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Poll
In regards to fish oil consumption. chesk all that apply
I use fish oil capsules 2
I do not use fish oil capsules 9
I take it for my joint pains or arthritis 0
I take it for general health 0
I have had a heart attack or stroke and want to prevent another 0
I have never had a heart attack or stroke but would like to prevent one 0
My doctor recommended that I take fish oil capsules 1
I decided on my own to take fish oil capsules 2
Total Votes: 14
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JUst a quick poll. WHo here uses FIsh Oil Capsules and for what indication are you taking them
Posted: 21 March 2014 04:42 AM   [ Ignore ]   [ # 46 ]
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RubyWoo - 21 March 2014 01:50 AM

Hello, macgyver,

You are incorrect in your statement that lowering cholesterol is not the primary mechanism by which statins are proposed to lower the incidence of CVD.  Check Wikipedia and any of the statin websites.  This is from the Lipitor website:

How Lipitor Works:

“Statins lower cholesterol in the body by blocking an enzyme in the liver. The body uses this enzyme to make cholesterol. When less cholesterol is made, the liver uses more of it from the blood. This results in lower levels of cholesterol in the blood.

Along with a low-fat diet, LIPITOR is clinically proven to lower LDL (“bad”) cholesterol by 39%-60% (average effect depending on dose).

If you have high cholesterol, it’s important you be proactive about your health. Having high cholesterol levels can make you more likely to have a heart attack. Talk to your doctor about your risk and if LIPITOR is right for you.

INDICATION:
LIPITORĀ® (atorvastatin calcium) tablets are a prescription medicine that is used along with a low-fat diet. It lowers the LDL (“bad”) cholesterol and triglycerides in your blood. It can raise your HDL (“good”) cholesterol as well. LIPITOR can lower the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL, or family history of early heart disease.

LIPITORĀ® (atorvastatin calcium) tablets can lower the risk for heart attack or stroke in patients with diabetes and risk factors such as diabetic eye or kidney problems, smoking, or high blood pressure.”

Reduction in vascular inflammation is a minor part of the statin mechanism of action and thus, confirms that statins are primarily used (and effective) in those who have established CVD, not as a primary preventative measure as you have previously stated.

Whether Omega-3 fatty acids have a positive effect on outcomes of heart attack and stroke, is not relevant for me, as I have not had either a heart attack or stroke, and Omega-3 FAs provide other healthy benefits that make them an important supplement to my less than ideal diet.

macgyver - 20 March 2014 04:52 AM

Lowering cholesterol is only useful if it reduces the risk of health problems like heart attacks and strokes. While statins do lower cholesterol it dos not appear to be the primary mechanism by which they reduce the risk of these diseases. Statins have the ability to reduce vascular inflammation and this may be more important than lowering cholesterol. There are a number of other types of medications that are capable of lowering cholesterol and none of them reduce heart attack risk to the same degree as statins. As stated previously Omega 3 fatty acids can indeed have a beneficial effect on the lipid profile and yet they have not been shown to have positive effect on outcomes like heart attack and stroke.

Wikipedia is not an authority. That being said the quote you posted here does not support your statement. It simply says that statins lower cholesterol and they also lower the risk of a heart attack. Your conclusion that lowering cholesterol is the main mechanism by which statins reduce the risk of heart attacks is neither correct nor supported by the statements in that article.

For future reference, Wikipedia is not an authoritative source of information. Its OK to use it as a starting point but you need to do real research from authoritative sources if you want to be sure you are getting accurate information.

[ Edited: 21 March 2014 04:48 AM by macgyver ]
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Posted: 21 March 2014 05:02 AM   [ Ignore ]   [ # 47 ]
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The information I posted was not from Wikipedia - it was from the Lipitor website (the link is provided).  Further, I am not searching for an ‘authoritative’ source, I review several sources and base my opinions from there.  And you give no rebuttal, by simply stating information I’ve provided does not support my statements, you are essentially providing no useful information.  So if you really want a discussion, please provide what you consider ‘authoritative’ sources that support your claims and/or expand on your reasoning.

Instead of asking me to do ‘real’ research…please follow your advice - otherwise… till next time?

Cheers!

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Posted: 21 March 2014 08:28 AM   [ Ignore ]   [ # 48 ]
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RubyWoo - 21 March 2014 05:02 AM

The information I posted was not from Wikipedia - it was from the Lipitor website (the link is provided).  Further, I am not searching for an ‘authoritative’ source, I review several sources and base my opinions from there.  And you give no rebuttal, by simply stating information I’ve provided does not support my statements, you are essentially providing no useful information.  So if you really want a discussion, please provide what you consider ‘authoritative’ sources that support your claims and/or expand on your reasoning.

