspoon
(out of a total fish oil content of 4,400 mg./tsp.)

Canada made "Natural Factors",
"Dr. Michael Murray recommended pharmaceutical grade" says label; extracted
from anchovy/sardine/mackerel;
1 teaspoon stateside cost works out to less than US$1 a teaspoon; each teaspoon has 40 calories, 15 mg cholesterol, total fat 4.5 gr. (being 3.5 gr. polyunsaturated), natural vitamin E and natural orange flavor, no heavy metals/environmental toxins ... I've no financial interest in the product.

What about Carlson's?



http://www.amazon.com/Carlson-Finest-Liquid-Omega-3-Orange/dp/B001LF39S8/ref=wl_it_dp_o?ie=UTF8&coliid=I27QWKFK5P760T&colid=1J0P20X13IM7F

What are your thoughts on Chris Masterjohn's research regarding very low requirements of polyunsaturated fats in the human diet?  High amounts of fish oil would certainly contravene this hypothesis.  I am referring to his position paper, How Essential Are The Essential Fatty Acids?

The best fish oils should be, as expected, in fish. Eat more fish!!!;))

"1 teaspoon Pharmax fish oil, for example, provides an equivalent quantity of omega-3 fatty acids as 6 standard fish oil capsules on a milligram for milligram basis, but more like 8 to 9 capsules when absorption efficiency is factored in."

Color me confused, Dr D. At the moment, I ingest 6 (3, 2x/day) Sam's Club Omega 3 capsules (the ones you recommended in a long-ago post) to obtain the 6 Grams of total DHA and EPA/day. Does your comment I quote above mean that, with the liquid form, I can take less than the equivalent of 6G/day  because of its absorption efficiency? And how much, if yes?

Really, I am sufficiently befuddled that I think even my question is not clear...

Help!

Where can I check if the fish oil is trigyleride form?

uh.. off topic.. when I clicked on my bookmark, to the Heart Scan Blog all of the website except these comments are in what looks like Russian!!  nothing else on my computer is corrupted...anyone else?.. and how do I fix this?  I am on an IMac.

Thanks,
Jeanne

Fixed it!  funny that it was only this website.

on topic- I am very intolerant to anchovies, will Krill oil help me?  can't take ANY fish oil with anchovy.

Thanks

Seeing some confusion here: the ideal active ingredients in fish oil are the EPA mg. & DHA mg. omega 3's. Lables indicate there are other omega 3 oils, plus other non-omega 3 oils in all products and together these are the mg of "fish oil" (product may specify yet another blending oil). Companies make their EPA mg. & DHA mg. concentrations different, incur production costs to make it higher doseage and our purchase price reflects that.

If you have a theraputic goal for intake: it is not so much how much fish oil, but how much you need to take of any one specific product a day to meet your target for total EPA mg. & DHA mg. Omega 3 fatty acids. For a name brand product Doc recommended and gave his daily dose (whether capsule or liquid)he apparently did the math.

Unfortunately I am illergic to fish oils and react badly to them. Not a good way for me to get my omegas so I need an alternative.

Udo' Oil does do a 369 oil that has no fish oils. So far that is the only one I have been able to find I can handle.

best fish oil is no fish oil. Certainly if anyone knew how fish oils were made , they would not take them. It's interesting how dr. Davis says fish oil with no odor are best but those are simply sterilized and deodorized and for a reason so that the taste of smell would not be repulsed. Trust your own gut instead of anyone else I guess. Ray Peat has chronicled data and science behind the dangers and lipid peroxidation of fish oils. Brian Peskin makes a case that these derivative oils are a huge burden for the cells and should never be taken. Naturally such oils are protected by vitamin E and saturated fat but not in these fish oils. Most other literature documents effects of omega 3 on cancer metastasis, just google it.

Now Foods Omega-3 Fish Oil 16.9 fl. oz.
Serving Size: 1 tsp (5 ml)
Servings Per Container: 100
EPA: 740 mg
DHA: 475 mg
Other Omega-3 Fatty Acids: 185 mg
Total Omega-3 Fatty Acids: 1,400 mg

Cost: $19

100% triglyceride form **

** Now Foods 16.9 fl. oz. is the brand I use and I can confirm this is the TG form after a polystyrene test.  (Take a styrofoam cup, place a small amount of fish oil at the bottom of the cup, wait ten minutes, and if it eats through the bottom it's the EE form.)  

