Sorry to insert this here since it only relates indirectly to the topic at hand, but I would be interested in your reaction to the following news item courtesy of TheStreet.com (TIA):

"AGIX - based on further analysis, the company believes the new class of drug, called AGI-1067, may be able to treat other indications."
"Although the formal primary composite endpoint in ARISE was not met, we believe that the trial generated strong evidence that the use of AGI-1067 will produce tangible clinical benefits for patients with coronary artery disease," said Marc Pfeffer, professor of medicine at Harvard Medical School and one of the principal investigators, said in a statement.
AGI-1067 is a drug with both anti-inflammatory and anti-oxidant activity that the company is developing to prevent serious cardiovascular events in people at risk of heart disease.
The drug is the first of a new class of medicines called vascular protectants, which work by blocking the inflammatory process in atherosclerosis, which is the buildup of fat, cholesterol and other substances in the inner lining of an artery.
The trial, which involved 6,144 high-risk patients in four countries with unstable angina, or chest pain, who had suffered a heart attack.
The trial met some predefined secondary goals such as reducing by 19% the risk of cardiovascular death, heart attack and stroke related to the build up of fatty plaque in the arteries.
Surprisingly, the drug also showed a beneficial effect on diabetes, yes - diabetes, reducing the risk of getting diabetes by 64% compared to a placebo.
Diabetes patients are at high risk of heart disease.
To repeat = "reducing the risk of getting diabetes by 64%". That's tremendous!
Chief Medical Officer Robert Scott said, "This gives us an opportunity to access both those markets."
Whether that will require additional clinical studies isn't clear.
AstraZeneca had agreed to pay AtheroGenics as much
as $1 billion for exclusive rights to the drug. Analysts had expected the drug to reach annual sales in excess of $1 billion if successfully launched.
AtheroGenics Chief Financial Officer Mark Colonnese said the company had the financial strength to bring the drug to market alone if necessary.
The company said that it will show the large data set to the Food and Drug Administration but that the results would require confirmation.
imo - If the FDA carefully looks again at the study, that same FDA might decide to give
a fast track to the Phase III trial."

Hi,
Sounds interesting. However, it sounds like it's still in the proprietary stage in which the manufacturer still keeps a lot of the particular close to the vest. We can only wait for more details on what this is, how it works, and whether it offers real benefits in real people, and at what price (monetary and otherwise).

Dr. Davis

Will all "old" heart attacks show up on EKG?  In other words, if the EKG is completely normal, can the existence of an "old" heart attack be ruled out?

Thanks!

Hi, Michelle-

No. Ekg's are kind of like judging a used car by its finish--it might look good on the surface, but beneath . . .

Dr. Davis,

I am curious to know if ECG results or a treadmill test results can vary for a asthamatic patient vs. him actually having a problem in his heart? Please suggest if in your experience ECG or treadmill test results have experienced a change for other reasons than blockages in the arteries.

Thanks
Kokil

Think of your EKG as just like buying a used car. Say I'm trying to sell you my 1999 Buick Century. It looks pretty good from the outside and I tell you that it has 70,000 miles and runs well. You ask to open the hood, look in the interior and take it out for a drive. I tell you no, you can't do that.

I think your are on to something, Dr. David. Every winter I get sad and depressed. After starting my omega-3 supplements, I noticed that I started feeling "better". I know that's very subjective. We set our clocks backwards 1 hour in a few days. I guess I will get a chance to test the "happy factor" of fish oil soon!

FYI, Laval is in Quebec, but Guelph is in Ontario (albeit both Canada). Perhaps you'd edit the post.
  --  Rob McVey, Markham, Ont.

Just to make it clear, the Univesity of Guelph is located in Ontario.

I live in a high-rise apartment building where many of the residents are grouchy old ladies.

Should I sneak fish oil into their food?

Or should I move into a building with lots of happy old Inuits?

I always enjoy and learn so much from you blog. Thank you.
I have tried taking omega 3 fish oil capsules but they give me acid stomach and fish burps. Any solution to these problems? I have tried the enteric coated ones too.

I am not surprised at this data.  When I began taking adequate fish oil (7gm EPA+DHA) I noticed an improved mood, memory, and ability to organize my activities.

Rob and Haggus--

Thanks for the correction.

Hi, Jim--

Perhaps throw a fish oil party for the ladies!

Of course, then you read of a new study discounting fish oil benefits for heart failure and you're left scratching your head:

http://www.sciencedaily.com/releases/2009/09/090929203024.htm

Deb,

You are experiencing the effects of "cheap" fish oil that has a lot of other stuff in it besides Omega-3. I tried Walmart's Nature Made stuff and it made me feel sick. Now I am take Omapure 4x a day (one capsule each time) and I do not feel the same "fishy" burps.

