Dr Davis:

PREVENTION v PREVENTION!
A curious thing but I wonder if you mid-westerners really need to be giving up iodized salt at all if you are taking care of your potassium and magnesium?
When you get time, please let us know your patient findings on mineral status.
"Lite" salt contains a % of potassium which may be  iodized. Of course one's ability to take potassium maybe compromised by some medications.

Mike V

*************************
UK ARTICLE
Is salt REALLY so bad for your blood pressure?
By Jerome Burne
30th March 2009

It's been demonised for years. But suddenly experts are asking whether we're missing the bigger picture about salt...

We're all eating too much salt and it's going to give us high blood pressure - that's the message we've heard for years, but now new research suggests salt is being wrongly demonised.
A recent study suggests that by concentrating on the effects of salt we could be missing the bigger picture. That's because salt doesn't affect blood pressure on its own; it does so with another mineral we get in our diet - potassium.
Blood pressure is constantly being raised and lowered - salt is involved in raising pressure by tightening arteries, while potassium is part of the relaxation system. So making sure you have enough potassium is vital.
Salty snack: Research has found that eating more salt does not necessarily raise the risk of heart disease
This was highlighted in the study from Loyola University in Chicago. Researchers measured the amount of salt in the urine, an accurate way of measuring how much had been consumed, and found no significant difference in the risk of heart disease whether patients had been eating a lot or a little. What did reduce the risk, however, was the ratio of salt to its balancing mineral potassium.
The new study 'is a quantum leap in the quality of the data', says lead author Dr Paul Whelton, an epidemiologist and president of the university's health division. That's because it followed nearly 3,000 patients for between ten and 15 years.
Whelton now believes many of us need to significantly increase our potassium intake to help our arteries.
'To lower blood pressure and dampen the effects of salt, adults should consume 4.7grams of potassium per day,' he says.
The British recommended daily dose of potassium is only 3.5g. Foods high in potassium include potatoes, sweet potatoes, yoghurt, tuna, lima beans and bananas.
'To lower blood pressure and dampen the effects of salt, adults should consume 4.7grams of potassium per day'
_______________________________________

As for salt, Dr Whelton and colleagues from America's Institute of Medicine say we should stick to less than 6g (a teaspoon) a day, which is the same as the existing UK guidelines.
But his study is not the only one to raise questions about conventional approaches to this problem.
A review of the evidence published in the British Medical Journal (BMJ) seven years ago found that while cutting back on salt might help those taking medication for high blood pressure, the research showed no clear benefits for everyone doing it.

Even more extraordinarily, in 2005, researchers at the Albert Einstein College of Medicine in New York published the results of a 13-year study that had followed 7,000 men and women - this showed that people who consumed less than 6g of salt a day actually had a ********'raised' risk of heart disease.*********

The author of that study, Dr Hillel Cohen, says this was only an observation, and more work is needed to establish why this trend was found. 'But it does suggest a set limit of salt for everyone doesn't work,' he adds.

Effective or not, cutting back on salt makes up only a small part of the regime recommended for anyone with raised blood pressure, which is also known as hypertension.
The first step is usually a version of the Dash (Dietary Approaches to Stop Hypertension) diet that recommends fruits, vegetables, and low-fat dairy foods, and which has been shown to be effective in bringing blood pressure down. But this can be hard to follow if you've been eating less healthily for years.
  Eating a healthy amount of potassium in your diet can offset the impact salt has on raising blood pressure
Dr Peter Berkin is a GP in Milton Keynes who favours treating chronic disorders with diet where possible.
'Doctors always recommend weight loss and improving your diet but they rarely have the time or facilities to help patients to make and stick with the changes,' he says.
The result is that after six weeks or so, most patients are prescribed drugs to lower their blood pressure.
An estimated ten million people in the UK have high blood pressure, and in England alone millions of prescriptions are written for drugs to treat them every year. But are drugs the best way to treat the problem?

