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Medical Research?
Posted: 05 December 2011 04:46 PM   [ Ignore ]   [ # 16 ]
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I take fish oil as well, though it hasn’t had a noticeable impact on my lipid levels. There is good evidence for primary and secondary prevention of cardiovascular disease.

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Posted: 06 December 2011 07:40 AM   [ Ignore ]   [ # 17 ]
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My Doc. mentioned that as well. I began the regimen a couple of weeks ago, and he wants to see me in Feb. to check the results. I hate blood work though! A great part of my problem is that I’m a chocaholic. I need to attend a CA!

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Posted: 06 December 2011 08:44 AM   [ Ignore ]   [ # 18 ]
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mckenzievmd - 05 December 2011 04:46 PM

I take fish oil as well, though it hasn’t had a noticeable impact on my lipid levels. There is good evidence for primary and secondary prevention of cardiovascular disease.

Thanks for the link Brennan. I was looking for a good review article on this very subject for a patient just yesterday but didn’t have the time to really search. You just saved me the effort.

I would love to find a good study comparing quality and efficacy of the various products though. There are lots of over the counter products. As most of you are already painfully aware the supplement industry has managed to game the system so they are not regulated by the FDA. As a result there is little if any surveillance or quality control of these products. My main concern when recommending such products is whether they have the potency that is claimed on the bottle and whether they are properly tested for contaminants. Mercury is the main contaminant that comes to mind with fish oil products but there may be others. It would be extremely helpful if there was at least some sort of impartial agency that could be set up to do independent testing, the result of which would then be available to the public. Something similar to the UL label on electrical products would even be helpful, just to say this product has what it says in it and has contaminants below certain acceptable levels.

There is a pharmaceutical grade fish oil product called Lovaza which is FDA approved and has to meet these standards but its insanely expensive compared to the over the counter products which makes it difficult to recommend routinely. The high cost is a direct result of the fact that they are the only ones who have run expensive clinical trials which gives them the sole right to make health claims. Testing just for efficacy and purity however shouldn’t really raise the price of these products very much. The OTC products should at least do that. In fact that should be a minimum requirement for anything that is sold for public consumption.

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Posted: 06 December 2011 10:00 AM   [ Ignore ]   [ # 19 ]
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Excellent point! Even for supplements which have some reasonable evidence base, there is such poor quality control that one has to wonder about both active ingredient levels and contaminants.


And it is worth pointing out that in many cases there is evidence that consuming a food with high levels of the agent one is trying to get may be more effective and safer than taking that agent as a supplement. The most recent AHA Statement on the subject still considers increasing dietary intake of EPA and DHA preferable to a fish oil supplement, thought he issue of mercury contamination is also an issue with eating fish.

Biology is complex, so our understanding is always imperfect and evolving.. So it goes. grin

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Posted: 06 December 2011 10:34 AM   [ Ignore ]   [ # 20 ]
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It really is a problem.  Because I can’t say a particular product is safe i generally don’t go out of my way to advise patients to take these things. If they are already taking something I won’t necessarily discourage them from continuing it but I advise them about the potential pitfalls and try to impress upon them that it would be better to try and improve their diet if possible. For patients who are very high risk for coronary artery disease or for those who are candidates for medications to lower their triglycerides I sometimes prescribe Lovaza but thats a very small proportion of the total number of people who might benefit from this supplement.

I think this is one good example of where the supplement industry has really shot themselves in the foot. By exempting themselves from any sort of regulation, all of their products are suspect and difficult to endorse.

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Posted: 06 December 2011 07:10 PM   [ Ignore ]   [ # 21 ]
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Update: A bit of an odd coincidence but this months consumer reports has a short article on Fish oil supplements providing an analysis of the potency and contaminant level of a number of fish oil products. Its not a long term solution to the problem since the makeup of these products can change from year to year but at least it provides some temporary if imperfect guidance.

