"Fish oil is stupid"

"Fish oil is a waste of time and money. It's stupid. Just stop it."

So a patient of mine was advised by another physician when he complained that he occasionally experienced a fishy aftertaste.

This attitude perplexes me. After all the confirmatory data that support the enormous health benefits of omega-3 fatty acid supplementation, including the 11,000 participant GISSI-Prevenzione Trial, you'd think this attitude would be history. What's a little fish aftertaste when heart attack risk is slashed 28%?

Perhaps the tendency to pooh-pooh fish oil is because it's available as a nutritional supplement. This shouldn't make fish oil appear inconsequential. Far from it.

If you witness the extraordinary power for fish oil to reduce triglycerides, you will be immediately convinced of its effectiveness. The ability of omega-3 fatty acids from fish to eliminate intermediate-density lipoprotein (IDL), the persistent abnormal lipoprotein which signals an inability to clear dietary fats from the blood, can also convince you. More than 90% of people with excessive IDL have it completely eliminated by 4000-6000 mg of fish oil (providing 1200-1800 mg EPA + DHA) per day.

The fact that fish oil is available as a prescription "medication," as well as an over-the-counter supplement, causes some physicians to dismiss the power of the supplemental form. This is nonsense. The over-the-counter form is every bit as effective as the prescription form.

The makers of prescription Omacor also make the claim that their preparation is safer and purer. That may be true, but I'd like to see independent verification from the FDA, USDA, or an unbiased organization like Consumer Reports before I accept their marketing as fact--particularly at $120 to $240 per month! If Omacor proves to contain substantially less mercury and pesticide residues, then that will need to be factored in. (Please note that both Consumer Reports and Consumer Labs measured no substantial mercury or pesticide residues in their analyses of 16 and 41 brands, respectively.)

I try to persuade my colleagues that the idea of taking supplements is a wonderful trend that allows people to express ownership of their own health. What people need is guidance, not salesmanship for a more expensive version, nor dismissal of nutritional preparations that actually possess considerable benefits.

Comments (13) -

  • Cindy

    4/3/2007 1:24:00 AM |

    I've heard that fishy burps means the fish oil is rancid and should be thrown out!? I've also been advised to cut open and taste a capsule every once in a while (I do it weekly) and to throw it out if it tastes or smells fishy.

  • Dr. Davis

    4/3/2007 1:49:00 AM |

    Cindy--
    You're brave. My experience is that virtually all fish oil is fishy to one degree or another. The Consumer Lab analysis is probably the most enlightening on this question: they found that only 2 of 41 preparations had any rancidity breakdown products present. That's pretty good. Neither of the two preparations that flunked their analysis were popular brands.

  • JJ

    4/3/2007 7:15:00 PM |

    Can you help interpret EBT scan results.  50 y/o male with 3rd EBT scan now indicates a decrease:  
    '05 152;
    '06 417;
    '07 350.  
    Is this common?  An error? Please advise.  Thanks you.

  • Dr. Davis

    4/3/2007 7:35:00 PM |

    JJ--
    I'd advise you to see the website, www.trackyourplaque.com. We discuss these issues extensively here. Or go to my book, Track Your Plaque, available on Amazon. From what little you've told me, it could be true or it could be an error, i.e., scanner inaccuracy, depending on the type of scanner used. However, the entire Track Your Plaque concept is built on the idea of trying to gain control over your heart scan score.

  • Anonymous

    5/22/2007 5:03:00 PM |

    Your last paragraph makes perfect sense and is logical. I think that this is exactly what the pharma companies dont want is for the patient to express ownership of their health or realize that otc supplements have any merit. I applaud you for sticking to the facts that you find not just the data and marketing that the pharma companies and reps feed the doctors.

