Moderation, Moderation, Moderation

One thing that I try to live by and try to tell people all the time is moderation in all things. I love steak, but I don’t eat it every day, or even every week. I remember one time I had steak 5 nights in a row in some form or another. My body felt like it had a rusted nail sitting in it. That’s seriously the only way I can describe it. Steak overload isn’t good. I did it one other time a few years later and felt the same way. I learned my lesson.

I talk to a lot of people around the pharmacy (patients) that have diabetes. Many of them younger than myself which is always surprising and sad to me. I always wonder if it is sheer ignorance of lifestyle, lack o care or both that gets them into trouble. There is a nutritionist at the clinic where I work and after talking with her and just talking to the patients themselves, much of the diabetes problem becomes clear, at least where I live and practice.

Tortillas are a mainstay of the immigrant population where I live. One man I talked to stated he had 7-8 tortillas with some beans and rice, just for breakfast. Now I don’t know how big these were but a medium size tortilla has about 100 calories or so. Bigger ones can have well over 200, not to mention they usually are cooked with corn oil. Assuming he had medium tortillas, he ate about 800 calories just in tortilla, not including the beans and rice. That’s a lot of carbohydrate from all three foods for breakfast as well as a lot of calories from 1 meal. One doc I work with told me he had a patient who would eat 20 at a time. Assuming medium tortillas again, that is 2000 calories. Not to mention tortillas don’t exactly have a lot of nutrients in them.

I’m not trying to say don’t eat tortillas, I’m saying 1-2 might be a little better. Both patients above suffer from diabetes. Eating lots of tortillas and rice as a diabetic, or even as a non-diabetic is suicide by sugar to blood vessels. Maybe mixed with some veggies and some meat would be better than rice and beans.

Sitting in front of the TV is also a problem. I’m a bit of a hypocrite today as I have been in front of the TV a good bit today seeing as I’m sick right now (bad stomach problems). It’s not because I ate something like tortillas or wheat or something. I picked up some sort of bug from a potluck. I wasn’t the only one. I digress. TV can cause people to lose sleep, sex, and time doing other more productive things. I don’t think this is anything new, in fact I know it’s not, but people seem to watch endlessly anyway. I have no cable or satellite, but even my Netflix can cause me to watch a little too much if I’m not careful. And to think that I keep putting of getting the garden ready for the summer. I’m just too busy I suppose….too busy watching Netflix.

Internet seems to get in the way of getting important things done. YouTube has replaced cable. I can find anything I want to watch with limited interruptions. Those commercials are starting to get annoying, so back to Netflix.

Exercise is great, but if you’ve ever over exercised you are doing your body no good. Muscles need time to recover and heal. Rest is a good thing. So is replenishing your muscles with good food and not starving.

These are just some thoughts from your friendly pharmacist. I talk to people all day long who use so many drugs. Many of them have genuine problems that require professional help. Others have problems that are usually self-induced. I very much dislike talking to women who believe they will find weight loss in a pill. They will try it for 2-3 months and may even lose a few pounds, but once the medicine is gone,  lifestyle replaces what little was lost quickly. I always counsel that exercise and diet will be their key to losing unwanted weight, but most just stare at me and give the look of “I really don’t care, just gimme my pills”.

Remember the moderation will bring more happiness in a life than overindulgence. Work is just as important as rest, and a sweet treat now and again is just as important as regular good nutrition. A good movie or book is a welcome distraction, but so are weight lifting or running. Life should be enjoyed and cannot be if moderation is not kept in all things.


The Brute


Fish Oil

Fish oil can be bought just about anywhere these days and many people use it. Some complain about fishy burping problems that some brands may cause and some do not like the nausea that comes along with it. These are probably the main side effects of this supplement, although arrhythmias have been documented as well at higher doses. I want to delve into fish oil today a bit and talk about some uses for this supplement.

Fish oil is actually composes of omega-3 fatty acids. These are essential fatty acids meaning they are absolutely necessary for human life as we know it. They complement omega-6 fatty acids which are also essential for human life. We as humans cannot make these and thus their “essential” status. Some of the more common are EPA or eicosapentanoic acid, DHA or docosahexaenoic acid, and ALA or alpha-linoleic acid. I’m going to refer to all omega-3 as n-3 as they are commonly known in scientific communities (especially since it shorter to type!)

