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 http://wholehealthsource.blogspot.com/2009/06/lyon-diet-heart-study.html
 
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.
 
CIAO
THE BRUTE
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.

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Coenzyme Q 10 Part Deux

Sorry for delaying in this post. I’ve been busy and not been able to get to the internet. Today I want to spend some time reviewing what depletes it and what types of supplementation can be used.

In the last post I put up a chart of CoQ10 reduction as one ages past the early 20’s.

Unfortunately ageing is inevitable. As you get older, your levels of the substance go down. Malnourishment will also speed that process along. Dr. Langsjoen discusses in the video linked from the first post about the need for folate, b vitamins 2, 3 6 and 12, pantothenic acid, vitamin c, tyrosine, methionine, Mg, and Se among others. If there is a deficiency in one or more of these, then coQ10 production could be impaired.

Drugs are going to be a big factor in depletion. Statins seem to be the most indicted when it comes to coQ10 depletion, but they aren’t the only ones. Tricyclic antidepressants are also offenders including;

Amitriptyline                 Clomipramine                   Doxepin                 Nortriptyline

Diabetic medications that raise insulin levels are offenders, namely;

glipizide          glyburide       tolbutamide

Blood pressure meds also lower coQ10 including

clonidine             atenolol                bisoprolol               labetalol                 metoprolol                    nadolol                pindolol                propranolol            hydralazine            hydrochlorothiazide, chlorothiazide         indapamide          metolazone

Gemfibrozil and statins that are for cholesterol lower coQ10.

Some others include chlorpromazine, fluphenazine and prochlorperazine.

Many people take these medications listed above, especially the statins and blood pressure medications. Some are even started in their 20’s. I know because I was started on simvstatin when I was 26. I took it for 2 years. I know others in their 20’s who are on blood pressure medications and/or statins as well because the numbers “are just high”. I find this rather disconcerting. Some people are actually lowering their coQ10 stores at ages when they are naturally their highest. I believe some doctors are unaware of the specifics when it comes to drugs that deplete coQ10 and the importance of resupplying the body.

Disease states such as congestive heart failure are also problematic. Many people are placed on drugs such as metoprolol, a beta blocker, which does seem to reduce mortality. Congestive heart failure is characterized by the heart not being able to pump sufficiently thereby causing problems with breathing, edema and other sequelae. The heart is literally in an energy crisis and many of the drugs used for blood pressure, cholesterol and in some cases diabetes actually cause longer term harm energetically. The underlying problem of getting the myocytes (heart cells) to produce energy is not addressed by many family docs and cardiologists, and even when it is with supplementation the amount being used may not be sufficient.

Supplementation

CoQ10 can be seen in many stores and online. It comes in many fancy packages and with many different claims. Some come in powder forms and others come in oil. Some are liquid preps and others are wafers. Traditionally I recommend to my patients to get the gel caps containing oil. Many times this oil is soybean because it is so cheap. I don’t recomment soy in any form unless it is fermented, soybean oil included. Look at the label if you want to get some. I know the amount is small in a gelcap, but if this is something your going to be taking long term, that amount will add up over time. I don’t know that it would technically be clinically significant, but I would stay away if possible.

CoQ10 also comes in the reduced form ubiquinol. Ubiquinol has been shown to abosrb better into the bloodstream than regular coQ1o or ubiquinone.1-3 Dr. Langsjoen has seen the benefit in patients that use ubiquinol over coQ10 in his clinical practice. Refer to the video that I posted last time for that story. It is also recommended that if taking regular coQ10, that it be done with a meal containing some fat so as to help the molecule into the blood. The main goal of supplementation is to raise blood levels so as to get more of the supplement into the cells where they are needed most. Blood levels of 4mcg/ml appears to be an effective treatment for heart failure per Dr. Langsjoen.4-6

CoQ10 may also be useful in treating neurodegenerative disorders like alzheimers. In a review of oxidative damage’s role in neurodegeneration, Beal discusses the potential role of substance like coQ10 can have on preventing or maybe treating this problem.7

Anecdotally I’ve talked to people at the pharmacy window who have told me it also seems to greatly improve muscle cramping. One lady said after a week of not taking it her cramps came back and she started it again. Within a week or so she said her cramps began to fade again. She is one of many who have reported this benefit. (I tell a lot of people to take CoQ10)

Recommendations

If coenzymeQ10 or ubiquinol is something you want to try then go for it. It does have a common side effect of nausea. Also it can interfere with warfarin binding to proteins in the blood, increasing the chance of bleeding for those patients. If you take warfarin, consult with a compentent doctor before supplementing. Ubiquinol appears to be the best absorbed so that is what I would recommend. For people using it as a preventative measure 50-100mg would probably be sufficient. For people with heart failure 200-300 mg divided twice daily or more may be required. It seems to depend more on the blood levels than the dose. For most of us, getting a coQ10 level measured may not be possible due to lack availability or money to pay. The supplement itself can be costly for some people, especially if you use ubiquinol rather than the less absorbable coQ10. If you have a doc or pharmacist who is knowledgable with this supplement, ask them for help. If they are unfamiliar, ask them to learn about it.

I think it important to note that it does take some time for coQ10 to begin working. It doesn’t start changing your life overnight so be patient.

There are other supplements that can be used to increase energy in the heart. I won’t be going over them in this post but would like to address them in future posts. A book that I would recommend is Reverse Heart Disease Now by James Roberts and Stephen Sinatra, two cardiologist who practice what they term integrative cariology. In the book they discuss the role of magnesium, l-carnitine, l-arginine and other supplements that can be used for the heart.

I want to express that I don’t receive any money from any company that makes any supplements or drugs. I believe CoQ10 and ubiquinol are great supplements and recommend them regularly.

