Can natural treatments "cure" or "treat" any disease?

According to current FDA policy, the answer is a flat "NO!"

No natural treatment, whether it be fish oil (as a nutritional supplement), l-arginine, vitamin D, magnesium, various flavonoids like theaflavin or resveratrol, can be declared to treat or cure any disease. That's why you see the evasive and vague wording on nutritional supplements, nutraceuticals, and various foods, like "Supports heart health" or "Supports healthy cholesterol". Claiming, for instance, that taking 6000 mg per day of a standard OTC fish will reduce triglycerides and stating so on the label of a supplement is unlawful and prosecutable.

Think what you will of Mr. Kevin Trudeau (author of Natural Cures They Don't Want You to Know About"): visionary, consumer advocate, David vs. the Goliath of the FDA and "Big Pharma", or huckster, scam artist, and one-time felon. But Trudeau got it right on one important issue: The FDA dictates what claims can be made to treat disease. On one of his ubiquitous informercials, Trudeau states:


"...the way the system works today, you have the Food and Drug Administration—the FDA, and you have the drug industry. They really work in tandem. Unfortunately, there’s an unholy alliance there. People don’t know that the majority of commissioners of the FDA, which allegedly regulates the drug industry, and the food industry—Food and Drug Administration, the commissioners of the FDA—the majority of them—go to work directly for the drug companies upon leaving the FDA and are paid millions and millions and millions of dollars. Now in any other format, that would be called bribery; that would be called a conflict of interest; that would be called payoffs. That’s exactly what’s happening right now. So what has occurred is the Food and Drug Administration is really working in tandem with the drug industry to protect their profits. Example: The Food and Drug Administration says that only a drug can diagnose, prevent, or cure any disease."


He goes on to say that

"...the Food and Drug Administration says only a drug--nothing else--can cure, prevent, or diagnose a disease. Therefore the Food and Drug Administration continues to call more and more and more things diseases. Therefore they eliminate all-natural remedies. No one can say what a natural remedy can do if it’s been classified as a disease. So Attention Deficit Disorder is now a disease. Therefore only a drug can cure, prevent, or diagnose it. Cancer is a disease. Acid reflux is now a disease. Obesity is now a disease."

(PLEASE do not construe this as an endorsement of Mr. Trudeau's overall opinions. But I do think he's right on this one point.)

The stated purpose of this restrictive policy is to protect the public. Indeed, in years past before protective legislation, ineffective and even poisonous products were commonly sold as therapeutic treatments. (Remember cocaine and morphine in cold remedies? Lead and other toxic agents were also common.) Unfortunately, a huge gap has emerged as clinical data accumulates that support the efficacy of nutritional treatments and other non-traditional methods to treat or alleviate diseases. Any disease, or anything construed as disease as Trudeau points out, can onlybe treated by a drug.

In the FDA's defense, they have made slow progress in allowing "claims" of benefits for several supplements and food substances, such as the beta-glucan of oat products, soy protein, and most recently barley (for cholesterol reduction). The scrutiny is quite thorough and the wording of the policy is quite specific. Regarding oat products, for instance, the policy states:

"FDA concluded that the beta-glucan soluble fiber of whole oats is the primary component responsible for the total and LDL blood cholesterol-lowering effects of diets that contain these whole oat-containing foods at appropriate levels. This conclusion is based on review of scientific evidence indicating a relationship between the soluble fiber in these whole oat-containing foods and a reduction in the
risk of coronary heart disease.

Food products eligible to bear the health claim include oat bran and rolled oats, such as oatmeal, and whole oat flour...To qualify for the health claim, the whole oat-containing food must provide at least 0.75 grams of soluble fiber per
serving. The amount of soluble fiber needed for an effect on cholesterol levels is about 3 grams per day."


(Source: FDA Talk Paper which can be viewed in its entirety at http://www.fda.gov/bbs/topics/ANSWERS/ANS00782.html.)

In light of the boom in nutritional and non-traditional research that validate or refute efficacy, is such a policy still necessary? Or does it inhibit the open dissemination of information and result in a extraordinary monopolization of health treatment for the drug companies?

This debate will likely rage for the next two or more decades, particularly as drug companies are increasingly viewed as profit-seeking enterprises and more validation is gained by non-drug treatments.

For the moment, don't dismiss a "treatment" because it doesn't come by prescription. But don't reject a drugjust because it is a prescription. We need to strike a healthy, rational balance somewhere in between.

Can procedures alone keep you alive?

My days in the hospital remind me of what heart disease can be like when no preventive efforts are taken--what it used to be like even with my patients before taking a vigorous approach to prevention (though over 12 years ago).

