Another Ornish casualty

23. April 2006 William Davis (0)
Barry's lipoproteins were nearly all corrected to perfection: LDL 64 mg, HDL 57 mg, triglycerides 45 mg. He was approaching the Track Your Plaque goal of 60/60/60, the levels we find tip the scales heavily in your favor for achieving plaque reversal.

But one problem still prominently persisted: small LDL. Of Barry's 64 mg of total LSL, 90% of his LDL were small.

Barry was already on niacin (Slo-Niacin; Upsher Smith)1000 mg per day and fish oil, 4000 mg per day, both of which contribute to correction of this pattern. He had added occasional raw almonds and oat bran to his daily habits, both of which also help suppress small LDL. "I thought you told me that small LDL should go away if I did all this!" he lamented in frustration.

We probed Barry's diet choices more closely. "I eat really healthy foods, just like an Ornish program." Uh oh.

"What do you mean?" I asked.

"For breakfast, I have two slices of whole wheat toast--no butter or margarine, of course! I'll have Shredded Wheat with skim milk. That's it. My typical lunch is low-fat turkey--no mayonnaise!--on whole wheat. I'll add some low-fat whole wheat crackers or pretzels. That's pretty much my habit."

"How about dinner?"

"Dinner varies a lot. I'll usually have a low-fat meat like chicken or turkey, never beef, a vegetable, and a potato. I love rolls but I try to make them whole wheat. I don't use gravy. I love ice cream, so I've been having low-fat frozen yogurt instead. I guess that's about it."

Barry had indeed been counseled on how we approach nutrition. We, of course, do not endorse the low-fat approach of the Ornish program. Low saturated and hydrogenated fat, yes, but not the super-strict low-fat, "all fat is bad" approach of Dr. Dean Ornish.

Barry's diet is typical of someone on a low-fat restriction. When I asked him why he was eating this way, he admitted that he'd seen Dr. Ornish on a TV program in which he persuasively proclaimed that he reversed heart disease in his patients over the past nearly 20 years using this low-fat approach.

That explained it. Barry's nearly pure carbohydrate diet was triggering high blood sugar responses after meals, causing his insulin to skyrocket and magnifying the small LDL pattern.

I advised Barry to dramatically reduce his carbohydates like breads, pretzels, low-fat yogurt, crackers, etc. Instead, he could increase his lean proteins like eggs, egg whites, Egg Beaters, raw nuts and seeds, low-fat (yes, low-fat!) dairy products like yogurt and cottage cheese (both high protein), and healthy oils.

I've seen this happen with many people over the years: A severe low-fat restriction becomes a high-carbohydate diet. It's not uncommon for many people to have more than 70% of calories from carbohydrates on these programs.

The low-fat approach worked in the era of high-fat diets in the 1980s. In 2006, where convenience foods made with carbohydrates, especially wheat, predominate and pack 80% of supermarket shelves, low-fat is now a distorted nutritional mistake that leads to problems like Barry's uncontrolled small LDL, and often pre-diabetic or overt diabetes.
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In heart disease prevention, shoot for perfection

In heart disease prevention, shoot for perfection

12. April 2006 William Davis (0)
It really struck me today that it's the people who've chosen to compromise their prevention program who end up with trouble--heart procedures, heart attack, even heart failure.

Take Bob, for example. Bob is 73 years old and had a bypass operation in 2000. The procedure went well and Bob enjoyed 6 years of seemingly trouble-free life. Bob had a seriously low HDL cholesterol for which he as taken a modest dose of niacin, but was unwilling to do much more. His HDL cholesterol was thererefore "stalled" at around 40 mg. (We aim for 60 mg or greater.) We talked repeatedly about the options for increasing HDL but Bob was content with his results. After all, since his bypass operation, he'd felt well and could do all he wanted without physical limitation.

But Bob underwent a stress test for surveillance purposes (which we routinely do 5 or more years after bypass surgery). The test was markedly abnormal with two major areas of poor blood flow to his heart (signalling potential heart attack in future). Bob ended up getting 5 stents to salvage two bypass grafts, both of which showed signs of substantial degeneration.

I've seen this scenario repeatedly: A person is unwilling to go the extra mile to obtain perfection in lipid/lipoprotein patterns, lifestyle changes, and taking the basic, required supplements. Compromises eventually catch up to you in the form of another heart attack, more procedures, heart failure, physical disability, even death.

The message: Don't draw compromises in heart disease prevention. Coronary plaque is a chronic process. It will take advantage of you if you ever let your guard down.
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Small fish oil capsules

Small fish oil capsules

3. April 2008 William Davis (12)
Many people complain about the size of fish oil capsules. Let's face it: They're usually big and kind of smelly.

Women in particular struggle with big capsules. This becomes a real problem when somebody requires high-dose fish oil for treatment of post-prandial (after-eating) abnormalities, high triglycerides, or lipoprotein(a), when 6 or more--occasionally up to the equivalent of 20--standard fish oil capsules are required.

I came across a small capsule alternative for people who struggle with the big capsules. It's a product called Learn from PharmaOmega, a source of super purified fish oil.

The Learn product is actually made for children, since omega-3 fatty acid supplementation has been linked with improved intellectual performance. But the small capsule size is convenient for women and other people who would like to avoid the big standard-sized capsules.

Each capsule is about 60% of the size of a standard fish oil capsule (the smaller capsule in the photo, next to a standard size fish oil capsule), yet contains 375 mg EPA + DHA per capsule, 25% more than standard capsules (which contain 300 mg per capsule). The ratio of of EPA:DHA is a little more heavily weighted towards EPA with a 5:2 ration, compared to 3:1 of standard capsules. The capsules are also faintly orange flavored and non-fishy.





