12 replies to this topic

[sgupta]

Hey all,

So I just got back from the doctor's today, and I'm making progress. She liked most of the supplements I'm taking, my BP is getting a little better (still a little ways to go, but it's in the ballpark), and overall things are going well.

I've been taking 2.2g of fish oil per day, and she and I discussed removing a supplement with both fish oil and soy in it and doubling my other fish oil supplements (including some krill). Which will bring me to 3.6g of fish oil per day (that's combined DHA/EPA).

I use high quality fish oil (as tested by ConsumerLab), but there seems to be some concern that too much fish oil can lead to more oxidative stress in the body, which could outweigh the benefits. I'm taking it for several reasons - lower BP, cardio health, brain health, blood thinning properties, etc. I've seen differing opinions; some say you shouldn't excede 1g, and others seem to indicate 3-4g is optimal and just fine. Any opinions on this?

Also, if oxidative stress did start to make an impact with fish oil supplementation, is this something that would show up on my next cholesterol panels for LDL, or would there be no way to know?

Thanks!

[LexLux]

while I like vegan epa+dha (avoids heavy metals and other contaminants) for its benefits for skin and the brain, I do think too much can be bad and I'm not convicned on the heart benefits (new videos that cites recent studies):

Edited by LexLux, 20 February 2014 - 08:05 AM.

[Kevnzworld]

Search earlier threads on fish oil/ peroxidation
I would and do take the ubiquinol form of Coq10, and the gamma form of vitamin E with fish oil.
Always look at the expiration dates on fish oil bottles. I won't use one with an expiration date shorter than a year away. and refrigerate after opening.

[nameless]

If taking for overall heart health, I am not sure of any studies showing that such a large dose would be of any benefit. It's iffy as to any dose providing a benefit. Perhaps if you have high trigs it could be of some help, but diet changes would be even better.

If going for BP reduction, you can try Ubiquinol, as has been mentioned, perhaps with grapeseed extract. I'm also not particularly fond of krill oil, as the small increase in absorption isn't nearly enough to make up for the high price.

[sgupta]

Hi all and thanks for the feedback so far! (Always interested in more discussion, of course!)

Re contaminants, I'm using two different fish oils from GNC that have been tested by ConsumerLab.com and are also screened by GNC for contaminants and certified free of things like mercury, so I'm not too worried about that aspect of it. (I know there are better values out there, but I trust GNC quality personally, have a store locally, and like that they routinely get good marks from ConsumerLab, though I'm sure there are many good brands out there.) I also like using actual fish oil as I've read some of the plant-based oils don't absorb as well (though to be fair, there are opposing opinions on that as well, which I'm quickly learning is the case with just about EVERYTHING nutrition related).

I did do a search for fish oil and peroxidation as recommended. Interesting stuff - seems like the jury is still out on a lot of it. Some things that stand out are, astaxanthin seems to help prevent oxidation, Krill oil contains astaxanthin on its own, CoQ10 and/or Ubiquinol seems to help prevent oxidation, and Vitamin E some say helps, but at least one study suggests doesn't. Well my multivitamin contains a small amount (50 mcg) of astaxanthin as is and 100% RDA of Vitamin E (so any in food is extra), and another supplement for blood pressure I'm taking has 200 mg of CoQ10 (as well as the grape seed extract mentioned). My fish oil supplement also contains some Krill oil, so that should be a bit extra astaxanthin (though it's not listed as far as amount on the label...just EPA/DHA and mg of actual Krill oil [the rest is from fish]).

I'm not taking any Ubiquinol at the moment, but I suppose I could discuss with my doctor adding it in addition to the CoQ10 I'm already taking; I just don't want to double up/overload as I know more isn't always better (not a philosophy I always followed), though I'm not sure with Ubiquinol/CoQ10 that's *too* much of a concern. Additionally, I'm taking a greens antioxidant supplement (using whole fruit and vegetable powders) as well as 800 mg (would be 1,600 mg if I doubled the fish oil as it's a combined supplement) of phytosterols, and I'm not sure if either of those would have a positive effect.

I guess the main question I still have is this. If I doubled the fish oil (to 3.6g/day) and it WAS causing oxidation, would that show up in cholesterol related blood tests as higher LDL levels? Or could it be causing me damage without me being able to see it (ie. great cholesterol levels, but I'm still having damage done)? If it was the former, I could simply trial doubling it up and get blood tests every 6 months or so to see where my cholesterol is at and make sure things were working as they should be... But if it's the latter, it's probably not a risk I want to take if there's no way to see what's going on.

