I guess it could be said that a flaw some have is a willingness to take advantage of the uneducated.  

On the niacin, my guess is that the over the counter Slo Niacin is manufactured by the same company in the same facility as the prescription form.  The machines used would be different as the FDA wants this, but the manufacturing procedures and source product would be the same.  I don't know this for a fact, but it would not surprise me if it were true.  

For fish oil, there are only a couple facilities in the world that manufacture fish oil.  The products these facilities sell are pretty much all the same in quality.  Everyone buys from the same places.  The facilities that encapsulate pharmaceuticals often times also manufacture health foods in the same plant.  The exact machines used for encapsulating pharmaceutical fish oil and store shelf fish oil will need to be different for government purposes but basic manufacturing practices followed will be about the same.

I was in a unique situation to witness a Germany company sell a product as a health food - and at the same time was going through the FDA drug approval process with the same exact patent protected product.  The product never did make it through testing in the end.  Phase 3 (I think that is what it is called) human studies at the Cleveland Clinic were a bust as too many people stopped taking the product. (Reportedly the product worked so well that people stopped taking it as they felt healed.)  I remember the German company planned to make “large” amounts of money off of their product if it passed testing as they would be able to charge a premium.  After testing fell through they decided to not try again.  A large American firm took on their product and placed it into every store in America, - and that was good enough for them.

http://www.ajcn.org/cgi/content/abstract/84/4/694
The case against ergocalciferol (vitamin D2) as a vitamin supplement provides more information which may interest some.
http://www.ajcn.org/cgi/content/full/85/1/6
Risk Assessment for Vitamin D shows that up to 10,000iu daily produces no observable adverse events but readers should note that actual harm occurs is 40,000iu are consumed daily.
However as you body uses only 4000iu daily http://www.ajcn.org/cgi/content/full/77/1/204 there has to be good reason to take more than 4000iu daily.

Dear Dr. Davis,

I've been reading your blog for sometime, since I found the link on Regina Wilshire's blog. I've learned a lot and want to thank you for sharing your insights and expertise with everyone. I imagine (and hope) that there are many, many more people reading it than are posting. I think what you and your colleagues are doing with Track Your Plaque is phenomenal. Interesting that there seem to be none of these services in New England, that bastion of tradition.

I've been fascinated by your articles on Vitamin D.  In looking around at Vitamin D3 (cholecalciferol) to purchase online (I can't find gelcaps locally), I came across the "Wilderness Family Naturals" web site.  In their article on cod liver oil ( http://www.wildernessfamilynaturals.com/cod-liver-oil-health-benefits.htm ), they state:
"Cholecalciferol is the form found in vitamin supplements and fortified dairy products and not the hormonal form of vitamin D, namely 1,25-dihydroxycholecalciferol."
The also state: "The form of vitamin D that we get from supplements is not fully active."

Can you talk about this for us?

In any case, my question is: can't I just take my cod liver oil to get my Vitamin D? Do I need the gelcaps of D3 in addition?

Thanks again,
Barbara

Wow! Thanks for the helpful commentary.

Barbara-
It's really very simple once you start checking blood levels on everybody--you quickly begin to learn what works and what doesn't.

Vitamin D3 (cholecalciferol) is what you need. Don't be confused by the comment about the "real" form, 1,25-diOH-vitamin D3. This is a kidney metabolite. We all still need vitamin D3.

It's best to find D3, not cod liver oil. I remain skeptical about the safety of cod liver oil due to some reports of preparations with excessive pesticide residues.

Try www.vitaminshoppe.com or look for Carlson's preparation, both 2000 unit gelcaps of D3.

I take D3 and have been for at least 3 months. I've been taking 3000iu/day and just had a blood test that indicates my blood level is only 33 (22 - 67 is the reference level).

I'm out in the sun at least 15 min a day, not including driving, walking to and from, etc.

So...how much Vit D should I be taking? I believe you recommend a level of 50-60?

Cindy--
We commonly use 5000-6000 when situations like this arise and generate desirable levels. Also, the values of "normal" in the reference range you provide suggests that your laboratory also runs an outdated method of measurement. (The newer methods tend to show "references ranges" of 20-100, or something close to that range.)

