What's that in your mouth?

7. January 2010 William Davis (17)



Fat = triglycerides

In other words, eat fat, whether it's saturated, hydrogenated, polyunsaturated, or monounsaturated, and blood levels of triglycerides will go up over the next 6 hours. This remains true if there are carbohydrates in the meal, or if there are NO carbohydrates in the meal. It also remains true if you chronically consume fats.

While fats are the primary determinant of postprandial (after-eating) triglycerides, carbohydrates are the primary determinant of fasting triglycerides.

So, if your triglycerides are high on a fasting cholesterol (lipid) panel, it's most likely because you overconsume carbohydrates.


Thanks to cartoonist Eli Stein, who has generously allowed me to reprint his artwork on these pages. Mr. Stein has published his work in dozens of magazines and newspapers, including the Wall Street Journal, Barron's, and Good Housekeeping. More of his work can be found at Eli Stein Cartoons.

De Novo Lipo-what?

5. January 2010 William Davis (16)
Humans have limited capacity to store carbohydrates. Beyond the glucose and glycogen in our blood and tissues, we have relatively little carbohydrate to draw from in time of energy need. That's why long-distance runners and triathletes have to carry sugar sources to keep blood sugar from plummeting.

Fat, of course, is different. We have virtually unlimited capacity to store energy as fat.

Because we have limited carbohydrate storage capacity, what can the body do with the excessive quantities of carbohydrates that Americans ingest? What becomes of a bagel for breakfast, wheat crackers for snacks, a whole wheat sandwich for lunch, pretzels, and whole wheat pasta that many people eat every day, not to mention the chips, soft drinks, and juices?

Excess carbohydrates are diverted to an interesting metabolic pathway called de novo lipogenesis (DNL). This refers to the liver's ability to make triglycerides from excessive carbohydrates in the diet. Triglycerides are packaged for release into the blood as VLDL. VLDL, in turn, interacts with other lipoproteins, creating small LDL particles, reduced HDL and smaller, less protective HDL. High VLDL will be measured on a standard cholesterol panel as higher triglycerides.

A University of California (Berkeley, San Francisco) group has done much of the work describing DNL.

A diet weighed towards carbohydrates, especially if 50% or greater calories are carbohydrate, is sufficient to provoke plenty of DNL, even in slender people. DNL is a big part of the reason why low-fat (and, thereby, high-carbohydrate) diets result in higher triglycerides. DNL really gets turned on many-fold if the carbohydrates are "simple," rather than "complex."

Overweight people, however, can demonstrate five-fold greater DNL even with lesser quantities of carbohydrate intake (e.g., 40% fat, 46% carbohydrate, 14% protein):





From Schwarz et al 2003. Mean (± SEM) fractional de novo lipogenesis in lean normoinsulinemic (NI), obese NI, and obese hyperinsulinemic (HI) subjects after 5 d of consuming a high-fat, low-carbohydrate diet and in different lean NI and obese HI subjects after 5 d of consuming a low-fat, high-carbohydrate diet. Values with different superscript letters are significantly different.


Excessive carbohydrates, a la standard low-fat diets, are good for nobody. The concept of de novo lipogenesis fills in a theoretical hole that now explains why people who eat carbohydrates have higher triglycerides, VLDL, and, eventually, insulin resistance and diabetes.

Gretchen's postprandial diet experiment II

3. January 2010 William Davis (37)
I previously posted Gretchen's postprandial diet experiment, in which she consumed a low-fat diet for a day, followed by a low-carbohydrate diet for a day. Grethen monitored blood glucose and triglycerides with fingerstick checks. (Blood glucose can be checked on any widely available glucose monitor; triglycerides can be monitored with the Cardiochek device.)

Let's now discuss what happened.

