How much omega-3s are enough?

8. May 2007 William Davis (7)
The basic dose we advocate for the Track Your Plaque program is 1200 mg per day of EPA + DHA, the essential omega-3 fatty acids.

1200 mg EPA+DHA is generally obtainable by taking 4 capsules of 1000 mg of fish oil, since the majority of preparations contain 180 mg EPA and 120 mg DHA per capsule.

But how will you know if a higher dose wouldn't be even better?

The principal parameter to look at is triglycerides. If triglycerides remain above 60 mg/dl, we usually consider increasing fish oil.

Another measure that's very important is intermediate-density lipoprotein, or IDL, also called "remnant lipoproteins" on a VAP panel. Persistence of any IDL or remnant lipoproteins is reason to consider more fish oil. Most commonly, if there is some persistence of either, we increase fish oil to 6000 mg per day of a standard preparation, or 1800 mg/day of EPA+DHA.

The only time we see persistence of IDL or remnant lipoproteins with this higher dose is when triglycerides are really high. If starting triglycerides are, for instance, 500 mg/dl, then even this higher dose may be insufficient. This is when more highly concentrated preparations of fish oil may be necessary, occasionally even the prescription form, Omacor. (We currently use Omacor only when high doses of EPA+DHA are required, most because of its outrageous cost. Two capsules per day costs around $120 per month; three capsules per day to provide 1800 mg/day of EPA+DHA costs $180 per month. I think this is outrageous and so we use it only when absolutely necessary.)

You might even argue that a higher dose of 1800 mg EPA+DHA, or 6000 mg of a standard capsule, might be preferable for more assured reduction of heart attack risk--even when triglycerides and IDL are perfectly under control. I wouldn't argue with you. But you won't observe any measurable feedback that tells you that a heightened effect is being obtained. I take that dose myself, in fact, despite the fact that elimination of wheat products and weight loss was sufficient to drop my triglycerides to the target level. I figure it's a small additional effort for added peace of mind.
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Comments (7) -

  • Anonymous

    5/8/2007 7:46:00 PM |

    I have just joined the Track Your Placque Site.  I take fish oil daily, 3200 EPA/1600 DHA.  At this dose my AA/EPA score is 2.14.  When I had LDL electrophoesis done, my pattern was A pattern and I was not on the fish oil at that time.  I am wondering whether it would be better to have an NMR test or a VAP test, or both?

  • Dr. Davis

    5/9/2007 1:57:00 AM |

    Hi,
    In general, I prefer the NMR. However, the electrophoretic test you already had should provide more information than just breaking your LDL pattern down into types "A" or "B". The real numbers to pay attention to are the LDL subclasses III and IV. Add up those numbers to determine how much small LDL you really have (in percent). Anything more than 10% we regard as sigificant.

  • Mike

    5/9/2007 8:00:00 PM |

    Is there any reduction in triglycerides from taking flax seed or other non-EPA/DHA sources of omega-3s?

  • Anonymous

    5/10/2007 12:18:00 AM |

    Thank you.  The report is broken down into the various LDL subclasses.  This information is helpful.

  • Dr. Davis

    5/10/2007 12:28:00 AM |

    Mike-
    No, unfortunately not. Only fish oil exerts the sort of triglyceride and lipoprotein correcting effects that we need.

  • Anonymous

    5/12/2007 10:12:00 PM |

    Dr., what do you think of Krill oil? Is it better than "regular" fish oil?

  • Dr. Davis

    5/13/2007 3:25:00 AM |

    We've actually had a fairly extensive conversation on this question on the Track Your Plaque Forum. Fish oil is tried and true, and the advantages of krill oil--purportedly containing less pesticide residues (no less mercury since fish oil does not contain mercury) and virtually pure DHA--are not fully worked out. However, if you choose to give it a try, let us know what kind of results you get.

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Report from Washington

Report from Washington

14. July 2006 William Davis (0)




I'm presently attending the Society for Cardiovascular Computed Tomography meetings in Washington, DC, along with 500 of my colleagues. It's exciting to see how interest in CT scanning for heart disease has balloonned in the past couple of years.

Several trends are noticeable today, based on the content and tone of the discussions:

--CT scanning of the heart, and imaging in general, is just getting started. In other words, the capabilities for CT scanners and other devices to detect heart disease (coronary and otherwise) are where the gasoline engine was in the 19th century. Scanning is getting faster, easier, safer, and more precise. Just as few people in 1905 could have predicted that automobiles would be computer-enhanced, high-speed, ubiquitous devices with several per household, the potential for CT imaging for heart disease is truly in its infancy.

--CT coronary angiography (so-called "64-slice CT scans") are not screening tests for hidden coronary disease in people without symptoms. I was grateful that this point has been made and reiterated by several speakers, as this is consistent with our views. Simple CT heart scans for coronary calcium scoring, in contrast, are screening tests. When the radiation exposure of CT angiograms are reduced to tolerable levels, then they may be used as screening tests. We are probably 3-4 years away from this point.

--Both stress testing and heart catheterizations will be partially replaced by CT scanning. In particular, over the next decade, you will see a dramatic drop in unnecessary catheterizations, i.e,, far less people saying "I had a heart cath but they told me that it was normal."


There has been heavy focus on applications of CT scanning for acute settings, particularly the emergency room and hospitals.

What has surprised me is that there is virtually no conversation whatsoever about the preventive uses of CT heart scanning. So far, only Dr. Daniel Berman of UCLA has shown that he has "seen the light": CT scans are a crucial tool for identification of early coronary plaque, and this tells us whether prevention is necessary and with what intensity.

There has been, however, no discussion at all about quantification of plaque in a program of reversal. Perhaps that should come as no surprise, given the imaging-technology focus of this convention. For most of my colleagues, prevention is also not terribly interesting. Identification and treatment of acute disease like impending heart attack is.

Of course, applying the information from your CT heart scan to empower you in a program and reversal is what the Track Your Plaque program is all about. I hope you see the light. I admit that it's not always easy to follow what we are advocating here. Perhaps not too different than telling someone in his horse-drawn buggy that one day he'll be driving a sleek car with onboard computerized mapping, air-conditioning, and micro-chips to modulate engine performance. He's probably tell us we're nuts.

I'll continue to update if any news relevant to our interests crops up in these meetings.
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