What patients are often not told is the numbers of people who have to be treated with a drug in order for just one person to benefit.
In the case of elderly patients with mild hypertension, of every 76 patients who take the drug, one will avoid a stroke, according to Michael Oliver, professor emeritus of cardiology at the University of Edinburgh, writing in the BMJ.
Professor Oliver was also concerned about the side-effects of these drugs that benefit so few. 'Reduction of mild hypertension can lead to vertigo, particularly in elderly people,' he wrote.

The drugs have a range of other effects. Diuretics, which make you go to the loo more often, reducing the volume of water in the blood and in turn lowering blood pressure, can cause gout.

Calcium channel blockers, which relax the arteries, can bring on headaches, while ACE inhibitors, which work by stopping the blood vessels from narrowing, often cause a nasty cough.

More seriously, several of these drugs are now linked, ironically, with a raised risk of heart disease.
One study of 1,860 men followed over 17 years found that ^^^^^^those treated with diuretics were 23 per cent more likely to have a heart attack********* than those who weren't.
Another widely used class of drug is the beta-blocker. These work by blocking a natural substance that causes the arteries to narrow and the heart to beat faster, enabling the arteries to widen again.
However, using these actually raises heart problems, according to a review by doctors at St Luke's Roosevelt Hospital in New York. They found that patients given beta-blockers had more heart attacks and more strokes.
'A study found that people who consumed less than 6g of salt a day had a *****raised risk of heart disease'******
_______________________________________

The reason could be that most of the studies involved a widely used beta-blocker, atenolol. Worryingly, even though the problems with atenolol have been known for years, 14 million prescriptions for it were written in England and Wales in 2007.

'Atenolol should not be given to anybody,' says Dr John Cockcroft of the Wales Heart Institute in Cardiff. 'Nobody disagrees atenolol is guilty, yet we are still using it.'
Drugs certainly bring dangerously high blood pressure down, and for those with high blood pressure they are a lifesaver. But do people with only slightly elevated blood pressure really need them? Research shows that 167 patients need to take the drugs for a single person to benefit.
A number of GPs believe that more could be done to help people simply with diet and lifestyle.

'Around 33 per cent of people aged 25 to 55 have borderline hypertension,' says Dr Adam Carey, a nutrition expert who runs a corporate health programme helping employees to get fit, as well as advising the Welsh rugby union team on nutrition.

'We can get that down to 9 per cent without using drugs, but by giving them a structured programme of diet and exercise.
'The key is to cut out refined carbohydrates such as white flour and sugar. These foods push up your blood sugar level, and the body stores the extra sugar as fat.
  
Foods high in potassium include potatoes, sweet potatoes, yoghurt, tuna, lima beans and bananas
'Eating carbohydrates that haven't been refined, such as brown rice and wholegrains, smoothes out the sudden spikes and troughs of blood sugar that come with sweets and pastries.'

The American study showed, raising your potassium is important. But there is another pair of minerals involved in controlling blood pressure in the same way as the sodium in salt and potassium do - calcium and magnesium.

While calcium tightens the blood vessels, magnesium relaxes them. The recommended daily allowance for magnesium is 300 to 400mg and it is found, together with potassium, in green leafy vegetables, nuts and seeds. One of the effects of diuretics can be to flush magnesium and potassium out of the body.

Relaxation techniques such as meditation can help, too. Anxiety pushes up your blood pressure by raising levels of hormones such as adrenaline and cortisol.

Dr. Davis, can you suggest a good omega-3 capsule? I know you have previously mentioned that one can use any omega-3 we get at Costco. I used Naturemade (or Nature's own, I do not remember the name right now) omega-3 capsules. HOWEVER, they have started smelling fishy these last few days! Obviously the oil in them has gone rancid! The capsules are not supposed to expire till 2011, so its really bothering me that they turned bad so soon. I store them in my pantry which is cool and dark, so the capsules were not exposed to harsh sunlight.

Dr.Davis

This is very informative.
What is the best base level of Iodine daily to promote thyroid health?

Thanks for you great blog!

