Thanks for that.  I still take Lovaza; have been lazy about switching.  I just checked the price my mail-order pharmacy pays and it's $546 per bottle of 120, or just over $1.50 per capsule.  While considerably less than what you quoted, it's still $6 per day and $2185 per year!  I'd no idea.  Plus I take Niaspan for another $900 per year.  I'm switching to OTC for both.  No wonder insurance rates are going up!

It's amazing how much some of these companies will try to scam people with 'pharmacy grade' vitamins. It's easy for me to tell how much fish oil is oxidized by taste and how well it works and the best brand I've found is from trader joe's for 8 bucks a bottle. For stuff like vitamin C the process is so simple it's pretty much literally impossible to have any real difference brand to brand aside from how absorbable it is and again it's easy to tell when pills are not absorbing due to how they feel.

And we wonder why healthcare costs are spiraling out of control in america...

What's sad, is the problem isn't limited to just pharmaceuticals, so many other areas like diagnostic imaging and durable medical goods are so much more expensive than they should be.

Do your part to reduce healthcare costs: Reject the idea that fish oil, niacin, and vitamin D should be costly prescription agents.

Pay for them yourself for SUPERIOR preparations that you can obtain without a prescription. This small effort alone will save us all hundreds of millions of dollars.

Anyone know when Lovaza is going generic? I thought I read that perhaps by end of the year their exclusivity may be up, which should open up cheap prescription alternatives -- and sort of kill Lovaza's profits too.

I use otc niacin at about $3 a bottle, and one of the doctors I work with asked me why I hadn't asked my doc for a prescription for Niaspan.
I just didnt know where to begin.

Jeanne

Wow - I'm so surprised that there are worries about a national health care service in the US such as we have in the UK. Here, Lovaza (Omacor) costs the National Health Service £50 for 100 capsules, ie 50p per capsule !

Of course that's not what patients pay. Patients who are charged prescription charges will pay  Â£7.20 per prescription of 100 capsules, and patients who don't pay prescriptions charges at all (approx 70% of patients), well they don't pay anything for their Lovaza....they have paid in their taxes for it already.

But to me the biggest surprise is that the pharmacutical company that makes Lovaza charges so much less in the UK than it does in the US !

Anne

Another way to save on prescription drugs--pill splitting. Too often the smaller dose costs almost as much as the bigger dose. Getting the bigger pill and cutting it down to smaller doses can save a lot of money.

I'm surprised we don't see scrips for "pharmaceutical-grade water", to wash these down.

pyker, its called "bottled water"

It's not really a problem that pharmacy grade fish oil is ridiculously expensive, as long as it's not illegal to sell cheaper fish oils too.

In Europe, the trend seems to be that supplements are becoming available only in pharmacies, which can then charge extraordinary prices for everything.

I have moderately high triglycerides at 255. My physician gave me a sample bottle of Lovazza to try which has 28 softgels. I have been taking one softgel a day.

I have been looking into OTC fish oil supplements. Some are very diluted and some are very concentrated. Most break down the EPA and DHA content while others don't. I created a spreadsheet that collects the EPA and DHA content of several OTC fish oil supplement. In order to make a fair comparison, I adjusted my serving size for each brand name to give me about the same quantity of the essential fatty acids. The prices range from $0.11 per dosage to $1.76 per dosage.

So once I figured out what's the most cost effective brand to buy now I have to worry and wonder about purity. Am I getting a less refined formula that will have heavy metals, PCBs, and other nasty chemicals? The words "triple distilled" mean nothing to me. I'd like to see "Contains no more than 0.010 PPM of arsenic" or something like that.

The Lovazza might have the advantage here since the FDA probably won't let poisoned fish oil out. I have no idea what my effective price per dosage is with Lovazza since my sample bottle was free. My company takes a decent chunk of my pay for health care and I rarely use it. Maybe it's time I get my money's worth and get some subsidized Lovazza?

