Amen!  I took Lovaza for a year when my physician gave me a coupon for a monthly supply at $5/month for 12 months.  I obviously stopped when it ran out because of the "real" price.  I've started using CardioTabs (http://www.cardiotabs.com/Omega-3-Fish-Oil/productinfo/OMEGA-EC/) instead on the advice of my physician.  Any feedback on this brand?

What is your opinion about Nordic Naturals DHA?  It contains 450 MG DHA and 90 MG EPA, along with 15 IUs of Vitamin E (alpha tocopherol) in two soft gels.  I've read in many places that fish oil containing more DHA than EPA is superior.

Even though Obama and his socialists would vehemently disagree, you make a logical point.

I use Spring Valley brand and it costs me about $11 for a two for one deal (two bottles). 200 capsules per bottle 1000 mg each. EPA + DHA is only 300 per capsule but for the price taking 6 per day isn't a problem. Under $12 every 2 months isn't bad.

Hello everybody!

Well, I see this article refer to a matter of price and less about quality.

Dr Davis, please, what do you think about NOW Foods suplements?
Sorry for being offtopic!
Thanks for your blog, your work changed my life.
All the best from Romania!

For maximum absorbability, use liquid not capsules or gels, and eat with a high fat meal.

New research also shows the probiotics in yogurt also help to minimize the oxidation:
http://www.nutraingredients.com/Research/Yogurt-proteins-could-stabilize-omega-3-enrichment

as does pollen spore shells (exines)
http://www.nutraingredients.com/Research/Pollen-spores-could-enhance-omega-3-bioavailability

A good value for omega-3s is Twin Labs:
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

Take a look at Trader Joe's odorless omega 3. 90 capsules for less than $9. 1200 mg fish oil 400 mg EPA and 200 mg DHA in each capsule. The only brand I have been able to find with a 2 to 1 ratio of EPA to DHA. And there is no after taste.

I eat omnly grassfed beef and wildcaught salmon. Chicken is pastured. I don't eat grains or vegitable oils. I use coconut oil and tallow for cooking.
That being said, can one get too much Omega 3?

Great point about the cost effecting others. Studies ghave shown that fish oil that is too pure is not as good as fish oil with a little bit of "mother" in it. Clean not sterile.

Huge props to you, Dr. Davis, for admitting regret and posting future accountability by NOT filling scrips for Lovaza.

Hopefully, the husband of that patient reads your blog.  But I doubt it.

Hi Dr. Davis,
Thank you for living your principles, and, as always, for your candid and unvarnished thoughts.
Sincerely,
Tom C

I take 4 of Sam's Club triple-strength fish oil plus a 1 gram Krill Oil from Puritan's Pride.  The omega 3s, ground flax seed, curcumin, and Jean Carper's Super Osteo Gold have allowed me to jog at age 71 without any joint injury.

Assuming no problems with Lp(a) you can reduce the need for so much fish oil by changing your diet to low omega-6 intact.  There is competition between the two essential fats so try to limit foods high in omega-6 first.  Once you've done that you can cut back on all those fish oil capsules. It's probably helpful to take some vitamin E too to prevent potential fatty acid oxidation.

Thanks for not being part of the problem, Dr. Davis.

The thing is, some prescription plans have a copay. If the plan of the couple is like mine, they'd have had a $30 copay. It's possible they were only saving $20 a month. For our friends outside the U.S., that'll buy a movie ticket and popcorn for one person. Nine hundred dollars is more than my mortgage payment.

The real problem is the pharmaceutical industry and not patients who wish for prescriptions or insurance companies. Here in the UK, the last I heard,  Lovaza (marketed under the name Omacor) costs the National Heath Service £50 ($78) per 100 capsules, that is considerably less than what it costs in the US and roughly the same as comparable fish oil omega-3 supplements from health food shops in the UK. This is the pharmaceutical company charging this and it is they who should be brought to account when it comes to over profiteering from patients and insurance companies, imho.

I've started using CardioTabs instead on the advice of my physician. Any feedback on this brand?

Not a very good deal, Anonymous.

Each bottle includes 180 capsules, but a serving size is 3 capsules (to equal 975mg of DHA and EPA). Multiply that serving size by 6 to attain Dr Davis's objective of 6000mg of DHA and EPA per day. This means:
1) You must ingest 18 (!) capsules/day;
2) Each bottle of 180 capsules is a mere 10 days supply; which means
3) 3 bottles/month at a cost of ~$100/month.

Several commenters have asked about specific brands.

Consumer Lab (www.consumerlab.com) is a great place to start to see what brands have been tested.

While it is clear that no mercury, PCBs, dioxin, or furans have been measured in any brand of OTC fish oil (slight contamination of cod liver oil, not fish body oils, with PCBs), there are differences in oxidative breakdown products.