Deb-

Try lemon-flavored liquid form of EPA/DHA. Go with a high quality brand like Carlson, which a lot of us use.

One tsp gives you 800EPA+500DHA (1300 total), and it actually tastes pretty good (it's not cod-liver oil).

Buy it online, such as from i-Herb as an example:

http://www.iherb.com/The-Very-Finest-Fish-Oil-Lemon-Flavor-16-8-fl-oz-500-ml/2796?at=0

You won't have to swallow all those softgels, which used to bother me.  Also, a good quality distilled fish oil should not cause gastro distress, etc.

Rich

They have done Omega 3 depression studies. I believe they found EPA more important than DHA for improving depression scores. A lot of the 'mood' fish oil supplements tend to be EPA heavy too.

I think they theorize that EPA helps the brain function, while DHA is primarily for structure (hence why it's important for children/babies).

I think this is an important study, but I have to wonder if low omega-3 might also indicate difficult in fiding adequate food, which would clearly be stressful.  It's a chicken and egg argument so to speak.  Without verying that total nutrition other than omega-3 was adequate, I'm no sure a real conclusion can be made.

The question would be is it the Omega 3's or the fact that those who eat carbs get more depressed?

I've battled depression on and off for most of my life.  Meds help.  Fish oil and lots of vitamin D help even more.  I increase my intake of both whenever my exposure to sunlight is limited (including when the summer heat keeps me indoors a lot.)

So what would be the typical EPA+DHA daily dose (not the oil) to reach these heights of happiness...or plasma levels?

Another recent report from Laval University suggests that highly purified ethyl-eicosapentaenoic acid (E-EPA) may relieve psychological distress in middle-aged women.
The daily dosage was about 1gram.
http://www.ajcn.org/cgi/content/abstract/89/2/641
E-EPA is a very popular omega-3 supplement in Europe and Japan.

In response to several comments--

Taken in the context of other studies, this study simply adds to the notion that omega-3 intake is associated with mood status.

While omega-3 plasma levels may also serve as a surrogate for other phenomena, such as vitamin D intake (also rich in fish, though not fish oil), the experience as a whole do indeed show a strong relationship between omega-3 levels and depression/mood/"psychological distress."

I'm skeptical of this study.  Look, I expect that, eventually, research will show a strong relationship between mood and LC ω-3.  But this study ain't it.

First off, this is an observational study.  When observational studies turn up order-of-magnitude differences, they point to cause-and-effect relationships.  But when they turn up relationships that barely pass the statistical significance test (p ~ .05) they are more likely measuring the shared influence of some other cause.

And what might this cause be?  Well, the authors point out (a) seafood consumption varies upwards with wealth and income.  (b) Happiness varies upwards with wealth and income. (c) They really would have liked to have controlled for wealth and income but they couldn't because the Inuits wouldn't fill out the wealth and income portion of the questionnaire.  

So their study was underpowered to measure one of the most obvious non-physiological explanations of the (weak) correlation they found.

This study would have us believe (a) Inuits have much higher ω-3 levels that other Quebec citizens.  (b) The suicide rate among Inuit in 1987–1994 was 6.5 times higher than in the rest of Québec, and the rate in the younger age group (15–
24 years) was 20 times higher. (!!) (c) ω-3 is associated with better mood.

Something is pretty discordant there.

I'll wait for an intervention study.

Hi, Red-

That's right.

This study, taken in isolation, proves nothing. It only adds to the other observations that suggest that omega-3 may exert an effect on ADHD, bipolar illness, depression, etc.

The fact that there appears to be concordance across different populations, though with differing frequencies of depession, is the argument of importance.

Hi, Red-

That's right.

This study, taken in isolation, proves nothing. It only adds to the other observations that suggest that omega-3 may exert an effect on ADHD, bipolar illness, depression, etc.

The fact that there appears to be concordance across different populations, though with differing frequencies of depession, is the argument of importance.

Fish oil makes me depressed and nauseous and tired . I do not  know what all the fuss is about.

I use a supposedly good type too, Carlson's.

A group from Laval University and University of Guelph, both in Canada, examined the relationship of plasma EPA + DHA levels and measures of psychological distress. This group had previously shown that Inuits older than 50 years had twice the plasma omega-3 levels (11.5%) compared to those younger than 50 years (6.5%), reflecting the shift away from the traditional diet.

Omega-3 is geally great. Improves memory , I'm loosing pounds and I don't feel hungry or depressed (and when I'm depressed I eat soooo much!).  I prefer flax oil of flax seed as a sourse of omega-3.  My body seems to reject fish oil and I think it's not for nothing. The mercury pollution won't do any good.