Aaron

So iodine aside, I'm curious as to your take about the whole salt issue. Taubes touches on it in Good Calories, Bad Calories, and essentially looks to insulin --not salt-- as the villain in blood pressure problems. NHANES III seems to help things along in that direction as well: http://www.ncbi.nlm.nih.gov/pubmed/18465175

I would grant that high salt intake might be a problem for a certain percentage of sensitive individuals, but I kind of doubt that percentage is all that high. I also wonder if sodium sensitivity in some people has more to do with other factors, such as magnesium deficiency (since magnesium regulates sodium) than with sodium actually being malicious in and of itself. *shrugs*

Some say that the chemically processed, straight sodium chloride is what causes the problems, and that a good full-spectrum sea salt is the way to go, as it contains all the original trace minerals to balance things out. I use Redmond RealSalt (I love the taste). I've known three people now who have gotten on the RealSalt (in large quantities) only to have their blood pressure go down. With no other changes. I don't really understand it, but it's interesting, and helps to further my skepticism about the supposedly universal salt/BP connection.

Loved this entry (a fellow paleo) -- thank you for your blog. I added my own libertarian take on it.

Eat two Egglands Best eggs a day and you'll get your daily allowance of iodine.

Or, just a pinch of dry sea kelp in your tea will do the same.

Or, just a single daily serving of seafood (any of the wild finfishes, roe [fish eggs], crustaceans, or mollusks) should do the trick too.

Unfortunately, sea salt (unless it's been purposely iodized) has only a small, insignificant trace amount of iodine.

Iodine seems to upregulate the sensitivity of steroid receptors. There is anecdotal evidence that in the case of diabetes the amount of injected insulin (which is a steroid hormone) has to be drastically reduced to avoid severe side effects like hypoglycaemia ( http://www.healthy-eating-politics.com/diabetes-iodine.html ).
Since vitamin d is actually a steroid hormone, too, could it be that the recommended range of sufficiency (60-80 ng/dl) has to be adjusted for someone who is on iodine supplementation and therefore likely has increased steroid receptor sensitivity?
Any thoughts?

Mike V--

Admittedly, "avoid salt" is a generalization.

There are genetic types who gain little by minimizing salt. Then there are people at the other end of the spectrum who gain visibly and dramatically with salt restriction, e.g., drops in systolic BP 30+ mmHg, weight (water) reductions of many lbs, even changes in blood electrolytes.

Salt is one of those things that is handled in dramatically different ways among different humans.

David, I believe there's also increased stomach cancer risk with salt...

It's easy to avoid salt imbalances if one avoids processed foods, as processed foods contain lots of sodium, very little potassium and magnesium.

Eating real foods one prepares at home may be salted with sea salt with little worry of taking in too much salt.  I tend to think that the association of disease with salt is a marker for malnutrition and poor nutrition from a crappy SAD diet, too high in carbs, too low in protein and natural fats, and deficient in multiple micronutrients.  

Taubes wrote a great article in Science a few years back on the soft (political) science behind the salt restriction advice.  That's eventually what moved him to investigate the fat/cholesterol hypothesis, because the most influential salt restriction theorist was such a "bad" scientist and bragged so much about his influence that Taubes' skepticism went on high alert.

Kismet,

I won't argue that point, but I would question it, just because I think more information would be helpful. A lot of the studies on salt and stomach cancer that I've seen are observational in nature. Observational studies are useful as far as they go, but they're not good at proving causality. In other words, perhaps it's true that people who get stomach cancer eat a lot of salt. But is the salt actually causing the cancer? People who eat a lot of salt also eat a lot of nitrates-- in fact the two often go together. So which is it that causes the cancer? Salt or nitrates? We can't tell from the observational studies, because there are still too many variables to narrow down the relationship.

Maybe lots of salt does cause stomach cancer. I honestly don't know what to think. But I do think that caution is needed when evaluating observational studies for the purpose of establishing causality, especially when they are so often contradictory (see another study on salt and stomach cancer here that shows an opposite conclusion from the mainstream: http://cebp.aacrjournals.org/cgi/reprint/1/7/607.pdf)

David

Dr. Davis:

What do you think of the ideas of those who advocate drastically increasing iodine intake to Japanese levels?

