Why haven't you heard about lipoprotein(a)?

1. July 2010 William Davis (26)
Lipoprotein(a), or Lp(a), is the combined product of a low-density lipoprotein (LDL) particle joined with the liver-produced protein, apoprotein(a).

Apoprotein(a)'s characteristics are genetically-determined: If your Mom gave the gene to you, you will have the same type of apoprotein(a) as she did. You will also share her risk for heart disease and stroke.

When apoprotein(a) joins with LDL, the combined Lp(a) particle is among the most aggressive known causes for coronary and carotid plaque. If apoprotein(a) joins with a small LDL, the Lp(a) particle that results is especially aggressive. This is the pattern I see, for instance, in people who have heart attacks or have high heart scan scores in their 40s or 50s.

Lp(a) is not rare. Estimates of incidence vary from population to population. In the population I see, who often come to me because they have positive heart scan scores or existing coronary disease (in other words, a "skewed" or "selected" population), approximately 30% express substantial blood levels of Lp(a).

Then why haven't you heard about Lp(a)? If it is an aggressive, perhaps the MOST aggressive known cause for heart disease and stroke, why isn't Lp(a)featured in news reports, Oprah, or The Health Channel?

Easy: Because the treatments are nutritional and inexpensive.

The expression of Lp(a), despite being a genetically-programmed characteristic, can be modified; it can be reduced. In fact, of the five people who have reduced their coronary calcium (heart scan) score the most in the Track Your Plaque program, four have Lp(a). While sometimes difficult to gain control over, people with Lp(a) represent some of the biggest success stories in the Track Your Plaque program.

Treatments for Lp(a) include (in order of my current preference):

1) High-dose fish oil--We currently use 6000 mg EPA + DHA per day
2) Niacin
3) DHEA
4) Thyroid normalization--especially T3

Hormonal strategies beyond DHEA can exert a small Lp(a)-reducing effect: testosterone for men, estrogens (human, no horse!) for women.

In other words, there is no high-ticket pharmaceutical treatment for Lp(a). All the treatments are either nutritional, like high-dose fish oil, or low-cost generic drugs, like liothyronine (T3) or Armour thyroid.

That is the sad state of affairs in healthcare today: If there is no money to be made by the pharmaceutical industry, then there are no sexy sales representatives to promote a new drug to the gullible practicing physician. Because most education for physicians is provided by the drug industry today, no drug marketing means no awareness of this aggressive cause for heart disease and stroke called Lp(a). (When a drug manufacturer finally releases a prescription agent effective for reducing Lp(a), such as eprotirome, then you'll see TV ads, magazine stories, and TV talk show discussions about the importance of Lp(a). That's how the world works.)

Now you know better.

How to have a heart attack in 10 easy steps

29. June 2010 William Davis (48)
If you would like to plan a heart attack in your future, here are some easy-to-follow steps to get you there in just a few short months or years:


1) Follow a low-fat diet.

2) Replace fat calories with "healthy whole grains" like whole wheat bread.

3) Eat "heart healthy" foods like heart healthy yogurt and breakfast cereals from the grocery store.

4) Use cholesterol-reducing plant sterols.

5) Take a multivitamin to obtain all the "necessary" nutrients.

6) Take the advice of your doctor who declares your heart "in great shape" based on your cholesterol values.

7) Take the advice of your cardiologist who declares your heart "like that of a 30-year old" based on a stress test.

8) Take a statin drug to reduce LDL and c-reactive protein while maintaining your low-fat diet.

9) Neglect sun exposure and vitamin D restoration.

10) Limit your salt intake while not supplementing iodine.



There you have it: An easy, 10-step process to do your part to help your local hospital add on its next $40 million heart care center.

If you would instead like to prevent a heart attack in your future, then you should consider not doing any of the above.

Kick inflammation in the butt

25. June 2010 William Davis (0)
C-reactive protein, or CRP, is a protein produced by the liver in response to inflammatory signals its receives. Thus, CRP has emerged as a popular measure to gauge the underlying inflammatory status of your body. Higher CRP levels (e.g., 3.0 mg/L or greater) are associated with increased risk of heart attack and other cardiovascular events.

The drug cartel have jumped on this with the assistance of Harvard cardiologist, Dr. Paul Ridker. Most physicians now regard increased CRP as a mandate to institute statin therapy, preferably at high doses based on such studies as The JUPITER Trial, in which rosuvastatin (Crestor), 20 mg per day, reduced CRP 37%.

I see this differently. Two strategies drop CRP dramatically, nearly to zero with rare exception: Vitamin D restoration and wheat elimination. Not 37%, but something close to 100%.

Yes, I know it sounds wacky. But it works almost without fail, provided the rest of your life is conducted in reasonably healthy fashion, i.e., you don't live on Coca Cola, weigh 80 lbs over ideal weight, and smoke.

