My bread contains 900 mg omega-3

15. February 2007 William Davis (8)
Phyllis is the survivor of a large heart attack (an "anterior" myocardial infarction involving the crucial front of the heart) several years ago. Excessive fatigue prompted a stress test, which showed poor blood flow in areas outside the heart attack zone. This prompted a heart catheterization, then a bypass operation one year ago.

FINALLY, Phyllis began to understand that her unhealthy lifestyle played a role in causing her heart disease. But lifestyle alone wasn't to blame. Along with being 70 lbs overweight and overindulging in unhealthy sweets every day, she also had lipoprotein(a), small LDL particles, and high triglycerides. The high triglycerides were also associated with its evil "friends," VLDL and IDL (post-prandial, or after-eating, particles).

When I met her, Phyllis' triglycerides typically ranged from 200-300 mg/dl . Fish oil was the first solution, since it is marvelously effective for reducing triglycerides, as well as VLDL and IDL. Her dose: 6000 mg of a standard 1000 mg capsule (6 capsules) to provide 1800 mg EPA + DHA, the effective omega-3 fatty acids.

But Phyllis is not terribly good at following advice. She likes to wander off and follow her own path. She noticed that the healthy bread sold at the grocery store and containing flaxseed boasted "900 mg of omega-3s per slice!". So she ate two slices of the flaxseed-containing bread per day and dropped the fish oil.

Guess what? Triglycerides promptly rebounded to 290 mg/dl, along with oodles of VLDL and IDL.

A more obvious example occurs in people with a disorder called "familial hypertriglyceridemia," or the inherited inability to clear triglycerides from the blood. These people have triglycerides of 800 mg/dl, 2000 mg/dl, or higher. Fish oil yields dramatic drops of hundreds, or even thousands of mg. Fish oil likely achieves this effect by activating the enzyme, lipoprotein lipase, that is responsible for clearing blood triglycerides. Flaxseed oil and other linolenic acid sources yield . . .nothing.

Don't get me wrong. Flaxseed is a great food. As the ground seed, it reduces LDL cholesterol, reduces blood sugar, provides fiber for colon health, and may even yield anti-cancer benefits. Flaxseed oil is a wonderful oil, rich in monounsaturates, low in saturates, and rich in linolenic acid, an oil fraction that may provides heart benefits a la Mediterranean diet.

But linolenic acid from flaxseed is not the same as EPA + DHA from fish oil. This is most graphically proven by the lack of any triglyceride-reducing effects of flaxseed preparations.

Enjoy your flaxseed oil and ground flaxseed--but don't stop your fish oil because of it. Heart disease and coronary plaque are serious business. You need serious tools to combat and control them. Fish oil is serious business for triglycerides. Flaxseed is not.
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Comments (8) -

  • John Townsend

    2/15/2007 6:59:00 PM |

    re: " Her dose: 6000 mg of a standard 1000 mg capsule (6 capsules) to provide 1800 mg EPA + DHA, the effective omega-3 fatty acids."

    Excellent blog entry! On fish oil, this dose seems to be very high. Do you recommend this as a typical regimen?

    On another related topic, your views on common statins (eg lipitor, crestor, zocor, etc) would be appreciated. I'm getting strong warnings from knowledgable friends that statins are dangerous for liver function and can cause irreversiable damage. On the other hand I personally have found them to be very effective in bringing my cholesteral numbers in line, more than anything else I've tried. TIA

  • Dr. Davis

    2/16/2007 2:19:00 AM |

    John--
    No. This dose is for treatment of high triglycerides or postprandial disorders. Our usual starting dose is 4000 mg (1200 mg EPA+DHA).

    Regarding the statin issue. I'd refer you to an article I wrote for Life Extension magazine  archived on their website, www.lef.com. The article, entitled Cholesterol and Statin Drugs: Separating Hype from Reality, can be accessed at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1044&query=davis%20statin&hiword=DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20STATI%20STATING%20STATINS%20STATIS%20davis%20statin%20

  • Cindy

    2/16/2007 3:24:00 AM |

    I just read your article that you referred to in your previous comment answer.

    I was on statins several years ago. Not only did I experience muscle and joint pains, I also had serious memory problems, depression and sleep problems. I also found that my long-standing "restless legs syndrome" became much much worse. I've also talked to many people who have experienced serious PND (peripheral nerve disorders).