Examples:

http://www.optimox.com/pics/Iodine/opt_Research_I.shtml

Radio inteviews Dr. Stan, Dr. Blaylock, Dr. Flechas:

http://curezone.com/ig/f.asp?f=1723

Lack of iodized salt may not be as big an issue as lack of iodine in store bought baked goods. We absorb only 10% of the iodine in salt but 90% of the iodine in baked goods. Bakeries used to condition doughs with iodine but now use bromine which competes with iodine. We are now under-Iodiniated and over-Brominated.

Braesikalla, insulin is not a steriod hormone, it is a peptide.

I've seen localised clusters of goiters in Europe but hadn't realised you had such a large zone of iodine depletion.

Here (UK) we have localised areas of other mineral shortages, animal farmers have to put out salt licks or add magnesium, manganese etc. to the feed, and some arable and vegetable farmers need to mineralise their soil. There are large areas deficient in selenium (and I believe in some parts of China it is at near toxic levels) your local farmer may be someone to ask about your local conditions.

They told me to eat less salt and my BP kept going up, plus I started getting leg cramps. I ate less carbs and it came back down, they didn't tell me that one! I believe the population of salt sensitive hypertensives is quite low, yet they tell the rest of us to avoid it as well.

Strangely when I was chomping sodium bicarbonate (acid reflux) I started getting leg cramps again, that time adding magnesium sorted them (and my electrolytes came back spot on) the interrelationship can be complex.

Who avoids salt?  That seems ridiculous.  Especially if you exercise, you need even more salt.

High salt levels can build up in your body and chlorine (chloride from the sodium chloride aka table salt) can displace the nessesary iodine in your body especially from thyroid. This can cause health problems including goiters. Iodine can be relaced by consuming it in small amounts. One very effective way is by adding small amounts of Lugol's solution of iodine in your drinking water. A couple of drops per liter is enough. Pure iodine itself will not dissolve in water therefore you must have some type of iodine solution in order to properly intake it.
You can easily make your own Lugol's Iodine. Here is the formula: (adjust it to your desired amount by multiplying or dividing the factors)
10 grams of potassium iodide
5 grams of pure iodine (crystals, prills, or flakes)
85 mL of distilled water or drinkable (spring) water
Mix the potassium iodide with the water first then add and stir the iodine until all is dissolves. This usually takes some time but can be speed up by heating the water a little.
You can purchase iodine and potassium iodide at www.ushalogen.com

It might be better to think of the buy-local movement in terms of, "It's silly to buy foods from elsewhere that we're perfectly capable of growing here," while still importing foods that contain nutrients that are deficient locally.  That's the whole point of trade, after all:  acquiring things you wouldn't have otherwise.

Expecting foods grown in the ground to provide us with iodine when we've got perfectly good seafood in the oceans that give us the same thing is kind of silly.  Rather on the order of using tofu or seitan as meat substitutes when there are perfectly good cows and chickens running around out there.

An alternative, too, is to completely avoid goitrogenic foods if you live far from the sea.  It's believed that this is why cruciferous vegetables taste bitter to some people but not others:  the genes responsible seem to have evolved in people who lived far inland.  They needed to maximize thyroid function, so a mutation that allowed them to detect foods that were most likely to mess with thyroid function came in very handy.  No reason we can't make conscious choices in that direction now--it's not like we can't live without any of the foods in question.

Dealing with environmental pollution and avoiding chemical stressors is important too, as you know.  But every little bit that we ourselves can control right now, counts for something.

Glorious post from skilled additionally it's going to probably be an exquisite know-methods to us and thank you numerous for posting this priceless info with us all.

"But too much is not good either. Some participants in Track Your Plaque, for instance, have experimented with very high doses of EPA + DHA in the 9000-10,000 per day range and witnessed dramatic increases in LDL."

So what?

Wolf, Sears, and Poliquin recommend a high fish oil dose of 0.5g-1.9g EPA/DHA per 10lbs BW; this generally equates to 9-10g range.  All three have had amazing success with sedentary, chronically ill individuals and elite level athletes.

