Lovaza vs fish oil supplements?

Lovaza is the FDA-approved form of fish oil that is available only by prescription. It contains 842 mg of the omega-3 fatty acids, EPA and DHA, per capsule.

The FDA application for Lovaza is viewable here on the FDA website. Interestingly, while there is plenty of the usual regulatory gobbledy-gook about toxicology, dose escalation, and efficacy in the extensive documentation, there is little said about the issue of contamination.

In other words, critics of nutritional supplement fish oil harp on the possibility of contamination with mercury and pesticide residues, like dioxin and PCBs (polychlorinated biphenyls). Yet there is virtually nothing about these same issues in the FDA application for Lovaza.

Let's take a look at a sample over-the-counter fish oil product. Our friends at PharmaNutrients (a new Track Your Plaque partner for nutritional supplements) have a fish oil product called PharmaNutrients" Cardio. Here's an independent analysis of the Cardio product (per 1000 mg fish oil capsule):

EPA content: 566.1 mg
DHA content: 216.6 mg
(Total EPA + DHA 782.7 mg)

Cardio passed all tests for peroxides, PCBs, dioxin, furans, dioxin-like PCBs, and heavy metals (arsenic, cadmium, lead, mercury) using criteria at least 60% more stringent than European Commission (EC) standards (EC standard <2 picograms/gm for dioxins and furans, PharmaNutrients <1 picograms/gm; EC standard <10 picograms/gm for dioxin-like PCBs, PharmaNutrients <3 picograms/gm). PCBs levels in particular are less than 0.009 ppm, 90% below the industry-wide purity standard of 0.09 ppm. Likewise, mercury is >90% lower than European Commission standards.

In other words, this over-the-counter "pharmaceutical grade" fish oil has virtually nothing but omega-3 fatty acids.

Interestingly, the PharmaNutrients fish oil capsule also contains the third omega-3 fatty acid, docosapentaenoic acid (DPA), a neglected form that some authorities have proposed has superior cardiovascular protective properties over eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). If DPA is included in the analysis, PharmaNutrient's Cardio contains a total of 900 mg omega-3 fatty acids per capsule.

At some point, I'd like to see a head-to-head comparison not just on purity grounds, since I am convinced that high-quality products like Cardio can match or exceed the purity of prescription fish oil, but on efficacy in raising omega-3 blood levels, the omega-3 index. (The omega-3 index is a predictor of heart attack and sudden cardiac death--the higher, the better.) My prediction: High-quality fish oil supplements will match or exceed prescription fish oil.

Comments (55) -

  • Renfrew

    1/27/2010 4:23:08 PM |

    Yes, quality and contamination of fish oil IS important.
    I have heard that KRILL oil is superior to fish oil on all fronts. It supposedly has much less contamination than fish oil, better bioavailability (bound to phospholipids) and additional ingredients, i.e. Zeaxanthin (important for retinal health).
    Can you comment on this?

    Thanks.

  • Anonymous

    1/27/2010 5:35:45 PM |

    "My prediction: High-quality fish oil supplements will match or exceed prescription fish oil."

    Not to mention the incredible difference in price... in the patients' favor... and not the pharmaceutical company's bottom line!

    madcook

  • Anonymous

    1/27/2010 6:24:52 PM |

    After my sample bottle of Lovaza from my physician was done, I switched over to Trader Joe's brand. It's really cheap at $10 per bottle and the EPA/DHA concentration is 50%. I take about 5 to 6 capsules a day and my last triglyceride in December was 109 (down from 255). I also tried Omapure too but it's pretty expensive. Omapure's advantage over the TJ stuff is that it is independently tested by IFOS. Who knows where TJ's stuff comes from? I tried the Spring Valley (or is it Nature Made) brand from Walmart. Pure nastiness! Stay away from those yellow bottles.

    I bet some MBA guy dreamed up Lovaza at a brainstorming session intended to come up with ideas to boost sales in a sagging economy.