Thanks!! I've made several changes recently thanks to your posts!!

Hi Dr. Davis,
I see both Vitamin D and Vitamin D3 supplements being sold:

Vitamin D

Do I need to assume that supplements labeled as simply Vitamin D are, in fact, D2?  Are there other forms that it could be?
Thanks,
Mike

Mike-
No, you can not assume D is D3.

Always look for:
1) gelcaps, not tablets
2) D3 or cholecalciferol
3) Never D2 or ergocalciferol.

Those little attentions to detail will help a bunch and ensure you get the right stuff.

Thanks!

I was diagnosed with a defiency in vitamin D in january . My total level was 12ng/mL . I started taking supplementation, 800 IU daily of Vitamin D3 (cholcalciferul), and a Centrum multi-vitamin which has another 400 IU . I took that for over 6 months. I just had my level checked again . It is only 15ng/mL still !
How much D3 should I be taking ?
And what would be a good target for a 31 year old male ?

There's no "one-size"fits-all" in dose for vitamin D. However:

1) The vitamin D in multivitamins doesn't work at all.

2) You're therefore taking 800 units per day, the dose for a small child.

3) Most adults require 2000-6000 units per day. The D must be in capsule form, not tablet.

4) In the Track Your Plaque program, we aim for a blood level of 50 ng/ml.

Thanks, Dr.

1) Can you expand on why that is re. multi-vitamins inefficacy of vitamin D ? Does this apply only to the vitamin D in them ?
Are the liquid forms of multi-vitamins any better than the tablets (eg. centrum liquid) ?

2-3) I thought according to the FDA, the recommended daily dose was 400 IU for an adult and the safe dose was 2000 IU. How did you come up with your numbers ?

3) You guessed it - I had been taking Vitamin D in tablet form only. I can certainly believe that they were not effective given my test results. But can you explain why the tablet forms don't work ?

Tonight I looked for vitamin D in liquid form . I had to go to 4 places - Costco, my Kaiser pharmacy, Longs, and finally Walgreen's, which had some softgels from fish oil. I bought 100 softgels of 1000 IU each for $7.99.

The tablets I have are Nature made brand. I have about 300 left. As far as tablets go, how do you rate them ? Would you just throw them away and just take the gels ? Or take some gels and tabs ? I hate to just waste the tabs.

4) Thanks !

Please refer to the several previous posts under "Vitamin D" or our extensive discussion on the www.trackyourplaque.com website.

Vitamin D should always be either "D3" or cholecalciferol, NEVER "D2" or ergocalciferol, since D2 exerts negligible benefits.

If your preparation fails to specify which form, look for another that does.

Hello I'm a vegan from Germany and like to respond to the argument that is circling through the web relating to D2. Since I'm vegan don't use D3 since that is produced by irridating butchers-wool with UV-light, an information that is often left out when touting this version of vitamin D as the "natural" one. Because of all the negative rap D2 has gotten, it has now in fact disappeared as a supplement in the EU, effectively starving vegans and other vegetarians of vitamin D. I was thus forced to look for alternatives to have my winter supply of vitamin D. What I do is grow my own delicatessen mushrooms right here at home and either dry them in the sun or irridate them with the Utra Vitalux 300 Watt UVB - Lightbulb after harvest which makes them a very rich source for vitamin D2.  Now here comes the interesting part. My previously utter deficient 25(OH)D below detection level, measured at the end of summer -I'm not the outside type and almost never get enough UV-exposure from sunlight- has after a year gone up to 105 nmol/L. Given that I have nowhere near enough sun exposure, and as a vegan no other dietary source of vitamin D, it is clear to me that the vitamin D2 from my sun-dried or irridated mushrooms is responsible for my recovery from hypovitaminosis D.

Now I don't know if there's a difference of vitamin D2 in mushrooms or the pharmacological D2 in pills, all I know is that Vitamin D2 is *my* primary source of vitamin D and it's giving me excellent levels of 25(OH)D.