What I've decided to do for the time being until I can get a better answer on this and potentially talk to the doctor again is take 1.8g/day of fish oil (that's active DHA/EPA; it'd be more like 3g of actual oil). This equates to 613mg DHA, 1187mg EPA, 800 mg phytosterols, and 300 mg Krill oil. Quite honestly, I'm not sure if the Krill oil has "separate" DHA/EPA levels or is included in the levels I just mentioned, but I think it's probably separate. From other labeling (standalone Krill products in the same product line), they don't tend to list DHA/EPA individually, so that would push me closer to 2g a total DHA+EPA a day if true and give me some extra protection in the form of astaxanthin right in the Krill oil.

My thinking is that even those who argue against high doses of fish oil generally have no problem with ~1g/day and most tout it has benefits at that level, but levels beyond that are dubious, and they recommend against "several" grams per day. This gets me a bit more than 1g to help with BP, eye dryness, mood, joints, etc, but I'm still under the 3-4g recommendation for people taking it specifically because of cholesterol/triglyceride concerns (which I don't have at the moment, though of course appreciate any help keeping my cholesterol in check), and it also keeps me well under the 6g used in some studies that showed oxidative stress damage. Krill oil seems relatively new and potentially unproven, but very promising, so it gives me a bit of that without going overboard as well, and cost is decently reasonable for my budget (and I could still double it if I ever wanted to). Also, since I eliminated the soy-based supplement I had been taking up to now, which had omega-6's, it should in theory actually reduce my omega-6 intake, which is favorable, as well as reduce my calories by a little bit. Also, I think this amount would be equivalent to having a small portion of moderately-fatty fish daily, whereas double would be a bit more than that.

Part of me really does want to double this, but after making the mistake of megadoses in the past (which didn't provably hurt me, though some things I question, such as heavy use of soy lecithin for years), I think moderation is the wiser course for now until I know more.

Thoughts? Opinions?

Thanks!
Shaun

Edited by sgupta, 21 February 2014 - 04:42 AM.

[medicineman]

I think the oxidized fish oil fear is overblown.

Oxidised fish oil does not influence established markers of oxidative stress in healthy human subjects: a randomised controlled trial.

AuthorsOttestad I, et al. Show all Journal
Br J Nutr. 2012 Jul;108(2):315-26. doi: 10.1017/S0007114511005484. Epub 2011 Dec 5.

Affiliation
Abstract
Intake of fish oil reduces the risk of CHD and CHD deaths. Marine n-3 fatty acids (FA) are susceptible to oxidation, but to our knowledge, the health effects of intake of oxidised fish oil have not previously been investigated in human subjects. The aim of the present study was to investigate markers of oxidative stress, lipid peroxidation and inflammation, and the level of plasma n-3 FA after intake of oxidised fish oil. In a double-blinded randomised controlled study, healthy subjects (aged 18-50 years, n 54) were assigned into one of three groups receiving capsules containing either 8 g/d of fish oil (1.6 g/d EPA+DHA; n 17), 8 g/d of oxidised fish oil (1.6 g/d EPA+DHA; n 18) or 8 g/d of high-oleic sunflower oil (n 19). Fasting blood and morning spot urine samples were collected at weeks 0, 3 and 7. No significant changes between the different groups were observed with regard to urinary 8-iso-PGF2α; plasma levels of 4-hydroxy-2-hexenal, 4-hydroxy-2-nonenal and α-tocopherol; serum high sensitive C-reactive protein; or activity of antioxidant enzymes in erythrocytes. A significant increase in plasma level of EPA+DHA was observed in both fish oil groups, but no significant difference was observed between the fish oil groups. No changes in a variety of in vivo markers of oxidative stress, lipid peroxidation or inflammation were observed after daily intake of oxidised fish oil for 3 or 7 weeks, indicating that intake of oxidised fish oil may not have unfavourable short-term effects in healthy human subjects.

PMID 22136711 [PubMed - indexed for MEDLINE]
Full text: Cambridge University Press

This is short term, but I'm suspicious of claims of doom regarding oxidized fish oil. Anyways, I go for a little E, maybe rosemary (nordic) to be safe.