    Dr. Davis, your EPA/DHA content listings in the post seem to contradict the label on the bottle. The bottle claims 2 capsules contain 1100 mg of EPA and 500 mg of DHA. That would translate to 550 mg of EPA and 250 mg of DHA. What am I missing?

    -- Boris

  • William Trumbower

    1/27/2010 6:26:05 PM |

    I always suggest opening fish oil capsules once in a while to see if the oil is stinky.  That is the advantage of liquid oils is that you can smell and taste them.  One of my nurses opened a Lovaza capsule and told me it made her gag it was so fishy.  The antioxidant used in Lovaza is hydrogenated soybean oil!!.  One of my patients who is sensitive to soy reacted to Lovaza with a rash.

  • Anonymous

    1/27/2010 7:12:37 PM |

    Dr. Davis,

    The following question was somewhat inspired by this post, although it relates more specifically to seafood consumption.

    A few months back, I started ordering seafood from Vital Choice. According to the Vital Choice website, their Albacore tuna has 0.05 ppm of methyl mercury and that number falls to 0.03 ppm for their sockeye salmon (which Is what I typically order).

    http://www.vitalchoice.com/uploads/Merc%20Comp%204_06.pdf

    I often hear a general guideline that 2 servings of non-predatory fish (preferably wild caught and definitely not farm-raised) is generally accepted as safe, or at least minimally risky, and that this is likely a good guideline for everyone, but especially pregnant women and children.

    However, when I would place a sizable order, I would find myself serving it at least 2, and often up to 4 times per week. So that would be up to 4 servings of roughly 4-6 ounces of fish during some weeks that I would serve to my wife and for myself.

    In your opinion, should we cut back to 2 or fewer servings or are the levels listed by Vital Choice low enough to skirt potential issues?

    NOTE: the only seafood I eat is what I purchase from Vital Choice, so that I know the source. While the methylmercury is a focus, I am also curious if this level of consumption is also risky in terms of PCB’s and dioxins. It’s frustrating to realize that there will always be some measure of inherent risk.

    My wife and I aren’t eating this in place of supplementing with a purified fish oil supplement, we simply add this to it, so on days when we eat fish we lower our dose a bit and on days we don’t, we bump up that dosage. Our primary reason for consuming it is the delicious taste, along with the “bonuses” of protein, astaxanthin, vitamin D, and omega 3’s that come along for the ride.

    On one final note, I am also curious if the selenium content of the seafood is at all protective against methylmercury, particularly at these lower levels found in the Vital Choice fish. I’ve heard selenium has the potential to chelate methylmercury, but I am uncertain if this lessens the risk to any noteworthy degree, that is if I am not misinformed to begin with on this front.

    -Rick Bachmann

  • Ateronon

    1/27/2010 8:27:15 PM |

    I'd need a second job to buy either one. Kirkland from Costco is my favorite.

  • Jenny

    1/27/2010 8:50:40 PM |

    One concern with all over the counter supplements, is that they are not continually tested. The test is applied to one batch of the supplement, perhaps years earlier.

    As a result, when random samples are sent to labs contamination is often found in supplements that claim to be free of contaminants.

    I don't know if there is better supervision in the case of products sold as pharamceuticals, but I think we have to be very careful in accepting purity claims from any company operating in the Wild West unregulated supplement market. The track record when these products are spot checked is terrible.

  • Peter

    1/27/2010 10:34:53 PM |

    Another question that (I think) is yet to be answered is if DHA enriched fish oil is more effective than normal DHA/EPA fish oil at improving a person's omega-3 index.

  • Ned Kock

    1/28/2010 3:35:28 AM |

    Another option is to eat sardines whole - approx. 1.6 g of omega-3 per 100 g - about 2 sardines, according to my estimation:

    http://healthcorrelator.blogspot.com/search/label/recipe

    These are wild-caught sardines, not the canned ones.

