Omega-3 Fatty Acids - Part I
The American Heart Association has recommended Omega-3 Fatty Acid (O3FA) intake in the form of routine fatty fish such as salmon for patients without Atherosclerotic Coronary Artery Disease (CAD), fish oil supplements in patients with CAD, and high dose O3FA (about 4000 mg/day) in patients with high triglycerides.
Early studies demonstrated that the major effect of O3FA on the lipid profile is to lower triglyceride levels between 10-45% depending on the severity of the triglyceride level and the dose of O3FA used. At the same time there is also a tendency for the LDL cholesterol (bad cholesterol) to rise between 0-30%, for LDL particle size to enlarge, and for HDL cholesterol (good cholesterol) to increase between 0-7%. The purpose of this review is to provide a modern perspective based on recent studies of the role of O3FA as they relate to the management of abnormal lipids.
Until the availability of a prescription O3FA in 2004, which contains 840 mg of EPA and DHA (the two main O3FAs) and 60 mg of other O3FA in a 1000 mg tablet, the treatment of high triglycerides with Omega-3 fatty acids required the ingestion of large amounts of unconcentrated fish oil. Also at this time it was identified that most of these over the counter products were not regulated for content of the environmental contaminants such as heavy metals, pesticides, and dioxin. Now that many insurance companies and Medicare drug plans pay for the prescription O3FA sold under the name Lovaza, many Americans have begun to start taking fish oil.
The most common complaint is an unpleasant fishy taste if one burps. Fish oils are naturally highly unstable and susceptible to oxidation which accounts for their rancid conversion and patient intolerance. One of the most common ways to reduce oxidation and thus maintain shelf life, maintain freshness, and reduce oxidation is to add Vitamin E to supplements.
I generally tell my patients to take their fish oil at night. Another practical way to improve tolerance and reduce the fishy aftertaste of the liquid O3FA is to refrigerate it, once opened. If one is taking the capsules, it is said that refrigeration before use will reduce the fishy taste.
The way the manufacturing process is performed is the most important measure to reduce the aftertaste and remove contaminants. It could be argued that when a patient describes a rancid horrible and bad taste that the product was poorly purified by the manufacturer.
Unfortunately the supplement industry is basically unregulated. I have my O3FA made by one of the few companies that pay to have an oversight board watch their manufacturing process. I tell my patients who need to take high dose fish oil to use the highly concentrated liquid form while others may take the pills.
I think it is extremely important that patients look on the side of the bottle because most purchased O3FA says it contains 1000 mg but may contain as little as 300 mg of EPA and DHA. Thus one would have to take around 7 tablets if they are trying to take 2000 mg a day rather then thinking the correct dose would be 2 of the 1000 mg capsules. I have gone around to the big retail and wholesale stores and the health food stores and was amazed what I saw.
In the next posting we will discuss environmental toxins that may possibly be in the preparation and I will share with you the recommendations from the National Lipid Association to healthcare professionals regarding the use of O3FA supplements.
Related Topics:
Technorati Tags: omega-3, fish oil, cholesterol, heart health
Early studies demonstrated that the major effect of O3FA on the lipid profile is to lower triglyceride levels between 10-45% depending on the severity of the triglyceride level and the dose of O3FA used. At the same time there is also a tendency for the LDL cholesterol (bad cholesterol) to rise between 0-30%, for LDL particle size to enlarge, and for HDL cholesterol (good cholesterol) to increase between 0-7%. The purpose of this review is to provide a modern perspective based on recent studies of the role of O3FA as they relate to the management of abnormal lipids.
Until the availability of a prescription O3FA in 2004, which contains 840 mg of EPA and DHA (the two main O3FAs) and 60 mg of other O3FA in a 1000 mg tablet, the treatment of high triglycerides with Omega-3 fatty acids required the ingestion of large amounts of unconcentrated fish oil. Also at this time it was identified that most of these over the counter products were not regulated for content of the environmental contaminants such as heavy metals, pesticides, and dioxin. Now that many insurance companies and Medicare drug plans pay for the prescription O3FA sold under the name Lovaza, many Americans have begun to start taking fish oil.