CIAO

The Brute

 1.  Hosoe K, Kitano M, Kishida H, et al. Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28.

2.  Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002 Oct;59(10):1541-50.

3. Shults CW, Flint BM, Song D, Fontaine D. Pilot trial of high dosages of coenzyme Q10 in patients with Parkinson’s disease. Exp Neurol. 2004 Aug;188(2):491-4.

4.  Langsjoen PH, Langsjoen AM. Overview of the use of CoQ10 in cardiovascular disease. Biofactors. 1999;9(2-4):273-84.

5.  Langsjoen PH, Littarru GP, Silver MA. Role of concomitant coenzyme Q10 with statins for patients with hyperlipidemia.
Curr Topics Nutr Res.2005;3(3):149–58.

6.  Langsjoen PH, Langsjoen AM. Coenzyme Q10 in cardiovascular disease with emphasis on heart failure and myocardial ischaemia.
Asia Pacific Heart J. 1998;7(3):160-8.

7. Beal MF. Mitochondrial dysfunction and oxidative damage in Alzheimer’s and Parkinson’s diseases and coenzyme Q10 as a potential treatment. J Bioenerg Biomembr. 2004 Aug;36(4):381-6.

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.

Women and Statins

This post is dedicated to my mom and she is the reason I’m blogging about this subject today.

Statins make money. Lipitor is the biggest one. Just go to the following site and see;

http://www.drugs.com/top200.html

You can look back to 2003. Lipitor was on top every single year until 2010 when Nexium, a drug used for acid reflux, finally dominated. I write this post because Lipitor is going generic very soon. Nov 30 2011 and the patent expires, meaning other companies can finally start bringing atorvastatin (the generic name of the drug) to market. I’m not a fan of statins and because of this new development I felt it was time to say something about it.

Here’s a quick note about cholesterol. Cholesterol isn’t bad. it is vitally important for everything to function properly in your body. Period. Hormones, nerve conduction, cell membranes (the things that are essentially the wall of every cell) etc. cannot function properly without cholesterol. If you disagree with this you know nothing about anatomy and physiology or are paid way too much by the drug companies. Cholesterol is carried around in the blood by small particles called lipoproteins. Since cholesterol doesn’t dissolve in water, which is a good percentage of what the blood is made of, the body needs another mode of transport. Lipoproteins and proteins that also contain things like fatty acids and antioxidants and carry cholesterol around inside of them. It is the measurement of these particles that typically are referred to when someone says they have and LDL of 150.

Atorvastatin is a potent statin. It lowers LDL in the body about the same as simvastatin but at half the dose and 10x the price. The NCEP (National Cholesterol Education Program) recommends an LDL level of ≤160mg/dL. Total cholesterol levels should be less than 200. Meh.

Ladies, cholesterol is good for you! That’s right cholesterol is good for you. Anthony Colpo, an independent researcher and trainer, discusses the results of a trial at his website here. The link to the study can be found at his website or here. I also highly recommend Anthony’s book The Great Cholesterol Con for additional information about cholesterol and you. It is an incredibly well researched book.

This study showed that as women age they tend have decreased all cause death risk from increased cholesterol and trended the same way for CHD mortality risk. For men it seemed to follow a U-shape curve meaning that you don’t want you cholesterol too high or too low.

This backs what some other studies have showed, that LDL is not the boogy man that everyone makes it out to be, especially in you ladies. A meta-analysis (a study looking at a bunch of studies to get a better picture of what they all mean) was done looking at women and cholesterol reduction. The study reported the following, “For the trials reporting total mortality, lipid lowering did not appear to have a beneficial effect for women with or without previous cardiovascular disease over the 2.8- to 6-year study period in the available trials”.¹ They of course said that they probably needed more time and older women to show any benefit for overall mortality. So if you are a women and do have or do not have cardiovascular disease, your going to die either way. Surprise! Now they did show reductions for women who have history of cardiovascular disease for non-fatal MI’s, CHD events, and revascularization, but your still going to die, just probably not of a heart attack.

How does atorvastatin tie in to all of this. Soon insurance companies are going to be more likely to cover the drug once the price comes down. Some times docs will choose atorvastatin over simvastatin or pravastatin because of its ability to lower LDL so much. With the price reduction some doctors may feel they should just put it on the regimen for a woman whose cholesterol levels are over 200. I don’t think this necessary. I believe there are other ways to manage cardiovascular risk that leaves your cholesterol to do what it’s supposed to do.

Ladies if you have a family history of CHD start looking at you diet and activity levels. Are you filling your mouths full of refined grains and/or vegetable oils? If you are then stop. Do you need to lose some weight? Then do it. For you diabetics out there, find whole foods that help control your blood sugar. With time, diet and the right kind of exercise, you can and should be able to reduce the need for medication. I counsel people daily about the need to get simple things out of their life (corn oil, daily soda drinks and junk food etc.) and get good simple things INTO their lives like rest, good exercise and whole foods. I also recommend Coenzyme Q10 or ubiquinol for many people taking or not taking medication. It is a great supplement with documented heart health benefits. We’ll have to discuss that one in another post.

If yoga grandma can do it, so can you!

So ladies, if your doctor wants to put you on atorvastatin, especially now that it is going to be generic, ask him about these studies and see what happens. I think education is a great tool and knowledge is readily available. Use the internet to access primary articles and learn how to read them. Ask questions constantly. Knowledge ceases when one stops asking and the mind begins to dull.

Ciao

The Brute

1.Walsh JM, Pignone M. Drug Treatment of Hyperlipidemia in Women. JAMA. 2004; 291 (18): 2243-52

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.