N-3’s are found in many types of food including, you guessed it, fish and other seafood. Raw milk is also a source. Some greens such as spinach or kale can provide n-3 but the best sources by far are animal. Nothing like some baked salmon or halibut fresh from the water. In Seattle markets these are readily available and make me salivate just thinking about them. Alas, I don’t live in Seattle and must make do with living in desert. I do like tuna, but eating it out of the can just isn’t the same as a nice tuna steak cooked medium rare encrusted with herbs and sesame seeds. It has been recommended that everyone have fish twice a week. It’s a great idea, especially if you like fish like myself, but sometimes because of location or economics, just not the most practical. Enter supplements like fish oil.

Nothing like some good ol’ fish to get some omega-3
I’ve seen some site like Mercola advertise krill oil and others do calamari oil. All the studies that I know of (at least the big ones) have been done with fish oil. Lets look at some of these and see what happened.
First lets look at GISSI-Prevenzione, a trial done in Italy with patient who had recently (within the last 3 months) suffered a heart attack. A total of 11,323 people were looked at. Patients received n-3, vitamin E, both or placebo. After 3 months total mortality was significantly reduced. At 4 months the risk of sudden death was reduced significantly and at ~8 months coronary, cardiovascular and cardiac deaths had also decreased. There was a decrease in the benefit of reduction of sudden death toward the end of the follow-up that the researchers partially attribute to a decline of adherence to the regimen, but only 4% stopped because of side effects.1  It’s also interesting to note that the group that had the fish oil had higher cholesterol levels up until the end of the study when they returned to baseline levels yet the protection from events was still present.
Another trial from Japan, JELIS, studied men and women who had hypercholesterolemia with or without heart disease. Patients were given a statin with or without EPA, one of the n-3 supplements. After a 5 year follow-up, a 19% reduction in major coronary events was found. That is to say coronary events happened in 3.5% of the control group and 2.8% of EPA group. It is a small absolute reduction to be sure, but considering this is on top of using a statin, I don’t consider it all that bad. It would be interesting to see a head to head trial of statin vs fish oil and see which comes out on top, both in terms of events and side effects. Other differences were found that trended toward reduced events with EPA, but non were statistically significant. 2
A meta analysis looking at studies of n-3 supplementation vs control diet and placebo showed that there was a significant difference between the two groups of deaths to fatal heart attack, sudden death and overall mortality. 3
A dietary study which sheds some light on the matter was the Lyon-Heart study done in France. Patients were given two different diets with differing levels of fat, and different types of fat. The intervention group had a diet that was similar to a “mediterranean” diet that emphasized fish and poultry over other meats as well as lots of greens. The standard diet allowed for no more than 30% calories from fat, no more than 10% from saturated fat and less than 300mg cholesterol/day. Stephan Guyenet does an excellent job of describing it more in-depth at
What the trial found was that after 4 years, mortality was reduced by 70% and cardiovascular deaths by 76%. As Stephan points out, cholesterol between the two groups was the same. Cholesterol didn’t change but cardiovascular mortality did. This is one of many reasons I’m not a fan of statin drugs. One of the keys of this study was the high amount of omega-3 in the diet and the low amount of omega-6. As pointed out earlier, they are both absolutely essential to human health. But the amount needed is small and a refined western diet has a large amount of omega-6 fats in just about everything. 4

Heart Healthy my butt!

Achieving a balance, just like in everything else is the key to good health. A ratio of 3-4:1 omega-6:omega-3 is probably a good balance for humans. There are some variations to this based on different epidemiologic data. The problem remains however here in western civilization that we consume far too much omega-6 fat, and it’s in everything. If you see vegetable oil on the ingredients, try looking for an alternative. Canola, corn, safflower and soybean are just a few. Avoid them and get some good source of n-3 from fish, grass-fed milk, flax, cod liver oil or a good fish oil supplement. Trying to overdo a fish oil supplement to make up for intake of omega-6 is the wrong approach. Reducing omega-6 is far better.
Proper diet and exercise are always going to lead to better improvements in cardiovascular health than any chemist in a lab could every do. It’s amazing to me how many healthcare professionals don’t take the time to research some of these basic tenants of medicine. Remember let thy food be thy medicine.
1. Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della opravvivenza nell.Infarto Miocardico (GISSI)-Prevenzione.2002; 105: 897-1903. Circulation 2002; 105: 1897-1903
2. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet March 2007 369:1090-1098
3. Bucher HC, Hengstler P, Schindler C, et al. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002 Mar; 112(4):298-304
4. De Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343:1454-1459.

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.