Dear Dr Davis,

A little off topic, but I take a good fish oil omega-3 supplement and I eat a lot of fish too (wild and therefore organic), but I've been finding disturbing reports on the net that omega-3s and fish are not so good for us after all because the oils are very easily oxidised in the body, and I'm wondering if you could comment sometime please. Here are some links about the 'dangers' of fish oil:

http://www.paleonu.com/panu-weblog/2009/6/19/fish-oil-or-not.html

http://high-fat-nutrition.blogspot.com/search?q=fish+oil

http://raypeat.com/articles/articles/fishoil.shtml

Anne

I guess there's no free link? Couldn't see it on the Lab's website.

Even if it wasn't better, some things definitely taste better, so the premium is apparent.

The problem with organic blueberries (for me) is simply finding them. Seems nobody locally sells organic blueberries.

As for fish oil, oxidation is a potential issue, but hopefully vitamin E protects against that. There could be a concern though with very large dosing, or bad fish oils. It'd be interesting to see more krill oil vs fish oil studies, testing oxidation, lipid changes, plaque reduction, etc. Krill would, seemingly, avoid some of the oxidation problems fish oil may have.

I would also be interested if Dr. David considered writing an article about oxidized cholesterol in the future, as it seems to get ignored a lot. But if fish oils did increase oxidized cholesterol in the body to such an extent as to increase plaque, I'd think he would have seen it by now, since most of his patients are probably taking fish oil.

Dr Davis, I have been reading alot about blueberries and their power to lower LDL cholesterol. But we just went over the fructose and how bad that is for the cholesterol. Am I missing something special with the blueberries? I know they are high in Vitamin C and K, but is that it? I feel like I don't know what to believe regarding blueberries. Thankful for a reply. Regards, Helena

Hi, Helena--

Blueberries are, on the whole, good. They have a wonderful complement of flavonoids and other nutrients.

But, too much of a good thing . . . Then the fructose gets you. So, a modest quantity is good, just as in many other foods.

Anne-

The fact remains: Large clinical studies that have looked at cardiovascular events and mortality, such as GISSI-Prevenzione, have demonstrated significant reductions.

I agree that we must always question "conventional" wisdom. But sometimes conventional wisdom is correct.

From what I understand, wild blueberries are higher in anthocyanins than are the standard blueberries. Wild blueberries are smaller in diameter than the standard.

In southern California, Trader Joe's carries wild blueberries at a good price -- about $2.99 for 16 ozs. Indeed, TJ's has a good selection of berries at a good prices.

http://www.wildblueberries.com/

This website that Anne posted - http://raypeat.com/articles/articles/fishoil.shtml - raises some pretty frightening concerns about supplemental fish oils, and he includes references to studies that seem to confirm some of his points.

Dr. Davis, have you had anopportunity to read his comments, and if yes, what is your thinking about his allegations?

Thank you.

Tom

Hi Dr. Davis,

Do you ever see patients that have a zero calcium score? I'm just wondering if your diet/lifestyle advice applies as well for prevention as it does for your sample of patients.  

Thanks,
David

Where can one find this study? Were both blueberries the same species?

I've wondered if the smaller wild blueberries had more skin and thus more flavinoids?

Tom, if anything the risks of Omega-3 fatty acids might outweight their benefits in a select few: exceptionally healthy people with no risk factors whatsoever. (And never forget that dosis sola venenum facit.)
I guess it certainly does not apply to Dr. Davis' patients and probably not to most of us.

There may be pros and cons of taking high or moderate doses of fish oil but that is to be expected, isn't it? It's a matter of risk:benefit ratios. If large interventional trials show a mortality benefit in certain populations, then we can be sure of it.

I've planned to read up on the issue of O-3 and those purpoted risks for quite some time (but haven't, so take my opinion FWIW).