How can something so easily reduced like CRP mean you "need" medication? Easy: Increased CRP means there are fundamental deficiencies and/or inflammation provoking foods in your diet. Correct neither and there is an apparent benefit to taking a statin drug.

Why not just correct the underlying causes?

Life without Lipitor

25. June 2010 William Davis (17)
One of the most common reasons people come to my office is to correct high cholesterol values without Lipitor. (Substitute "Lipitor" with Crestor, simvastatin, Vytorin, or any of the other cholesterol drugs; it's much the same.)

In the world of conventional healthcare, in which you are instructed to follow a diet that increases risk for heart disease and not advised to correct nutrient deficiencies like vitamin D and omega-3 fatty acids, then a drug like Lipitor may indeed provide benefit.

But when you are provided genuinely effective information on diet, along with correction of nutrient deficiencies, then the "need" and apparent benefits of Lipitor largely dissolve. While there are occasional genetic anomalies that can improve with use of Lipitor and other statins, many, perhaps most, people taking these drugs really would not have to if they were just provided the right information.

Anyone following the discussions on these pages knows that wheat elimination is probably one of the most powerful overall health strategies available. Wheat elimination reduces real measured LDL quite dramatically. Provided you limit other carbohydrates, such as those from fruits, as well, LDL can drop like a stone. That's not what your doctor tells you. This approach works because elimination of wheat and limiting other carbohydrates reduces small LDL. Small LDL particles are triggered by carbohydrates, especially wheat; reducing carbohydrates reduces small LDL. Conventional LDL of the sort obtained in your doctor's office will not show this, since it is a calculated value that appears to increase with reduced carbohydrates, a misleading result.

Throw vitamin D normalization and iodine + thyroid normalization into the mix (both are exceptionally common), and you have two additional potent means to reduce (measured) LDL. Not restricting fat but increasing healthy fat intake, such as the fats in lots of raw nuts, olive oil, and flaxseed oil reduce LDL.

While I still prescribe statins now and then, a growing number of people are succeeding without them.

(Note that by "measured" LDL I am referring to the "gold standard," LDL particle number by NMR provided by Liposcience. A second best is measured Apoprotein B available through most conventional labs.)

In search of wheat: Emmer

23. June 2010 William Davis (13)
While einkorn is a 14-chromosome ancient wheat (containing the so-called "A" genome), emmer is a 28-chromosome wheat (containing the "A" and "B" genomes, the "B" likely contributed by goat grass 9000 years ago).

Both einkorn and emmer originally grew wild in the Fertile Crescent, allowing Neolithic Natufians to harvest the wild grasses with stone sickles and grind the seeds into porridge.

Having tested einkorn with only a modest rise in blood sugar but without the gastrointestinal or neurological effects I experienced with conventional whole wheat bread, I next tested bread made with emmer grain.

The emmer grain was ground just like the other two grains, cardiac dietitian Margaret Pfeiffer doing all the work of grinding and baking. Margaret added nothing but water, yeast, and a little salt. The emmer rose a little more than einkorn, but not to the degree of conventional whole wheat.

I tested my blood sugar beforehand: 89 mg/dl. I then ate 4 oz of the emmer bread. It tasted very similar to conventional whole wheat, but not as nutty as einkorn. Also not as heavy as einkorn, only slightly heavier than conventional whole wheat.

One hour later, blood sugar: 147 mg/dl. I felt slightly queasy for about 2-3 hours, but that was the end of it. No abdominal cramps, no sleep disturbance or crazy dreams, no nausea, no change in ability to concentrate.

I asked four other wheat-sensitive people to try the emmer bread. Likewise, nobody reacted negatively (though nobody tested blood sugar).

So it seems to me, based on this small, unscientific experience, that ancient einkorn (A) and emmer (AB) wheat seem to act like carbohydrates, similar to, say, rice or quinoa, but lack many of the other adverse effects induced by conventional wheat.

Modern wheat , Triticum aestivum, contains variations on the "A," "B," and "D" genomes, the "D" contributed by hybridization with Triticum tauschii at about the same time that emmer wheat hybridization occurred. It is likely that proteins coded by the "D" genome are the source of most of the problems with wheat products: immune, neurologic, gastrointestinal destruction, airway inflammation (asthma), increase in appetite, etc. This is consistent with observations made in studies that attempt to pinpoint the gliadin proteins that trigger celiac, the area in which much of this research originates.

If I ever would like an indulgence of cookies or cupcakes, I think that I will order some more einkorn grain from Eli Rogosa.

In search of wheat: Another einkorn experience

23. June 2010 William Davis (6)
Lisa is a trained dietitian. Unlike many of her colleagues, she has "seen the light" and realized that the conventional advice that most dietitians are forced to dispense through hospitals, clinics, and other facilities is just plain wrong. 