What I find highly irritating is the meme like argument flying around that vitamin D3 is the one "naturally appearing in the body". Duh. Vitamin D2 is also converted into vitamin D3 so the fact that D2 is not "naturally in the human body" should be as relevant that Vitamin C is not "naturally in the human body" and has to by sourced from diet. There are many nutrients that are "not natural" in the human body and which we need to source from diet, for example the essential amino acid. Besides, since when does "natural" equate to being good? If a Uranium miner has "natural" radioactivity in his body because he is exposed to it during work, is that good? I don't think so.

The reason I'm irritated is because the information about vitamin D2 being bad (when that is, at least in my case *not* true) has real implications and discriminatory effect on vegans and other vegetarians because not everybody of us has the patience and curiousity to produce their own Vitamin D at home, and perhaps some people don't enjoy eating mushrooms.

There is one more point and then I'll end my rant. Every time us vegans were informed that a particular plant based nutrient like vitamin A (beta-carot.) or iron was inferior because it has a lower bio-availability, later research discovered that that lower bio-availability has actually real benefits. I wouldn't be surprised if the same appears to be true for vitamin D2. I have already come across research which noted one of the D2 metabolites to have anti cancer properties, although this study is based on non-human animals meaning it has little to no relevance to humans and is based on the exploitation and death of rats.

For those who (despite reading this on an electronic network of computers) lay any importance on _naturality_ regarding nutrients, you may want to consider my method of just drying mushrooms in the sun. That's certainly more natural than killing sheep, stripping the hair grease of their wool and irridating that with UV-B light, which is the standard method of how vitamin D3 is produced - a byproduct of butchers waste.

Fascinating solution!

However, I stick by my claim that, for most people, vitamin D2 supplementation does not work. I have seen many people on as much as 50,000 units of D2 per day with zero or near zero levels of conversion to the active D3, all proven by blood levels.

However, for a vegan, I do not have any useful non-animal solutions beyond getting sun.

My Vitamin D levels, when first tested, were 12.  I have been using a Vitamin D lamp to try to raise the levels, which are now 32-33.  Initially, I took Puritan's Pride Vitamin D, which made me feel like a new person, but I quickly learned that it interfered with the efficacy of Cytomel, which I take because Synthroid interferes with yet a different medication.  Do you know of any form of Vitamin D that might not interfere with Cytomel?  

Thank you.

I just found out my vitamin D level is abysmally low from a blood test. My endocrinologist gave me a prescription for 50,000 units of vitamin D.  After reading about the subject here, I don't know whether to fill the prescription or go the the health food store and get a bottle of vitamin D3 capsules and disobey doctor's orders. We are investigating whether I have disturbances in my cortisol levels.  So far, testing has shown very low morning cortisol levels.

I went from sickly to healthy from taking 50,000IU (once a week) of Calciferol, proven by my recent bloodwork.  My D level was 18 in November,  and 4 months later it was 38!!!  Taking D2 has changed my life and I continue to take it without hesitation or reservation.

I have read that I should be taking a cal/mag supplement to increase absorbtion but I have not done so . . . your thoughts please.

Maybe the lab you use for blood tests isn't DEQAS certified, and isn't accurate.  I don't know how else to explain why a recent study contradicts what you're saying about D2:

http://jcem.endojournals.org/cgi/rapidpdf/jc.2007-2308v1.pdf

Hello, can you tell me what form of D3 is best and why.

Ergocalciferol (D2) has a kenetic half life of 10 days.  Calcitriol (D3) has a half life of 3 days. I am surgically hypoparathyroid and replaced 100% of that function with calcitriol or ergocalciferol for 30+ years. I find the D3 form is smoother on my body, until I forget to take my dose on any particular day. Then my mood, energy, stamina, sense of well being etc noticably deteriorate. I lived quite easily on D2 for nearly 28 years until medicare decided this life essential medication was a non life essential vitamin and forced a change to the more expensive calcitriol they would pay for. So now I painfully die in 10 days without D3 instead of 30 days if taking D2. This is germane when the price of ergocalciferol in 1991 was $1.99/100 50000IUs dose. After several years of repeated "offshore supply problems" the price is now $125/100 forn teh identical medication. Sometimes I'd drive 75 miles to another pharmacy (dealer - lol) to refill the D2 when the supply dried up. On correct fo the supply problem the price would double or triple (WTF???). Oh well - rather that a "DNR" I insist on a "JSM" (just shoot me).