I can also attest that I do not suffer from "fish burps" that the EE form is known to cause.

Anonymous about Lp(a)--

We have no formal data on dosing regimens, but I have been advising dividing dose in two, a.m. and p.m. This appears to be working well.

David--

You may be confusing fish oil dose with dose of EPA+ DHA.

Check your label to see EPA + DHA content. This is what you use to dose your fish oil.

Readers

Is Carlsons fish oil the Triglyceride form one?

SVinay:  Carlsons Super Omega-3 Fish Oil is the ethy ester form.

I am currently taking Heart Health Omega-3 1000mg by Swiss Natural Sources.EPA 300 and DHA 200.  I take three capsules daily.  I have also purchased Jamieson's Omega-3 Select with the same EPA DHA content as the Swiss.  The Jamieson's is less fishy smelling and I will switch back to it when I finish the Swiss.  
Canned boneless herring fillets are usually a part of my lunch.  Omega-3 2g.  I also found some canned cod liver.  I'll try it in an egg bake.

For the poster who had a question about Carlson's... the liquid and low-dose caps are natural triglyceride. Their higher concentrate capsules are ethyl ester.

I currently like Barlean's, as it's triglyceride and relatively inexpensive. Their higher concentrates are ethyl ester though, so go for the lower conc. ones if you want the trig form.

I do disagree with Dr. Davis as far as preferring liquid however, due to oxidation issues. I'd recommend the caps instead, and simply chew them, if swallowing capsules bothers you. The caps do offer some extra oxidation protection.

Hi Vlado,
I think so-called
"pharmaceutical" grade fish oil is distilled to seperate out concentrated gradients of "x"% DHA & "x" % EPA in a product. Yes, fish scraps that the oil is extracted from first gets heated, but so is cooked fish. Solvent residues concievably might be in some products; you can inform me of other compounds resistant to purifying out.

1 teaspoon oil = 5 mL. = 200 pharmaceutical size droplets = 4.54 grams .... I, for example, weigh 79,379 grams (175 pounds/79.4 Kg.) and assume a daily teaspoon dose of 4.5 grams fish oil can be metabolized safely. If you've details on how the omega 3's are noxious when added into the diet please explain.

Is my fish oil already peroxidized and/or are ingested omega 3 lipids peroxidized to my detriment at this level? My math shows that one teaspoon for me is 5.7 hundred-thousandths of my body weight; multiplying 0.000057 x 79379 grams that I weigh = 4.5 grams in teaspoon of oil.

Is there any data guiding recommendations on the ratio of EPAHA? I've never come across any primary data on the subject. To the best of my knowledge, the ideal intake and ratio of EPA and DHA remain unknown and a point of contention. I've noticed many fish oils have a 3:2 ratio of EPAHA, but I don't know where that is coming from. I'd love to know your thoughts, Dr. Davis.

I love the brand from www.strongerfasterhealthier.com
They make 5 flavors with zero fish oil taste. My kids ask for it, so it's a big win in our house. The concentration of EPA and DHA towered over even barleans.

Carlson's Super DHA Gems and EPA Gems concentrate capsules are TG form.

Dear Dr Davis

I am looking for a Kosher liquid omega 3 fis oils
I find nutri supreme research
Calories   40

Calories from Fat   40

Total Fat   4.5g    7%**

Cholesterol   18mg   6%**

EPA   950 mg   *

DHA   475 mg   *

Other Omega 3   325 mg   *

Total Omega 3 Fatty Acids   1750 mg

is this ok? or there is something Kosher better?---------------------------------------------

Check out Ascenta! All their fish oil is in triglyceride form.

ascentahealth.com

What is your opinion of Krill Oil?

Dr. Williams, I am wondering what you think of only taking high doses of EPA? See the following article:
http://igennus-hn.com/omega-3-epa-treatment-for-a-heart-condition-news-release/

As I have M.E. (post viral fatigue syndrome) as well as astronomical total cholesterol (great tryglycerides), I''m interested in trying this protocol. Would love your input.

Dr. Davis,

You keep making posts about things this newcomer to the Track Your Plaque program is thinking about.

I was thinking just last night that I would soon make a post at the Track Your Plaque (TYP) forum asking about what a TYP+ Supplement program might look like.