Several cardiologists in my hospital, for instance, express skepticism that heart disease prevention works at all. Yes, they know about the statin cholesterol drug trials. But they claim that, given their experience with the power of coronary disease to overpower an individual's control, statin drugs are just "fluff". Coronary disease is a powerful process that can only begin to be harnessed with major procedures, i.e., a mechanical approach.

So these cardiologists routinely have their patients in the hospital, often once a year, sometimes more, for heart catheterization and "fixing" whatever requires fixing: balloon angioplasty, stents, various forms of atherectomy. Year in, year out, these patients return for their "maintenance" procedures. Their cardiologists maintain that this approach works. The patients go on eating what they like, taking little or no nutritional supplements, and medications prescribed by their primary care physicians for blood pressure, etc. But no real effort towards heart disease prevention beyond these minimal steps.

Can this work? Very little at-home, preventive efforts, but periodic "maintenance" procedures?

It can, perhaps, for a relatively short time of a few years, maybe up to 10 years. But it crumbles after this. The disease eventaully overwhelms the cardiologist's ability to stent or balloon this or that, since it has progressed and plaque has growth diffusely the entire period that maintenance procedures have been performed. In addition, acute illness still occurs with some frequency--in other words, plaque rupture is not affected just because there's a stent in the artery upstream or downstream.

Not to mention this can be misery on you and your life, with risk incurred during each procedure. It's also terribly expensive, with hospitalization easily costing $25,000-$50,000 or more each time. (Compare that to a $250 or so CT heart scan.)


As people become more aware of the potential tools for prevention of heart disease, fewer are willing to submit to the archaic and barbaric practice of "maintenance" heart procedures in lieu of prevention. But it still goes on. If you, or anybody you know, are on this pointless and doomed path, find a new doctor.




Bloodletting, another antiquated health practice

Support your local hospital: HAVE A HEART ATTACK!

I'm kidding, of course. But, in your hospital's secret agenda, that's not too far from the truth. Catastrophes lead to hospital procedures, which then yields major revenues.

Prevention, on the other hand, yields nothing for your hospital. No $8,000 to $12,000 for heart catheterization, several thousand more for a stent, $60,000-plus for a bypass, $25,000 or more for a defibrillator. In other words, prevention of heart attack and all its consequences deprive your hospital of a goldmine of revenue.

The doctors are all too often conspirators. I heard of yet another graphic example today. A man I didn't know called me out of the blue with a question. "I had a heart scan and I had a 'score' that I was told meant a moderate quantity of plaque in my arteries, a score of 157. My doctor said to ignore it. But I got another scan a year later and my score was 178. So I told this to my doctor and he said, 'Let's get you into the hospital. We'll set up a catheterization and then you'll get bypassed.' Of course, I was completely thrown off balance by this. Here I was thinking that the heart scan was showing that my prevention program needed improvement. But my doctor was talking about bypass surgery. Can you help? Does this sound right?"

No, this is absolutely not right. It's another tragedy like the many I hear about every day. Heart scans are, in fact, wonderfully helpful tools for prevention. This man was right: he felt great and the heart scan simply uncovered hidden plaque that should have triggered a conversation on how to prevent it from getting worse. But the doctor took it as a license to hustle the patient into the hospital. Ka-ching!

This sort of blatant money-generating behavior is far from rare. Don't become another victim of the cardiovascular money-making machine. Be alert, be skeptical, and question why. Of course, there are plenty of times when major heart procedures are necessary. But always insist on knowing the rationale behind such decisions, whether it's you or a loved one.

Hospitals contain experts in ILLNESS

Hospitals contain many experts in sickness. This seems obvious. But walk down the hallways of any hospital, and you'll quickly be convinced that hospitals contain almost no experts in health.

People (hospital staff, that is, not the patients) in hospitals are especially good at identifying and treating disease. They lack knowledge of health.

If your nurse is 100 lbs overweight and struggles to walk down the hall because of arthritis in both knees, would you entrust her with health advice?

If your doctor sits down in the cafeteria and eats his lunch of a ham sandwich with cheese on a bun, fried onion rings, and a milkshake and pastry, can you believe that he/she possesses any insight into health and nutrition?

If your physical therapist or cardiac rehabilitation counselor struggles nearly as much as you while climbing a single flight of stairs, can you accept their advice on how to regain your stamina and use exerise to full health advantage?

The answer to all these questions is, of course, no. Hospital staff are generally expert at dressing surgical wounds, stopping bleeding, identifying infections, and providing the support services for surgical and diagnostic procedures. In contrast, they are generally miserable at conveying genuine health advice. They certainly fall short in being examples of health themselves.

To hospitals and their staff, health is a temporary situation that persists only until you become ill. Illness is an inevitability in the hospital staff mindset. Health is a temporary state in between illnesses.

