Does fish oil ADD to statin therapy?

18. October 2008 William Davis (9)
Yet another patient came to my office today saying, "My primary doctor said that I should stop taking fish oil. He say's that I don't need it because I take Crestor."

The woman was in tears, confused and frightened over a potential disagreement between her doctors.

Is this true? If someone takes a statin drug, like Crestor, Lipitor, Zocor (simvastatin), pravachol, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

No. Not even close to the truth.

First of all, let's accept that virtually the entire body of statin drug literature--hundreds of studies, billions of dollars spent--was paid for by the drug industry. It's no news that studies paid for by the sponsor are likely to favor the sponsor. Imagine Ford sponsored a study of Ford vs. GM cars vs. Toyota, paying $10 million to fund the effort. Guess who is likely to come out on top? "Studies show that Ford makes the best car in America." (Sorry, I don't mean to pick specifically on Ford. It's just a widely-recognized brand.)

So that means that the statin literature likely overestimates the benefit of statin drugs. Even so, it's clear from the hundreds of studies performed that the best we can hope for by taking statin drugs is a reduction of heart attack and death from heart attack of 30-35%--best case. That doesn't sound like elimination of risk to me.

What are the incremental benefits of adding omega-3 fatty acids from fish oil added to statins? The best data originate with the JELIS Trial (Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis), in which 19,000 Japanese participants (who already have a high omega-3 intake from diet, usually ranging from 1800-3000 mg per day) experienced a 19% reduction (relative reduction) in cardiovascular events.

GISSI Prevenzione demonstrated a 28% reduction in heart attack, 45% reduction in death from heart attack with fish oil.

Omega-3 fatty acids from fish oil also:

--Reduce triglycerides dramatically
--Accelerate after-eating clearance of digestive by-products, i.e., they correct post-prandial abnormalities
--Modify the character (fragmentation potential, structural strength) of plaque
--Raise HDL modestly

If you buy your fish oil from Sam's Club, Costco, or other discounter, a healthy dose of fish oil might cost you $3 per month. Compare that to the $120 per month average cost of a statin agent. Why is there even a discussion over this?

Sadly, the doctor on Main Street, U.S.A, is the unwitting puppet of the pharmaceutical industry. The pretty drug company representative with nice legs and a cute smile promises lunch, dinner and . . who knows what else? Wink. The fifty-something, hairline-receding doctor can't resist. "Of course I'll prescribe your drug!"

Don't kid yourself: The drug industry knows precisely how to manipulate the behaviors of the deliverers of their products.

So, do statin drugs make omega-3 fatty acids from fish oil irrelevant? Absolutely not.

It's all about trying to inch closer and closer--not to reduction--but to elimination of risk for heart disease.
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Comments (9) -

  • Steve

    10/18/2008 3:23:00 PM |

    Dr. Davis:
    doctors including most in your specialty use statins as their first line of defense in treating heart disease. Perhaps because it is easy; perhaps because of the drug company sponsored tests.  In any event, it may be that it makes sense in some cases, only we the public do not know when they should be prescribed.  Perhaps you can enlighten us on when and for what reasons you would prescribe statins, if at all.
    Excellent post.

  • Anonymous

    10/19/2008 2:47:00 AM |

    Why didn't you tell her that it's now been proven that no woman should ever be on statins (and very few men should be.)

    My mom now has to walk with a cane after six months on statins, at her idiot doctor's insistence.

    At least I'm sure her doc enjoyed his free lunches (paid for by hot, nubile drug reps, just a year or two out of the sorority.)

    Sometimes this country makes me want to VOMIT!

  • Zbigniew

    10/19/2008 8:01:00 AM |

    Dr. Eades keeps repeating it's never been proven that statins do any good to women of any age - what do you think about it, maybe that patient should just stop taking statins and increase fish oil?

  • TedHutchinson

    10/21/2008 4:27:00 PM |

    http://www.lipidworld.com/content/pdf/1476-511x-7-37.pdf
    In this paper Das proposes that a rational combination of -3 and -6 fatty acids and the co-factors that are necessary for their appropriate action/metabolism is as beneficial as that of the combined use of a statin, thiazide,a  blocker, and an angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin.
    Furthermore, appropriate  combination of -3 and -6 fatty acids may even show additional
    benefits in the form of protection from depression, schizophrenia, Alzheimer’s disease, and enhances cognitive function; and serve as endogenous anti-inflammatory molecules; and could be administered from childhood for life long.