For people like me who have already experienced cardiac events this would be a huge thing.

I've now got my blood testing done.  I appreciate your providing feedback yesterday at the forum to my posting my blood test results there.

I also had a heart scan done even though I know it's of more limited use given my cardiac history and that you basically don't recommend it.  Frankly, I disagree with you a bit on the usefulness of a heart scan with preexisting cardiac events.  I'll explain why later.

So, I'm ready to go with TYP+ Supplement Program.

I have some specific supplements in mind that aren't among the current recommended TYP Supplements.  I'll make a note of the ones you mention in this post.  I'd like your feedback on a comprehensive list to try for inclusion in a TYP+ program of supplements.

I'll make that post to the forum soon now that I know you're thinking about this already.

Dream big my friend!

I am thinking a resort off the coast of Thailand. You take a month for the treatment. Fly in to a first class medical resort - do your fast while lounging in a tropical paradise - get lots of sun lounging by the pool (aids in Vit D absorption). While you are receiving the various medical and supplement treatments for your heart disease you might want to look into getting a little "touch-up" plastic surgery  or maybe that hip replacement you've been putting off...

I bet your "instant Heart Disease" treatment, some plastic surgery and a hip replacement in total would still be less money than a cardiac cath and stenting back in the United States!

I being somewhat facetious in writing this post...but I truly believe that scenario I discribed  
will be the norm in the next 10 or 15 years - as the rest of the world becomes richer and the regulatory environment in the US and Europe slows cutting edge development i could see some fast developing nation such as Thailand assembling a team of highly skilled Doctors in order become the world leader in treat a particular disease.


Peace

Joe E O

Hi, Joe--

Interesting perspective. I hadn't thought of it in those terms. If nothing else, it would make a fascinating experience to watch.

I think that method exists since the fifties and is known as chelation therapy.

Admittedly the mix, which is often vitamin C and other supplements plus EDTA or something similar, needs to be improved with the current knowledge about amino acids etc. But it could do the job.

Diet on the other hand is unbeatable. One could spend two weeks in a resort and eat ideal meals to improve health.

Sorry, but the chelation in my experience has never worked. I personally have seen several people go through it, usually provided by shady types, with huge rises in heart scan score. Until genuine evidence suggests otherwise, chelation falls in my scam file.

Hi Dr. Davis,

I have now got my intake of Niacin up to 3g a day using Slo Niacin.  I'm wondering if I shouldn't attempt to get it higher to impact my Lp(a) number.

I'm 6' tall and at 250 pounds am a "big person".  I'm working on the weight of course.

I understand there are potential impacts on the liver.

I have been told and found in the past that Silibinin Plus from LEF and n-acetyl-cysteine work pretty well to keep liver numbers under control.

What would you think about my taking my niacin dose up to 4g a day (or even potentially higher) if I could keep my liver numbers under control.

Thanks.

I'm a big believer in going slow with niacin. It may take a year or more for it to exert full effects, including reduction of Lp(a). I am generally not in a hurry to raise doses.

I do favor periodic cycles off niacin, however, especially in people with Lp(a). In my many hundreds of patients with this disorder who take niacin for several years, there is a peculiar creep back up of Lp(a) levels back to the starting values. I believe that periodic "vacations" off niacin are necessary from the start, e.g., one month off every six months. Resume dose gradually and work with your doctor if/when you do this.

Re: liver protection. I'm only superficially familiar with those agents, and I cannot say specifically whether they spare the liver from niacin effects. Interesting idea, though. Phosphatidylcholine? The liver-sparing effects of this agent are interesting, also. But I know of no specific experience with niacin, unfortunately.

Thanks for the reply Dr. Davis,

I understand that, because you're not my doctor, you can't give me specific medical advice.

It's also true that I know of no other doctor who has more of the scientific literature and practical supplement experience than you have.

First, however, thanks for the tip on periodic Niacin vacations.

Let me then put another question to you this way...

I'd like to propose to my doctor the following to get his expert insight but before I do, having your opinion would come in handy.

Suppose I pumped up my intake of niacin to 5 grams.  After a month of that, I get a liver numbers test.  Then I begin the Silibinin Plus - N-Acetyl-Choline regimen.  Then after another month, I take another liver numbers test.

Would a scenario like that provide me with useful information for long term Lp(a) treatment without doing permanent damage to my liver?