"I'm surprised we don't see scrips for "pharmaceutical-grade water", to wash these down."

What, like this?

http://www.marksdailyapple.com/bling-water/

My one month experiment with Lovaza is over. I received a free sample bottle with 28 capsules last month from my physician. The recommended dosage was four a day but he told me to take one. I did that for one month. My triglycerides went down from 255 to 135 with no significant change in diet. My total cholesterol went down from 221 to 177, and it was all LDL. Unfortunately, my HDL levels stayed almost the same.

So do I continue with Lovaza and get a prescription or do I get a high quality OTC like Omapure?

I will see my physician tomorrow.

Decisions, decisions, decisions!

Just want to add that Omacor (European Lovaza) costs £2 per day, while Triple Strength Omega 3 from a reputable company costs 12p per day in comparison, for roughly the same amount of EPA and DHA. You just have to take 6 capsules instead of 4.
My jaw would've dropped if I hadn't been getting my vitamin D!

I can also go to Sam's Club and buy a bottle of their Triple-Strength fish oil with 900 mg omega-3 fatty acids per capsule at $18.99 per bottle of 180 capsules. That comes to 10.5 cents per capsule. That puts the price of fish oil from Sam's Club at 97.6% less cost compared to Lovaza for an equivalent quantity of omega-3 fatty acids.

Dear Dr. Davis.  I am really hoping that you will answer this note.  I have read your book and it resonates with me so much.  I am ready to drop the wheat..which is in everything!  Here is my question.  My husband has high blood pressure...he first heard about Dr. Dean Ornish for revrersing heart disease, then Dr. Esselstyn..the two doctors treated President Bill Clinton..my husband is convinced that is the way to get healthy...yet reallyquestion it..because Esselstyn has bread bread and more wheat products for breakfast and tofu...too much of it...and no meat, no dairy no cheese...

My husband wrote an email to Dr. Esselstyn asking about how a person can live with out meat or something that comes from animal protein...he actIually called us at our home.... to talk to my husband about his questions.  I am hoping that you would do that too??? 250-869-1677...or my husbands cell 250-470-0042 ...that would be such a bonus ..even call collect!

I believe in what you say...I was thought to be " a little bit Celiac"...am not actually yet my numbers can show up to 45 when I do the test...anyhow, it is just what you say, how you say, that makes so much sense to me....

What is bothering my husband is to go from no meat, oil, dairy etc allowed to it being allowed in your diet?  can you help us in this?

I just noticed I haven't received any of your blogs this year.  I tried signing up again and it said I was already signed up.  Your blogs aren't in my spam folder either.  Can you get me receiving your blog again please.

my daughter gave up weight several years ago and still does not loose her belly fat....are there other foods that you think could be interacting? she is almost 21.

Drs. Esselstyn and Ornish are doing the public a grave disservice with their fairly absurd approach to diet and health. If you read the many posts on this blog, you can see why.

The Ornish diet that I followed 22 years ago made me diabetic while I was jogging 5 miles a day. It is nonsense.

Ah, thyroid normalization. My favorite. Of course, this has a trickle-down effect on DHEA, estrogen, and testosterone as well. Perhaps Lp(a) is one mechanism by which Broda Barnes was able to prevent heart attacks in his patients?  

http://180degreehealth.com

Aw darn it. Again health info to be confused about. From Taubes' GCBC I read it was apoB supposed to be the one associated with smaller and denser LDL, "the bad LDL", and I thought apoA was the "large and fluffy" or more benign LDL. I'm pretty sure Dr. Lustig says pretty much the same in his "Sugar, the bitter truth" video. There goes my newly acquired "understanding" out the window again.

The last of the 4 treatments doesnt' seem very specific...

is "T3" a supplement.. if not, how does one go about normalizing the Thyroid?

That's a lot of fish oil. I take about 1/5 that amount and would find it irritating to have to increase my intake by a factor of 5.