    But I suspect that such an approach would not be as profitable as the use of a polypill.

  • Gabrielle

    10/24/2008 10:29:00 AM |

    RCT's have demonstrated that Omega 3 fatty acid supplements can reduce
    cardiac events like death,non fatal MI and non fatal stroke.

    I like Omega3 fatty acid supplement from Neurovi.It has many benefits related with Heart disease.Check out the website of Neurovi.

    www.neurovi.com

  • Anonymous

    10/26/2008 6:19:00 AM |

    There's a relatively new (rat) study on krill oil.

    If you're interested, you can access the abstract here:

    http://www.ncbi.nlm.nih.gov/pubmed/18755044?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  • buy jeans

    11/3/2010 10:30:02 PM |

    Is this true? If someone takes a statin drug, like Crestor, Lipitor, Zocor (simvastatin), pravachol, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

  • simvastatin side effects

    5/7/2011 11:26:23 AM |

    We must first gather some informations bbelieving that when we take statin, we should not take any other like fish oil.

  • simvastatin side effects

    5/7/2011 11:27:12 AM |

    We must first gather some informations before believing that when we take statin, we should not take any other like fish oil.

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Don't believe the negative press on fish oil

Don't believe the negative press on fish oil

25. June 2006 William Davis (0)


A British Medical Journal study released in March, 2006 has prompted a media flurry of reports on the worthlessness of fish oil. (Hooper L, Thompson RL, Harrison RA et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: a systematic review. BMJ March,2006)

Don't believe it for a second.

First of all, the study was a re-analysis of the existing published scientific literature. It was not a new study. It included a wild conglomeration of different clinical observations, as the studies examining fish oil over the years have been extraordinarily heterogeneous--in populations examined, omega-3 supplement (e.g., fish vs. capsule), period of observation, endpoints measured.

The results were skewed by inclusion of a moderate-sized British study by Burr et al in men with angina. In this study, no benefit was demonstrated and, in fact, a negative effect--more heart attack and death--was observed with fish oil. This was not news, since the study was published in 2003. It's results have been a mystery to everyone, since its unexpected negative result for fish oil was so starkly different from virtually every other study that preceded it (suggesting a study flaw or statistical fluke).

Nonetheless, the Burr study served to throw off the overall analysis. It diluted the dramatic and persuasive outcome of the GISSI-Prevenzione Study of 11,000 people in which a 28% reduction in heart attack and 45% reduction in cardiovascular death was observed. Note that the substantial numbers of the GISSI make the study's outcome nearly unassailable.

Another important fact: fish oil is among the most powerful tools available to correct elevated triglycerides. Drops of 50% are common. Recall that triglycerides are a necessary ingredient to create the nasty LDL, as well as VLDL, Intermediate-density lipoprotein, and an undesirable shift from large to ineffective small HDL. Reducing triglycerides is therefore crucial for your plaque control program.

This re-analysis serves to prove nothing. Such analyses can only pose questions for further study in a real study like GISSI: a randomized (random participant assignment), controlled (treatment vs. placebo or other treatment) study.

The weight of evidence remains heavily in favor of fish oil, not only as helpful, but fabulously beneficial, particularly for anyone aiming to reduce coronary plaque.
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Vitamin D disappointment ahead

Vitamin D disappointment ahead

5. June 2007 William Davis (9)
Anyone following the Track Your Plaque conversation know that we are rabid fans of normalizing blood vitamin D blood levels (25-OH-vitamin D3).

A wonderful report on vitamin D was aired this morning on the NBC Today show. The interviewed guests did a good job of describing the health effects of vitamin D, thought the focus was on some new data on the use of vitamin D for breast and prostate cancer.

I learned that shiitake mushrooms have some vitamin D--I didn't know that! (They contain 260 units per 4 mushrooms.)