A quick test of oxidation: Smell your fish oil. It should only be faintly fish, not overwhelmingly fishy.

Can you give us some references on why 6,000 epa/dha for lp(a) carriers?

Finding a suitable plaques for our home is little hard to do. Your special taste of art and rare places provide it in best quality sometimes become the challenges to do it. But, because of the importance of the plaques you have to find it whatever it takes.

What about Weston A. Price suggesting that there is a potential for Omega 3 overdosing as well as the concern from contaminants  in fish oil compared to Cod liver oil due to fish oil being mostly from farmed fish? Also the benefits of Vitamin A and D from taking Cod liver oil rather than fish oil.  Personally I don't use cod liver oil, but should I be concerned about too much fish oil? Have there been long term studies?
Thanks

Tommy

This is one of the many reasons for our skyrocketing insurance costs. People need to take more responsibility for their own health. Unfortunatley, this concept is in direct conflict with the prevailing trend in our society.

With the direction our health care industry is going, future costs will become quite prohibitive. In an effort to fight class warfare this new health care system will create a class of those who will be able to afford effective health care while the rest of us who are dependent on the government's version will be left waiting . . . It really is our fault.

What's pathetic about the situation is, if the insurance company would shoulder some of the cost of basic fish oil instead of the prescription Lovaza, everyone in the system would benefit.  The way it is, everyone in the system loses.

I have always used scott emulsion. A couple tbs per day.
is that one good?

Anonymous about insurance paying for supplement fish oil--

Yes, a brilliant idea!

I've had the same idea and wondered why an insurance company didn't just shell out the money to prove for themselves that OTC is every bit as good as the prescription, then encourage their insured to use this instead. It would provide HUGE savings with no downside.

Dr Davis

with the us treasury printing currency by the boatload if everyone operated with cost savings in mind there would be hyperinflation due to excess money floating in the economy. So government channels try to mop up and circulate as much currency as possible and keep the bottlenecks to a minimum.

No wonder usa is looking at a consistent high inflation future or maybe hyperinflationary future.

I wonder about oxidation and possible immune system suppression at the 6 gram dose level. Although I suppose in patients with high Lp(a), it's the lesser of two evils. Emulsified fish oil may be worth trying, to see if it decreases Lp(a) even further.

Eventually Lovaza will go generic, which will be sort of odd, when prescription fish oil potentially could be in the same ballpark as OTC. Not sure how the FDA will make sense of it, unless the dosages are exactly the same... not sure how prescription fish oil ever really made sense really.

Also, don't eat with fiber as this hurts absorption.  

The following are listed in the ConsumerLab.com report, but I'm not a member so don't know how it rates:

Twin Labs Mega EPA ( 1 capsule = Epa 550 Mg, Dha 215 Mg )
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

Nordic Natural Ultimate Omega + CoQ10  ( 2 capsules = Epa 650 Mg, Dha 450mg)
http://www.nordicnaturals.com/en/Products/Product_Details/98/?ProdID=1446

Green Pastures Fermented Cod Liver Oil and Butter Oil Blend (~139 mg EPA, ~83mg DHA),
http://www.greenpasture.org/retail/?t=products&a=line&i=fermented-cod-liver-oil

Vital Choice Wild Salmon Oil (240 mg EPA, 220 mg DHA)
http://www.vitalchoice.com/product/omega-3-salmon-oil/1000-mg-sockeye-salmon-oil-softgels-180-count

The nordic product also has 60mg of CoQ10, and 30IU of vitamin E!

Dr Davis as a practicing neurosurgeon and age management doc I write for Lovaza all the time.  At least 75 Rx a month.  Does it bother me?  Yes it does.  But I feel better knowing those who are taking it are being proactive and healthy instead of a dog chasing its tail with his or her PCP.  Everything is relative my friend.  I suggest you focus in on the good because their is bad in everything but if you focus in on the good it magnifies itself.  Keep fighting the battle.  I do. I get more patients off Statins and on Fish Oil and resveratrol than you can imagine.  Love your work and the book.  I have saved lives because of you.  you passed it forward and now I do too everyday.  Dr. K

Presumably, the guy has been paying his health care insurance premiums.  Based on the facts you describ, his insurance covers prescriptions for Lovaza.  Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?

@anonymous who wrote:

"Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?"

If we focus only on an insured and his contractual rights under his insurance policy, he should not "have to pay additional money out of pocket..."

However, that focus is arguably too narrow as it fails to consider the effect on insurance premiums for the rest of an insurance company's policy holders/payers. This is one of the evils of a system that requires citizens to obtain health insurance - it forces other people to subsidize, to use Dr. Davis's example, an expensive prescription when cheaper and equally effective alternatives exist. This is not an isolated example; consider prescription Vitamin D2 vs. D3 supplementation, etc...