Instead of asking me to do ‘real’ research…please follow your advice - otherwise… till next time?

Cheers!

I was responding to this comment which you made ” Check Wikipedia and any of the statin websites”

I don;t have the time to do the research for you now but if you had been reading the literature over the past few years you would know that the general consensus in the medical community is that the antiinflammatory effect is as or more important than the cholesterol lowering effects of statins. This comes about from several different lines of reasoning not the least of which is the fact that the only class of cholesterol lowering drugs which have ever been shown to improve outcomes such as stroke and heart attack are the statins. Other drugs are capable of lowering LDL’s but have not similarly improved outcomes.

The latest cholesterol treatment guidelines are formally published in this document: http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf

Its rather long but the change in guidelines is now away from using LDL levels as a primary indicator for treatment (except at very high levels above 190) and toward using overall risk and indicators of inflammation as the main criteria for treating patients with statins. This relfects the current thinking that that vascular inflammation mediated partly through LDL but also through many other insults such as hypertension, diabetes, and smoking, should be our main target.

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Posted: 21 March 2014 11:14 AM   [ Ignore ]   [ # 49 ]
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RubyWoo,

My citation of the SELECT trial info was in response to TimB’s comment that he would prefer taking a fish oil to a prescritpion medication because he perceievs the prescription drug to have unacceptable risks. I was pointing out that any medical therapy which has desirable effects on the body, including dietary supplements, is going to have undesirable effects as well. Side effects are an intrinsic consequence of tinkering with a complex system in which there is inticate interaction between elements. We cannot adjust one part of the system without having some impact on other parts, and the goal is to find the best possible balance between desirable and undesirable effects.

The SELECT data do not demonstrate that fish oil causes cancer. The study found, as you point out, an association between levels of fatty acids found in fish and increased prostate cancer risk. This suggests a possible undesirable effect to be further investigated. This is improtant information even though it is not definitive simply because so many people assume the absolute safety of dietary supplements, and that is a dangerously misinformed view. I’m not suggetsing it is your view, simply that potential risks must always be considered along with potential benefits for any intervention.

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Posted: 21 March 2014 11:51 AM   [ Ignore ]   [ # 50 ]
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Perhaps I’m misreading people’s posts, but I get the impression that not everyone is understanding what I take to be macgyver’s point about muscle pains and statins. FWIW, here’s how I understand the issue:

The clinical trial evidence suggests that when placebo controls are in place, very, very few people appear to have muscle pain associated with taking statins. However, in the “real world,” a much higher number (up to about 20%, I believe) report such side effects. So what are the reasons for the differences. I think there are several, and it isn’t clear how much of a role each has.

1. There is evidence that pharmaceutical companies conduct licencing trials in ways that subtley decrease the apparent negative effects of drugs. Often, for example, there is a “wash-in” period during which people who have negative symptoms while taking a drug can be identified and excluded from the trial. There are also ways in which study populations are selected and data is collected and reported that influence this, and it is difficult to get a clear view of the impact of such manipulatons because much of the data collected are not made public or filed with regulatory agencies. So to some extent, there is reason to think the real side effect rates are higher than appear in the clinical trial literature. Here is a link that discuss this in more detail:

Ben Goldacre (co-author of a recent paper on statin side effects)


2. Nocebo effects and other cognitive biases. As macgyver correctly points out, when people expect negative side effects from a drug, they tend to experience them when given the drug. The issue of muscle pain with statins is widely known, and it is reasonable based on extensive cognitive psychology literature to believe that some of the people experiencing these are have a psychological, rather than a purely muscle-based, experience of pain. While I know those of you who have had such discomfort yourself will absolutely reject this idea, it is a well-established phenomenon in the medical literature. Pain, nause, itching, changes in blood pressure, and many other unpleasant symptoms can be induced simply by telling someone to expect them and then giving them an inert substance, so it is naive to assume this cannot happen with statins.

Similarly. as macgyver points out, it is common for people to have minor aches and pains all the time, and there is a natural tendancy to look for a cause for these when they occur. It is very common to choose a new medication as the putative cause for such things because it is such an obvious candidate. This is partly why there is hardly a drug on the market that doesn’t list “headache” as a possible side effect. Not every single drug in the world really causes headaches, but headaches are common and we naturally are suspicious of new medications we are taking as the cause.