I believe you yourself have stated in the past that fish oil causes a shift from VLDL and IDL to large particle LDL---a benign, if not beneficial action.

So is the raising of LDL in high dose fish oil even a concern?  Some clarification on this would be appreciated.

Gosh... what an ODD response to fish oil! *wink* Do you actually believe it?  The reports would be contrary to the literature.  At least fish oil would have a strong role in stabilizing plaque and prevents soft ruptures in growing plaque (just like the Tokelau and Masai, high carb H-G societies)!

Nowhere in the literature that I can find reports omega-3 increases dense LDL. Perhaps there is a TYP program-omega3 interaction? Or perhaps this only occurs in those who take high-dose statins and fail to convert to Pattern A (due to the overstatination phenomenon, as reported by researchers where TG <  150)) and complain annually about their EBCT plaque progression 10-25%??  I have tried to admonish the statin overuse but apparently that doen't go over well with this individuals as you are aware. Oh well.

I have noticed that in the summers people's HDLs drift down.  Have you Dr. Davis in your practice?  I suspect a strong fruit-effect on splaying out dense LDL. Thoughts?

IMHO many on the TYP members consume WAY way way too much grains, orange juice, oat bran, oatmeal, FRUITY SHAKES (e.g. JJ) and consume several servings of fruit all day (e.g Jeg). Do you think this may play any part of complaints related to higher dense LDL?  My first thoughts are ALWAYS... diet.  

Your observastions are always UNIQUE!!  Thank you putting the highlights on the omega-3 index and the role of n-6 to n-3 on inflammation, the root cause of CAD!  You are certainly the biggest quantum EVOLVER.

http://drbganimalpharm.blogspot.com/search/label/Evolver

Gosh... what an ODD response to fish oil! *wink* Do you actually believe it?  The reports would be contrary to the literature.  At least fish oil would have a strong role in stabilizing plaque and prevents soft ruptures in growing plaque (just like the Tokelau and Masai, high carb H-G societies)!

Nowhere in the literature that I can find reports omega-3 increases dense LDL. Perhaps there is a TYP program-omega3 interaction? Or perhaps this only occurs in those who take high-dose statins and fail to convert to Pattern A (due to the overstatination phenomenon, as reported by researchers where TG <  150)) and complain annually about their EBCT plaque progression 10-25%??  I have tried to admonish the statin overuse but apparently that doen't go over well with this individuals as you are aware. Oh well.

I have noticed that in the summers people's HDLs drift down.  Have you Dr. Davis in your practice?  I suspect a strong fruit-effect on splaying out dense LDL. Thoughts?

IMHO many on the TYP members consume WAY way way too much grains, orange juice, oat bran, oatmeal, FRUITY SHAKES (e.g. JJ) and consume several servings of fruit all day (e.g Jeg). Do you think this may play any part of complaints related to higher dense LDL?  My first thoughts are ALWAYS... diet.  

Your observastions are always UNIQUE!!  Thank you putting the highlights on the omega-3 index and the role of n-6 to n-3 on inflammation, the root cause of CAD!  You are certainly the biggest quantum EVOLVER.

http://drbganimalpharm.blogspot.com/search/label/Evolver

My EFA results showed an Omega3 index of 11.7% and a Omega 6:3 ratio of 2.3/1. I supplement with 1600mg EPA and 800mg DHA daily. I follow a low carb (high fat) I can't afford to eat "grass fed", but I do avoid processed foods whenever possible and my dietary fats are from coconut oil, lard, beef tallow, butter, olive oil and small amounts sesame oil. The Omega 3 Index test was a bit pricey, but...it did give me some comfort that I am on the right track.

For those who witnessed an increase in LDL, what was the profile of small, dense VLDL vs large, fluffy VLDL reflected in the increase?

Also, first-time commenter. Thank you for a great, informative blog.

"But too much is not good either. Some participants in Track Your Plaque, for instance, have experimented with very high doses of EPA + DHA in the 9000-10,000 per day range and witnessed dramatic increases in LDL."