I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
  I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
I can see both sides of the situation. The situation is a grey area.
I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
  I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
I can see both sides of the situation. The situation is a grey area.
I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

As a liberal, I say thank you. We can only provide health care for all, if it is affordable. Abusing the system only ensures less and less people will have access to quality health care.

I love this article.  It makes me gag when I see commercials on TV for Lovaza or Niaspan.  This is one example of what's broken in our healthcare system.

+! on the Trader Joe's omega-3 capsules. They are cheap and they have 50% concentration of combined EPA/DHA. TJ's sells two models of their omega-3 and the other has a lower concentration.

I'll take Lovaza when it's a free sample. It has a 90% concentration but I think the overall total in Lovaza is not much higher than what is available from the local drug store.

The only advantage Lovaza could have is that is monitored very carefully for purity and the like. I'm not sure that's much of a concern.

-- Boris

Are such high doses necessary? 7-8 grams per day of EPA/DHA seems like it would get you well past the desirable 8-10% on the HS-Omega-3 Index (usually only requiting 1-3 grams daily). Is there any need to go beyond 10%?

I take 5-6 TJ omega-3 capsules during the day. Maybe that's a bit much but maybe there is a saturation point? I don't know. I know that omega-3 has cleared my mind, reduced my eye pain, and lowered my blood pressure.

-- Boris

So glad to hear it. When the ads came on TV, it was just another Big Pharma scam. Take a natural product and package it for mega profits.

I finally knuckled under and let my doctor write a prescrption for Niaspan for me - as we were fighting terribly as she was *ADAMANT* that I HAD to take STATINS as my cholesterol was too high (though my HDL was 62 and my triglycerides were 65) and I was flat out refusing. So she then suggested I had to take Niacin.

I was willing to give Niacin a try as I have seen Dr. Davis talk about it here - and she just sent in the prescription via her computer to the mail-order pharmacy I'm required to use to get my prescription insurance coverage.

So imagine my SHOCK when I got the online notice that the prescrption had been filled, and I was able to look it up. A 90-day prescription of Niaspan was about $400! I almost fainted, though my patient share was $75 - or $25/month.

But I still thought it was highway robbery and will never fill the prescription again. If I continue t take Niacin I think it will be Slo-Niacin for me. I'd heard Niaspan was expensive, but had no clue it was that much!

Dear friends,

On Omega-3 highdoses EPA/DHA ; Minami Nutrition is providing Supecrital extraction (low temperature, and not molecular distillation!!) Omega-3 as well guaranties on purity below the detection limit next provinding a 93% Omega-3 per one softgel or 820 mg EPA/DHA per one softgel. look into www.minami-nutrition.co.uk availabel in the US at Wholefoods.

Some people are worry on too much intake of fish oils. Indeed if you swallow standard fishoils with low levels of EPA/DHA as most US products you may swallow also a lot of saturated fats. Go for 1 softgel a day a softgel tahts provide you almost 1 g Omega-3 or a minimum as 820 mg EPA+DHA per softgel. a lot of brands having high levels of pcb's.(see http://www.cbsnews.com/stories/2010/03/02/health/main6259938.shtml ) be also a ware when mention "per serving" could be 2 to 4 or more softels a day.  Avoid liquid oils as they oxidize fast, as well I'm not in favor of codliver oils as too low on EPA and DHA and to high on vitamin A when taking 500 mg EPA/DHA.

THANK YOU!! For taking a stand where many in your profession will not. We need more of this!

Even the traditional medical community is finally realizing that the omega 3s in fish oil provide some of the best natural health benefits on the planet. Worldwide, the omega 3 supplement market is in the billions of dollars. The drug companies want a piece of the action.

Great insights about how we can have a healthy lifestyle.Omega 3 is good for the heart that's why many people are eating foods rich in Lycopene.

Vitacost.com has their own brand of fish oil, NSI Mega EFA® Omega-3 EPA & DHA.  At 6000mg EPA/DHA a day (10 capsules) in a 240 cap container for $22, that comes out to be $27.50 per month.  And they often have 10% off sales, like right now till 10/31/10.  My personal experience with them has been good, their NSI brand has been high quality, and I rarely find a better price elsewhere.  I'm currently taking 6000mg EPA/DHA daily.

Dr. Davis: This is incredibly encouraging, especially since it occurred in an 81 year old man, whose biological repair systems would be expected to be somewhat slow, in the short span of a year. I hope you will tell us what he did.

Hi, Rich--

Please watch for the upcoming Track Your Plaque newsletter for February and we will detail his entire program.

The question I have - what happens if you eliminate wheat, add the fish oil, and niacin, normalize vitamin D and still don't hit the TYP target of 60-60-60? What's the thought process for deciding to take a statin???