I expect this will come up in the upcoming report on Anthocyanins, but a recent study has shown some nice lipid improvements using approx the equivalent to a cup of blueberries --

http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27814v1
http://inhumanexperiment.blogspot.com/2009/08/anthocyanins-from-berries-increase-hdl.html

The study used an extract, so they seemingly got around the fructose issue. But I think the benefits of blueberries would outweigh the relatively low levels of fructose anyway. It's really the only affordable way to get enough anthocyanins to match the study, until some pharmaceutical company gets wind of it, I guess. *Black Currant/Blueberry pills ala Lovaza*

Anne,

I've read the blog posts from both Hyperlipid and Panu you've provided.  I think Peter at Hyperlipid raises some very interesting questions, but I'm really not prepared to get carried away with panic.  First, I think it's very important to keep in mind that the study Peter cites had the subjects consuming 30 ml of fish oil per day.  Total omega-3 content alone was in the neighborhood of 15 ml, if I recall correctly.  This is an enormous dose!  Furthermore, Peter makes the point that this is probably only an issue with concurrent consumption of excessive carbs and/or alcohol (and excessive omega-6, one suspects...), perhaps thus explaining why Eskimo on a traditional diet do not experience hepatic steatosis, etc... at such high levels of omega-3 intake.  As for the "raypeat" article you've provided, I can only say that I've checked out two of the papers he cites, and was left a bit puzzled.  For instance, the issue of liver toxicity he mentions (I first followed this issue based on the concern Peter @ hyperlipid raised) refers to a study using a rabbit model.  Very interesting, but it's critical to ask just how much fish oil you can force-feed a herbivore before something horrible happens.  We've seen very wrong and enduring dietary advice arise from studies using rabbit models before (ie the lipid hypothesis), so I say, let's not jump to conclusions.  The second study raypeat points us to "Mechanisms for the serum lipid-lowering effect of n-3 fatty acids" really doesn't have much to say about deleterious effects, as far as I can see.  Here's a quote for you: "The finding that n-3 fatty acids are transported from the liver as ketone bodies to a larger extent than n-6 fatty acids may thus explain that a high intake of n-3 fatty acids is not accompanied with hepatic steatosis."

I'll keep reading up in the meanwhile.  This is a pretty fascinating subject to me.

Oh, and I like my blueberries!  Lots of tasty organic options in the SF Bay Area.  I think Michael Pollan mentioned in one of his books that wild and organically raised plants tend to have a much higher antioxidant content because they're left to their own devices, having to fend for themselves rather than rely on the crutch of insecticides to protect them...

Kind regards,

Van Rensselaer

I forgot to say that Aronia, aka "chokeberry" is supposedly loaded with anthocyanins.  I've bought the juice from Trader Joe's before.  It's not very sweet at all and is astringent like unsweetened 100% cranberry juice.  Maybe an ideal candidate?  Low in sugar, high in anthocyanins.


Van Rensselaer

To the risks of O-3s... I understand that some genetic variants are linked to these risks.  I would very much like to know the good Doc's opinion on genetic testing and variation, and how it affects they way we metabolize certain nutrieints.  Perhaps there is no "one diet fits all" solution, but rather a "one diet fits a genotype."

Hello Readers and Dr. Davis,

Let me try to clear up what may be a little confusion regarding the USDA organic vs conventional blueberry results for phenolic profile, total anthocyanins, and the ORAC value of each. Firstly, organic blueberries are grown and harvested from the wild and although they do get some management, they are supremely adapted to their cold northern environment and fare well enough left alone and are are "organic" by default (some managers do apply fertilizers and set fires for weed control). These wild northern bluberries are Vaccinium angustifolium. On the other hand, "conventional" blueberries are generally more southerly tetraploid and hexaploid species, Vaccinium corymbosum and V. ashei and interspecific hybrids developed for the fresh market and the emphasis on uniform, dry scar fruit with pleasing color and shelf life to withstand the rigors of the food system. The wild types have far more phenols and anthocyanins located just under their skins on a per gram basis than modern cultivars of V corymbosum and relatives. However, they also do not stand up well to the logistics of shipping fresh to millions of retail outlets and tend to "bleed" anthocyanin when disturbed. For this reason, most are canned or frozen. The point is that USDA did not really segregate their data properly if it was not a straight comparison between like species and known environments. Comparing V. angustifolium from Maine or Canada with V. corybosum used for the fresh market for these constituents does not give a clear picture that "organic" techniques automatically infer higher concentrations of components desirable for human consumption than "conventional" cropping. There is much more going on than production techniques and these conclusions do not hold as a consequence of technique when applied to the exact same cultivar. I work on the genetic improvement of blueberry and other small fruits so I have a bit of experience with this. If you want the antioxidants of blueberries on a year-round basis, buy the Dole frozen wild blueberries. BTW, I don't work for Dole. Hope this helps. Thanks.

Robert C. Richardson, Ph.D.

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"They didn't teach that to me in medical school (back in 1980)!"

Unfortunately vitamin d is not mentioned in med school nowadays except for osteoporosis prevention...