Again, some links on the subject:

Nocebo effect

Review of drug studies and nocebo/placebo effects

Possible mechanisms for such effects


So while I think there is plenty of room for legitimate suspicion of the pharmaceutical industry and the data it produces, I also think there is at least as much room for skepticism about the value of our own personal experinces. If someone takes a statin and has muscle soreness, it may or may not mean the statin is responsible. If someone takes a statin and has muscle soreness, it is not in any way a reason to suggest others should be reluctant to take these drugs. And our own personal assessment of cause and effect relationships in daily life is deeply flawed and subject to errors we cannot directly eprceive, so the sense of certainty we often feel about such assessments is unjustified. As I have pointed out before (though, unfortunately, people seem to miss the general point and take personal offence instead), it is a bit ironic that those gathered here presumably share a skepticism about the evidentiary value of personal experiences of the supernatural, and yet we often claim near certainty in our conclusions about our own personal experiences with dietary supplements. Skepticism rests on the idea that all personal experiences are unreliable compared with formal, objective evidence, and we should apply this as rigorously to our own experiences as to those of others.

My own personal experience is as unreliable as anyone else’s, but it is illustrative of how I approach such issues as askeptic. I have taken three different statins, and with all of them I have begun, stopped, and resumed taking them in blocks of time to attempt to see a pattern in my responses. I believe I have more exercise-associated muscle pain when taking a daily statin than when not taking it, but since I do martial arts I have muscle pain somewhere much of the time, and I cannot be certain there is a real association. I have finally settled on every other day dosing, and I do not appear to have the same negative effects. This is a compromise. My CVD risk calculation is slightly below the threshold for statin therapy, but I come from a long line of men who die of CVD far too early, so I am eager to modify whatever risk factors I can (and yes, I have addressed all of the others: healthy diet, plenty of exercise, not smoking, not overweight, not diabetic, not hypertensive, etc., so I’m not takin a statin as a lazy way of avoiding changing my lifestyle). However, the evidence for the primary prevention value of every other day statin dosing is not strong, so it is unclear whether my attempt to avoid perceived side effects, which may or may not be real, is undermining the purpose of taking the medicine. The point is that there is a great deal of complexity and uncertainty in medicine, and making such decisions involves thoughtful considerations of the data and the circumstances of each patient, so we should be wary of confident generalities.

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Posted: 21 March 2014 12:09 PM   [ Ignore ]   [ # 51 ]
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mckenzievmd - 21 March 2014 11:51 AM

The point is that there is a great deal of complexity and uncertainty in medicine, and making such decisions involves thoughtful considerations of the data and the circumstances of each patient, so we should be wary of confident generalities.

Important point and why we should never forget that guidelines are just that..guidelines not dictates. We have to take into account the individual circumstances of each patient. As an example in your case, the cardiac risk calculator only asks about family history as a positive or negative value although one would imagine that someone with a single first degree relative with premature heart disease might not be at as much risk as someone with 3 or 4 such relatives. The current method of calculating risk is not refined enough to differentiate between those two individuals. Such guidelines can’t take into account every variable so physicians must attempt to incorporate that into their recommendations.

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Posted: 21 March 2014 12:22 PM   [ Ignore ]   [ # 52 ]
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mckenzievmd - 21 March 2014 11:51 AM

1. There is evidence that pharmaceutical companies conduct licencing trials in ways that subtley decrease the apparent negative effects of drugs. Often, for example, there is a “wash-in” period during which people who have negative symptoms while taking a drug can be identified and excluded from the trial. There are also ways in which study populations are selected and data is collected and reported that influence this, and it is difficult to get a clear view of the impact of such manipulatons because much of the data collected are not made public or filed with regulatory agencies. So to some extent, there is reason to think the real side effect rates are higher than appear in the clinical trial literature. Here is a link that discuss this in more detail:

Ben Goldacre (co-author of a recent paper on statin side effects)

I have no doubt that this is certainly part of the problem but the side effect percentage would also be expected to increase when a product goes to market because the Nocebo effect will most certainly increase among a population that is aware of the possible side effects as opposed to a study group that may not be prompted in the same way. The possibility of muscle pains has been publicized to such an extent that the majority of the patients I see are already expecting this side effect when I discuss statins with them.