On the low-carb, high-fat day, there was an initial surge in triglycerides to 250 mg/dl late morning, followed by a secondary peak several hours following dinner. Because fat is mostly triglycerides, Gretchen's high-fat (sausage, bacon, butter, whole-fat yogurt) breakfast provided a large quantity of triglycerides that needed to be absorbed. This generally occurs over approximately 6 hours, varying depending on body weight, how accustomed you are to fat, activity level during the day, the kind of fat in the meal. The high content of saturated fat in Gretchen's high-fat breakfast likely caused the somewhat slower drop in triglycerides over approximately 7 1/2 hours.

As Gretchen herself had noted, triglycerides the following day were lower, a typical low-carb response. Blood sugar throughout showed only minor variation, with only small postprandial increases.

Thus, Gretchen experienced what we'd expect with a low-carb, high-fat diet: an initial high surge in triglycerides, followed by a decline in fasting levels, while blood sugar shows a normal contour.







Now, the more confusing low-fat experience:



Blood glucose makes a striking peak at 200 mg/dl after the low-fat breakfast of pasta and rice, in contrast to the low-carb breakfast. Triglycerides behaved very differently from the low-carb experiment: While there was no initial postprandial surge, there was a late surge developing 6-24 hours later. The late surge continued into the next day, with fasting levels the following morning (210 mg/dl) exceeding the starting triglyceride level (60 mg/dl).

The one potentially confusing aspect of all this is Gretchen's late rise in triglycerides on the low-fat diet. This phenomenon is due to something called de novo lipogenesis, or the liver's conversion of carbohydrates to triglycerides that occurs when an excessive carbohydrate load comes through diet. Because the human body cannot store anything beyond a minor quantity of carbohydrates (as glucose and glycogen), carbohydrates are converted to fats.

Another factor causing the late triglyceride increase is insulin resistance, given the high blood sugar response. When insulin resistance is present, the activity of the enzyme, lipoprotein lipase, is reduced. Less lipoprotein lipase activity allows slower VLDL degradation, allowing VLDL (and thereby triglycerides contained in VLDL) to "stack up" in the blood. Thus, the higher triglycerides late after eating and into the next morning.

One issue to be aware of: Acute responses can differ from chronic responses. In other words, had Gretchen had the luxury (and time and money) to conduct the experiment over, say, 4 weeks, rather than a single day, there would be somewhat different responses. The best data on this come from Dr. Jeff Volek of the University of Connecticut, in which 4 weeks of low-carbohydrate eating modify fasting and postprandial responses over time.

Several conclusions can be made from Gretchen's experience:

1) Low-carb, high-fat acutely generates extravagant postprandial triglyceride responses.
2) Low-fat causes a late triglyceride surge and higher fasting triglycerides.
3) Low-fat leads to high blood sugars and, by implication, diabetes.


Both the low-carb and the low-fat responses are undesirable, both leading to increased risk for heart disease. Which is worse? I believe that low-fat is more destructive, since it leads over time to both high triglycerides and diabetes, while low-carb/high-fat only leads to postprandial triglyceride surges, at least acutely.

How to best balance the responses to reduce risk for heart disease? That's a discussion for future.


Again, my thanks to Gretchen and the substantial amount of effort that went into generating these numbers. More of Gretchens' own writing can be found on her blogs:
http://wildlyfluctuating.blogspot.com
http://www.healthcentral.com/diabetes/c/5068

A wheat-free 2010

2. January 2010 William Davis (22)
A Heart Scan Blog reader sent this fascinating description of his wheat-free adventure.

Whenever I discuss this notion of going wheat-free and the incredible health effects that develop, I invariably receive comments or emails saying something like "I eat wheat and feel fine. That can't be true." The problem is that not everybody needs to go wheat-free. 20-30% of people can include wheat in their diet and suffer little more than weight gain, some not at all.

But stories like Michael's (below) are commonplace in my experience. I've had many patients who, at first, refused to believe that wheat exposure might be the underlying cause for health struggles. But they finally give it a try and find that rashes, arthritis, acid reflux, irritable bowel symptoms, mood swings, anger, etc. are miraculously improved or gone.