Hi everyone,

Firstly, I must say I agree with ava reactions being irritated above, even if not being vegan myself, but vegetarian.

I would like also to point out that health is definitly not numbers on a paper coming from tests but is how we can feel and act.

Good health is about feeling balanced and in a state that allows personal accomplishment. It is not, not at all, about obtaining or aiming a level of that molecule or this other one in a blood test.
You can take two people with same amount of that molecule, or with similar tests results and having one feeling very healthy and being really so and the other one being and feeling desperetly ill. Blood tests reflect only very poorly what is really happening in the vast universe of our cells and tissues. It does not indicate at all how plenty of important biological reactions are going in us.

It makes me smile when I read 50,000 IU of D2 did not increase D3 levels. When you place carrots in your dish, you do not have sprouts !! The purpose of taking D2 is not about raising D3 and D3 metabolites levels but D2 and D2 metabolites ones. D2 and D3 molecules react in same biological fields, and D2 is beeing used with success for decades. It is not honnest to omit that and to pretend D2 is worthless because D3 levels do not raise : it is a false demonstration.

In my view solar exposition is the most important factor for everyone, but when not getting enough D from sun, the plant-form D (D2) is perfectly suiting. I have never read any animal study that tends to show D3 supplementation is preferable to D2; on the contrary toxicity is shown to be a lot greater with D3 hypervitaminosis than with D2 hypervitaminosis (a lot more calcifications with D3 than with D2). Plants represent the reference in food because everything we need, even B12 for example, can be found in the plant kingdom; that is not the case if the animal kingdom is taken as food. Then ask your intuition about D2 and D3 being the most desirable form of Vit. D when not receiving enough sun...

Readers should remind that there is two different 25(OH)D : the one with D2 and the one with D3, and also two 1,25(OH)2D. Measuring the D3 forms (most commonly measured in blood tests) is meaningless if you take D2 supplements. It is NATURAL having in the blood less 25(OH)D in its D3 form during winter than during summer because at that time there is less sun activity. Correcting lowering Vitamine D activity during winter with D3 supplementation rather than with D2 is illogical and unatural.

R. Jehl
Naturotherapist in France

Individualized Vit D supplementation is necessary. The arguments regardind D2, D3, single Hydroxy and double hydroxy depend on your body and its current disease status. For example, giving a D2 or D3 to a patient without kidney function is useless because they cannot convert it to the ACTIVE form of 1,25(0H)2D3. Kidney patients must take activated or the final form of vitamin D 1,25(0H)2D3. Liver dysfunction patients cannot convert the D3 to the single hydroxylated form, which the kidney needs in order for its metabolism. So, really, blank statements as given by the French provider indicating D2 for all is FALSE. Look up the metabolic pathway. If you are stone cold normal and only have low Vit D, then you can take either form of regular D2 or D3. If you have a disease, GI malabsorption, liver or kidney disease, granulomatous disease etc you should consult a professional to guide your dosage for proper results. I do like combining some fast acting forms with some slower acting forms to help folks feel better faster and then long term treating with slower forms if they can metabolize them. Everyone is unique and sometimes trial and error are required.

I have read through these posts with interest. I am new to this site, looking for a solution to my 'no beef' diet and insufficiencies in Vitamin D (3 mostly). I am on synthroid, but never knew of the Vitamin D correlation.

I find that in the US there appears to be NO 50,000 Vitamin D without bovine capsules. I cannot find a veggie tab surrounding even the D2.

Can anyone advise where I might 50,000 units of Vitamin D3 with no 'cow' gelatin coating?

Do you have any recommendations for those who are vitamin D deficient but cannot tolerate oil based capsules but have no problem with fortified foods?  Is the UV lamp a safe alternative?  Is there a powder form of D that is effective?