I'm hoping (and wondering if...) that while those diligent enough to take that high a dose of omega-3's may have higher measured LDL levels, they indeed have much larger, fluffier particles now than when they began the megadosing.  That would be something marvelous to hear.
Good stuff here, as usual!
-Adam

If one's LDL's raise dramatically on omega-3's, without the corresponding increase in hdl, or decrease in trigs, is it better to lower the omega 3's?

Ex:

pre-omega
tc 240
hdl 45
ldl 165
tg 70

during 2000mg omega-3's
tc 320
hdl 58
ldl 240
tg 90

Also, the pattern size of the ldl's are type a with a low carb, no grain diet.

I'd very much like to know what subfraction of LDL was elevated in the TYP followers on 9,000 plus omega 3's a day.  My experience is that large fluffy LDL increases but not small dense.

What about lipid peroxidation on high dose of fish oil?

The form of LDL that increases depends.

It seems to depend on the genetic basis for small LDL. In other words, if the triggers of small LDL have been removed along with other efforts aimed at reducing small LDL like niacin, and there is no genetic basis for small LDL, then large LDL increases.

If small LDL is genetically programmed (a lot more common than many think), then small LDL can increase explosively.  

Having performed many thousands of lipoprotein panels, the latter situation in which small LDL increases is worrisome.

I am unsure of the implications of the first situation. Sure, we can extrapolate and speculate that it might not be related to increased risk. But I am not willing to gamble someone's health and life on pure speculation with no human data.

The only references to an increase in LDLC with fish oil supplementation is from WS Harris who authors 95% of the omega 3 index studies including a 2008 review which concludes that the omega 3 index is superior to omega 3/omega 6 ratio.  When 95% of literature comes from one man who promotes a pricey lab test I can't help but wonder if he gets part of the profits. I have no data to say he does though.

He has two 1997 publications,one showing that Omnacor given at 4 g epa/dha a day raised ldlc by 10%. 1997 was the predawn era of advanced lipids.  In his second publication individuals with severe hypertriglyceridemia (baseline fasting levels on statins of 500 to 2000) did have a 32% rise in LDLC.  
Harris has ties to Big Pharma (the maker of Lovasa/Omnacor) and to Monsanto.
Data that I can easily access ascide from Harris shows effecacy of fish oil supplementation up to 4 grams of epa/dha a day.  5 grams a day for plaque stabilization/ antiinflammatory effect.  9 or 10 grams a day only in obese heart failure patients.  
My bottom line:  if your baseline tg's are 500-2000, watch out for your ldlp on high dose fish oil.  If you are an obese heart failure patient, lose weight.

I believe that when people use theraputic levels of fish oil (more than 3gm EPA=DHA)  they should follow their omega profile and lipoprotein analysis closely.  It is possible to push the eicosanoid synthesis pathways toward the arachadonic acid side depending on your diet.   Once you know your optimal dose, then you can adjust it up in certain circumstances.  I attended a football tailgate and found some of the mixed nuts were cooked in soy oil, so I took an extra dose of fishoil when I got home to compensate.

Thanks for your thoughts on this.  Regarding LDL particle size, how dependable would TG/HDL ratio be?  Sears indicates a ratio less than 2 indicates large benign LDL.  In my own experience over the past few years, as I've increased my fish oil intake (along with a Paleo diet) my HDL has gone up, my LDL has gone up, and my TGs have decreased.

I have increased my intake of omega-3 since I answered the poll. My problem was that I couldn't take it all at once. Too much fish oil gave me a super upset stomach. Granted, it was the impure Nature Made brand sold at Walmart (34% pure). Now that I am using Omapure, I take one capsule with every meal and then one before bed time. It 6x more expensive than the Nature Made junk but I'm not getting sick from it.

Does it matter that I break up my intake over the course of the day rather than swallow four capsules all at once?

great information here, thanks all.