The most common complaint is an unpleasant fishy taste if one burps. Fish oils are naturally highly unstable and susceptible to oxidation which accounts for their rancid conversion and patient intolerance. One of the most common ways to reduce oxidation and thus maintain shelf life, maintain freshness, and reduce oxidation is to add Vitamin E to supplements.
I generally tell my patients to take their fish oil at night. Another practical way to improve tolerance and reduce the fishy aftertaste of the liquid O3FA is to refrigerate it, once opened. If one is taking the capsules, it is said that refrigeration before use will reduce the fishy taste.
The way the manufacturing process is performed is the most important measure to reduce the aftertaste and remove contaminants. It could be argued that when a patient describes a rancid horrible and bad taste that the product was poorly purified by the manufacturer.
Unfortunately the supplement industry is basically unregulated. I have my O3FA made by one of the few companies that pay to have an oversight board watch their manufacturing process. I tell my patients who need to take high dose fish oil to use the highly concentrated liquid form while others may take the pills.
I think it is extremely important that patients look on the side of the bottle because most purchased O3FA says it contains 1000 mg but may contain as little as 300 mg of EPA and DHA. Thus one would have to take around 7 tablets if they are trying to take 2000 mg a day rather then thinking the correct dose would be 2 of the 1000 mg capsules. I have gone around to the big retail and wholesale stores and the health food stores and was amazed what I saw.
In the next posting we will discuss environmental toxins that may possibly be in the preparation and I will share with you the recommendations from the National Lipid Association to healthcare professionals regarding the use of O3FA supplements.
Related Topics:
Technorati Tags: omega-3, fish oil, cholesterol, heart health
10 Comments:
Dr Richman-I wish other physicians knew this information. It makes me frustrated to think how the supplement industry is totally unregulated and "lie" to get you to use their products. I know me and my family are appreciate of the information you provide and your ability to break it down so that normal people can read it. Keep up the great work! I was wondering if there is any way I get get fish oil from you directly?
Thank you for your kind words. If you are unable to find suitable O3FAs in your area, you can go to my website at www.lipidcenter.com for information on how to purchase them in either the liquid or capsule form.
Dr. Richman - Have you heard of a new kind of nutrition bar called the 'aristo' wellness bar that has EPA/DHA omega-3's from purified fish oil and also has plant sterols....to help people manage their lipid profile?
I have not heard of this bar. There are so many health bars, drinks, and food items that are marketed to manage lipids. If you have high Triglycerides, you should be taking at least 4000mg/day.
Dr Richmond, my doctor has me taking 5 or 6 prunes and 3 or 4 tablespoons of flaxseed powder stirred up in applesauce. This is supposed to be my omega 3 fatty acid. Is this any kind of sub. for the fish oil?
Thanks for your question. Flaxseed oil is not a substitute for O3FA.there is no harm in taking them both
crfluoOK wish brand gives you the most DHA/EPA.Mine is only432mg epa and 288dha pewr tablet. The brand is nature made.... Larry Reilly
Dr Richman,
I was told I have both high cholesterol (high LDL/low HDL) and high TGs. My doctor has just switched me from Niacin therapy because of the adverse effects...(I was thinking of writing a short story called My Own Private Summer Part Duex or Name That Circle of Hell)...to Lovaza...which I just started taking today (2 caps 2xday). I have no cardiac or BP issues or diabetes; my only diagnosed conditions involve back pain and the "dysfunctional duo" of fibro and chronic fatigue--neither of which effects my cardiac/circulatory systems. About a year ago I made some excellent changes in my life. After about 30 years on the stick, I quit smoking, changed my diet and began to exercise regularly; but these levels remain elevated.
After reading your article, I have to ask: Is this a complete treatment? Do I need a statin (or other such medication) as well or is Lovaza all I need? If you were my physician...what would you tell me to do?
Thank you for your time,
--Mystic
Forgive my additional post as I forgot to check the replies on the last one.
Blessings to all and to all a good night...
Dr. Richman, I noticed that you recommended that patients take their Omega-3's at night to reduce the side-effects of bad taste. I was wondering if taking these supplements at night would also have a greater impact in reducing TG's since this is when most cholesterol synthesis occurs. I was prescribed twice a day dosing and was instructed on a morning and afternoon dose. I know night-time dosing is used for other agents like statins.
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