[nameless]

I guess the main question I still have is this. If I doubled the fish oil (to 3.6g/day) and it WAS causing oxidation, would that show up in cholesterol related blood tests as higher LDL levels?

Yes, possibly. I'm not sure if the risks of oxidized oil are so overblown, as if you look at a longer term study, it may very well increase cholesterol levels.

I posted on this a while ago:

http://www.longecity...-lipid-numbers/

I also ask this very basic question -- if there isn't much data showing higher doses of fish oil providing a benefit, why would you even take that much? Do you have high trigs? Have you suffered a heart attack? Do you have an autoimmune disorder? If none of the above, and you are simply taking it for prevention, you can go with a much lower dose ... 200-400mg/daily of EPA/DHA is probably fine.

[Kevnzworld]

The data I've read suggests that there is a concern
" All women showed a significant increase in plasma lipid peroxide through mo 2 of supplementation. After 2 mo, older women had significantly higher lipid peroxide levels than young women. The lipid peroxide:TG ratio, which declined by mo 3, was still significantly higher than baseline. These data indicate that although long-term fish oil supplementation may be beneficial in reducing plasma total TG, susceptibility of plasma lipids to free radical attack is potentiated. "
http://europepmc.org...dnSwdcQvfGE1t.8
"CONCLUSION: Dietary FO reduces body fat mass and stimulates lipid oxidation in healthy adults."
http://web.a.ebscoho...NuPsx7g==&crl=c

I've posted studies on other threads that shows that CoQ10 can mitigate, not necessarily eliminate lipid peroxidation. I take 2000 mg a day of fish oil.
Ubiquinol is the more readily absorbed form of CoQ10. I would supplement a mixed tocopherol form of vitamin E and not rely on the small amount of alpha E contained in the fish oil.

Edited by Kevnzworld, 22 February 2014 - 01:12 AM.

[sgupta]

Thanks all for the interesting discussion. Still lost, but I have decided for now at least not to increase my fish oil supplementation any further. I think the ~2g I'm taking now is as much as I'd be willing to go, and I'm still going back and forth on whether I should keep that as is or reduce it. I hate to make a change since my numbers appear to be improving, but on the other hand, I don't want to be causing long-term damage either.

Found another interesting summary of research here, which seems to indicate peroxidation shouldn't be too much of a problem. But it's all so confusing as much like some of the responses, there seems to be indicators both ways. I hope some newer studies come out to shed some more light on this...

http://examine.com/s... Oil/#summary11

Kevnzworld, when you say 2000mg, I assume you mean total EPA+DHA, or are you counting the the totality (meaning EPA+DHA is less)? I am considering adding Ubiquinol after my next doctor's visit; as I mentioned, I already do take 200mg CoQ10 (and can't switch easily as it's part of a more diverse supplement).

I also ask this very basic question -- if there isn't much data showing higher doses of fish oil providing a benefit, why would you even take that much? Do you have high trigs? Have you suffered a heart attack? Do you have an autoimmune disorder? If none of the above, and you are simply taking it for prevention, you can go with a much lower dose ... 200-400mg/daily of EPA/DHA is probably fine.

To answer your question, I take fish oil for a variety of reasons:
- I have not had a heart attack fortunately, but my dad died of one at 52 (unfortunately I don't have access to the details), so it is a worry (granted, he smoked like a chimney, which I don't do, and I don't have a lot of data on his other habits).
- I don't take aspirin, so between that (as well as some garlic and cayenne), it's a "natural" blood thinner.
- Until a year ago, with lower dose fish oil, I did have some high cholesterol numbers (nothing terrifying, but bad enough the doctor was concerned); since being on a bit more fish oil, those seem to have improved a great deal; my cholesterol numbers are quite good, with the only nitpick being HDL a tad lower than the doctor would like it.
- I have extremely dry eye and was actually recommended to take fish oil by my eye doctor years ago, though she didn't recommend a specific dosage (but I've seen 1g-3g is not uncommon).
- Fish oil also helps with high blood pressure; while I'm in the prehypertensive range, I'd certainly like to avoid prescription meds if possible.
- I don't take any other specific supplements for my joints, and fish oil is supposed to help with that as well.
- Other general things seem to benefit like dry skin, for inflammation, virility, etc.