I know Lisa personally and we've had some great conversations on diet and nutritional supplements. I told Lisa about my einkorn experience and how I witnessed a dramatic difference between bread made from einkorn wheat and that made from conventional whole wheat. So she decided to give it a try herself. 

Here's Lisa's experience:


This past Friday, June 18th, I conducted my "Einkorn Wheat Experiment".

7 am 
FBG [fasting blood glucose] 97 mg/dl

8 am-9 am 
1 hour high-intensity aerobic workout

10:05 am 
BG 99

10:05 am 
I embarked upon the journey of choking down, I mean enjoying, the hefty piece of Einkorn bread. Wow, was that bread dense!  It was a lot of work chewing. 

10:50 am 
(45 minutes after consumption, wanted to see what BG did a bit before the 1 hr mark)  BG 153

11:05 am 
1hr PP 120

11:35 am 
90 mins PP [postprandial] 113

12:05 pm 
2 hours PP  114 ... at this time I ate an egg & veggie omelet for lunch.

12:50 pm 
BG 100

Before dinner 5:10 pm 
BG 88

I was surprised with the BG of 153. However, it was good to see my insulin response is reactive and decreased BG 33 points in 15 minutes to end up with a BG of 120 1 hr after the bread.  

So, it appears my response is similar. A slight elevation of BG at the 1 hour mark, but not to the degree of conventional whole grain wheat bread.  

Of note, also, was the fact that I cannot remember the last time I ate a piece of wheat bread of this magnitude that did not make me bloated... not at all: No cramps, no brain fog, no headache and, did I mention not bloated?  

I believe you are on to something with tolerance of Einkorn wheat for those of us with wheat sensitivities, in addition to its apparent lower glycemic response.

Along with Lisa, I asked four other people with various acute intolerances (all gastrointestinal) to conventional wheat, i.e., people who experience undesirable effects from wheat within minutes to several hours, to eat the einkorn bread. None experienced their usual reactions.

Obviously, this does not constitute a clinical trial. Nonetheless, I find this a compelling observation: People like myself who generally experience distinct undesirable reactions to wheat did not experience these reactions with einkorn.

Note, however, that einkorn behaves like a carbohydrate. No different, say, from brown rice or quinoa. However, unlike modern whole wheat flour from Triticum aestivum,  in this little experience there were no immune reactions, no neurologic phenomena, no gastrointestinal distress--just the blood sugar consequences.

While this may not be true for all people consuming einkorn, it suggests that primordial einkorn wheat is quite different from modern conventional wheat for most people.

Increased blood calcium and vitamin D

21. June 2010 William Davis (50)
Conventional advice tells us to supplement calcium, 1200 mg per day, to preserve bone health and reduce blood pressure.

Here's a curious observation I've now witnessed a number of times: Some people who supplement this dose of calcium while also supplementing vitamin D sufficient to increase 25-hydroxy vitamin D blood levels to 60-70 ng/ml develop abnormally high levels of blood calcium, hypercalcemia.

This makes sense when you realize that intestinal absorption of calcium doubles or quadruples when vitamin D approaches desirable levels. Full restoration of vitamin D therefore causes a large quantity of calcium to be absorbed, more than you may need. In addition, two studies from New Zealand suggest that 1200-1300 mg calcium with vitamin D per day doubles heart attack risk.

We have 20 years of clinical studies demonstrating the very small benefits of supplementing calcium to stop or slow the deterioration of bone density (osteopenia, osteoporosis). These studies were performed with no vitamin D or with trivial doses, too small to make a difference. I believe those data have been made irrelevant in the modern age in which we "normalize" vitamin D.

Should hypercalcemia develop, it is not good for you. Over long periods of time, abnormal calcium deposition can occur, leading to kidney stones, atherosclerosis, and arthritis.

Until we have clarification on this issue, I have been advising patients to take no more than 600 mg calcium supplements per day. I suspect, however, that the vast majority of us require no calcium at all, provided an overall healthy diet is followed, especially one that does not leach out bone calcium. This means no foods like those made with wheat or containing powerful acids, such as those in carbonated drinks.

Heart health consultation with Dr. Joe D. Goldstrich

20. June 2010 William Davis (3)
Cardiologist, nutritionist, and lipidologist, Dr. Joe D. Goldstrich, is a frequent contributor to the Track Your Plaque Forum, where we discuss the full range of issues relevant to coronary health and coronary plaque reversal.