Disclosure: I receive no compensation for discussing or promoting this product.


Copyright 2008 William Davis, MD
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Comments (12) -

  • Michael

    4/3/2008 4:55:00 PM |

    Nature's Way also makes a small capsule, Super Fisol. It's enteric-coated, and has 350mg Omega 3 per capsule.

    But I personally think a liquid form (like Carlsons or Nordic Naturals) would be a better choice for those of us who have to take lots of Omega 3s, or those who have a problem with large pills.  It's a lot easier to take a teaspoon of fish oil 2-3x daily, instead of 10+ pills.

    Something not touched upon when discussing fish oil here has been vitamin E content. Is it a concern when someone takes 10+ pills? If each pill contains 10-15mg vitamin E, as some brands do, you are then taking 100-150mg vitamin E (in alpha form only) + probably more, from a multi-vitamin. The alpha only form of E will displace gamma, so it might not be the healthiest choice.

  • Anonymous

    4/3/2008 7:58:00 PM |

    Hi Dr. Davis:
    My Cardiologist was quite impressed by my lipid profile after 3 months on Krill Oil.  He was skeptical when I told him that I wanted to try it out.  Seeing is believing.  Because of the phospholipid and vit E content of Krill oil, you can take smaller doses to get the same effect as higher doses of fish oil.  The phospholipids make the omega 3 in Krill oil more bioavailable.

  • Richard A.

    4/3/2008 9:27:00 PM |

    Nature's Way has a fish oil product called Mega-DHA that contains 500 mg of DHA and 200 mg of EPA in standard-sized capsules of 1000 mg. That's 70% DHA+EPA. Just two capsules will give you 1.4 grams of DHA+EPA. The ratio of EPALaughingHA is tilted toward DHA with a ratio of 2:5. This might be a good product for those who are also concerned about Alzheimer's.

    Nature's Way, Mega-DHA --
    http://tinyurl.com/2ff5h9

  • Dr. B G

    4/4/2008 4:19:00 PM |

    Dear Anonymous,
    Thanks for sharing your experience!  There is only one report in the literature of Astaxanthin (the main antioxidant component of Krill Oil) that it raises HDLs (and it's in Spanish, subjects were RATS).  

    But it makes sense.  THAT is SPECTACULAR! (btw what degree from baseline improvement did you noticed?)

    Here are other benefits of Astaxanthin and Vitamin A on insulin, thermogenesis, plaque, MMPs, heart rhythms:
    drbganimalpharm.blogspot.com

    Thanks again!
    --G

  • Anonymous

    4/5/2008 12:28:00 AM |

    Well I was one of the whiners as I got terribe stomach and chest pain from 10 caps a day.
    I switched to Webber Naturals liquid omega 3 with my evening meal, I take 3 to 4 tsps.
    Each tsp gives me:
    fish oil conc: 4550mg
    omega 3 :      2383 mg
    epa:           980 mg
    dha            545mg
    vit d 3:       200iu
    vit a:         2500iu

    so it seems like a good product, I chase it down with some crystal lite and can manage it, no burning, chest pain gone,no burping,the hint of taking it with a meal worked for me.It has some Vit e but doesn't say how much.

    chick

  • ALANSD

    4/5/2008 10:55:00 PM |

    I take fish oil daily, and that and 1500 mgs niacin dropped my total cholesterol 70 points ( 250 to 180).
    I wonder about the comment from some professionals about fish oil being   "rancid",and hard on the kidneys,as the brand I use says it is  
    molecularly distilled.

  • Anonymous

    4/7/2008 12:33:00 AM |

    that really is interesting about fish oil increasing intelligence.  I have three highly intelligent young nephews and their mom took fish oil while pregnant.  My sister had read that EPA/DHA from fish oil helps the brain develop so she took a few capsules each day.  Two of the nephews are in school, and both have already advanced a grade, with talk that the middle nephew will be skipping another grade next year.    My nephews mom and dad are smart people, but didn't do as well as these boys have done so far in school.  Who knows if it was the fish oil that has given them this advantage, but it does make me wonder.

  • GenesisHealthCentre

    4/12/2008 6:41:00 PM |

    I currently take http://nordicnaturals.com/, and have excellent results with them.

    Regards Dave,
    Genesis Health Centre

  • Holistic Health Solutions

    8/16/2009 7:29:24 PM |

    Nordic Naturals is the most high quality fish oil available.

    Azantis Krill oil is a better product since the dual chain phospholipid structure of the epa in fish oil is much more bioavailable than the tryglyceride fish oil version.

  • mitchdcba

    4/30/2010 2:40:47 AM |

    There are extra motives to use a fish oil health supplement even if you aren’t concerned about cancer or heart attacks or aren’t pregnant.. It is considered that the oil may be of use to the body produce serotonin,
    deep sea fish oil

  • buy jeans

    11/3/2010 12:22:35 PM |

    Each capsule is about 60% of the size of a standard fish oil capsule (the smaller capsule in the photo, next to a standard size fish oil capsule), yet contains 375 mg EPA + DHA per capsule, 25% more than standard capsules (which contain 300 mg per capsule).

  • moseley2010

    12/6/2010 5:56:44 PM |

    I thought I was the only one who found fish oil supplements too big and yucky-smelling. I thought I was just being too much of a complainer when it comes to supplements and pills. I always dread having to take my fish oil capsules. If it wasn't beneficial to the health, and if it wasn't good for the heart and all that, there's no way I would be forced to swallow them. But then again, the health benefits outweigh everything.

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