I've read this discussion with a great deal of interest.  I've been supplementing with Vital Nutrients capsules which are vegetarian.  They make 2000iu capsules and 5000iu capsules. http://www.vitalnutrients.net/vnestore/detail.asp?product_id=VNVD2

Hello this is Ava again from Germany, I posted a long rant into this thread some while ago.

I'd just like update that I've switched from irradiated mushrooms to a vitamin D2 supplement as drops ( Sterogyl 2,000,000 ergocalciferol ) and my 25(OH)D levels are really nice in winter at 156 nmol/L or 62 ng/ml! In France it's availalbe without perscription and we've been able to get it Germany too. It's very cheap around 2 Euro for 400,000 IUs despite the name. I started out with 13 drops / 5200 IU for 14 days, then I took a single mega dose of 300,000 IUs. Since that I've been taking 70.000 IUs once a week. I'm very tall at 6' flat and this is the dose my body needs to achieve good levels.

It's also possible to just keep on taking 3500 to 5000 every day, however it then takes much longer to reach desired serum levels.

If you have access to this cheap product and take 5200 every day, the 2.50 Euro or so will still last you almost 3 months.

Vitamin D3 Iu:

NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 Iu on discount at NutroVita.com.

For more details please visit:
http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively

The drug industry seems to have put a full time anonymous troll at work  replying to posts my blog.

They always appeal to authority, along the lines of "How dare you say .... I'm a medical professional and what you are saying is dangerous...." They don't seem to get the part about how no one is going to believe their authority since they're posting anonymously.

I occasionally post one of their screeds as my forum regulars enjoy bashing them. But my blog policy is that I don't make anonymous posts public if they are without merit.

I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug.  I suppose he considers himself smart and ahead of the game? Hah!!! Mother nature always wins!

Hi, Jenny--

Good for you to stand up to them.

I agree: They're very clever about crafting their comments to make you feel small. I find it funny. Here we are, David vs. Goliath, and they resort to deception, subterfuge, and smear to make their points.

Anonymous (above): Excellent point! I failed to mention how effective diet is for high triglycerides.

The argument that the vitamin industry is self-regulated and answers to nobody is genuine.  Look what happened to the financial industry with self regulated derivative products!  Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.  My triglycerides were 800+ ... now they are 300.  My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins.

Re:  "I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug."

So you've set up a hypothetical situation and trash the person on the basis of your assumption/wondering?  And that makes you smarter than ... who?

lol OUCH, Dr. Davis.

I think the CEO's Mama is going to feel that one.

Excellent reply.  Although, I do think that one positive thing that can be taken away from what the "anonymous" person wrote is that it is very true that supplements are not regulated.  It is extremely important that everyone researches where their supplements come from and if they do meet some kind of quality control standards.

I was thinking the same thing, what is he eating that nothing less than a prescription(?) drug has any effect?

Regarding purity...  What?  Like no one else has ever had any recalls?

What about all of the drugs that garnered FDA approval and were then recalled due to long term effects that did not show up in trials?

I agree that person was probably affiliated with Big Pharma in some way.

In early 2006, my triglycerides were 432mg/dl with no supplements. After taking four Life Extension Super Omega-3 capsules (which yields 2.4 grams of EPA/DHA) once daily and absolutely NO changes in my diet or added exercise, my triglycerides dropped to 157mg/dl when I retested a little over 3 months later, so I know their fish  oil works at reducing triglycerides. Life Extension brand costs me about 63 cents per day at that dosage and it has a 5 star rating from the International Fish Oil Standards. Here is a snip it from their website:

"The International Fish Oil Standards (IFOS) is an international program concerned with the quality of omega 3 products, as it relates to the international standards for purity and concentration established by the World Health Organization and the Council for Responsible Nutrition."

http://www.lef.org/Vitamins-Supplements/Health-Nutrition-Awards/Fish-Oil-Supplements.htm

http://www.nutrasource.ca/ifos_new/index.asp?section=ifosfaq

I also like the fact the Life Extension fish oil has sesame lignans & olive fruit extract in it as well.

Supplements are not FDA regulated?  It kinda ruins your point when you make a completely false comment like this.

Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:

http://www.cfsan.fda.gov/~dms/supplmnt.html

http://www.cfsan.fda.gov/~dms/dscgmps6.html

Oh, to be a complete buffoon....

I have noticed that any time I leave a comment that challenges any part of the current dogma that inevitably someone claiming to be a doctor steps up to tell me that I don't know what I am talking about....

I eat tons of saturated fat and sometimes I take my fish oil but my trigs are 104  because I dont't eat any sugar or starch. Why take drugs when you can control the entire spectrum of cholesterol values and other health issues with diet?

People you dont' need to take any drugs. You've been brainwashed big time.

OOps Dr. Davis, I accidentally published my last comment before proofing it and messed up a link. here it is as it was intended (post this one instead of the other one please).

I can think of one instance where fish oil won't reduce triglycerides / VLDL:  in the presence of antioxidants.

I know it sounds strange, but the mechanism by which VLDL/triglyceride reduction takes place depends on peroxidation products of n-3 polyunsaturated fatty acids.  

It was noticed that when people take antioxidants with their fish oil, for instance vitamin E, the plasma TG/VLDL reductions did not take place.  I experienced this first hand... and I was baffled why the fish oil was "not working" at reducing my triglycerides.

In a nutshell, the liver determines the presence of peroxidized [hopefully glycated as well] polyunsaturated fatty acids (PUFA), is not ideal for release into circulation, so through a process dubbed PERPP, the VLDL particle that never was is aborted and is instead kept inside the liver.

The article is called "Hold The Antioxidants and Improve Plasma Lipids?" by Ronald L. Krauss, M.D. Ph.D. can be read at
PubMed or
The Journal of Clinical Investigation

Peter genially deconstructs the described process in detail at AGE RAGE and ALE: VLDL degradation and Fish Oil

So probably the best way to reduce triglycerides is to cut out the wheat/starch/sugar/honey/fructose.

I still take fish oil (with antioxidants) but I eat low-carb so my triglycerides are below 100.

R.L. Krauss is one of the researchers responsible for recognizing that small dense LDL  are the atherogenic LDL.  yet as an advisor to the AHA, well... not much progress there, unfortunately.

Thanks for your blog Dr. Davis!

Alex

...And if they don't work for the industry, they probably should and collect their commission!

It just shows desperation. You can paste posters and ads everywhere but when it comes down to it, you can never beat word of mouth which will always help you achieve minimal cost and max. benefit. And word of mouth just expanded with the net.

People like to help each other. Industries don't.

Dr. Davis: Did you and Jenny compare IP addresses between your emailer and her commenters by any chance?

I searched for the following keyword combinations:

fish oil recall
cvs fish oil fire retardant
cvs fish oil recall
cvs omega fire retardant recall
cvs fish oil PBDE recall
cvs fish oil PCB recall

I would hope that news of the nation's number 1 chain pharmacy having a very popular supplement recalled because of toxic contamination would be heavily represented in search results. But NO!

Except that last keyword combo's first result did have "lab tested for contaminants", and surprise, CVS's fish oil caps passed (and they sourced Consumer Lab, so extra cred for their article):
http://www.supplementgenius.com/2008/08/09/50-fish-oil-supplements-get-lab-tested/

One of the emailer's other claims intrigued me, so I searched these keyword combos:

omega 6 inhibits bioavailablity of omega 3
omega 6 decrease bioavailablity of omega 3

I haven't found much on omega 6 affecting bioavailability of omega 3 yet, but I did find a 97 study about "inadequate intake of vitamin E results in a decreased absorption of omega-3" at least.

"Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:

http://www.cfsan.fda.gov/~dms/supplmnt.html

http://www.cfsan.fda.gov/~dms/dscgmps6.html"

Sadly, that's not really regulation.  

From the FDA website:
"Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.* Manufacturers must make sure that product label information is truthful and not misleading."

It's the classic case of police oversight (actively looking for violators) vs. fire-alarm oversight (only responding when an alert has been raised).  So while it's true that regulation exists, it's not where it needs to be.

If you have time, check out the documentary "Bigger, Faster, Stronger."  They show how absurdly easy it is to produce, promote and sell supplements that are complete and total garbage.