If the pharma industry could actually come up with drugs that work and don't just chase surrogate markers, I'm sure that would be helpful.  I'm all for nutritional and lifestyle fixes, but this won't work perfectly for everyone all the time, so useful drug therapies would be nice too.

Anonymous, I think you're confusing LDL pattern A and B ("fluffy" vs dense) with apoA and ApoB (HDL associated vs LDL associated proteins).

Cynthia

Dr. Davis,
How low do you like to see Lp(a)? I've seen recommendations of below 30mg/dl, below 20, and below 10. Mine is 19. Thanks,

Anthony

Anthony-

Excellent question . . . for which there's no solid answer.

Despite all we know about Lp(a), no endpoint data have been generated. However, I can tell you that using particle count measurements in nmol/L a level of 60 nmol/L works very well. In mg/dl, a measure of weight per volume, it depends on the method of measurement used. If the "normal" range is 30 mg/dl or less, then aiming for around 20 mg/dl has worked well.

I asked my cardiologist about it (heads up preventive cardiology at a major research institution in Texas) and he said:

"Well, there's not anything we can do about it, so why test it?"

My cardiologist and PCP have never ever discussed this with me even though I brought it up for discussion. I think my PCP didn't know much and ignored it. I desperately need a new cardiologist (I live in the SF bay area). Anybody here love their cardiologist and like to share some details? I will be forever thankful

TIA

I found this to be a very interesting post over at the Animal Pharm blog concerning this very subject:
Auto-Tuning Lp(a): Value of Low Carb, High Sat Fat


They basically come to a very simple conclusion in controlling Lp(a); eat some damn saturated fat! And stay away from the damn carbs!

Now, let me get back to making my LDL the plain and fluffy kind... someone pass me the ghee please...

Anonymous and Drs. Cynthia and David, there are several "A" designated particles that frequently get confused. Dr. Davis is talking about lipoprotein(a), with a lower case "a", which consists of an LDL particle with a particle of apolipoprotein(a) attached to it. This apolipoprotein is also designated by a lower case "a". Lp(a) is very atherogenic, and should be minimized.

Apolipoprotein A, with an upper case "A", on the other hand, is an atheroprotective particle that is a component of HDL. It comes in several varieties. The most plentiful one is designated Apolipoprotein A-I, or Apo A-I, which is the main particle that participates in reverse cholesterol transport, which is the principal way that HDL protects against atherosclerosis, by removing cholesterol from plaque and transporting it back to the liver for disposal. There are also particles designated Apo A-II and Apo A-IV that are also associated with HDL, but their function is not well understood. All the HDL-associated apo A particles are described with the upper case "A".

Finally, there is the LDL pattern A, which indicates that the LDL particles are mostly large, whereas LDL pattern B indicates that LDL particles are mostly small. These are usually designated with an upper case "A" and "B", and the A pattern is thought to be less atherogenic than the B pattern.

It is easy to confuse these "A" types, especially Apo A and Apo a, which are two very different particles, the large A apo is good and the small a apo is bad.

My LP(a) started a year and a half ago at 198 nmol/L, it is now down to 35 nmol/L. Thanks to Dr, Davis's advice that I followed in the Track Your Plaque book, including 4800mg combined EPA, DHA fish oil and 2000mg Niaspan, etc.

I also want ot mention though that I have been following the Linus Pauling protocol as well, which I believe has a synergistic effect with the other principles applied.

An interesting thing happened that is worth mentioning, my LP(a) had been gradually dropping over that period of a year and a half from 198 to 45 nmol/L, then I switched to immediate release niacin and my LP(a) jumped back up to 150 nmol/L. That was the only change I made, so I switched back to Niaspan and that is when it went back down to 35 nmol/L.

Kent

Hi All.The following paragraphs were taken from http://www.drlam.com/opinion/Lp(a).asp

Lipoprotein A, commonly called Lp(a), is a major independent risk factor for cardiovascular disease. The optimum laboratory level should be under 20 mg/dl and preferably under 14 mg/dl.