Anyway, hear what Michael has to tell us:


Dr. Davis,

I want to thank you. I was browsing the web a while back and happened to stumble upon your blog post about wheat belly. The first thing that caught my attention was that I thought you had somehow gotten a photograph of me. The young man you posted an image of looked exactly like me. So I read what you had to say. After reading, I thought "Four weeks isn’t so bad. I think I can handle this."

It has now been nine weeks and all I can say is that I am completely amazed. Let me say first that twice in the past twenty years I have been tested for allergies. The first time I was tested I showed a slight reaction to Timothy Grass, but not enough to cause me any problems. The second testing I did not show a reaction to anything. So, I have always assumed that my chronic sinus problem were due to sensitivities to environmental pollutions. Now I am not so sure. I would like to list for you everything that has happened to me since I eliminated wheat from my diet.

1. I have lost a total of 12 pounds in the last 9 weeks.
2. I have lost 1 ¼ inches of belly fat
3. I have lost a tremendous amount of fat from my neck.
4. My entire life I have had problems with oily hair. I could wash my hair and three hours later I looked as if I hadn’t washed in a week. Now my hair stays clean and soft for two to three days without shampoo.
5. My hair was always flat and stringy. Now it has lots of body.
6. I used to have thick layers of dry skin on my scalp. It would come loose in chunks as large as a fingernail. That dry scalp is gone.
7. I used to have dry flaky skin that seemed to secrete oil. That no longer happens. My skin is now soft and smooth.
8. I have lived with bad acne for at least 35 years. Now it is hard to find a pimple on my body.
9. I have always had to fight dehydration. That is no longer a problem.
10. I used to drink two large cups of coffee every morning just to be able to function. I now have enough energy that I have eliminated caffeine from my diet.
11. I sleep more soundly than ever before and my dreams are clear and vivid.
12. My thought processes are more active and clear than they have ever been.
13. My chronic sinus issue is now a thing of the past.
14. I used to have problems with getting the “shakes” if I had gone more than a couple of hours without eating. It was as if I was suffering from low blood sugar. I would even be afraid that I would pass out. Now all I feel is hunger. I can go all day without eating and never feel in danger of losing consciousness.


Today is Thursday. This past Monday my wife and I were eating out and I ordered a burger without a bun. What I didn’t realize was that the burger would arrive covered in onion rings. I knocked the mountain of onion rings onto the plate but there were still a couple that were embedded in the cheese. I decided, what the hell, a couple of onion rings shouldn’t make that much of a difference. I will not make that mistake again anytime soon. Within 30 minutes I felt like there was a steel spike going through my left eye socket. I don’t remember ever being in that much pain. My sinuses were exploding. This morning, as I write this, I still feel the vestiges of that pain. Just enough that I know it is there. But after two and a half days, I am at least able to function again.

I owe you a debt of gratitude. You may have just saved my life. In the very least you have given me the means to improve my life in ways that I never thought possible.

Thank you so much,
Michael B.


Now, if wheat exposure can do that in Michael, what damage can it do in other people?

Personally, I previously experienced many of the same symptoms that Michael suffered, all gone with wheat elimination.

My advice: If you have any inkling that you might have a wheat sensitivity, make a New Year's resolution to stay wheat-free for 4 weeks and see whether you can feel any difference. Not everybody will, but many will be telling us about the dramatic health turnarounds they experienced.

Lipoprotein lipase and you

30. December 2009 William Davis (0)
Lipoprotein lipase can make the difference between having heart disease and not having it. Having sky-high triglycerides or normal triglycerides. It can mean dinner hanging around for over 12 hours in the bloodstream, rather than the usual 4-6 hours.