I have come to value Dr. Goldstrich's unique insights, especially in nutrition. Formerly National Director of Education and Community Programs for the American Heart Association and a physician at the Pritikin Center, his dietary philosophy has evolved away from low-fat and towards a low-carbohydrate focus, much as we use in Track Your Plaque. Like TYP, Dr. Goldstrich is always searching for better answers to gain control over coronary health. His unique blend of ideas and background has helped us craft new ideas and strategies. Dr. Goldstrich has proven especially adept at understanding how to incorporate new findings from clinical studies in our framework of coronary atherosclerotic plaque management strategies.

Dr. Goldstrich is offering to share his expertise with our online community. If you would like a one-on-one phone consultation with Dr. Goldstrich, you can arrange to speak with him at his HealthyHeartConsultant.com website.

Wheat aftermath

16. June 2010 William Davis (18)
Following my 4 oz whole wheat misadventure that yielded the sky-high blood sugar of 167 mg/dl, compared to einkorn wheat's 110 mg/dl, I suffered through a 36-hour period of misery.

After I obtained the blood sugar of 167 mg/dl, I biked hard for one hour. This yielded a blood sugar back down in the 80s. I felt spacey in the ensuing few hours, as well as a little queasy. However, about 12 hours later, I awoke with overwhelming nausea along with that hypersalivating thing that happens just prior to vomiting. It did not come to that, but persisted all through the following day.

The next morning, I could barely concentrate. Trying to read a study (admittedly on the complex topic of agricultural genetics), I had to read each paragraph 4 or 5 times. Abdominal cramps and a bloated feeling also developed, though I was able to eat.

The 2nd night was filled with incredibly vivid dreams and intermittent sleeplessless. I awoke about 5 times through the night, but periods of sleep were filled with detailed, colorful dreams. I dreamt that a large corporation was secretly trying to gain control over the world's water supply, and I snuck onto a complex underwater vessel that was exploring and mapping the coastline of the Great Lakes in preparation. Weird.

I recognized these odd feelings as various facets of wheat intolerance, since they were all reminiscent of feelings I used to experience before I removed wheat from my diet. They were amplified and compressed, likely because I had been wheat-free for so long.

The odd thing is that, despite the modest blood sugar effect of my einkorn experience, none of the gastrointestinal or neurologic effects of wheat developed. So far, two other people with acute gastrointestinal wheat sensitivities have consumed our einkorn bread, also without reproduction of their usual symptoms.

Einkorn contains gluten, though the structure of the many gluten proteins of einkorn differs from that of the wheat bread I consumed, an example of modern Triticum aestivum. 14-chromosome einkorn carries what biologists call the "A" genome, while Triticum aestivum has the combines genomes of 3 plants, the combination of the A, B, and D genomes. It is the D genome that contains the genes coding for the most obnoxious, immunogenic forms of gluten.

So einkorn may not be entirely benign, but it is a good deal less obnoxious than modern Triticum aestivum.

I am awaiting the reports from a few other people on their experiences.

In search of wheat: Einkorn and blood sugar

14. June 2010 William Davis (32)
There are three basic aspects of wheat's adverse health effects: immune activation (e.g., celiac disease), neurologic implications (e.g., schizophrenia and ADHD), and blood sugar effects.

Among the questions I'd like answered is whether ancient wheat, such as the einkorn grain I obtained from Eli Rogosa, triggers blood sugar like modern wheat.

So I conducted a simple experiment on myself. On an empty stomach, I ate 4 oz of einkorn bread. On another occasion I ate 4 oz of bread that dietitian, Margaret Pfeiffer, made with whole wheat flour bought at the grocery store. Both flours were finely ground and nothing was added beyond water, yeast, olive oil, and a touch of salt.

Here's what happened:

Einkorn wheat bread:

Blood sugar pre: 84 mg/dl
Blood sugar 1-hour post: 110 mg/dl

Conventional wheat bread
Blood sugar pre: 84 mg/dl
Blood sugar 1-hour post: 167 mg/dl

The difference shocked me. I expected a difference between the two, but not that much.

After the conventional wheat, I also felt weird: a little queasy, some acid in the back of my throat, a little spacey. I biked for an hour solid to reduce my blood sugar back to its starting level.

I'm awaiting the experiences of others, but I'm tantalized by the possibility that, while einkorn is still a source of carbohydrates, perhaps it is one of an entirely different variety than modern Triticum aestivum wheat. The striking difference in blood sugar effects make me wonder if einkorn eaten in small quantities can keep us below the Advanced Glycation End-Product threshold.
 
No more Lovaza

No more Lovaza

30. July 2010 William Davis (45)
That's it: I will NEVER ever write another prescription for Lovaza.

I actually very rarely write a prescription for Lovaza, i.e., prescription fish oil. But this was the last straw.

I advised a patient that we've had good success using high-doses of fish oil to reduce lipoprotein(a), Lp(a). 6000 mg per day of the omega-3 component (EPA + DHA) from fish oil reduces Lp(a) in 60% of people after one year. (Recall that Lp(a) is the most aggressive known lipid-related cause of heart disease.)