  • Anonymous

    1/28/2010 9:59:15 PM |

    Your promotion of PharmaNutrients' Cardio is quite shocking. The price for 15 capsules is $29.95. That's $2/capsule - not far from $4/capsule of Lovaza. Surely you must remember your own post "Lovaza rip-off"?
    http://heartscanblog.blogspot.com/2008/12/lovaza-rip-off.html

  • Dr. William Davis

    1/29/2010 2:50:13 AM |

    Ren-

    While I think that krill oil is a fascinating product that we have used, I feel that the manufacturer's over-the-top marketing has clouded its real value. It is absurd to propose that krill oil be used as a replacement for fish oil until we have 1) confident data on omega-3 RBC levels, and 2) outcome data.

    In other words, fish oil has been shown to dramatically reduce cardiovascular risk. Krill doesn't yet enjoy this advantage. While it might be true, it is premature to make claims to that effect.

  • Dr. William Davis

    1/29/2010 2:51:28 AM |

    HI, Rick--

    Sorry, but I've not heard about this argument that selenium counteracts the mercury in fish. That seems a bit of a stretch.

    Any idea where this came from?

  • Dr. William Davis

    1/29/2010 2:54:57 AM |

    Hi, Jenny-

    Sorry, but I've got to disagree with you on this one.

    Take a look, for instance, at the two analyses by Consumer Lab (www.consumerlab.com). 77 fish oil products tested; 2 flunked due to oxidative byproducts. None flunked due to mercury, dioxin, PCBs, or related compounds. This has held true in Consumer Report and several other analyses.

    Frankly, I wouldn't be caught dead taking Lovaza, because I care too much about healthcare costs. Why stick it to other people when I can buy fish oil for a lot less?

  • Anonymous

    1/29/2010 7:18:36 PM |

    Jenny, I've seen you bashing supplements before.  Do you have any references for your claims?

  • Adolfo David

    1/30/2010 2:45:26 AM |

    Biotivia is going to launch a 100% vegetarian Omega 3 about which says has teh greatest EPA DHA levels around, also with resveratrol, green tea or sesame lignans. I would prefer Omega 3 in one supplement and resveratrol in others, not together because children pregnants..shouldnt possible take resveratrol. But I am so intriguing with a vegetarian Omega 3 with high levels of EPA DHA, arent you?

  • Anonymous

    1/30/2010 6:25:28 AM |

    I strongly agree that Lovaza is a rip-off.

    But unfortunately, the brand it's being compared to (PharmaNutrients) is a rip-off too. Once upon a time you were mentioning the benefits of Costco brand fish oil, or cheaper alternatives. $30/bottle isn't really cheap, when anyone can go to iHerb and get much better deals.

    Jarrow Formulas, EPA-DHA Balance, 630mg/Gel -- $13 for 120 softgels. Or 240 softgels for $23.

    PharmaNutrients vitamin D is another ripoff. $20 for 120 gels, 2000IU. I can get 120 gels of 5000IU for around $8 at iHerb (Now brand).

    I question why you decided to choose PharmaNutrients as a partner, when they are clearly so overpriced.

  • William Trumbower

    1/30/2010 6:46:00 PM |

    Do any of you have any experience with Vectomega, a phospholipid coated salmon oil?

  • Dr. William Davis

    1/31/2010 3:18:51 PM |

    Hi, Dr. Trumbower--

    Only limited experience. Because it has omega-6 added to the preparation, I have been avoiding it.  I can't imagine why they do it. Also, the astaxanthin added makes the capsule appear orange, making it difficult to judge its oxidative status.

  • Anonymous

    2/2/2010 12:00:10 AM |

    The good doctor here gives lots of free advice that runs counter to the big bucks pockets of the drug and insurance industry. So far his advice hasn't failed me yet. My lipid profiles have greatly improved since I started reading this blog. If Dr. Davis wants to partner up with a premium brand of omega-3 then that is OK by me. Nothing comes free and this is one way we can all say thank you and support this blog.