If you take niacin, you must exercise

30. December 2009 William Davis (23)
We use a lot of niacin in the Track Your Plaque program.

Niacin:

--Increases HDL and shifts HDL towards the large, protective fraction

--Reduces small LDL--In fact, niacin is the best treatment we have to reduce small LDL after wheat elimination and carbohydrate reduction.

--Reduces fasting and postprandial (after-eating) triglycerides

--Reduces heart attack risk by 20-28%--even as a sole agent.


But . . . niacin also triggers higher blood sugar because it partially blocks the effects of insulin (insulin "resistance").

While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

Yes, through exercise. Here's one interesting observation in obese (BMI 34.0), sedentary men given placebo, exercise, niacin (1500 mg Niaspan, once per day), or niacin + exercise:





From Plaisance et al 2008.

Blood was drawn following a high-fat meal challenge. (Yes, a high-fat challenge, not a carbohydrate challenge. In this study, there were only 17 grams carbohydrates in the test meal, but 100 grams fat. More on this in future.) Exercise consisted of walking for 50 minutes at a moderate pace one hour prior to the meal challenge.

You can see from the graph that exercise partially corrected the increased insulin level provoked by niacin.

Judging from this and other studies, exercise can help minimize the insulin-blocking effects of niacin. It doesn't take much, just moderate exercise for at least 30 minutes.

Adequate sleep can also help, since sleep deprivation is a potent trigger for insulin resistance, only worsened in the presence of niacin. Vitamin D supplementation to achieve desirable blood levels (which I define as 60-70 ng/ml) is also an effective means to minimize this effect.

To track small LDL, track blood sugar

24. December 2009 William Davis (28)
Here's a trick I learned after years of fussing over people's small LDL.

To gain better control over small LDL, follow blood sugars (blood glucose).

When you think about it, all the foods that trigger increases in blood sugar also trigger small LDL. Carbohydrates, in general, are the most potent triggers of small LDL. The most offensive among the carbohydrates: foods made with wheat. After wheat, there's foods made with cornstarch, sucrose (table sugar), and the broad categories of "other" carbohydrates, such as oats, barley, quinoa, sorghum, bulghur, etc.

Assessing small LDL requires a full lipoprotein assessment in which small LDL particles are measured (NMR, VAP, GGE). Not the easiest thing to do in the comfort of your kitchen.

However, you can easily and now cheaply check your blood sugar. Because blood sugar parallels small LDL, checking blood sugar can provide insight into how you respond to various foods and know whether glucose/small LDL have been triggered.

Here's how I suggest patients to do it:

1) Purchase an inexpensive blood glucose monitor at a discounter like Walmart or Walgreen's. You can buy them now for about $10. They're even sometimes free with promotional offers. You will also need to purchase lancets and test strips.

2) With a meal in question, check a blood sugar just prior to the meal, then again 60 minutes after finishing the meal. Say, for example, your pre-meal blood sugar is 102 mg/dl. You eat your meal, check it 60 minutes after finishing. Ideally, the postprandial (after-meal) blood sugar is no more than 102 mg/dl, i.e., no higher than pre-meal.

Perhaps you're skeptical that oatmeal in skim milk with walnuts and raisins will do any damage. So you perform this routine with your breakfast. Blood sugar beforehand: 100 mg/dl. Blood sugar 1 hour post: 163 mg/dl--Uh oh, not good for you. And small LDL will be triggered.

This approach is not perfect. It will not, for example, identify "stealth" triggers of blood sugar and small LDL like pasta, for the same reasons that pasta has a misleadingly low glycemic index: sugars are released slowly and not fully evident with the one-hour blood sugar.

Nonetheless, for most foods and meals, tracking your one-hour postprandial blood sugar can provide important insight into your individual susceptibility to sugar and small LDL-triggering effects.

C-reactive protein: Fiction from the drug industry?

21. December 2009 William Davis (0)
C-reactive protein (CRP) is the liver product of inflammatory responses anywhere in the body. If there's an inflamed left knee, CRP will be increased. If viral bronchitis is making you cough, then CRP will be increased.