The two preparations I generally suggest are either the very affordable Sam's Club Members Mark Triple-Strength Fish Oil with 900 mg EPA + DHA per capsule: 7 capsules per day. Another great product (my personal favorite because of its extreme purity--it doesn't even smell like fish oil): Pharmax Finest Pure Fish Oil with 1800 mg EPA + DHA per teaspoon: 3 to 3 1/2 teaspoons per day.

Both preparations work great and are quite affordable, given the high dose. For the Sam's Club preparation, it will cost around $30 per month, while the Pharmax liquid will run around $49 per month.

Well, the woman's husband insisted on a prescription for Lovaza. One Lovaza capsule contains 784 mg EPA + DHA per capsule: 7 to 8 capsules per day.

Here are some prices for Lovaza from online pharmacy discounters:
Prescription Giant: $78.99 for 30 capsules ($2.63 per capsule)
Planet Drugs Direct: $135 for 100 capsules ($1.35 per capsule)

These are lower than the prices I obtained in past by calling local pharmacies in my area, quite a bit lower, in fact.

Filling the Lovaza prescription at Prescription Giant will therefore cost $552.93 to $631.92 per month; at Planet Drugs Direct it will cost $283.50 to $324.00 per month. At local pharmacies, a similar 7 to 9 capsules Lovaza per day will cost upwards of $800 to $900 per month.

The patient's husband insisted on the Lovaza prescription because he knew that his insurance would cover it. When I pointed out that this was a large cost that would have to be borne by others in their healthcare premiums, he said that didn't matter to him.

I hesitated, but ended up writing the prescription for 7 Lovaza capsules per day. As soon as I handed to him, I regretted it. In fact, I am embarassed and angry at myself for having given in.

So I vowed: I will NEVER EVER write another prescription for Lovaza.

I do not believe that we should spread the excessive profiteering of the pharmaceutical industry around on the backs of people who pay their healthcare insurance premiums, just so that a few people, like this selfish couple, can save a few dollars a month.
Tags :

Comments (45) -

  • Anonymous

    7/30/2010 4:52:21 PM |

    Amen!  I took Lovaza for a year when my physician gave me a coupon for a monthly supply at $5/month for 12 months.  I obviously stopped when it ran out because of the "real" price.  I've started using CardioTabs (http://www.cardiotabs.com/Omega-3-Fish-Oil/productinfo/OMEGA-EC/) instead on the advice of my physician.  Any feedback on this brand?

  • Anonymous

    7/30/2010 5:17:35 PM |

    What is your opinion about Nordic Naturals DHA?  It contains 450 MG DHA and 90 MG EPA, along with 15 IUs of Vitamin E (alpha tocopherol) in two soft gels.  I've read in many places that fish oil containing more DHA than EPA is superior.

  • Joe D

    7/30/2010 5:19:13 PM |

    Even though Obama and his socialists would vehemently disagree, you make a logical point.

  • Anonymous

    7/30/2010 5:19:14 PM |

    I use Spring Valley brand and it costs me about $11 for a two for one deal (two bottles). 200 capsules per bottle 1000 mg each. EPA + DHA is only 300 per capsule but for the price taking 6 per day isn't a problem. Under $12 every 2 months isn't bad.

  • Pater_Fortunatos

    7/30/2010 5:29:53 PM |

    Hello everybody!

    Well, I see this article refer to a matter of price and less about quality.

    Dr Davis, please, what do you think about NOW Foods suplements?
    Sorry for being offtopic!
    Thanks for your blog, your work changed my life.
    All the best from Romania!

  • Anonymous

    7/30/2010 6:26:43 PM |

    For maximum absorbability, use liquid not capsules or gels, and eat with a high fat meal.

    New research also shows the probiotics in yogurt also help to minimize the oxidation:
    http://www.nutraingredients.com/Research/Yogurt-proteins-could-stabilize-omega-3-enrichment

    as does pollen spore shells (exines)
    http://www.nutraingredients.com/Research/Pollen-spores-could-enhance-omega-3-bioavailability

    A good value for omega-3s is Twin Labs:
    http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

  • David

    7/30/2010 7:50:15 PM |

    Take a look at Trader Joe's odorless omega 3. 90 capsules for less than $9. 1200 mg fish oil 400 mg EPA and 200 mg DHA in each capsule. The only brand I have been able to find with a 2 to 1 ratio of EPA to DHA. And there is no after taste.

  • Dave, RN

    7/30/2010 8:09:31 PM |

    I eat omnly grassfed beef and wildcaught salmon. Chicken is pastured. I don't eat grains or vegitable oils. I use coconut oil and tallow for cooking.
    That being said, can one get too much Omega 3?