  • Ateronon

    2/2/2010 4:39:56 AM |

    http://online.wsj.com/article/SB10001424052748704107204575039590838522222.html

    Is there anything fish oil can't do?

    How about as an engine oil additive. Could prevent those gummy deposits.

    http://online.wsj.com/article/SB10001424052748704107204575039590838522222.html

  • Anonymous

    2/5/2010 9:16:27 PM |

    Wish we could get Dr Oz and Dr Davis together somehow...... see the following from the RealAge website where Dr Oz is suggesting animal fat are bad and grains are good...again

    source http://www.realage.com/tips/live-longer-with-this-protein

    "The red-meat and processed-meat eaters also had a higher risk of dying from cancer or heart disease. Why? Researchers aren't exactly sure. Could be the preservatives in processed meats. Could be the artery-clogging fats found in beef and bacon. Or it could be that both red- and processed-meat eaters consume less body-friendly foods like whole grains, fruit, and veggies. In fact, other research shows that vegetarians fare best when it comes to heart disease mortality."

    The last line is interesting.
    Trevor

  • H. Guide

    2/15/2010 8:42:25 AM |

    I often hear a general guideline that 2 servings of non-predatory fish (preferably wild caught and definitely not farm-raised) is generally accepted as safe, or at least minimally risky, and that this is likely a good guideline for everyone, but especially pregnant women and children.

  • Jenny

    3/4/2010 12:08:18 AM |

    I also take OMAPURE.  It's almost as pure as LOVAZA (70% vs. 84%) but is tested by third party IFOS and has no PCBs and mercury.  I wish OMAPURE was cheaper but it is still less than Sears Fish Oil and much much less than the rip off Lovaza!  Lovaza is such a joke - should be exposed on 60 minutes.

  • Jason

    3/9/2010 1:41:28 PM |

    This Pharmatrend Cardio Formula is ALMOST as concentrated as Lovaza.  Lovaza is about $150 for 120 capsules (a 1 month supply for a the FDA approved 4g/day dose for triglyceride reduction).  The Pharmatrend is $30 + shipping for a 15 capsule package!  That's almost a 4 day supply for triglyceride reduction.  So, it's $30 x 7.5 for a month supply.  That's $225/month!  However you slice it, it's actually less expensive to go with the prescription.  If you are covered by insurance, you will only come out of pocket at around $30-$40 per month for the FDA approved prescription.  Don't let "supplement" make you think it's better or less expensive

  • Rohit

    3/12/2010 5:19:27 PM |

    Lovaza is an ethyl ester of EPA not the actual EPA itself. It also includes DHA. However, the ester is supposed to significantly lower blood pressure and cholesterol far more than just plain old normal omega 3.

  • H. Ghr

    4/11/2010 12:35:44 PM |

    Gilles, just out of curiosity, do you consider me a “priest” of this “new religion of health data as the solution to all/most healthcare problems”? If not, what are you talking about? You read a lot more than I do but I don’t recall hearing anyone suggest that.

  • Charlotte

    5/22/2010 10:12:43 PM |

    What really upsets me is that physician only supplement companies with high quality supplements and processing standards that meet or exceed GSK's are NOT allowed to make the claim that Omega 3's helps lower triglycerides. Simply because the FDA has not evaluated their product. Really?

    The FDA is a joke. They approve unsafe drugs based on studies given to them from drug companies. Since the FDA does not require them to provide all of their research, drug companies are allowed to show them their studies that had positive results with little side effects, leaving out the incriminating studies. Some drugs are "fast tracked" through the approval process are then later pulled from the market due to a high number of deaths and side effects. If you think that the FDA protects us...think again.

    Also note, that a majority of studies are only done on men. Women are excluded due to the risk of pregnancy and drugs are NOT tested on pregnant women in a lab. They use animals for this. While we are biologically similar to rats, we are NOT the same. But nevertheless there are many "approved" drugs that are deemed safe for pregnant women and are only restricted later after clinical usage has shown to cause birth defects.