We need to shake off this perverse mentality. Health is the state of life that should dominate our practices and philosophies. Illness via the occasional catastrophe, e.g., broken leg from skiing, car accident, etc., is the province of hospitals. We should gravitate towards this philosphy and away from the over-reliance on hospitals that has come to dominate our present perceptions of health. Hospitals are not glamorous. They are, for the most part, profit-seeking businesses intent on portraying themselves as champions of health.

When I walk down the halls of hospitals, I am shocked and ashamed at the extraordinary examples of ill-health presented by hospital staff. Yet they falsely paint themselves as experts in both illness and health. Don't believe it for a second.

Are there still unexplored causes of heart disease?

I met a woman today. She had her first heart attack at age 37. She just had her 2nd heart attack this morning, at age 40.

Several issues are surprising about her story. First, she's pre-menopausal. Heart attacks before menopause are unusual. We'll occasionally see women have a heart attack before or during menopausal years only if they're heavy smokers and/or they have had diabetes (either type I or type II) for many years. But this young woman had neither. She is slender and has never smoked.

Even more surprising are her basic lipid values: LDL cholesterol 35 mg/dl, HDL 150 mg/dl, triglycerides 317 mg/dl. This is a very unusual pattern.

Unfortunately, this is all developing acutely in the hospital. (I've just met her today--she's not a Track Your Plaquer!) Lipoprotein analysis would be extremely interesting. In particular, I'd like to see whether she has any other markers besides elevated triglycerides of a "post-prandial" abnormality, i.e., persistence of abnormal particles after eating. The high triglycerides make this quite likely.

If this proves true, the omega-3 fatty acids from fish oil will be a lifesaving treatment for her, since they dramatically reduce both triglycerides as well as persistent postprandial particles like intermediate-density lipoprotein (IDL). (Track Your Plaque Members: See the Special Report on Postprandial Abnormalities on the present home page at www.cureality.com for a more in-depth discussion of this fascinating collection of patterns that is just started to be explored.)

In the real world, especially acute care medicine, there's always a kicker: she speaks no English. Unfortunately, communicating the intricacies of a powerful program like ours that aims to identify all causes of heart disease, then corrects then and aims for coronary plaque regression, is difficult if not impossible.

I also do occasionally worry that, given this woman's extraordinary risk at a young age, and overall very unusual lipid patterns (HDL 150?!), if there are causes presently beyond our reach. We have to make use of the tools available to us for now.

Everything causes heart attack!

The media are presently gushing about a recent study that associates caffeine intake with heart attack.

CBS News: That cup of coffee you're craving might not be such a good idea. Research in the September issue of Epidemiology suggests coffee can trigger a heart attack within an hour in some people.


Some reporters and their quoted sources are musing about whether it's the caffeine, cream vs. other whiteners, time of day, interaction with other risk factors, etc.

My advice: Get a grip! How many relatively benign, every day factors in life can be blamed for dire health risks?

The problem with many of these studies is that they are cross-sectional. They do not enroll participants, then "treat" with coffee (or other substance in question) vs. placebo. In other words, it is not a randomized trial, the sort of trial necessary to prove a hypothesis. That's all that can be generated by a study like this one: a hypothesis.

Perhaps there's a bit of warning for the person with uncorrected lipids and lipoproteins, has no idea that they have extensive coronary plaque because they've never had a heart scan, and have a slovenly lifestyle. Maybe that person might have exaggerated risk from a cup of coffee.

But for us, involved and intensively addressing all causes of coronary plaque to the point of stabilizing or reducing it, coffee is likely a non-issue.

For more conversation on coffee and this report, go to the www.cureality.com home page.

Excessive Heart Procedures Makes New York Times Headline


One example of flagrant cardiac procedure excess has made New York Times headlines:


Heart Procedure Is Off the Charts in an Ohio City
The number of angioplasties performed in Elyria is so high that Medicare is starting to ask questions.

(The full article can be accessed through the New York Times website at http://www.nytimes.com/2006/08/18/business/18stent.html?pagewanted=2&ei=5094&en=b81be5f43f98a99b&hp&ex=1155960000&partner=homepage)



Cardiologists in little Elyria, Ohio, about a 30-minute drive west of Cleveland, do more coronary angioplasties and insert more stents than any other location in the U.S.--four times more than the national average, three times more than the Cleveland average. They perform even more than the recently-indicted cardiologist in Louisiana, who performed twice the national average of procedures.


The Times article, part of a series about financial incentives in medical care, provides a responsible and incredibly balanced report on the situation in Elyria. I have to give them credit, because from the eyes of a colleague (myself), this looks like blatant and extreme profiteering: "cathing for dollars".