  • Fr. Gregory

    8/17/2007 1:28:00 PM |

    Fish oil is immensely beneficial for many reasons.  The challenge is that most manufacturers of fish oil are not held to any standards, so as Cindy says above, if you are having problems with "fishy heartburn" or the like, chances are it is rancid.  Norway is one country that has strict standards for the production of fish oil.  Hence, Nordic Naturals is a good brand, because it is produced there.  My two cents worth: use Norwegian Fish oil products.  Be wary of product in America.  The "taste test" is a good way to note if the fish oil is of quality.  Rancid fish oil, I've been told, can be worse for you than no fish oil at all.

  • mill

    9/23/2007 6:53:00 PM |

    I know of so many people who have lowered their cholestral but after 6 months of taking 6 caps of 1250 mg daily mine actually went up a few points. I called the company (Res-Q) and they said that happens to some people. What is your opinion?

  • Dr. Davis

    9/23/2007 11:39:00 PM |

    I have never seen anyone reduce LDL cholesterol with fish oil, but that is not its purpose.

    Fish oil 1) reduced triglycerides, 2) reduces lipoprotein patterns like VLDL and IDL, and 3) reduces heart attack and other heart events.

    The only way fish oil can reduce LDL cholesterol is by reducing triglycerides and thereby providing the appearance of a drop in LDL, since LDL is calculated with values that include triglycerides.

  • Mark

    3/18/2008 11:44:00 PM |

    I think it is quite ignorant of you to claim that a dietary supplement is the same as a prescription medication.

    There is a reason that manufacturers need to place a disclaimer on their products "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."  Simply put, manufacturers can put whatever they like in a supplement, as long as they put their precious disclaimer on the bottle.

    By the way, there is no such thing as an "over the counter" fish oil.  OTC implies that a product, at one time, was available with a prescription (i.e. Claritin), and is now available without a prescription.

    Lastly, your idea about Consumer Reports doing a comparison of dietary supplements versus Lovaza/Omacor is a valid one.  However, it seems to me it would be easier to simply compare the EPA and DHA contents of the product to get an idea of their efficacy.  In my experience, there are no products in the market that can match the potency of the prescription product.

  • mill

    6/27/2008 12:36:00 PM |

    Dr Davis
    I've been on 2 naicin tabs daily and my cholestral is done from 240 to 164!!!!it's amazing. Can i go back to taking just one daily  now?
    Thanks so much!

  • mill

    7/9/2008 9:39:00 PM |

    How much naicin is bad for the liver?

  • lizzi

    8/25/2008 3:05:00 PM |

    I worry about omnacor (Lovaza) because they chemically altered fish oil, (made it an ester, I think) in order to increase stability.  I just hope this doesn't ruin its good effects.  The process reminds me of the creation of transfat to enhance the stability of margarine in the 1950's.  It took us 40 plus years to figure out that was a big mistake.  Anyone else worried about this?

  • Mary P

    4/27/2009 2:03:00 PM |

    I have concerns about the amount of fish that it takes to produce supplements.

    If you don't want to take a fish oil supplement and are not in one of the demographics that should limit the consumption of oily fish - is there a daily consumption of dietary fish that would meet nutritional needs? E.g., 80g of sardines or mackerel?

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Rerun: To let low-carb right, you must check POSTPRANDIAL blood sugars

Rerun: To let low-carb right, you must check POSTPRANDIAL blood sugars

Checking postprandial (after-eating) blood sugars yields extraordinary advantage in creating better diets for many people.

This idea has proven so powerful that I am running a previous Heart Scan Blog post on this practice to bring any newcomers up-to-date on this powerful way to improve diet, lose weight, reduce small LDL, reduce triglycerides, and reduce blood pressure.



To get low-carb right, you need to check blood sugars

Reducing your carbohydrate exposure, particularly to wheat, cornstarch, and sucrose (table sugar), helps with weight loss; reduction of triglycerides, small LDL, and c-reactive protein; increases HDL; reduces blood pressure. There should be no remaining doubt on these effects.

However, I am going to propose that you cannot truly get your low-carb diet right without checking blood sugars. Let me explain.