To follow on Dr.BG's note on statin overuse :  there is an interesting presentation of baylor college's lipidsonline.org with discussion of guidelines for statin dosage.  The presenter notes how very little value is obtained from subsequent doubling of a statin dose and the risks for side effects.

http://www.lipidsonline.org/slides/slide01.cfm?tk=82

Dr. D.  Thank you for the caution on fish oil. I take 1650mgs EPA/DHA twice per day.  Might be a good idea to cut out a dose if I eat salmon or other oily fish.

Would love to see more info on MK4/Mk7 K2 and MCFAs like coconut oil.

Hi, Mike--

While the Triglyceride/HDL ratio can serve as a useful measure of small LDL in a population, it performs poorly when applied to specific individuals. This is because small LDl, while influenced by the situation creating low HDL and high triglycerides, can also behave independently.

Small LDL is, in my view, best measured specifically.

It's pretty straightforward to end up in the middle of the pack on that poll.  But don't take gels or you'll be there all day.  One tablespoon of Carlson's Finest has 4800mg O-3's with 2400mg EPA and 1500mg DHA.  One swallow just as I'm sitting down to breakfast makes for a great start to every day.

I was told than an ApoE 4 Patient should not be on therapeutic doses of fish oil (for reasons which you have stated- raising LDL).

Dr Davis:

I would like to know which WS Harris 2008 you referenced and the reference for the females in the Harvard School of Public Health please.
I also would like to know if there was a correlation between baseline tg levels and those who experienced a more marked elevation of sd LDL on fish oil.

I guess that this is my day to ask you questions.
When you read a MDCT, do you also measure pericardial fat?
What do you think of Dr. Ding's new MESA findings re pericardial fat.  Thanks in advance.

I take 6000 units daily or more, but I also consume a few tablespoons of ground flax seed daily as well.
AND still eat fish a few times a week, especially oil rich sardines.

Homertobias:

Lots of interesting work being done on pericardial adipose tissue (PAT) and using CT imaging done in conjunction with CAC scoring to more precisely determine the relationship between PAT and the development of CAD and calcified plaques, i.e., in order to more precisely "score" the level of PAT and to determine association and/or causality with calcific lesions.

Dr. Lerber at University Hospital in Munich, Germany has observed that PAT accumulation precedes the development of calcified plaques, that increased volume of PAT are associated with reduced levels of  adiponectin and higher CRP.   So the idea is that with more precise measurements and concomittant imaging of both PAT and CAC, we might be able to better detect the presence of disease in an earlier stage.   There is also some push among those doing such research to link PAT thickness assessment with administering routine echo stress testing but this hasn't gained much traction yet other than in a small circle of folks.   The hope though is that PAT can also be used as another surrogate marker for diagnosing preclinical atherosclerosis.

But as of now, I don't think anyone who does a routine CAC scan, whether with MDCT or EBT is doing any form of assessment of PAT, at least not until there is more data on the reliability of using this as a clinical marker of disease.

Personally, I think there's a lot of interesting info that can come from this, and the idea of deposition of fat into muscle tissue and necrosis of that tissue, inflammation and the relation to levels of saturated fats consumed from dietary sources is an area that is just begging to be better researched.

Oh, and by the way, don't believe everything you read here from BG about what foods I consume, how much statin I take, or much else when it comes to me.  In fact, I'd prefer that she simply not make references to me in her writings wherever they appear.  This will obviate the need for me to continue to correct her misstatements about me, my lipids, and drug and supplement usage, as well as the fact that she continues to misrepresent that I have not achieved plaque stability and/or demonstrated regression through serial MDCT CAC scoring over a period of three years despite very low dose use of rosuvastatin.

A correction....  My serial scan scores show that I have achieved stability and optimally regression of coronary calcium.   My point is that Dr. BG continues to claim that those taking rosuvastatin at doses of ~10mg daily cannot possibly achieve regression on EBT/MCDT scanning, and that just isn't so.