I find it outrageous that this group of cardiologists claims that they have some special insight into heart care that justifies this extraordinary reliance on heart procedures. There's bound to be variation in practice patterns, but this is so outside the norm that I believe criminal behavior will be exposed. In fact, I believe that even the "norm", or average, rate of procedures is also excessive.

This is symptomatic of the perverse equation in heart disease care. If there's money to be made in major heart procedures, who wants to bother with prevention? Programs like the Track Your Plaque program present real potential to stop coronary heart disease in its tracks for many, if not most, participants--but don't expect to hear about it from your cardiologist. Don't expect to hear about it from the increasingly hospital-employed primary care physician.

Hopefully, media exposure like that in the New York Times is just the beginning of a public re-analysis of not only what's wrong with medicine today, but recognition of the tremendous power in preventive strategies when everyone stops being so enamored with hospital-based procedures. CT-based heart scanning that ignites your heart disease prevention program is your way to dodge the mainstream obsession with procedures.

More on "Bio-identical hormones" and Wyeth Pharmaceuticals

In October 2005, Wyeth petitioned the FDA, requesting that it completely ban the bioidentical alternatives that women have been using in ever-increasing numbers to achieve optimal hormone balance. With bioidentical replacement therapy clearly reducing its market share, Wyeth asked the FDA to outlaw all compounded bioidentical hormone formulations that compete with its own discredited drugs. If Wyeth is successful, then menopausal women will have no choice other than to take potentially life-threatening hormone drugs or to forgo hormone replacement therapy altogether, thus enduring the physically and emotionally debilitating effects of menopause-induced hormone depletion.

Dave Tuttle
Life Extension Magazine
August, 2006



For more commentary on Wyeth Pharmaceutical's outrageous and brazen petition to the FDA to bar prescription "bio-identical" hormones, i.e., hormones that are identical to natural human forms, read Life Extension's article, Health Freedom Under Attack!
Drugmaker Seeks to Deny Access to Bioidentical Hormones





This well-researched article is in the August, 2006 issue of Life Extension Magazine. The article can also be accessed online at http://www.lef.org/magazine/mag2006/aug2006_cover_attack_01.htm

or go to www.lef.org and click on the August, 2006 issue.

The author, Dave Tuttle, details the baseless arguments raised by Wyeth, a pathetic and amazingly selfish act in the name of protecting profits for Premarin, their prescription agent. It's bad enough to be selling this worthless drug. It's even worse--criminal, in my mind--to try to stamp out our right to have a physician write a prescription for a pharmacy to mix up hormones identical to that humans produce, individualized to our needs.

If you are as angry about this as I am, please go to the Life Extension online reprint that provides access to the International Academy of Compounding Pharmacists website to send the FDA an e-mail describing your opinion, or go to www.iacprx.org.

How accurate is LDL cholesterol?

Watch TV and you'd get the impression that the world revolves around LDL cholesterol: Commercials for Lipitor, Zetia, Vytorin, etc., all drugs to reduce cholesterol (total and LDL). Your doctor looks first and often only at LDL cholesterol.

If there's so much attention paid to LDL, how accurate is it? 100%? 90%? 80%?

Well, it varies widely. Occasionally, it's truly accurate, but most of the time it's miserably inaccurate . Every single day, I see people with LDL cholesterols that underestimates true (measured) LDL by 40%, 50%, and even over 100%. In other words, LDL cholesterol might be 120 mg/dl by the conventional method, but the genuine measured value might be 160 mg/dl, or even 240 mg/dl. It can be that far off--and it's not rare.

The converse can occasionally be true, though rarely in my experience: that conventional LDL overestimates true LDL. I saw someone in the office today like this, with a conventional LDL of 142 mg/dl but a true measured LDL of 115 mg/dl. I may see one or two more people like this the rest of this year.




Why is LDL so inaccurate? Several reasons:

--LDL in most labs is calculated, not measured. The "Friedewald calculation" derives LDL by substracting HDL and triglycerides (divided by 5) from total cholesterol. The higher triglycerides are, especially above 150 mg/dl, the more inaccurate the calculation becomes. As HDL drops below 50 mg/dl, this also introduces greater and greater inaccuracy.

--LDL particles vary in size. A more accurate representation and measure of LDL's dangers are therefore found in measures of LDL particle number , rather than a weight-based measure or calculation. LDL particle number can be measure as just that, LDL particle number (NMR), or as apoprotein B, the protein in LDL that occurs one apoB per LDL.

I liken conventionally calculated LDL cholesterol to a broken speedometer. You simply won't have an accurate measure of how fast you're going, though you may have a ballpark sense. But try telling that to the state patrol.

Or, as a cardiologist colleague said to me in a similar conversation about LDL: "Well, it's better than nothing!"