The argument put forward by the drug industry is that, because CRP indicates underlying inflammation, very low-grade levels that can be measured in the absence of overt inflammation like the sore knee or bronchitis is associated with increased risk for cardiovascular events. There are now many studies that conclusively demonstrate that, the higher the CRP, the greater the cardiovascular risk.

Naturally, any marker of risk is followed by the inevitable study: Do statin drugs reduce the excess cardiovascular risk of excessive CRP?

And, yes, indeed they do. My statin-crazed colleagues rave about the so-called "pleiotropic," or non-lipid, effects of statins. CRP reduction and the reduction of risk associated with CRP result with statin treatment.

But is life really statin vs. placebo, as most statin trials are constructed? Are there strategies that can outdo statins like Crestor for reduction of CRP?

Watch your fish oil labels

17. December 2009 William Davis (36)
A quick quiz:

How much omega-3 fatty acids, EPA + DHA, are in each capsule of fish oil with the composition shown on the label below:





If you said 1340 mg (894 mg + 446 mg), sorry, but you're wrong. There are 670 mg EPA + DHA per capsule.

Did you notice that the composition, or "Supplement Facts," lists the contents of two capsules? Rather than the usual one capsule contents, this product label lists two capsules.

I don't know why some manufacturers or distributors do this. However, I have seen many people tripped up by this kind of labeling, taking half the omega-3 fatty acids they thought they were taking. This can be important when you are trying to obtain a specific dose of EPA + DHA to reduce triglycerides, reduce Lp(a), control abnormal heart rhythms, reduce bipolar mood swings, or other important effects.

I liken this to pulling up to a gas station where the sign says gasoline for $1.25. Wow! Can't beat that! You then find out that it's really $1.25 for a half-gallon, or $2.50 a gallon.

In truth, the labeling is accurate; it's just very easy to not notice the two capsule composition.

Why do I need a prescription for Olava?

16. December 2009 William Davis (0)
Imagine this:





What is OLAVA?

Olava is prescription olive oil. It is the purest, highest concentration of olive oil available.




Why Do I Need a Prescription for OLAVA?

Studies show that olive oil contains essential fatty acids, "good" fats that:



--Contain natural compounds your body needs for good health but can't produce on its own.

--Has antioxidants that may provide protection from heart disease.



So, it is common for people to ask why they need a prescription for OLAVA if it is made from a natural ingredient--olive oil. It's time to get the facts about OLAVA. Learn why OLAVA is different from olive oil you can buy at a store.



OLAVA Is an FDA-Approved Medication

OLAVA is the only FDA-approved medicine made from olive oil that's proven, along with diet, to reduce risk for heart disease


The FDA enforces standards to make sure that prescription medications like OLAVA are safe, effective, and quality controlled.


The way OLAVA is manufactured is reviewed and approved by the FDA.


OLAVA uses a 10-step purification process that helps remove lead and other environmental toxins that can be present in olive oil.


Each 1-gram capsule of OLAVA contains 1000 mg of pure olive oil.


The FDA-approved dose of OLAVA is 4 capsules per day. It could take up to 2 tablespoons per day of regular olive oil to provide the same amount of active ingredients proven to lower heart disease risk.




What Else You Should Know About Olive Oil

Regular olive oil has not been approved by the FDA to treat any specific disease like heart disease.



Olive oil doesn't have specific dosing information; it has a food label.



Olive oil does not go through an FDA-approved manufacturing process.





Talk to Your Doctor About OLAVA

If you have very heart disease, you may need a prescription medicine, along with diet, to treat your condition. Talk to your doctor about OLAVA. Print a trial offer to use on your first prescription of OLAVA.

Lovaza vs fish oil supplements?

Lovaza vs fish oil supplements?

27. January 2010 William Davis (55)
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.
Tags :

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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  • 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.

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  • 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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  • 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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