Dr. Davis,

Have you checked this out yet. It looks like something worth considering. I've heard some very interesting things lately about new microbes being found in association with diseases not considered infectious until now. The association of enterovirus with Type 1 and Type 2 diabetes also points to the inflammation potentially being nonautoimmune in nature and raises the question of whether Vitamin D is downregulated as part of the body's attempt to fight invasion.

Since the studies I've found show raising Vitamin D does NOT have a positive impact on diabetes, though Vitamin D is low in diabetes, this is a serious concern.

If we are eliminating inflammation but not organisms causing inflammation, long term the results may not be so good.

A total cholesterol of 132 can be quite unhealthy considering that all cause mortality in the lowest quartile of total cholesterol is twice the death rate in the upper quartile of total cholesterol.  A paleo diet would produce more optimum cholesterol numbers (no grains, etc, as recommend here) but that diet varies by latitude with more carbs the closer to the equator one lives with total cholesterol varying accordingly.

Additionally, dig a little deeper and Sam likely has a much better LP(a) value than John.  He's probably sick fewer times during the year, and he's risk of getting cancer is half that of John's.

Oh, and Sam probably has less bodyfat as a nice healthy side effect of wheat reduction.

My HDL was suck at 38 since 2002. I went to 40mgs crestor mid 2008. I put myself on 2 grms of niacin, this fixed the perpetually high trigs, and the 40gms crestor crushed the LDL

Then I found this blog and went on vitamin D.  I already had followed fish oil but not consistently so I fixed that.  After 4 months on Vitamin D, my HDL was up to 50
oh...and my LDL dropped too.

My Dr. told me I was a poster child for Crestor treatment but she allow the change back to 20mgs anyhow.  I did take a month off from crestor to get rid of the muscle/bone aches and pains and have now restarted 20mgs with no problems.

I am going to spend a few months on 20mg and check the lipid profile, if good, next step is statin free for me.

I eliminated wheat - and all grains - from my diet nearly three years ago (I eat low carb Paleo). My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John's or Sam's:

LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl

My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.

I have read too that too low a cholesterol level is just as bad and, maybe worse, than too high !

Anne

Hi, Jenny--

Excellent point. Perhaps a topic for a future discussion.

However, we do witness positive effects on various phenomena associated with diabetes when vitamin D is normalized: reduction in CRP, dramatic increase in HDL, modest reduction in triglycerides and small LDL, and reduction in blood sugar if insulin resistance is present.

Will vitamin D replacement impact on cardiovascular mortality in diabetics? Uncertain, though I predict it does to a substantial degree.

Plus John will likely experience some nasty side effects from the statin that Sam will not!

Jenny, love your blog, your spirit,and your free questing mind.

My take on Vitamin D and Diabetes:

In general, Vitamin D does better at preventing disease than ameliorating it once it exists.  There is soom good Finnish epidemiological evidence that supplementing Vitamin D to levels in the 50's can decrease the incidence of Type 1 diabetes in children.
Proposed mechanism has to do with the leaky gut hypothesis.  D deficiency leads to impaired intercellular signalling through degredation of tight junctions between cells.  Adjacent intestinal lining cells can't effectively talk to each other. Bacteria, viruses etc "leak" through, The immune system gets overwhelmed, then the immune system notices that pancreatic islet cells look a whole lot like a portion of a proteus or klebsiella bacteria and whammo, you have type 1 diabetes, rheumatoid arthritis, etc.  

Type 2 diabetes seems to be another story.  Since Vitamin D is often sequestered in fat, lowering serum 25-OH Vitamin D levels, and type 2 diabetics tend to be obese, therein may be part of the association.  

But no one essentially dies of a Hgb A1c of, say, 6.7.  As you know, it's the sequelae -  the heart attacks, strokes, CHF.  I do recall one recent study on MI, diabetes, and Vitamin D levels.  It may be that D can help prevent the adverse sequelae of type 2 dm with no direct effect on A1c.

Dr. Davis,

I just saw your reply to my earlier question.  The one decent study I've found suggests that dramatically raising Vitamin D has no significant effect on blood sugar.

My concern is this: when we lower inflammation by raising Vitamin D are we putting out the fire or turning off the smoke alarm.

Though inflammation clearly raises heart attack risk and lowering it does prevent heart attack, there are many other forms of inflammation that are important because it's a sign we are fighting off invaders that need to be fought off. So if we turn down inflammation we may be promoting microbe-stimulated cancers five years later.

And if as some evidence suggests, cardiac inflammation stems from bacteria originally associated with gum disease, raising the Vitamin D might lower the inflammation but not bacterial infestation which over time cannot be good for us.

Is there any evidence that Vitamin D does more than improve the markers like CRP (the smoke alarm) and actually eliminates the disease state?

So far I am not seeing that in Diabetes.