The lesson: If you're interested in plaque control, and control or reduction of heart scan score, you need a measured LDL, preferably LDL particle number by NMR or an apoprotein B. Another option is "direct" LDL.

Green tea: friend or faux?

The www.HealthCastle.com website is a helpful website on healthy eating that sends out a free newsletter. The content is all produced by licensed dietitions and nutritionists. Although I don't agree with everything said on the site, there's still some good information.

I'm a fan of green tea. Although I believe the effects are relatively modest (weight reduction, cholesterol reduction, anti-oxidation, etc., with theaflavin and/or green tea as a beverage,) they alerted me to the fact that the Lipton Green Tea product is one you should steer clear of. Here are their comments:



"More like Soft drink than Green Tea!With 200 calories, 13 teaspoons of added sugar and a long list of artificial ingredients, Lipton Iced Green Tea is more like a bottle of soft drink than tea, in our opinion."


The Lipton website lists the ingredients:

Water, high fructose corn syrup, citric acid, green tea, sodium hexametaphosphate, ascorbic acid (to protect flavor), honey, natural flavors, phosphoric acid, sodium benzoate (preserves freshness), potassium sorbate (preserves freshness), calcium disodium edta (to protect flavor), caramel color, tallow 5, blue1.

An 8 oz serving yields 21 grams of sugar. If you drink the full 20 oz. bottle (not hard to do!), that yields 52.5 grams of sugar! You will also notice that the second ingredient listed after water is high fructose corn syrup. This ingredient, you may recall, causes triglycerides to skyrocket, causes an insatiable sweet tooth, and is a probable contributor to obesity and diabetes.

In their defense, the Lipton people do also offer a sugar-free alternative without the excessive sweeteners and empty calories.

Do the Lipton products offer the same kind of benefits from green tea catechins (flavonoids) offered by freshly brewed teas? This product has not been formally tested by an independent lab to my knowledge, though, in general, commercially prepared and bottled teas tend to have dramatically less catechin/flavonoid content compared to brewed. (The USDA website provides access to an extraordinary collection of flavonoid food content at their USDA Database for the Flavonoid Content of Selected Foods - 2003. You'll find it at http://www.ars.usda.gov/Services/docs.htm?docid=6231.)

I think the HealthCastle people got it right: Brew your own, making sure to steep for at least 3 minutes. Alternatively, a green tea or theaflavin supplement provides many of the benefits. (Theaflavin has been used in trials at doses of 375 to 900 mg per day.) An in-depth report on green tea will be coming in a future Special Report on the www.cureality.com Membership website.
The Omega-3 Index: The higher, the better?

The Omega-3 Index: The higher, the better?

So you take a few fish oil capsules every day and eat fish once or twice a week. What is the blood and tissue level of omega-3 fatty acids generated by your habits?

A number of variables enter into the equation. For instance, if you take fish oil capsules, what is the concentration of omega-3 fatty acids? How well are they absorbed? After absorption, how effectively are omega-3 fatty acids incorporated into cell membranes?

Even if you take fish oil supplements, it is hard to know just how much you’ve increased blood levels. It is now possible to measure the amount of omega-3 fatty acids in your bloodstream, a value called the omega-3 index. Too little and you might still be at high risk for cardiovascular events.


The Omega-3 index and sudden cardiac death

Two large studies have demonstrated that higher omega-3 blood (the level in red blood cells, or RBCs) levels were associated with reduced likelihood of sudden cardiac death. The risk for sudden cardiac death was 10-fold higher for the lowest omega-3 RBC levels compared to the highest.



Harris WS 2008; adapted from Siscovick DS et al 1995 and Albert CM et al 2002
(The omega-3 Index was derived from whole blood omega-3 levels, which correlate with RBC omega-3 levels, and are thus “estimated.”)



What’s the average omega-3 RBC level for Americans? Most Americans have omega-3 RBC levels in the 2.5-4.0% range, consistent with the tallest bars at the left and associated with greatest risk for sudden cardiac death. People with heart disease can have levels less than 1%. Some authorities propose that this new measure be called the omega-3 index.

Subsequent studies have shown that the omega-3 index has greater power to discriminate who will have a heart attack or die from sudden cardiac death better than any other common laboratory measure of coronary risk, including LDL cholesterol, HDL cholesterol, triglycerides, total cholesterol to HDL ratio, homocysteine, and c-reactive protein.

Just as hemoglobin A1c offers a 3-month look into blood glucose levels, the omega-3 index reflects your long-term omega-3 intake. The quantity of RBC omega-3s also closely parallels the quantity of omega-3s in heart tissues.


What is an ideal omega-3 index?