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Posted: 08 December 2011 06:13 AM   [ Ignore ]   [ # 22 ]
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George - 05 December 2011 04:45 PM

I took my kids for a checkup to an optometrist who recommended that they take fish oil supplements. I have enough kids to have kept the doctor busy for almost an hour, so I went on the internet to find out what Dr. Google had say on this. From what I could find, the evidence that fish oil has any proven benefit on our health is inconclusive. I showed it to the eye doctor who responded that there is enough of evidence to show that the fish oil stuff works. He said, she said. Anyway, I decided not to give my kids anything.

I trust my doctor because his qualification were recognized by other specialists, and because he has a lot of experience. Yes, I know that medicine (as a field of knowledge) is a mixture of art and science. Yes, I know that mistakes are made. That is why I go for a “second opinion,” in some situations.
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Posted: 08 December 2011 06:50 AM   [ Ignore ]   [ # 23 ]
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Ludwik, I understand what you are saying about trusting your doctor, but optometrists are not M.D.s and should not be giving advice on dietary supplements unless there is good evidence to show those supplements benefit the eyes.

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Posted: 08 December 2011 07:58 AM   [ Ignore ]   [ # 24 ]
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I’ll trust doctors only when I have no choice. I’ve gotten into two arguments in my past with doctors and in both cases I was right. Once when I was prescribed antibiotics for a fungal infection and a second time when our doctor wanted to take an x-ray of my pregnant wife because he was suspecting she had TB. There have been other less dramatic instances, but in these two cases I really lost my cool.

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Posted: 08 December 2011 09:04 AM   [ Ignore ]   [ # 25 ]
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George - 08 December 2011 07:58 AM

I’ll trust doctors only when I have no choice. I’ve gotten into two arguments in my past with doctors and in both cases I was right. Once when I was prescribed antibiotics for a fungal infection and a second time when our doctor wanted to take an x-ray of my pregnant wife because he was suspecting she had TB. There have been other less dramatic instances, but in these two cases I really lost my cool.

Just curious George ( pardon the pun), but why would you argue with a doctor wanting to do a chest xray if he was worried your wife had TB? I understand that she was pregnant but I think you may have been guided by misinformation here. It is perfectly safe to do a chest xray in a pregnant woman as long as proper precautions are taken. The amount of radiation from a standard chest xray is pretty low. In fact you get more radiation on a flight across the country and pregnant women do that all the time.

[ Edited: 08 December 2011 09:16 AM by macgyver ]
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Posted: 08 December 2011 09:37 AM   [ Ignore ]   [ # 26 ]
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macgyver - 08 December 2011 09:04 AM
George - 08 December 2011 07:58 AM

I’ll trust doctors only when I have no choice. I’ve gotten into two arguments in my past with doctors and in both cases I was right. Once when I was prescribed antibiotics for a fungal infection and a second time when our doctor wanted to take an x-ray of my pregnant wife because he was suspecting she had TB. There have been other less dramatic instances, but in these two cases I really lost my cool.

Just curious George ( pardon the pun), but why would you argue with a doctor wanting to do a chest xray if he was worried your wife had TB? I understand that she was pregnant but I think you may have been guided by misinformation here. It is perfectly safe to do a chest xray in a pregnant woman as long as proper precautions are taken. The amount of radiation from a standard chest xray is pretty low. In fact you get more radiation on a flight across the country and pregnant women do that all the time.

That’s not what what it says HERE: “For a typical cross-country flight in a commercial airplane, you are likely to receive 2 to 5 millirem (mrem) of radiation, less than half the radiation dose you receive from a chest x-ray.”

But that’s not the point. The problem was that the doctor had other options. It was me who initially went to see the doctor due to a cough that was lasting more than two months, IIRC. The doctor tested my sputum and it came back positive for TB. Our family was put into a quarantine and the doctor wanted to do an x-ray on me and my wife, who also had a cough. I asked him to do the x-ray on me first and if it confirmed that I had TB, then do an x-ray on my wife as well. It took about ten minutes or arguing after which he agreed to take an x-ray of me first. It came back negative. I was told by a specialist that the false positive in my sputum was due to a TB vaccine I received as a child.