Carbohydrates are the dominant driver of blood sugar (glucose) after eating. But it's clear that we also obtain some wonderfully healthy nutrients from carbohydrate sources: Think anthocyanins from blueberries and pomegranates, vitamin C from citrus, and soluble fiber from beans. There are many good things in carbohydrate foods.

How do we weigh the need to reduce carbohydrates with their benefits?

Blood sugar after eating ("postprandial") is the best index of carbohydrate metabolism we have (not fasting blood sugar). It also provides an indirect gauge of small LDL. Checking your blood sugar (glucose) has become an easy and relatively inexpensive tool that just about anybody can incorporate into health habits. More often than not, it can also provide you with some unexpected insights about your response to diet.

If you’re not a diabetic, why bother checking blood sugar? New studies have documented the increased likelihood of cardiovascular events with increased postprandial blood sugars well below the ranges regarded as diabetic. A blood sugar level of 140 mg/dl after a meal carries 30-60% increased (relative) risk for heart attack and other events. The increase in risk begins at even lower levels, perhaps 110 mg/dl or lower after-eating.

We use a one-hour after eating blood sugar to gauge the effects of a meal. If, for instance, your dinner of baked chicken, asparagus brushed with olive oil, sauteed mushrooms, mashed potatoes, and a piece of Italian bread yields a one-hour blood sugar of 155 mg/dl, you know that something is wrong. (This is far more common than most people think.)

Doing this myself, I have been shocked at the times I've had an unexpectedly high blood sugar from seemingly "safe' foods, or when a store- or restaurant-bought meal had some concealed source of sugar or carbohydrate. (I recently had a restaurant meal of a turkey burger with cheese, mixed salad with balsamic vinegar dressing, along with a few bites of my wife's veggie omelet. Blood sugar one hour later: 127 mg/dl. I believe sugar added to the salad dressing was the culprit.)

You can now purchase your own blood glucose monitor at stores like Walmart and Walgreens for $10-20. You will also need to purchase the fingerstick lancets and test strips; the test strips are the most costly part of the picture, usually running $0.50 to $1.00 per test strip. But since people without diabetes check their blood sugar only occasionally, the cost of the test strips is, over time, modest. I've had several devices over the years, but my current favorite for ease-of-use is the LifeScan OneTouch UltraMini that cost me $18.99 at Walgreens.

Checking after-meal blood sugars is, in my view, a powerful means of managing diet when reducing carbohydrate exposure is your goal. It provides immediate feedback on the carbohydrate aspect of your diet, allowing you to adjust and tweak carbohydrate intake to your individual metabolism.

Comments (12) -

  • Chris Keller

    4/1/2010 9:56:58 PM |

    I understand low carb diets in general, but the way you talk about postprandial blood sugar levels, what can you eat?  

    You continuously point out that foods you didn't think would cause high blood sugars do (is it because of the actual food or hidden ingredients like sugar), so what's on your acceptable list?  (in general).  I realize everyone's body will react slightly differently...

  • kris

    4/2/2010 2:41:20 AM |

    Dr. davis,
    I always follow your valuable blogs. please keep up the good work. here is the link to the type of meals to cut down on the carbs.checkk it out.
    http://www.phlaunt.com/diabetes/18856280.php

  • Anonymous

    4/2/2010 8:29:25 AM |

    My suspicion is that the balsamic vinegar was the culprit. Some brands are extremely sweet because they have added sugar.

  • Anonymous

    4/2/2010 12:54:14 PM |

    Dr. Davis,
    What is an acceptable blood glucose level after a meal? What goal do you recommend for your patients?

  • DrStrange

    4/2/2010 4:55:55 PM |

    I don't know about the Life Scan bg monitor but I do know that some monitors are totally inadequate!  Walmart Relion for one.  I have one and can easily do 2 tests within a few seconds of each other and get readings of 180 and 135!!!!  AcuCheck by Aviva which I also have has never given me a multiple reading spread of more that about 5 points, and that is a 3 year old meter.  You don't do yourself any favors by going cheap. It you have a sympathetic doc who will write a scrip you can get meter for free and have a big chunk of test strip cost covered.