The above studies relating RBC omega-3 levels and sudden cardiac death suggest that a level of 6.3-7.3% is associated with far fewer fatal events?but events are not eliminated at this level. Is there even greater benefit with levels higher than 6.3-7.3%?

A recent analysis of females from the Harvard School of Public Health suggested that RBC omega-3 levels as high as 8.99% were still associated with non-fatal heart attack (myocardial infarction), compared to 9.36% in those without heart attacks. This suggests that even higher levels are necessary to prevent non-fatal events.

Should we target 10%? 12%? Maybe higher? Any higher and we are toeing the level achieved by the Inuits, the “Eskimoes” of Greenland, northern Canada and Alaska who have been observed to have a low rate of heart disease.


What’s your omega-3 index?

The appreciation of the importance of omega-3 fatty acids marks one of the greatest health revelations of the last 50 years. We can now measure it.

The ability to measure the proportion of omega-3 fatty acids in red blood cells may provide yet another means for all of us to further reduce risk for cardiovascular events.

If you are interested in knowing your omega-3 index, we are now making the fingerstick test kits available by going here.

Comments (26) -

  • Red Sphynx

    10/6/2009 5:05:01 AM |

    Cool.

    But reading your ad page, it isn't clear to me.  Does this kit measure the abundance of all the ω-3 and ω-6 (including the n-18 linoleic / linolenic acids)?  Or is it specific to the long chain (EPA+DHA / AA)?

  • antidrugrep

    10/6/2009 9:05:37 AM |

    One thing that seems to be left out of this analysis: omega-3 to omega-6 RATIO. There is some evidence that the ratio is what is important, and biochemically it makes some sense. The PUFAs compete for the enzymes in the eicosanoid pathways, determining relative strength of the inflammatory response. Nowadays, the typical developed-world diet contains far more vegetable oil (rich in omega-6) than people are adapted to. To keep the ratio favorable would require far more omega-3 than a traditional Inuit would need to achieve the same effect on chronic inflammation. To my patients, I stress the importance of limiting use/consumption of vegetable oils as much as seeking extra fish oil.

    And by-the-by, there may be a trade-off for the Inuits' lower risk of heart disease - I can't cite a source at the moment, but do you recall hearing that their risk of hemorrhagic stroke is/was higher? The speculation being that the less-active omega-3-based thromboxanes permitted more bleeding to occur. Don't misunderstand me, I'm a big proponent of omega-3 supplementation (I take 6+ grams of fish oil daily myself). But I'm thinking that there must be an optimal ratio/dose, leading to a "trough" in mortality.

  • Dr. William Davis

    10/6/2009 10:48:49 AM |

    Red-

    The omega-3s measured are EPA and DHA.


    Antidrugrep--

    Interesting name!

    To my knowledge, the question has been raised but not confirmed. However, there is prolongation of a measure called "bleeding time" in some Inuit groups, though not all.

  • Health Man

    10/6/2009 1:35:48 PM |

    I've had this test done using the home kit. My test measured RBC levels of EPA, DHA, ALA, 4 monounsaturates, 7 omega-6s, 4 saturated fats and 3 trans fats.  It also shows Omega-6/Omega-3 ratio and AA/EPA ratio.

    For what it's worth, I was taking 1,600 mg of total EPA/DHA and my Omega-3 index was only 7.3%.  I've upped my intake to 2,000 mg EPA/DHA daily to try and get it over 8%.

  • Dr. B G

    10/6/2009 3:20:32 PM |

    Awesome post Dr. Davis!!!


    antidrugrep -- I concur! that wins for  name of the year! *haa*

    For 24 mos I took high dose omega-3 4-8 grams daily (SUPER EPA by Now -- I have no finanacial afflilation with them). For my ENTIRE life I consumed a LOT of omega-6
    --cooked with gallons of canola oil (dep on the brand may be 20-30% omega-6 LA)
    --ate fast food
    --ate margarine in the 1970-1990s
    --ate restaurant food and still do (it's ALL n-6 PUFAs and worse trans-fat unless you are in NYC)


    Omega-6 stays in our cell membranes for up to 18-24 mos (or longer). On the hand omega-3s (flaxseed, EPA DHA) are used up and depleted very quickly for cellular processes, cemm membrane structure/ compositon, nerve conduction, heart rate regulation, and in the control of cardiac and mitochondrial energetics.

    A few years ago, the ratio of n-6:n-3 in the U.S. was estimated to be 30:1 however I believe it is somehow far worse. The AHA recommendations will push it even further up (subequently raising cancer and CAD rates).

    You bring up an excellent point -- I believe the Inuit experience hemorrhagic strokes if the ratio is below 1.0 (n-6:n-3). This low ratio would be  VERY hard to establish consuming modern foods. All industrial lot cheese, milk, dairy, eggs,  beef, pork, chicken of CHOCK FULL of n-6.  