Any suggestions for improving the idea?

One last thought...

Because Lp(a) is believed to be formed in circulation (per McCormick, Marcovina, et al), it seems to me that continuous availability of niacin in circulation is important.  So, I'm thinking 2 or 3 doses of niacin per day at 1.5g to 2.5g per dose.

Seems to me that dosing like that would be beneficial to assessing the impact of the Silibinin Plus - N-Acetyl-Cysteine regimen.

Does that make sense?

Thanks for all you do!

wccaguy--

I think that it depends on your endpoint.

If Lp(a)reduction alone is your endpoint, then raising niacin even to 5 g per day is reasonable.

However, if control of plaque growth is your endpoint, then you might make do with far less, e.g., 2000-3000 mg per day. It can vary enormously. (In fact, I have even seen an occasional person reverse without Lp(a) control, though this is unusual.)

One warning re: the frequent dosing of niacin. Far more likely to yield liver toxicity than dose is frequency. Taking niacin three times a day as SloNiacin virtually guarantees serious liver toxicity--I would strongly urge you to NOT do this. You are safest with once daily dosing of the SloNiacin preparation.

Re: liver toxicity gauged by liver function tests. Unfortunately, these are not really good tests for quantitative assessment of liver toxicity; they are rather weak, qualitative tests. So I do not believe you can make much of shifts within the normal range.

Thanks Dr. Davis for the niacin regime tips:

To sum up.

1   I will try to get my Slo Niacin dose to 5g per day in a single dose.

2   I will monitor Lp(a) test scores.

3   I will take a one month niacin vacation every six months.

Thanks again.

Your blog is very informative i must say. I like such dedicated blogs. I too write a blog on fitness and health and life. it is http://dreamfit.blogspot.com
do stop by sometime.

Dear Dr.Davis,

I just came across your site for the first time and very much like the content and layout.

I'm aware that you don't answer personal questions but am not quite sure with what one can post or comment on? I hope my post is considered acceptable and I hope you will take the time to comment briefly.

I'm in a desperate need to help my mother who had a hearth attack a month ago. She's always had a low blood pressure and considered herself to be very healthy. She is 63 and never been on any medication, no pains or complaints. And all of a sudden-a heart attack! She has had two stents put in and is on several medications-Plavix 75mg, Beloc Zok 25mg, Triatec, Sortis 40mg, Aspirin 100mg and Nexium 40mg.
I'm aware of the interactions of Plavix and Aspirin-Nexium and am terrified of the complications. She started taking a nattokinease supplement and thought that it will be better if she didn't take the Aspirin-Nexium. However after reading all your comments on natto-i feel this might not be a wise idea. I've been a regular reader of Dr.Mercola.com for many years and ordered a product called Cardioessentials from the site. I must say am not a fan of the statin drug as well but have only insisted on CoQ10 as ubiquinol of 200mg a day.
She has become more thoughtful of her diet and exercise. I know that thing rarely happen without warnings and am sure she  could have taken a better care of herself. She did gain a bit of weight lately and I know that visceral fat does come with a price on heart health! She is following a diet rich in vegetables and fruits, lean meat and fish, nuts and seeds and low in grains. She takes fish oil, flax oil an olive oil,garlic, green tea, vit C in high doses, vit E and D, ALA, vit B complex, grape seed extract and chlorella. I'm considering L-carnitine, L-arginine, taurine, lutein and NAC.

Please share a few wise words on this protocol and let me know if there is anything she is missing out on or should not be taking.
I would greatly appreciate your comment. Thanks in advance,

Lidija McLaren

Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

This is a routine widely practised in Japanese hospitals for many diseases. They also use an IV glucose solution with electrolytes.

I am doing exactly what you suggest at the moment.

Supplements:

1/2 teaspoon of salt and 1/2 teaspoon of salt substitute (potassium chloride) dissolved in 2L of water. This provides very roughly 2g sodium and 2g potassium/day.

300mg magnesium and 800mg to prevent cramps.

A single multivitamin tablet.

A high potency B group supplement.

500mg vitamin C.

5g fish oil.

After 3 days I have never felt better in my life

This is simply whimsical at this point. I don't know if such an approach would work. But if it did, you might imagine that it would offer an opportunity--for the properly motivated--as an alternative treatment for angina, advanced coronary disease, a means to pull someone back from the brink.