Unfortunately, the closing comments from the guests, among whom was nutritionist and author, Joy Bauer,MS, was that you should get vitamin D from your multivitamin or your calcium with vit D.

That is absolutely wrong. When you check blood levels of vitamin D, as we do in everybody we see, you quickly learn what works and what doesn't.

Vitamin D in multivitamins is very poorly absorbed, if at all. Likewise, about 90% of the D in most calcium preparations is not absorbed. The vast majority of tablet or powder preparations, such as those in calcium tablets, are not absorbed to any significant extent. Take all you want and you remain vit D-deficient with osteoporosis, growing coronary plaque, low HDL, and exposed to risk for prostate and colon cancer.

If you take vitamin D in supplement form, it must--MUST--be in an oil-based capsule. The tablets are simply much too poorly and erratically absorbed to be reliable. There's nothing more frustrating to take, for instance, 4000 units of vitamin D in tablet form, only to have a blood level of 12 ng/ml--severe deficiency. Take the same 4000 unit dose in capsule form and blood level skyrockets to 58 ng/ml. And it's no more expensive.

One other thing: If you want to waste time and money, take the prescription vitamin D prescribed by many doctors. This is vitamin D2, also known as "ergocalciferol". Why use the synthetic vitamin D2 when D3 is the form your body needs? Because the D2 is patent-protectable and profitable to the drug manufacturer, similar to using Premarin (horse estrogens) when human preparations would suffice--or be superior. I saw a woman today taking 50,000 of prescription D2 once per week. Her blood level of 25-OH-vitamin D3? 17 ng/ml--severe deficiency. Don't waste your time with this garbage.
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Comments (9) -

  • Ortcloud

    6/5/2007 4:50:00 PM |

    I am often disappointed with "experts" that you see being interviewed on tv. It makes you wonder where they get these people. Do you think they would ever interview you if you offered? Maybe you could get on their list of experts to refer to.

  • Anonymous

    6/5/2007 5:13:00 PM |

    Dr. Davis, Thank you for this posting!  My vitamin D levels were tested in early April at 17.  I have been taking citrical with vit. D.  From your post, this sounds like a bad idea!  Can you recommend a good brand of oil-based D3 capsules?  Also, how long should it take for my vit. D levels to normalize?  Thank you!

  • Dr. Davis

    6/5/2007 8:20:00 PM |

    Ortcloud--
    Thanks for the vote of confidence.

  • Dr. Davis

    6/5/2007 8:21:00 PM |

    We've used Carlson's and Vitamin Shoppe's 2000 unit vitamin D3 (cholecalciferol) capsules with great results. It takes about 4 weeks to fully reflect the dose.

  • Anonymous

    6/30/2007 12:34:00 PM |

    How about co-administering an oil along with a powdered vitamin D tablet or capsule? I would be curious to see absorption rates using this method vs. oil-based vitamin D.

    Also does this low absorption apply to all fat soluble vitamins? In other words, must vitamin A, E, and K also be in an oil or oil-based to maintain optimal bioavailability? Thanks.

  • Dr. Davis

    6/30/2007 1:51:00 PM |

    Including oil with a powder form of D does enhance absorption though in my experience it remains erratic.

    I'm uncertain about the E and A, though I suspect the same remains true. I would really like to know how important this phenomenon is with K2, but I am not unaware of any real data, nor do I have sufficient experience to say at this point. With time.

  • Anonymous

    8/13/2007 12:51:00 PM |

    After taking Prescription Vitamin D ( oil ) capsule for
    3 month my levels were up to 50.
    Now I am taking 1ooooIU's daily and my levels are down to 29. Does fish oil capsule interfere with the asboprtion of Vitamin D?
       Maria

  • Dr. Davis

    8/13/2007 2:51:00 PM |

    Hi, Maria--

    No, in fact fish oil should do the opposite and can increase D absorption. It might therefore be variation in your preparation.

  • Doug

    4/7/2009 6:21:00 PM |

    I live in Canada and am on a perpetual 50,000 iu/week dose of Vitamin D due to low blood levels.

    AFAIK only D2 is available in Canada, and the endo dismissed any negative comparison with D3.

    What can I do ?

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