    What I also experinced was a rather significant drop in HDL cholesterol.

    Thoughts?

  • Mike

    2/16/2007 3:37:00 PM |

    "But Phyllis is not terribly good at following advice. She likes to wander off and follow her own path. She noticed that the healthy bread sold at the grocery store and containing flaxseed boasted "900 mg of omega-3s per slice!". So she ate two slices of the flaxseed-containing bread per day and dropped the fish oil."

    Allow me to defend Phyllis. If all she had been told was to take a given amount of omega-3s, then she was following the prescribed path. She should have been educated as to what the various omega-3s are and which type she needed to consume.

  • John Townsend

    2/16/2007 9:31:00 PM |

    Thank you for passing on your article 'Statin Drugs: Separating Hype from Reality'... very informative I must say! Just a quick heads up on your comment about folic acid (ie “always take folic acid and vitamin B12 with niacin to protect against disruption of healthy methylation patterns”), although studies are not conclusive, apparently folate therapy (taking a combination of folic acid, vitamin B6, and vitamin B12) may be harmful after stent placement and probably should be avoided. For those who have this condition it’s advised instead, to try to get enough vitamin B by eating a balanced diet. [ref: Lange H, et al. (2004). Folate therapy and in-stent restenosis after coronary stenting. New England Journal of Medicine, 350(26): 2673–2681]

  • madcook

    2/17/2007 5:32:00 PM |

    I have to chime in here regarding Cindy's comment on statins:

    I dutifully tried for nearly two years to tolerate the various statins prescribed by my doctor.  The deep muscle aches and spasms were nearly unbearable... getting far worse when my "numbers" still weren't right and he decided to DOUBLE my dosage of Vytorin (Zocor + Zetia) from 10/20 to 10/40.  What resulted was a true nightmare for me.  I terminated this med when I had such severe muscle aching, spasms and dis-coordination that navigating up a flight of stairs was nearly impossible.  Not only that, but my memory was (fortunately temporarily) impaired, and I can remember little from a three month period of time.  Interestingly my CK was never elevated and this all happened while taking 200mgs. daily of a very reputable Co -Q10 formulation.  Cessation of the Vytorin saw the aches subside within 2 or 3 days and full mental clarity resumed within a week.  I was lucky.

    My doctor stated that there were three other statins we hadn't yet tried... fat chance doc!

    What chaps me is that the pharmaceutical companies continue to state that there is only a small percentage of patients who have side effects.  In practice, LOTS of people have problems tolerating statins, BUT these things never are reported, certainly mine wasn't by my doctor.

    Side effects can be reported to the UCSD Statin Study, and to the FDA.  The FDA form is unduly cumbersone and frankly, unless you nearly died, it probably isn't worth the time.  The UCSD Statin Study questionnaire is very thorough... and as soon as I get some time I'm planning to report my experiences with statins to them.

    I am not optimistic that doing either of the above will change the statistical misinformation out there on statin side effects.  The pharmaceutical giants have too many billions at stake to ever allow this information to attain credibility.  Their advertising billions shout otherwise...

    Great meds, IF they work for you without problems.  For me they appear to be deadly, so I think I'll just stick with the other strategies, including niacin, fish oil, etc., etc. that I've learned through TYP.

    madcook

  • madcook

    2/17/2007 5:33:00 PM |

    I have to chime in here regarding Cindy's comment on statins:

    I dutifully tried for nearly two years to tolerate the various statins prescribed by my doctor.  The deep muscle aches and spasms were nearly unbearable... getting far worse when my "numbers" still weren't right and he decided to DOUBLE my dosage of Vytorin (Zocor + Zetia) from 10/20 to 10/40.  What resulted was a true nightmare for me.  I terminated this med when I had such severe muscle aching, spasms and dis-coordination that navigating up a flight of stairs was nearly impossible.  Not only that, but my memory was (fortunately temporarily) impaired, and I can remember little from a three month period of time.  Interestingly my CK was never elevated and this all happened while taking 200mgs. daily of a very reputable Co -Q10 formulation.  Cessation of the Vytorin saw the aches subside within 2 or 3 days and full mental clarity resumed within a week.  I was lucky.