Dr. Davis -- thank you for your blog. I am a med student interested in REAL evidence based medicine (which makes me a bit unpopular between my teachers).

I researched vitamin D after reading your blog, and decided to mega-dose on it. It's been 4 weeks now and my "inespecified mood disorder" (never met criteria for depression, but have never been really "well" since I was 16) is GONE. Like a "veil" has fallen or something. PMS is gone as well.Now I have discovered that the periods of my life in which I felt truly well were when I spent outside most of the day (I live in the mediterranean coast).

I also had a single attack of MS some years ago, so vitamin D will help to prevent full blown multiple sclerosis.

My comment is in no way related with atherosclerosis, but I just wanted to thank you, and congratulate you for having found a way to help people outside conventional medicine. I feel greatly inspired by your work.

Regards,

Angela Nicolas

"primary care physicians are completely in the dark"

For the record, we aren't ALL in the dark. In fact, I stumbled across your website a few years ago as I was looking for supportive testimony from other practitioners who saw things clearly. In fact, I watched as you "caught up" with the idea of adding Vitamin K2 to your regimen - presumably based on the results of the 2004 Rotterdam Study.

I hate to sound defensive, but such a sweeping generalization is uncharacteristically irrational of your posts up to now. Perhaps you haven't known any primary care "grunts" without a cranial suppository.

Now you know at least one.

I guess it's just a matter of time until someone breaks the record again?

I know you have talked highly of vitamin K2, I'm wondering if you've made it a staple of the TYP program already? I think there's all reason to do so.
Below two studies using high doses of K1, but it should work via conversion to K2 (the epidemiology of K2 hints at the same phenomenon).

Am J Clin Nutr. 2009 Apr 22. [Epub ahead of print]
Vitamin K supplementation and progression of coronary artery calcium in older men and women.
Shea MK, O'Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, Price PA, Williamson MK, Booth SL.

One of THE most impressive studies I've ever read:
Thromb Haemost. 2004 Feb;91(2):373-80.
Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study.
Braam LA, Hoeks AP, Brouns F, Hamulyák K, Gerichhausen MJ, Vermeer C.

Over the last year, I have seen about a dozen physicians (for a reason other than heart disease).

Be they a GP, cardiologist, pulmonologist, oncologist, or hematologist, they all tell me the same thing; we all "naturally" develop coronary plague as we age and that it can only be minimally "managed" by lowering our cholesterol with -insert your statin drug here.

Every time I reply with; there is nothing natural about having calcified plaque build up in our coronary arteries at any age and that it can be very effectively managed by following Dr. Davis' "Track Your Plaque" protocol. (As I pull out your book to show them.)

The physician then usually looks at me like I have two heads and dismisses me by standing up to signal that the visit is over.  Except for one physician, honestly, who responded by reaching for his script pad and saying that he would like to start me on an antidepressant medication right away... lmao.

I have now given up looking for any local physician who would be willing to help me in any way with the heart scan/track-your-plaque program.

Antidrugrep--

Actually, that generalization was intended principally for the sorts of primary care docs who wouldn't read a blog like this. You are clearly the exception.

If you had responded that most cardiologists are knuckleheads out for a buck, I would have agreed, too.

Kismet--

Thanks for the references. I hadn't seen the Shea study; the findings are interesting.

We haven't had enough people have pre-K2 and post-K2 heart scans, so it's hard to know what effect it ADDS to the existing battery of strategies. Nonetheless, K2 is definitely on the list of most promising. Given its benign nature, I do encourage people to add it, though dosing remains entirely uncertain.

I seem to be developing atherosclerosis at age 26 and I've been doing a lot of research. B12 and Vitamin D are related, but you should also be aware of magnesium. See the study at Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals. In this study they basically explain how magnesium works as a natural statin and calcium channel blocker. If you do further research online you may become convinced, as I am, that magnesium deficiency is just as widespread as Vitamin D deficiency.

You need to take a chelated form of magnesium, such as glycinate, because other forms (like magnesium oxide) are poorly absorbed by the body and not worth the money.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Worst thing you can do is use the tobacco drug, either by smoking or through spit tobacco.

Also, being exposed to toxic tobacco smoke (sometimes called second-hand or environmental tobacco smoke) is EXTREMELY Dangerous! Make sure you work to BAN SMOKING EVERYWHERE, INDOORS OR OUT!

Better yet, BAN THE TOBACCO DRUG, NOW!