Currently, there is no medicine or drugs that to effectively lower your Lp(a). A high Lp(a) is genetically linked. Fortunately, Mother Nature has provided us a much better non-toxic alternative. It consists of large doses of vitamin C, L-lysine, and L-proline.

Many conventionally trained physician uses niacin to reduce Lp(a). This does work to a limited extend. Niacin reduces the production of lipoprotein A in the liver, and helps to bring down the lipoprotein A in the blood. This is what most conventional doctors use. However, this approach has its limitations because until the endothelial wall is optimized and cleared, the lipoprotein A level will not be able to reduce significantly. The effects of niacin usually hit a plateau after 6-9 months of therapy. If you are on niacin, make sure the liver enzyme levels are taken periodically to make sure the liver is able to handle the high dose of the niacin.

This last flower:
Replacing carbohydrates with proteins ignores the fact that protein, once in the intestinal tract, converts to amino acid. Amino acids increase insulin secretion. It is unclear, however, whether proteins are as potent as carbohydrates in stimulating insulin secretion.

My comment: Is it possible that protein can produce high insulin secretion? So, what is left for simple humans? No carbs, no protein?

Is the LDL carried in the blood by a protein or has it already been oxidized. I'm trying to understand what form chlorestral is in the blood.

Alfredo,

It's true that protein stimulates insulin, but the key is that it doesn't only stimulate insulin. Glucagon, insulin's counter-regulatory hormone, is also stimulated. Insulin secretion  is undesirable in the context of low glucagon (which is what we have with high carbohydrate intake), but it's not such a big deal when the ratio of the two are more balanced (which is what we have with low-carb protein intake).

David

The VAP cholesterol profile, which gives the distribution of LDL and HDL particle sizes a other information, shows an upper limit of 10 mg/dl for Lp(a)cholesterol.

In recent tests, my wife had an Lp(a) of 6 while mine was 8. Through no fault of our own I might ad.

HI, Kent--

Great results!

You are living proof that Lp(a) can indeed be tamed. It sometimes requires some unusual strategies, but huge reductions are possible . . . and Lipitor is not part of the equation.

Long-term commitment to the effort is the key.

what kind of doctor shoudl i see to get the right tests done.  I know I have high Lipo(a) from a previous test at Mayo.  They recommended that I take drugs and I declined.  Now I'm realizing I don't have the complete story.  I need to know more than just my lipo(a) is high.

thanks!
Linda

Hi
Are there stats on people with lp(a) that don't develop any plaque?
Also does the same happen with lp(a) as with ldl? that is that is better to have a higher mg/dl with big paricles than a lower mg/dl with small particles?
Santiago

I would say apoprotein(a) is normal phenomenon. What is not normal is the abundance of small dense LDL which apoprotein(a) binds to. So the best way to avoid LP(a), is to avoid the abundance of sugars and starch in the diet. All the other (still costing) treatments for Lp(a) won't be necessary then.

Hi,   I recently had a VAP test done via LEF -- I seem to have some very good numbers and some bad LDL ones.  Any comments would be appreciated.

all values in mg/dl
LDL 105
HDL 71
VLDL 14
Total Cholesterol 190
Triglycerides 51
LP(a) 4.0
IDL 3
HDL2 18
HDL3  53
VLDL3 8
LDL1 PatternA 5.4
LDL2 PatterA 7.5
LDL3 PatternB 61.6
LDL4 PatternB 22.4


LDL Density pattern = B, flagged abnormal

Vit D  65.4 ng/ml
Homocysteine 6.2
C-Reactive Protein 0.2

I am 55 yr of age, 6'0", 165 lbs, exercise regularly.

Heart disease in family, mother's father died of heart attack at 66, other 3 grandparents lived into 90s.  father died leukemia cancer 53, mother living at 80 in good health.  Thanks,   Jim

I use Lugols solution 2% and I have absolutely no idea what dosage I should be using.  I have been using one drop about twice a week, but I would like to have a better idea of proper dosage.  Can you help?