Who needs fish oil supplements when you can eat the whole fish???

In all seriousness there may be quality control issues with supplements, but I *decimated* my trigs simply by not eating excess carbs. I can't think of a way that something you don't eat could be adulterated

Hi, Shreela--

Sorry, but it didn't even occur to me. We'll have to do that next time (and I'm sure there will be a next time).

Remember: We take fish oil to accomplish more than reduce triglycerides.

It also reduces cardiovascular events, accelerates clearance of post-prandial abnormal particles, and modifies plaque composition.

My cardiologist tried to prescribe me Lovaza over the fish oil I normally take, using the argument that OTC brands may have mercury in them. I of course declined her offer, and tried to tell her that OTC brands are rather unlikely to have mercury.

But it got me interested in the differences, if any, between Lovaza and OTC fish oil. I originally contacted GlaxoSmithKline, which was a waste of time, no response. So I went right to the source, Pronovo, the company that actually makes Lovaza for Glaxo. I had two questions, why are transfats listed as being in the product, and what about oxidation, which is the real potential problem with fish oils, not mercury contamination.

Response from Pronovo for the transfats question:
However I can assure you that Lovaza has never contained partially hydrogeneated oil. This is simply a mistake. I agree, it is not good marketing - and we are working on it.

-- Okay, weird answer, but I guess it's believable... kinda. I still don't see why they wouldn't have fixed it by now though. It's sort of like marketing Lipitor -- now with extra trans-fats!

And regarding oxidation, which i consider the main issue with fish oils, they say that Lovaza is stable at room temperature, even after its opened. They went on to say they don't recommend refrigerating it, as the shelf life may not have been determined in refrigerator conditions.

Huh? To the best of my knowledge, after fish oil has been opened it's always been considered safest to refrigerate it, to limit potential oxidation. If a liquid is used, it's even more important. And the higher the percentage of omega 3s, the greater the potential for oxidation. So why wouldn't it be suggested to refrigerate Lovaza?

The only reason I can come up with relates to the last thing they said to me:

Anyway, you can store Lovaza toghether with other medications. I gues this may be considered a
good thing when it comes to patient compliance.

---

And then I thought about how pharmacists store medications. Or say, mail order places, which ship 3 month supplies, where they will ship using their own bottles -- meaning they had to use open Lovaza bottles. So this basically means patients will be getting fish oil that has been sitting around for god knows how long, open, and non-refrigerated... and then finally shipped in the Medco (or whatever mail order) bottles, to be used for the next 3 months. And this whole time the fish oil has been exposed to air with no refrigeration.

So how is Lovaza better than OTC fish oil again? At least I can count on OTC fish oil being sealed and not exposed to air when I buy it.

Hi, Nameless--

The pharmacist opening the bottle of Lovaza hadn't occurred to me. Excellent point.

Yet another reason to avoid using this overpriced product.

We're missing this:

the peroxidation is what allows the liver to abort the production of VLDL/triglycerides and through the subsequent delipidation cascade the other particles that would result. See my post above!

The plaque composition and reduction of cardiovascular events "probably" due to it affecting the omega balances (6:3) and therefore the eicosanoid production.

I take generic, enteric-coated fish oil. The one I buy has some tocopherols (to prevent peroxidation).

The anon poster made a grave mistake fish oil is not a "drug" it is a food!

The only advantage to Lovaza I can see, assuming the patient gets sealed bottles of the stuff, is the reduction in pills daily. And I guess that'd be good for those with stomach issues where they can't tolerate too many pills a day. Although even there we are only talking about like 1 or 2 less capsules daily.

What would be interesting are studies comparing high dose capsules vs low dose in patients, and see if there is any difference in outcomes. I am curious if Dr. Davis has noticed any difference between patients on fish oil with higher omega 3 content (ex: 600mg/capsule vs 300mg/capsule). In theory, the additional non-EPA/DHA fats in the capsule of lower strength fish oils could have some negative effects. But without studies, who knows?