I happen to be one of those whom I believe Dr. Davis was referring to with "too much of a good thing" with reference to EPA/DHA dosing.  My dose was upped from ~1-2 grams per day (of EPA/DHA) to ~10 grams based on recommendations from Dr. BG.  This occurred in or around December 2008 and continued until very recently. Based on five consecutive, quarterly NMR's and VAP's, my sdLDL-P remained at >85% of LDL-P, and my trigs went from ~40 to ~75, and, more significantly, my overall LDL-P rose from ~1000 to ~1300.   No other significant impacts were noted, other than CRP dropping to 0.7, which I attribute not to the n-3's, but instead to continued use of rosuvastatin together with combined high dosing of both boswellia and 5-Loxin and large doses of aspirin (taken specifically as an anti-inflammatory due to nerve and muscle pain from a herniated cervical disc in the month immediately prior to the last VAP testing).

The point though is that in some, excess fish oil can convert to higher trigs and higher LDL, and will not improve the concentration or ratios of sdLDL-P/LDL-P.

Yes, n=1, but I'm the n, so that's really most important to me, not what Wolf, Sears or anyone else has to say about this.  After all, what we're after is personalized medicine, not epidemiological observations that may be valid in large population studies but which may have no relevance to a particular individual.

Hi JEG,
Thanks for the references.  I am truly upset that you andBG seem to be having a cybertiff.  She has a big heart, alot of enthusiasm, alot of intelligence and makes me laugh. You are a sincere intellectual, very bright, searching for truth in medicine and are doing a good job of it.  I can learn from both of you and want to continue to do so.
As to omega 3 and dosage.  I can't seem to find any solid benefit to doses over 4g to maybe 5g per day. This seems to max out tg lowering, ldl improvement in particle size, minimal increase in hdl, bp lowering, improvement in tnf alpha, interleukin 6.  Reports on irs effect on HSCRP are conflicting.  One interesting report, Thies F, in Lancet 2003 took 188 patients scheduled for carotid endarterectomy and treated them with either DHA/EPA, sunflower oil, or placebo for an average duration of 42 days prior to surgery.  There was a significant difference in thickness of the fibrous cap over the plaque,the degree of monocyte  infiltration of the fibrous cap, percent DHA etc.  This directly addresses plaque stability.  I love it.

Homertobias,

That is a great plaque stablization article -- will have to ck out!



Jeq,

I must be correct again as indicated by the length and duration of the post!

Let me get this straight -- the lipoproteins were less than desirable for both you and JJ/Jim for the past 2008 to 2009 (you reported increased sdLDL?), yet both of you posted regression recently on BOTH of your EBCT/MDCT results....  

Gosh... I wonder if the high dose fish oil had anything to do with it?

EPA DHA get infiltrated directly locally into calcified plaque and has immense immeasurable benefits for regression BEYOND lipoproteins.  I think you have seen some them, personally IMHO.

-G

Homertobias,

That is a great plaque stablization article -- will have to ck out!



Jeq,

I must be correct again as indicated by the length and duration of the post!

Let me get this straight -- the lipoproteins were less than desirable for both you and JJ/Jim for the past 2008 to 2009 (you reported increased sdLDL?), yet both of you posted regression recently on BOTH of your EBCT/MDCT results....  

Gosh... I wonder if the high dose fish oil had anything to do with it?

EPA DHA get infiltrated directly locally into calcified plaque and has immense immeasurable benefits for regression BEYOND lipoproteins.  I think you have seen some them, personally IMHO.

-G

By the way, congratulations to you two gentleman, JJ and Jeg, for achieving regression with Pattern B! I have looked for regression in Pattern B forum posters, but turned up none. You two are the FIRST at TYP that I can find...

Do you think omega-3 had any role in your success since that appears to be the common link as well as major supplement change you guys identified?

I wonder what the omega-6:3 ratio is now off the fish oil?

By the way, congratulations to you two gentleman, JJ and Jeg, for achieving regression with Pattern B! I have looked for regression in Pattern B forum posters, but turned up none. You two are the FIRST at TYP that I can find...

Do you think omega-3 had any role in your success since that appears to be the common link as well as major supplement change you guys identified?

I wonder what the omega-6:3 ratio is now off the fish oil?