    This low ratio is difficult as well to achieve when inflammation is present
    --heart disease (post-cabg, PTCA, MI, revasc)
    --subclinical heart disease
    --food allergies (gluten, A1 casein, dairy,e tc)
    --hypertension, diabetes, Metabolic Syndrome, hyperinsulinemia, obesity, asthma, chronic kidney disease (Cr > 1.0-1.2), low HDL/high sdLDL, etc
    --chronic pain syndromes, fibromyalgia, LBP, migraines, etc
    --mental illness (SAD, depression, schizo, bipolar which occurs freq in inflammed or CAD patients)

    -G

  • Kismet

    10/6/2009 9:30:17 PM |

    I'm just not sure, if high N-3 doses are necessary for otherwise healthy people.
    The JELIS study suggests that there is no significant benefit in primary prevention from 1800mg EPA in a Japanese population (high background consumption of fish), while there were significantly more side-effects.
    The study looked somewhat stronger when it comes to secondary prevention, but, again, only soft endpoints were affected (if I recall correctly).

    Due to the small rate of eventes, the study apparently lacked power to detect changes in some of the sub-groups, but it really did not look that impressive for primary prevention...

  • Dr. William Davis

    10/6/2009 10:45:38 PM |

    Hi, Kis--

    I believe that JELIS showed a 19% (relative reduction) in cardiovascular events in a primary prevention population when 1800 mg EPA was added to the already substantial omega-3 intake of the nearly 19,000 Japanese participants.

  • Neonomide

    10/7/2009 12:15:21 PM |

    I might add that in JELIS study the japanese used EPA ethyl ester, which has a bit different pharmacological profile thaan common EPA.

    For example, EPA ethyl ester (E-EPA) may cross blood-brain barrier more easily than common EPA.

    http://www.ncbi.nlm.nih.gov/pubmed/19442696

  • Boris

    10/7/2009 1:54:13 PM |

    The test looks kind of pricey. If I take the test once as a baseline then when should I take it again after making a change in my omega-3 intake? 6 months? 6 weeks? A year?

  • Boris

    10/7/2009 6:45:31 PM |

    I don't mean to hijack the topic but can someone tell me what the difference is between omega-3 and ethyl ester based omega-3?

  • Nameless

    10/7/2009 8:23:47 PM |

    Hey Kismet,

    One thing about the Jelis study that shouldn't be overlooked is the fact they used EPA only.

    If I remember my Pubmed studies correctly, DHA tends to be the Omega 3 that increases HDL, and decreases trigs more than EPA does.

    And fish (real fish) usually have a higher DHA/EPA ratio than fish oil capsules do. I sometimes wonder if a higher DHA ratio or DHA alone may be a better therapy for heart people.

    As for forms, I'm not sure if ethyl ester matters... maybe? Perhaps it absorbs less than the trigylercide form does, but most studies tend to use ethyl esters anyway. Populations studies excluded, of course, as they just eat fish.

  • homertobias

    10/7/2009 11:42:36 PM |

    I just don't understand the utility of taking a test.  Why?  Just to look at a number?  Similiar tests have been available for a number of years, are not reimbersible by insurance, and may be of questionable accuracy.  
    To me, both limiting omega 6's and increasing DHA/EPA is a slam dunk.  Of course it should be done and there is no way that any of us will get anywhere near the Intuit's 1:1 ratio.  Anyway, hemorrhaggic strokes, even if you were to double your risk, would still be a rare event especially compared to an MI or thrombotic stroke.  
    Too much fish oil?  Your pocketbook may limit you, your rosacea may limit you, diarrhea/ GI side effects may limit you, but not a blood test.
    Too little Omega 6?  I guess Borage Oil is ok for a transfat but I wouldn't pay money for it. And the food industry's Omega 6 PUFA's,.....well you know.

  • Roger

    10/8/2009 12:16:02 AM |

    It's all a bit confusing.  We're told that nuts are associated with improved heart health, yet nuts are chalk full of Omega-6.  (Even walnuts, the nut with the most Omega-3, is still 4 to 1 Omega 6.)

  • susan allport

    10/8/2009 2:00:56 PM |

    I thought you would be interested in my article on omega-3s in Prevention Magazine: http://health.msn.com/nutrition/articlepage.aspx?cp-documentid=100245164

  • Robb Wolf

    10/8/2009 5:55:13 PM |

    doc-
    Outstanding piece and blog. I've been a fan of your work for a long time, keep it up!!

  • Dr. William Davis

    10/8/2009 10:07:41 PM |

    Hi, Robb--

    Good to see you here!