    When a drug is removed from the market everyone is upset at the drug companies. I say, stop blaming the drug companies for being what they are and are expected to be. How about we start blaming the FDA?! Let's hold them accountable for their actions. Suing the drug companies it ineffective. No, they don't want to lose money but let's face it...they don't won't go bankrupt and often settle. People need to wake up...just because something is FDA approved, does NOT make it safe!

    Sorry to rant...but this really irks me.

  • E Xtenze

    6/13/2010 5:58:03 AM |

    Yes, i agree fish are high protein, but for the fish oil supplement, we should have to take care about the quality and contamination.

  • fish oil

    6/22/2010 6:09:47 AM |

    After read this post I think that fish oil is better to take as supplement because as I think that fish oil is more beneficial and also good for health. It is also gives prevention against many of decease.

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    7/27/2010 5:28:01 AM |

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  • Todd

    9/9/2010 1:50:30 AM |

    You guys are all missing the point entirely. As can easily be seen from the commercial, Lovaza is manufactured in the future from a lab at the bottom of the ocean.  It requires a prescription because it must be shipped from the future to the present, which you can imagine is quite expensive (and dangerous).  The FDA regulates this process of transporting the drug through time.  The dietary supplement formulations of fish oil are actually smuggled through the time rift by rebels similar to those depicted in the Mad Max movies, starring Mel Gibson, thus explaining their cheaper price tag.

  • safe supplements

    9/30/2010 8:36:34 AM |

    Fish oil supplements and liquid fish oil have been suggested by doctors for lowering triglyceride levels, but people who are allergic to fish should not take fish oil supplements.

  • TedHutchinson

    9/30/2010 10:19:43 AM |

    @ safe supplements
    I used to be allergic to fish.
    I couldn't eat fish 2 days running because if I did I'd have a severe sore throat.
    I found raising my anti-inflammatory status with omega 3, vitamin d and magnesium has eliminated my tendency to get allergic reactions to fish or anything else. So now I don't get hay fever either. It's now been some years since I last used an anti histamine.
    Some fish allergic people may find Krill oil is less likely to cause a reaction but be aware some Krill oil capsules also contain fish oil.
    There are also omega 3 formulations from algal-docosahexaenoic acid: effects on triglyceride levels and other cardiovascular risk factors. that you may want to consider but they are a lot more expensive when considering the amounts required to be effective.

  • Micheala Woods

    10/22/2010 6:56:00 PM |

    Fish oil without doubt is highly beneficial, make sure you take the purest form available in the market.

  • buy jeans

    11/3/2010 4:55:42 PM |

    Cardio passed all tests for peroxides, PCBs, dioxin, furans, dioxin-like PCBs, and heavy metals (arsenic, cadmium, lead, mercury) using criteria at least 60% more stringent than European Commission (EC) standards (EC standard <2 picograms/gm for dioxins and furans, PharmaNutrients <1 picograms/gm; EC standard <10 picograms/gm for dioxin-like PCBs, PharmaNutrients <3 picograms/gm). PCBs levels in particular are less than 0.009 ppm, 90% below the industry-wide purity standard of 0.09 ppm. Likewise, mercury is >90% lower than European Commission standards.

  • Anonymous

    11/19/2010 2:35:25 PM |

    for years the fish oil products that we bought in vitamins stores contained a statement that " The FDA has not evaluated these statments". all of a sudden lovaza comes on the scene & its nowe okay. they say lovaza is purified. This raises the question that the FDA either is lying to us now or they were letting us be pisioned before. which one is it? the FDA in the most corrupt agency of the federal government. ask yourself this question. did you ever hear of restless leg syndrome until the FDA approve a prescription medication for it? if the drug companies pay the right people they can get anything approved.

  • fish oil supplements

    12/1/2010 2:24:21 AM |

    I have been using fish oil supplements for years and so far I am very satisfied on its performance. Lovaza is very new to me. I am still looking for more info about it. This article will help he clarify everything.