  • Michael Barker

    4/2/2010 9:17:23 PM |

    You should add this one caveat. Fructose and its various aliases does not raise blood sugar immediately. It will do so eventually when it screws up your liver.

    Mike

  • Narda

    4/3/2010 2:33:53 PM |

    Regarding the dressing...I learned decades ago in high school biology that vinegar turns to sugar in the blood. Is this true?

  • TedHutchinson

    4/3/2010 4:11:09 PM |

    Regulars will know I bought a meter after the first appearance of this post. I was regularly over 8.6 = 155 at one hour.
    Went to doctor fasting blood glucose 4.9= 88.2 and HbA1c 5.6 = 100.8 which my doctor thought fine.
    I pointed out the day before and day after my meter was reported much higher numbers, he suggested a fasting oral glucose tolerance test for which I had to prepare by consuming 175mg carbs daily for 3 days, which I did gaining several lbs.
    However 2hr reading 5.8 = 105
    My meter reported  11.3 =203.4 at 1 hr but I peaked at 17.3 = 311.4 the following meal.
    Inflammation markers and metabolic characteristics of subjects with one-hour plasma glucose levels
    this paper suggests that Elevated one hour plasma glucose (1hPG) in people with normal glucose tolerance and pre-DM subjects is associated to subclinical inflammation, high lipid ratios and insulin resistance. Therefore, 1hPG >155 ( = 8.6) could be considered a new 'marker' for cardiovascular risk.
    Medscape article on same paper.
    One-Hour Plasma Glucose Levels May Be a Marker for Cardiovascular Risk

    So as far as my doctor is concerned I've no problems whatsoever. It seems to me absurd that if I followed his advice I'd be a diabetic basket case and the situation would be almost irretrievable before they will take any action.
    I've been a bit stricter with the carbs and have followed some other suggestions so have managed to keep 1hr numbers below 6.7 = 120

  • Anonymous

    4/6/2010 1:54:16 PM |

    So if the peak blood glucose is important, then things that lower it are generally good? Foods with a low glycemic index, which are slow release?  Polyphenols like green tea and red wine, which inhibit amylase and reduce the sugar spike?

  • Anonymous

    4/8/2010 11:21:34 AM |

    You have a choice?

    To die of heart disease or alzheimers?

    http://www.naturalnews.com/028523_Alzheimers_juicing.html

    "Those who drank juice three or more times per week experienced a 76 percent reduced risk for Alzheimer's. Those who drank juice once or twice a week experienced a 16 percent reduced risk."

    But various polyphenols have been show to also modify glucose levels in some cases?

  • jpatti

    5/7/2010 7:46:47 AM |

    What you can eat is *based* on postprandial bg.  

    My husband can eat 1/6th of a 2-layer chocolate cake.  

    I can eat around 20g carb at breakfast, 40g at lunch and dinner, and that requires insulin injections.

    We're all different, you have to test yourself: http://www.alt-support-diabetes.org/new.php

  • Anonymous

    4/20/2011 12:08:55 PM |

    After finding your blog, I purchased a blood glucose monitor and have been checking my post-prandial blood sugars 1 and 2 hours after eating a meal.  I am also checking some fasting a.m. blood sugars.

    I am obese, though I have lost 49 pounds by reducing overall carb intake and eliminating all grains, sugars and processed foods.  I eat primarily a whole food diet other than a little (.25 oz.) of very dark chocolate a day (85%).

    My post-prandial 1 hour are between 90-110 most meals, and 2 hours are almost always below 100.  However, I am noticing that my fasting blood sugars are rising, sometimes above 100.

    Should I be concerned?  Is there anything I can be doing differently to reduce the insulin resistance that seems to be developing due to carb restriction?  Total carb intake daily is around 50 grams, including fiber.

    Stephanie A.

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