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Posted: 08 December 2011 09:44 AM   [ Ignore ]   [ # 27 ]
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macgyver - 08 December 2011 09:04 AM

Just curious George ( pardon the pun)

BTW, it would not be a pun if you separated “curious” and “George” by a comma, as the grammar rules dictate.  wink

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Posted: 08 December 2011 09:48 AM   [ Ignore ]   [ # 28 ]
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George - 08 December 2011 09:37 AM

But that’s not the point. The problem was that the doctor had other options. It was me who initially went to see the doctor due to a cough that was lasting more than two months, IIRC. The doctor tested my sputum and it came back positive for TB. Our family was put into a quarantine and the doctor wanted to do an x-ray on me and my wife, who also had a cough. I asked him to do the x-ray on me first and if it confirmed that I had TB, then do an x-ray on my wife as well. It took about ten minutes or arguing after which he agreed to take an x-ray of me first. It came back negative. I was told by a specialist that the false positive in my sputum was due to a TB vaccine I received as a child.

Me too George - the TB tine test always comes back positive for me and I always have to get an X-ray to prove I don’t have TB. Not sure if it’s from a vaccine though.

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Posted: 08 December 2011 09:57 AM   [ Ignore ]   [ # 29 ]
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traveler - 08 December 2011 09:48 AM

Me too George - the TB tine test always comes back positive for me and I always have to get an X-ray to prove I don’t have TB. Not sure if it’s from a vaccine though.

Yeah, I don’t know what’s up with that. I know of three (!) of my friends (one from Europe and two from South America) who were put on strong antibiotics for months to cure their TB. All of them were eventually told that it was a mistake and they never had TB.

Why does that happen, macgyver?

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Posted: 08 December 2011 10:03 AM   [ Ignore ]   [ # 30 ]
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George - 08 December 2011 09:37 AM
macgyver - 08 December 2011 09:04 AM
George - 08 December 2011 07:58 AM

I’ll trust doctors only when I have no choice. I’ve gotten into two arguments in my past with doctors and in both cases I was right. Once when I was prescribed antibiotics for a fungal infection and a second time when our doctor wanted to take an x-ray of my pregnant wife because he was suspecting she had TB. There have been other less dramatic instances, but in these two cases I really lost my cool.

Just curious George ( pardon the pun), but why would you argue with a doctor wanting to do a chest xray if he was worried your wife had TB? I understand that she was pregnant but I think you may have been guided by misinformation here. It is perfectly safe to do a chest xray in a pregnant woman as long as proper precautions are taken. The amount of radiation from a standard chest xray is pretty low. In fact you get more radiation on a flight across the country and pregnant women do that all the time.

That’s not what what it says HERE: “For a typical cross-country flight in a commercial airplane, you are likely to receive 2 to 5 millirem (mrem) of radiation, less than half the radiation dose you receive from a chest x-ray.”

But that’s not the point. The problem was that the doctor had other options. It was me who initially went to see the doctor due to a cough that was lasting more than two months, IIRC. The doctor tested my sputum and it came back positive for TB. Our family was put into a quarantine and the doctor wanted to do an x-ray on me and my wife, who also had a cough. I asked him to do the x-ray on me first and if it confirmed that I had TB, then do an x-ray on my wife as well. It took about ten minutes or arguing after which he agreed to take an x-ray of me first. It came back negative. I was told by a specialist that the false positive in my sputum was due to a TB vaccine I received as a child.

George we can quibble over the exact numbers but the dose is in the same ballpark ( especially if you plan on coming home from your cross country trip). You’re facts still don’t add up though. I think you may have misspoken here. If the doctor tested your sputum and it came back positive it wouldn’t really matter what your chest xray showed.. you have active TB regardless of the xray findings and all member of your household should be checked. You would NEVER get a false positive on a sputum test as a result of being vaccinated for TB as a child. If what you really had was a skin test ( PPD or Mantoux) for TB, then that could come up falsely positive from the old vaccine and a chest xray would possibly be warranted to try and clarify the issue before going on and testing household contacts.

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