  • PJNOIR

    7/30/2010 9:41:11 PM |

    Great point about the cost effecting others. Studies ghave shown that fish oil that is too pure is not as good as fish oil with a little bit of "mother" in it. Clean not sterile.

  • Mike

    7/30/2010 11:54:33 PM |

    Huge props to you, Dr. Davis, for admitting regret and posting future accountability by NOT filling scrips for Lovaza.

    Hopefully, the husband of that patient reads your blog.  But I doubt it. Smile

  • Tom C

    7/31/2010 12:20:05 AM |

    Hi Dr. Davis,
    Thank you for living your principles, and, as always, for your candid and unvarnished thoughts.
    Sincerely,
    Tom C

  • mongander

    7/31/2010 1:28:30 AM |

    I take 4 of Sam's Club triple-strength fish oil plus a 1 gram Krill Oil from Puritan's Pride.  The omega 3s, ground flax seed, curcumin, and Jean Carper's Super Osteo Gold have allowed me to jog at age 71 without any joint injury.

  • nightrite

    7/31/2010 2:31:02 AM |

    Assuming no problems with Lp(a) you can reduce the need for so much fish oil by changing your diet to low omega-6 intact.  There is competition between the two essential fats so try to limit foods high in omega-6 first.  Once you've done that you can cut back on all those fish oil capsules. It's probably helpful to take some vitamin E too to prevent potential fatty acid oxidation.

  • Lori Miller

    7/31/2010 4:01:37 AM |

    Thanks for not being part of the problem, Dr. Davis.

    The thing is, some prescription plans have a copay. If the plan of the couple is like mine, they'd have had a $30 copay. It's possible they were only saving $20 a month. For our friends outside the U.S., that'll buy a movie ticket and popcorn for one person. Nine hundred dollars is more than my mortgage payment.

  • Anne

    7/31/2010 6:46:03 AM |

    The real problem is the pharmaceutical industry and not patients who wish for prescriptions or insurance companies. Here in the UK, the last I heard,  Lovaza (marketed under the name Omacor) costs the National Heath Service £50 ($78) per 100 capsules, that is considerably less than what it costs in the US and roughly the same as comparable fish oil omega-3 supplements from health food shops in the UK. This is the pharmaceutical company charging this and it is they who should be brought to account when it comes to over profiteering from patients and insurance companies, imho.

  • David M Gordon

    7/31/2010 1:37:49 PM |

    I've started using CardioTabs instead on the advice of my physician. Any feedback on this brand?

    Not a very good deal, Anonymous.

    Each bottle includes 180 capsules, but a serving size is 3 capsules (to equal 975mg of DHA and EPA). Multiply that serving size by 6 to attain Dr Davis's objective of 6000mg of DHA and EPA per day. This means:
    1) You must ingest 18 (!) capsules/day;
    2) Each bottle of 180 capsules is a mere 10 days supply; which means
    3) 3 bottles/month at a cost of ~$100/month.

  • Dr. William Davis

    7/31/2010 3:23:45 PM |

    Several commenters have asked about specific brands.

    Consumer Lab (www.consumerlab.com) is a great place to start to see what brands have been tested.

    While it is clear that no mercury, PCBs, dioxin, or furans have been measured in any brand of OTC fish oil (slight contamination of cod liver oil, not fish body oils, with PCBs), there are differences in oxidative breakdown products.

    A quick test of oxidation: Smell your fish oil. It should only be faintly fish, not overwhelmingly fishy.

  • homertobias

    7/31/2010 4:22:41 PM |

    Can you give us some references on why 6,000 epa/dha for lp(a) carriers?

  • Metal Wall Art

    7/31/2010 4:30:59 PM |

    Finding a suitable plaques for our home is little hard to do. Your special taste of art and rare places provide it in best quality sometimes become the challenges to do it. But, because of the importance of the plaques you have to find it whatever it takes.

  • Tommy

    7/31/2010 6:33:18 PM |

    What about Weston A. Price suggesting that there is a potential for Omega 3 overdosing as well as the concern from contaminants  in fish oil compared to Cod liver oil due to fish oil being mostly from farmed fish? Also the benefits of Vitamin A and D from taking Cod liver oil rather than fish oil.  Personally I don't use cod liver oil, but should I be concerned about too much fish oil? Have there been long term studies?
    Thanks

    Tommy

  • kellgy

    7/31/2010 6:49:16 PM |

    This is one of the many reasons for our skyrocketing insurance costs. People need to take more responsibility for their own health. Unfortunatley, this concept is in direct conflict with the prevailing trend in our society.

    With the direction our health care industry is going, future costs will become quite prohibitive. In an effort to fight class warfare this new health care system will create a class of those who will be able to afford effective health care while the rest of us who are dependent on the government's version will be left waiting . . . It really is our fault.