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Posted: 21 March 2014 01:56 PM   [ Ignore ]   [ # 53 ]
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I took two capsule a day for over 8 years because I almost never eat fish and there is a history of heart and cardiovascular disease in my family. Then I read that most of the research done supporting fish oil, has been done by companies that have a stake in the business that used unscientific methods and few controls. The rest of the evidence is mostly anecdotal for its efficacy. There is also the mercury poisoning issue. So now, I try to eat some fish and I include ground flax seeds in my diet as often as possible. They actually contain high levels of omega oils.

My cholesterol level was a problem in the states seven years ago, but when I moved to Spain, I was told my levels were not bad enough to require medication. It also went down as I began to eat a much more Mediterranean diet with lots of vegetables and olive oil. I almost never used butter anymore and I never had anything other than vinegar and oil for salad dressing. I just moved back to the US and expect that when I see a doctor again, I am going to be told that I need to take a prescription drug for my cholesterol. Not sure what I will do about it though. I am also not yet over my “just got back” love affair with creamy rich salad dressings and really tasty beef.

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Posted: 21 March 2014 03:07 PM   [ Ignore ]   [ # 54 ]
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There’s no reason you can’t continue the Mediterranean you followed in Spain over here. You have good evidence that in your case cholesterol levels can be controlled with diet alone. Of your levels come back higher ask your doctor about the new guidelines. If cholesterol is your only risk factor you may not need to be treated with medication. Lifestyle modification may be sufficient.

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Posted: 25 April 2014 10:29 AM   [ Ignore ]   [ # 55 ]
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Hi!
Shortly my story. About a year ago I started taking a new natural Omega 3 North- Europe producer product (they are promised ratio 3:1 or lower) because I have psoriatic arthritis and five years ago it really flared up in my joints so I couldn’t exercise anymore and two years ago patches started appearing on my skin and under nails. I measure Omega 3 effect and Omega 6:3 ratio due to its importance. I use a blood test from leading laboratories. This is a simple dry blood-spot test for home sample collection. Leading laboratories analyze the sample to determine your fatty acid profile as a reflection of your diet. It takes less than a minute to complete, and you can access your results online anonymously after about 20 days.  The balance test identifies levels of 11 fatty acids in the blood with 98% certainty. You will learn your blood levels of omega-3 and your ratio of omega 6:3 for balance, plus receive report to increase your health and dietary awareness. Test results will show whether your diet is balanced or unbalanced. Continue using the balance products and, adjust your diet as recomended based upon your balance test report. For example my first test ratio was 8,4:1, second after four months 3,4:1 and third a year later 1,6:1. By the way- if you hold ratio 3:1 or lower then all life style diseases (skin diseases, asthma, allergies, diabetes 2, high blood pressure, thyroid problems, osteoporosis, cardiovascular diseases and so on) are disapeared.

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Posted: 28 April 2014 11:58 AM   [ Ignore ]   [ # 56 ]
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RihoZN - 25 April 2014 10:29 AM

Hi!
Shortly my story. About a year ago I started taking a new natural Omega 3 North- Europe producer product (they are promised ratio 3:1 or lower) because I have psoriatic arthritis and five years ago it really flared up in my joints so I couldn’t exercise anymore and two years ago patches started appearing on my skin and under nails. I measure Omega 3 effect and Omega 6:3 ratio due to its importance. I use a blood test from leading laboratories. This is a simple dry blood-spot test for home sample collection. Leading laboratories analyze the sample to determine your fatty acid profile as a reflection of your diet. It takes less than a minute to complete, and you can access your results online anonymously after about 20 days.  The balance test identifies levels of 11 fatty acids in the blood with 98% certainty. You will learn your blood levels of omega-3 and your ratio of omega 6:3 for balance, plus receive report to increase your health and dietary awareness. Test results will show whether your diet is balanced or unbalanced. Continue using the balance products and, adjust your diet as recomended based upon your balance test report. For example my first test ratio was 8,4:1, second after four months 3,4:1 and third a year later 1,6:1. By the way- if you hold ratio 3:1 or lower then all life style diseases (skin diseases, asthma, allergies, diabetes 2, high blood pressure, thyroid problems, osteoporosis, cardiovascular diseases and so on) are disapeared.

Peer reviewed studies please? This is all unsubstantiated gobbldygook.

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Posted: 28 April 2014 12:07 PM   [ Ignore ]   [ # 57 ]
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Nearly identical text has been posted by someone with the same username on other for a, so I suspect this is marketing message.

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Posted: 28 April 2014 05:05 PM   [ Ignore ]   [ # 58 ]
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Sounds like marketing to me. Smells like Spam.

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