    You are doing absolutely fabulous work on your blog.

    Anyone interested in an exceptionally insightful discussion of the role of diet, exercise, and supplements would benefit from reading Robb's wonderful blog: Robb Wolf: Intermittent Fasting, Fitness, Paleo & CrossFit Nutrition
    at http://robbwolf.com.

  • Dr. William Davis

    10/9/2009 2:28:11 AM |

    Hi, Boris--

    My understanding is that the ethyl ester form is simply a modification to allow more omega-3s to be contained within a smaller volume. While prescription Lovaza uses the ethyl ester form, so do some quality retail brands, such as Costco's enteric-coated ethyl ester fish oil.

  • Nameless

    10/9/2009 4:57:28 AM |

    Costco's Kirkland enteric-coated ethyl ester failed a Consumer Labs test, just in case people didn't know. The enteric coating didn't work right and released the oil too soon. The actual fish oil in the capsule is fine, or should be  (Meg-3, which it uses, is considered pretty good). But if anyone is taking it solely because of the enteric coating, and are getting fishy burps, perhaps it isn't working correctly.

    http://www.healthnews.com/natural-health/vitamins-supplements/consumerlab-finds-fifty-fish-oil-supplements-free-contaminants-1553.html

    You can find the same Meg-3 from Jarrow pretty cheap, although it's not enteric coated and capsules are somewhat large.

  • Boris

    10/10/2009 1:28:40 PM |

    Speaking of Enteric coating, Nordic Naturals posted that the coating is a cover-up for cheap quality.

    http://www.nordicnaturals.com/en/General_Public/FAQs/264/#19

    What do you think?

  • Anonymous

    10/13/2009 1:46:31 PM |

    Nordic Naturals has a history of lying to consumers to promote their own product.  For example, right now they promote their fish oil concentrates as being in a "natural triglyceride form".  The truth is that their concentrates are reconstituted triglycerides that were once ethyl esters.  ALthough still healthy to consume, they are anything but natural form.  Furthermore, there will always be a small fraction of residual ethyl esters left in a triglyceride concentrate because the transesterification process is never 100%.

  • Boris

    10/14/2009 8:02:13 PM |

    It's interesting to hear that Nordic Naturals may not be the most honest business out there. Do you have any proof of that? It's not that I don't believe you. I just want to read more about it. All I can find are articles like this:

    http://www.reuters.com/article/pressRelease/idUS123643+11-Feb-2009+PRN20090211

    That one says Nordic Naturals became the official omega-3 supplement of the American Pregnancy Association.

  • Arne Orgiba

    10/16/2009 5:22:57 PM |

    Nice post! Base from the previous posts, it's not only how high the Omega-3 but the ratio between Omega-3 and Omega-6. I'm not the expert here but I found a FOOD that has the perfect ratio of Omega-3 and Omega-6. You check it out here http://tinyurl.com/ykvj3uw

  • Rick

    10/25/2009 11:21:09 PM |

    Dr B.G. (or anyone),
    Why are restaurant foods full of Omega-6? And how is NYC different?

  • l

    10/30/2009 3:03:31 AM |

    Rick,

    Back in 2006 NYC banned transfats from restaurants:
    http://www.nytimes.com/2006/09/27/nyregion/27fat.html?ex=1317009600&en=e20e688e95d428bd&ei=5090&partner=rssuserland&emc=rss

    The article cites Americans consume 5800 mg of transfats daily. OMG. Transfats are worse than omega-6, they are artificially hydrogenated omega-6 which biologically stay in our lipid bilayers (the coating of EVERY CELL OF YOUR BODY), visceral fat depots (eg, our meno-pots and beer bellies), subcutaneous fat stores (under our skin), and in our brains -- where fat comprises 60% of this very important master controller... Trans fats wreak havoc b/c our bodies don't know how to dispose, metabolize or eliminate these synthetically derived oils. That is why there is a HIGH HIGH incidence of heart disease and transfats. All progressive cities and states should follow suit with New York City. Otherwise the food expenses for a transfat ban are being shifted to disability, mortality, and health care dollars!

    -G

  • Keenan

    7/8/2010 5:15:25 PM |

    Doc,

    I'd love to know your thoughts on the ratios of DHA to EPA. I notice that NOW brands now makes a DHA-weighted supplement that is enteric coated and free of additives.

    What ratio of DHA to EPA do you recommend, and what sort of literature/studies have you found discussing the differences between them?

  • buy jeans

    11/3/2010 7:00:34 PM |

    Even if you take fish oil supplements, it is hard to know just how much you’ve increased blood levels. It is now possible to measure the amount of omega-3 fatty acids in your bloodstream, a value called the omega-3 index. Too little and you might still be at high risk for cardiovascular events.

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