  • Anonymous

    7/31/2010 7:33:45 PM |

    What's pathetic about the situation is, if the insurance company would shoulder some of the cost of basic fish oil instead of the prescription Lovaza, everyone in the system would benefit.  The way it is, everyone in the system loses.

  • Anonymous

    8/1/2010 5:31:27 AM |

    I have always used scott emulsion. A couple tbs per day.
    is that one good?

  • Dr. William Davis

    8/2/2010 12:43:50 AM |

    Anonymous about insurance paying for supplement fish oil--

    Yes, a brilliant idea!

    I've had the same idea and wondered why an insurance company didn't just shell out the money to prove for themselves that OTC is every bit as good as the prescription, then encourage their insured to use this instead. It would provide HUGE savings with no downside.

  • Anonymous

    8/2/2010 6:16:54 AM |

    Dr Davis

    with the us treasury printing currency by the boatload if everyone operated with cost savings in mind there would be hyperinflation due to excess money floating in the economy. So government channels try to mop up and circulate as much currency as possible and keep the bottlenecks to a minimum.

    No wonder usa is looking at a consistent high inflation future or maybe hyperinflationary future.

  • Anonymous

    8/2/2010 8:13:20 PM |

    I wonder about oxidation and possible immune system suppression at the 6 gram dose level. Although I suppose in patients with high Lp(a), it's the lesser of two evils. Emulsified fish oil may be worth trying, to see if it decreases Lp(a) even further.

    Eventually Lovaza will go generic, which will be sort of odd, when prescription fish oil potentially could be in the same ballpark as OTC. Not sure how the FDA will make sense of it, unless the dosages are exactly the same... not sure how prescription fish oil ever really made sense really.

  • Anonymous

    8/2/2010 11:42:10 PM |

    Also, don't eat with fiber as this hurts absorption.  

    The following are listed in the ConsumerLab.com report, but I'm not a member so don't know how it rates:

    Twin Labs Mega EPA ( 1 capsule = Epa 550 Mg, Dha 215 Mg )
    http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

    Nordic Natural Ultimate Omega + CoQ10  ( 2 capsules = Epa 650 Mg, Dha 450mg)
    http://www.nordicnaturals.com/en/Products/Product_Details/98/?ProdID=1446

    Green Pastures Fermented Cod Liver Oil and Butter Oil Blend (~139 mg EPA, ~83mg DHA),
    http://www.greenpasture.org/retail/?t=products&a=line&i=fermented-cod-liver-oil

    Vital Choice Wild Salmon Oil (240 mg EPA, 220 mg DHA)
    http://www.vitalchoice.com/product/omega-3-salmon-oil/1000-mg-sockeye-salmon-oil-softgels-180-count

    The nordic product also has 60mg of CoQ10, and 30IU of vitamin E!

  • Anonymous

    8/3/2010 1:41:04 AM |

    Dr Davis as a practicing neurosurgeon and age management doc I write for Lovaza all the time.  At least 75 Rx a month.  Does it bother me?  Yes it does.  But I feel better knowing those who are taking it are being proactive and healthy instead of a dog chasing its tail with his or her PCP.  Everything is relative my friend.  I suggest you focus in on the good because their is bad in everything but if you focus in on the good it magnifies itself.  Keep fighting the battle.  I do. I get more patients off Statins and on Fish Oil and resveratrol than you can imagine.  Love your work and the book.  I have saved lives because of you.  you passed it forward and now I do too everyday.  Dr. K

  • Anonymous

    8/3/2010 3:43:20 PM |

    Presumably, the guy has been paying his health care insurance premiums.  Based on the facts you describ, his insurance covers prescriptions for Lovaza.  Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?

  • Onschedule

    8/3/2010 7:02:28 PM |

    @anonymous who wrote:

    "Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?"

    If we focus only on an insured and his contractual rights under his insurance policy, he should not "have to pay additional money out of pocket..."

    However, that focus is arguably too narrow as it fails to consider the effect on insurance premiums for the rest of an insurance company's policy holders/payers. This is one of the evils of a system that requires citizens to obtain health insurance - it forces other people to subsidize, to use Dr. Davis's example, an expensive prescription when cheaper and equally effective alternatives exist. This is not an isolated example; consider prescription Vitamin D2 vs. D3 supplementation, etc...

  • Anonymous

    8/3/2010 7:50:48 PM |

    I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
    Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
      I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
    I can see both sides of the situation. The situation is a grey area.
    I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

  • Anonymous

    8/3/2010 7:51:19 PM |

    I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
    Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
      I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
    I can see both sides of the situation. The situation is a grey area.
    I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

  • stephen

    8/7/2010 6:06:18 AM |

    As a liberal, I say thank you. We can only provide health care for all, if it is affordable. Abusing the system only ensures less and less people will have access to quality health care.