My cardiologist is treating my high Lp(a) with Niaspan, but even with high doses, it has not had much effect. What do you mean by items 3 and 4 on DHEA and T3? Please be more specific. Thanks.

Could you give some dose for T3 and DHEA that you are recommending?

Thanks!

"If your Mom gave the gene to you, you will have the same type of apoprotein(a) as she did. "

Does that mean that high levels of Lp(a) is not inherited from the father?

Thanks

Dear Dr. Davis,

I'm a 44 yr old female.   I recently had a consultation w/ a cardiologist here in Canada.   I was sent for the consultation because of some strange left jaw and low chest tightness I'd experienced at work the week prior (had been seen then in the ER, normal ECG x 2, normal CXR, normal bloodwork).  Prior to the appt I was told I needed to have fasting bloodwork (so that results were available for the cardiologist to review at my appt).  

HDL good, LDL good (though at the higher end of the normal range).  Lipoprotein A was 0.55 g/L (which i guess works out to 55 mg/dl which is what the usual unit of measurement is for this one in the U.S.).  The cardiologist told me that all of my bloodwork was normal and that I was very low risk for a heart attack but I requested a copy of my results just to have on file.   I am surprised she didn't mention the elevated Lipoprotein A (normal range for this lab is: 0.00 to 0.33 g/L).   So that got my on my search for info on what exactly Lipoprotein A is, and what it indicates.

My question is:   I was only told to fast for 12 hours prior to my bloodwork, nothing was said about ensuring I didn't smoke.   Well I did smoke over the 12 hours up until the blood was drawn (even about 30 minutes prior to).   Now I'm reading online that one should not smoke prior to blood being drawn for Lipoprotein A, HDL and LDL, etc.    So could my smoking right up to the time bloodwork done have negatively impacted the results?   Could smoking have made my LDL and Lipoprotein A higher?    Should I have these redone but ensure I don't smoke for 12 hrs prior to blood draw?  (I have a 'quit date' set for next Saturday, so don't worry, I will be quitting).

Thanks so much,
Lisa

Thanks for having the courage to say all of this!

Yes, and let's elect a socialist for president who will work to make sure all American citizens have "free" access to this high standard of care they have a right to. Let's have a government that tells the people to eat in such a way they are all but guaranteed heart disease and then let's devise a universal health care system that will take their tax money to make them pay for their heart procedures. I'm going off a bit on a tangent here, but whenever I hear anyone start advocating a government-run univeral health insurance program, I think of the points you make about the greed of hospitals, and realize it puts a different perspective on just what it is these politicians are wanting the government to pay for.

Dr Davis,

Excellent pair of posts.  I wish more people would understand that while there are many people in medicine who are dedicated to caring for patients in the best way they know how, the "system" and some people in it have rigged the game to perpetually favor "the house", like gambling establishments.  Like post-vacation gamblers, post-procedure patients come away awed by the smoke & mirror shows.

I am afraid we need to get medicine back to its altruistic roots.  Physicians should be limited to pay not to exceed $200k/yr. If you want to make more than this you should go to business school not medical school. Make it a law.

On another note as the economy continues its colapse you will see medicine return to a decetralized model complete with a return to altruism and much less regulation. This is not an optimistic hope-it is where it is going.

And we should make it a law that Angelina Jolie must dump Brad Pitt and date me. And that she must never make any dish for me that includes broccoli.  

I hate broccoli.

^^
I hope you're right, but I don't see it happening that way.

People with money and power will always struggle to increase both, regardless of the consequences.

"Democracy is the worst form of government except for all those others that have been tried."

~ Winston Churchill
Similarly with the hospitals, the pts seem to like them. It employs lots of people. Does it really matter that it is a lot of smoke? Is there a better way?