  • Anonymous

    12/6/2010 7:56:55 PM |

    I take EPA Xtra from Nordic Naturals

    Two Serving:

    EPA 1060 mg
    DHA 274 mg

    Cost Less than $30 per 60 capsule bottle. Just do your own research on quality and efficacy.

  • Anonymous

    12/15/2010 4:13:24 AM |

    Lots of info to take in....I see the pros and cons written before me. but just tell me this!

    "i could buy purity products sealogix pharmacuetical grade fish oil ---- 1.8g EPA & .9g DHA per teaspoon.

    or..........

    Loveza comes in at 1.8g EPA and 1.5g DHA per 4, 1 gram capsules

    which one?

  • Vegetarian supplements

    12/22/2010 1:26:55 AM |

    Fish oil is also a healthy alternative apart from the usual vitamins being used.

  • grace058

    1/25/2011 10:47:48 AM |

    fish oil supplements for me. It's proven to our family because of its very rich benefits gives to our health condition such as Eases Depression, Lowers Cholesterol, Eliminates Joint Pain and so much more!

  • Amy Wike

    1/27/2011 5:28:20 AM |

    I definitely believe in the benefits of fish oil supplements.

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    I admire the valuable information you offer in your articles. I will bookmark your blog and have my children check up here often. I am quite sure they will learn lots of new stuff here than anybody else!

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    2/28/2011 1:01:29 PM |

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  • Anonymous

    3/15/2011 8:20:18 PM |

    I dont know why everyone thinks lovaza is a rip off.  My prescription plan covers it and I pay less than $10 per/month and despite what some people on here have been saying, nothing, NOTHING, has anywhere near the EPA/DHA as lovaza....almost 3600MG daily dose

  • Anonymous

    3/30/2011 1:13:47 AM |

    Hi everyone
               I started on Lovaza about a month ago, my doctor feeling this is a last resort to lowering my triglycerides as all other meds left me with with severe muscle soreness when using them. I've been reading as far back as I can go on this particular subject w/ using Lovaza and I'm confused. I have a couple of questions...1, is Lovaza a safe product with as much natural ingredient as possible? 2, or is it an artificial made product?

  • Swacher

    5/14/2011 3:20:35 PM |

    GSK made the financial investment to have the studies done.  What's stopping the supplement companies?  To answer your question, yes I did hear of retless leg syndrome before the FDA approved a prescription medicine for it.  I understand people's frustration with big pharma and the FDA and if you dislike them you are free not to utilize any FDA approved pharmaceuticals.

  • Angelo

    5/15/2011 12:16:30 AM |

    What a way to sell your supplements. Your a good hustler Doctor.

  • Angelo

    5/15/2011 12:18:52 AM |

    You haven't researched very much then. And it's not 3600 per 4 pill dose it's 3,360. Big difference.

  • Angelo

    5/15/2011 12:23:16 AM |

    Your an idiot if you need to ask "what's stopping the supplement companies from making the financial investment to have studies done. What supplement company has the money a pharm company has. Do you have any idea what a good study cost? I guess not.

  • Angelo

    5/15/2011 12:25:22 AM |

    Dude, stop reading the Health Ranger and Mercola. when you get cancer you'll be begging the Pharm company for there FDA approved drugs.

  • kansas mom

    6/17/2011 2:22:56 AM |

    Hey Doc.,
    Ok I have a question Doc. what fish oil brand do YOU say we should take? I got on here just to see what the diff. was between the two because our doc. said we should take Lovaza. I find it a little interesting that she said to take it along with our reg fish oil we've been taking...

  • Minnie

    8/18/2011 4:38:39 AM |

    I have 280 triglycerides I was prescribed Lovaza, but  my insurance denied it, my doctor told me to take  over the counter fish oil. I am undecided and confused I need help. Which brand and its purity etc

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Comments (3) -

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