  • Knox

    8/7/2010 3:03:21 PM |

    I love this article.  It makes me gag when I see commercials on TV for Lovaza or Niaspan.  This is one example of what's broken in our healthcare system.

  • Anonymous

    8/8/2010 6:20:11 PM |

    +! on the Trader Joe's omega-3 capsules. They are cheap and they have 50% concentration of combined EPA/DHA. TJ's sells two models of their omega-3 and the other has a lower concentration.

    I'll take Lovaza when it's a free sample. It has a 90% concentration but I think the overall total in Lovaza is not much higher than what is available from the local drug store.

    The only advantage Lovaza could have is that is monitored very carefully for purity and the like. I'm not sure that's much of a concern.

    -- Boris

  • Anonymous

    8/11/2010 4:53:48 PM |

    Are such high doses necessary? 7-8 grams per day of EPA/DHA seems like it would get you well past the desirable 8-10% on the HS-Omega-3 Index (usually only requiting 1-3 grams daily). Is there any need to go beyond 10%?

  • Anonymous

    8/13/2010 4:19:23 PM |

    I take 5-6 TJ omega-3 capsules during the day. Maybe that's a bit much but maybe there is a saturation point? I don't know. I know that omega-3 has cleared my mind, reduced my eye pain, and lowered my blood pressure.

    -- Boris

  • Anonymous

    8/16/2010 4:03:53 AM |

    So glad to hear it. When the ads came on TV, it was just another Big Pharma scam. Take a natural product and package it for mega profits.

  • scall0way

    8/22/2010 10:21:58 PM |

    I finally knuckled under and let my doctor write a prescrption for Niaspan for me - as we were fighting terribly as she was *ADAMANT* that I HAD to take STATINS as my cholesterol was too high (though my HDL was 62 and my triglycerides were 65) and I was flat out refusing. So she then suggested I had to take Niacin.

    I was willing to give Niacin a try as I have seen Dr. Davis talk about it here - and she just sent in the prescription via her computer to the mail-order pharmacy I'm required to use to get my prescription insurance coverage.

    So imagine my SHOCK when I got the online notice that the prescrption had been filled, and I was able to look it up. A 90-day prescription of Niaspan was about $400! I almost fainted, though my patient share was $75 - or $25/month.

    But I still thought it was highway robbery and will never fill the prescription again. If I continue t take Niacin I think it will be Slo-Niacin for me. I'd heard Niaspan was expensive, but had no clue it was that much!

  • Anonymous

    8/27/2010 9:57:38 PM |

    Dear friends,

    On Omega-3 highdoses EPA/DHA ; Minami Nutrition is providing Supecrital extraction (low temperature, and not molecular distillation!!) Omega-3 as well guaranties on purity below the detection limit next provinding a 93% Omega-3 per one softgel or 820 mg EPA/DHA per one softgel. look into www.minami-nutrition.co.uk availabel in the US at Wholefoods.

  • Anonymous

    8/27/2010 10:13:49 PM |

    Some people are worry on too much intake of fish oils. Indeed if you swallow standard fishoils with low levels of EPA/DHA as most US products you may swallow also a lot of saturated fats. Go for 1 softgel a day a softgel tahts provide you almost 1 g Omega-3 or a minimum as 820 mg EPA+DHA per softgel. a lot of brands having high levels of pcb's.(see http://www.cbsnews.com/stories/2010/03/02/health/main6259938.shtml ) be also a ware when mention "per serving" could be 2 to 4 or more softels a day.  Avoid liquid oils as they oxidize fast, as well I'm not in favor of codliver oils as too low on EPA and DHA and to high on vitamin A when taking 500 mg EPA/DHA.

  • Mike OD

    9/21/2010 8:28:53 PM |

    THANK YOU!! For taking a stand where many in your profession will not. We need more of this!

  • Metal Wall Art

    10/15/2010 12:26:58 PM |

    Even the traditional medical community is finally realizing that the omega 3s in fish oil provide some of the best natural health benefits on the planet. Worldwide, the omega 3 supplement market is in the billions of dollars. The drug companies want a piece of the action.

  • fireplace screen

    10/23/2010 6:40:37 AM |

    Great insights about how we can have a healthy lifestyle.Omega 3 is good for the heart that's why many people are eating foods rich in Lycopene.

  • Chris P

    10/28/2010 4:16:06 PM |

    Vitacost.com has their own brand of fish oil, NSI Mega EFA® Omega-3 EPA & DHA.  At 6000mg EPA/DHA a day (10 capsules) in a 240 cap container for $22, that comes out to be $27.50 per month.  And they often have 10% off sales, like right now till 10/31/10.  My personal experience with them has been good, their NSI brand has been high quality, and I rarely find a better price elsewhere.  I'm currently taking 6000mg EPA/DHA daily.

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