Same with the forms of fish oil, which tend to be ignored. Are ethyl esters as effective as triglyceride forms? The current studies are mixed... some show no difference, some show the triglyceride  form of Omega 3s absorbing a lot better.

For Lovaza to back up any of their claims, they need to do a head-to-head study with a good OTC fish oil, say like Carlson's or Nordic Naturals. But we know that'll never happen. Generic Lovaza may hit the market by years end too, depending on what the courts rule, which will be weird. Companies like the ones I mentioned above, or Meg-3, could cash in by licensing with a drug maker and just reselling their OTC fish oil as a new 'drug'. Which would completely obliterate any notion that Lovaza is different than OTC fish oils too.

I am prescribed Lovaza, though it's called Omacor here in the UK. I used to buy my fish oils from the health food store and it was costing me around £25 ($36) per month - obviously fish oils are much dearer in the UK - so I asked my cardiologist to prescribe me Omacor and he did. My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

I was very puzzled that the manufacturers say not to store Omacor in the refrigerator and on pressing them, saying that in the summer I could not be sure that the temperature in my house would stay under 25 C they conceded that I could store the Omacor in the fridge: "If you feel that a temperature rise may affect your Omacor, then it is possible to store the product in the fridge."  !

Anne

Has anyone found differences between brands (or between the same brand at different times, they may come from different sources) in their palatabily?

I tend to feel bloated and get fishy belches with the capsules I've tried (not Costco or Lovasa but various OTC and mail order types) which doesn't happen with the whole fish, except for elderly mackerel or stale kippers. You don't know how old the capsules might be or how they've been stored.

My theory is, by reducing the carbs and Omega 6s a lower dose of Omega 3s will probably work. I'll let you know if I'm right or not after I'm dead (grins)

Michael said: "The argument that the vitamin industry is self-regulated and answers to nobody is genuine."

Comment: Some easily identifiable companies self-regulation is far superior than the FDA's regulation of drug companies Michael considering the FDA's record on such matters. If one were to take the time to look for reliable providers of high-quality supplements they would be far ahead of the game and have zero the risk of the myriad of side effects caused by pharmaceutical drugs which are often times rehashed toxic byproducts of the manufacturing process put in pill form instead of being paid for to dispose of.

Michael said:" Look what happened to the financial industry with self regulated derivative products!"

Comment: Relevance?

Michael said: "Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.

Comment: Have at it Michael and take with it the dozens of risks for side effects that go with it vs. the safety of the fish oil supplements.

Michael said: "My triglycerides were 800+ ... now they are 300. My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins."

Comment: Just what you would expect from a doctor who is PROGRAMMED to view vitamins or other nutritional supplements as worthless from YEARS of programming efforts by Big Pharma and virtually no classes on Orthomolecular medicine which has been widely studied for decades upon decades with great results and few risks at even high levels of dosing to deal with serious nutritional deficiencies (aka-"chemical" imbalances).

Chalk another one up to the propoganda machine Michael - you seem to have bought in hook line and sinker or maybe you're just a paid propogandist?

In health and in truth,
Bill

Anne... I must pick at a nit.  Yu said:

My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

They are far from free.  I understand you do not seem to have to pay for them, but we are all paying, even on this side of the sea, for the "free percriptions" folks receive.

Hi Capslock,

The money I am charged in my taxes goes towards the cost of the National Health Service so from that point of view my prescriptions are not free, but I am paying my taxes regardless of whether I buy the fish oils from the health food store or get them at no cost on prescription. Since the fish oils are *extremely* expensive from the health food store and since I pay my  taxes this seems the best deal to me.

Anne

Hi Capslock, a PS to my previous message - I'm thinking you must be thinking that the UK system is similar to the American one and that only low income people don't pay prescription charges ? No, everyone under 18 and over 60 gets their prescriptions free, and anyone who has one of certain chronic conditions gets them free too, doesn't matter what your income is or even if you're a millionaire !

If I did pay for my prescriptions then the maximum charge for anyone is £7.20 per prescription, no matter the price of the medicine, no matter the income of the patient....and £7.20 for a prescription of Omacor fish oils is still much cheaper than buying fish oils from the health food store !

Anne

Thanks for this informative post