    My doctor stated that there were three other statins we hadn't yet tried... fat chance doc!

    What chaps me is that the pharmaceutical companies continue to state that there is only a small percentage of patients who have side effects.  In practice, LOTS of people have problems tolerating statins, BUT these things never are reported, certainly mine wasn't by my doctor.

    Side effects can be reported to the UCSD Statin Study, and to the FDA.  The FDA form is unduly cumbersone and frankly, unless you nearly died, it probably isn't worth the time.  The UCSD Statin Study questionnaire is very thorough... and as soon as I get some time I'm planning to report my experiences with statins to them.

    I am not optimistic that doing either of the above will change the statistical misinformation out there on statin side effects.  The pharmaceutical giants have too many billions at stake to ever allow this information to attain credibility.  Their advertising billions shout otherwise...

    Great meds, IF they work for you without problems.  For me they appear to be deadly, so I think I'll just stick with the other strategies, including niacin, fish oil, etc., etc. that I've learned through TYP.

    madcook

  • John Townsend

    2/17/2007 8:05:00 PM |

    RE: Madcook's comment "Side effects can be reported to the UCSD Statin Study, and to the FDA. "

    I'm wondering if the 'UCSD Statin Study' provide summary reports on submission findings?

    BTW, his note is a very interesting personal account which echos mine to a certain extent, albeit I'm seemingly in the early stages. I'm starting to have pretty severe shoulder pain coming out of nowhere after six mths on Zocor. I've started taking Q-10 (re: your rec) to see if it helps. Previously my reaction to Lipidor was almost immediate with severe skin rash symptoms.

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Take a niacin "vacation"

Take a niacin "vacation"

20. November 2006 William Davis (2)
I've been seeing a curious niacin phenomenon that has not, to my knowledge, been reported anywhere in the medical literature.

People with lipoprotein(a), or Lp(a), are best treated with niacin, particularly given the relative lack of other effective therapies. I now have seen approximately 10 people with great initial responses to niacin, only to observe Lp(a) levels slowly drift back up to the starting level over a period of 2-3 years.

In other words, if starting Lp(a) is 200 nmol/l (approximately 80 mg/dl), drops to 70 nmol/l on niacin. Then, over 2-3 years of treatment, it drifts back to 200 nmol/l. Very frustrating.

Somehow, your body's Lp(a) manufacturing mechanism circumvents the niacin, sort of like antibiotic resistance (without the bacteria, of course).

My response to this, though untested, is to have people take an occasional "niacin vacation". I don't mean take a trip to the Bahamas while on niacin. I mean take 2 weeks off from niacin every three months or so. My hope is that the occasional vacation from niacin will allow the body to continue to respond and suppress "resistance". When resuming niacin, you may have to escalate the dose gradually to avoid re-provoking the "flush".

The same "resistance" seems to develop to testosterone in males: an initial drop followed by a gradual increase. Curiously, I've not seen this in females with estrogens, which seems to generate a durable Lp(a) suppressing effect. For this reason, an occasional testosterone "vacation" might also be considered.

So far, I've advised several people to try this. The long-term success or failure, however, is uncertain. I know of no other solutions, however.

If you have Lp(a) and are on long-term niacin, you should consider talking about this issue with your physician. Like many aspects of Lp(a), while fascinating in its complexity, much remains uncertain. Stay tuned.
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Comments (2) -

  • David

    3/10/2009 7:45:00 PM |

    Any updates on this "niacin resistance" phenomenon? It's been awhile since this post, so maybe you've developed a better feel for what's going on and how to deal with it? Are you still recommending the 2 week break every three months or so?

    Maybe revisiting this subject would be a good idea for a new post in the near future?

    That was a lot of question marks.

    David

  • Anonymous

    3/18/2011 3:06:24 AM |

    My theory: I believe this is a limiting reagent type issue.  Niacin flushing is a histamine reaction that occurs with the conversion of niacin into nicotinamide. The histamine reaction itself is the cause of the lipid altering effects of niacin supplementation(no flush, no effect.) Chronic use of niacin can deplete histamine levels and people typically find that flushing lessens over time. No flush, no effect, lipids start going back out of whack.  A vacation would allow histamine levels to build back up. This would also help explain your hyper-responders.

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