[Kevnzworld]

" Kevnzworld, when you say 2000mg, I assume you mean total EPA+DHA, or are you counting the the totality (meaning EPA+DHA is less)? I am considering adding Ubiquinol after my next doctor's visit; as I mentioned, I already do take 200mg CoQ10 (and can't switch easily as it's part of a more diverse supplement)."
You should take a high quality stand alone CoQ product ( like ubiquinone from Jarrow or LEF ) not something that is part of some diverse multi....
I take 2000 mg fish oil providing 1100 mg EPA/DHA. I am not adverse to moving that to 3000 mg. I believe that lipid/ cholesterol oxidation contributes to vascular disease and lessened longevity , so I take steps to mitigate that....
Given that heart disease is your primary concern, I would think about a few other things.:
Magnesium. Most people are deficient
Take the right forms of vitamin K4, MK7. ( search threads )
Get your homocysteine level checked, keep it close to 7 with certain b vitamins like 5 methyl folate
Get your inflammation measured ( CRP ). Lower it.
Get a carotid / periphery artery thickness ultrasound
Get a more comprehensive lipid cholesterol panel done ( from LEF, your doc, Berkeley heart lab etc )

Edited by Kevnzworld, 22 February 2014 - 04:35 PM.

[nameless]

Good advice from Kevinzworld above.

As for CoQ10/Ubiquinol, what supplement are you currently taking that includes it as an ingredient? Is it a dry capsule or a gel with fats? Ideally take CoQ10 w/ fats. You can get CoQ10 pretty cheaply at places like iHerb (I've used Healthy Origins) and as for Ubiquinol, Costco actually has it pretty cheap. 200mg Ubiquinol/daily may lower your blood pressure a bit too.

And has been mentioned, get the Berkeley or VAP test and make sure it includes Lpa too (Lpa is sort of important and is a hidden cause of heart disease). It might not hurt to get a full workup at least once, thyroid, liver panel, ferritin, HBA1c, CBC, and stuff like that... not really heart related exactly, but worth doing at some point. You can even get a Mag rbc done, if you want to check if it's worth taking magnesium.

As for homocysteine, I'm not aware of any of the homocysteine lowering studies showing B supplementation improving heart disease risks.

Edited by nameless, 22 February 2014 - 07:11 PM.

[Dorian Grey]

Peroxidaton of fish oil and polyunsaturated fats is largely dependent on iron (and to a lesser extent copper), which act as catalyst's for the reaction...

When iron is low, the effect of fish oil and PUFA's can be a positive one. When iron is at all elevated, it is difficult to avoid excessive oxidation. Most men accumulate excess iron as they age (women after menopause). The notation from Kevnzworld above: "After 2 mo, older women had significantly higher lipid peroxide levels than young women" is interesting. Age related iron accumulation may be the key to whether or not fish oil is a good thing.

I would definitely avoid taking fish oil with (at the same time) a multi that contains copper or iron. The form of iron in many fortified foods (breakfast cereal, flour, pasta) should also be quite reactive with fish oil taken with meals containing this type of iron.

An iron study included in one's next blood lab might be wise to see if you've got elevated levels (ferritin into triple digits) that may be turning fish oil rancid in your body.

Edited by synesthesia, 22 February 2014 - 08:30 PM.

[sgupta]

Thanks again for all the wonderful feedback!

Kevnzworld/Nameless, the CoQ10 is along with other stuff but not a full multivitamin, and it is a "dry" supplement. It's a blood pressure supplement including MegaNatural BP Grape Seed Extract (300 mg), Cutch Tree & Chinese Skullcap, Arginine (250 mg), Carnitine (250 mg), Resveratrol (30 mg), and CoQ10 (200 mg) along with some Quercetin and low-dose Lutamax 2020 and Lycopene. But no, it's not liquid with fats, so I will take it under advisement to possibly add 200 mg of Ubiquinol to this in non-dry form - if it will help even further with blood pressure, fantastic. My doctor also put me on Magnesium, so I'm taking that as well (and a small amount of supplementary Potassium).

I know I'm definitely having a few more cholesterol tests in the near future, and I would like that plaque ultrasound of the carotids you mention and a thyroid test. I'll have to ask about the other tests mentioned as well. (I think she did test things like CRP and do basic panels like CBC, liver, etc.). Appreciate the advice!

I'd actually never heard of MK7. (I did check my fruit/veggie supplement and noticed it contains fermented soybean in a small quantity, so I'm hoping I already get a little bit based on early research into it, but I will discuss with my doctor.)

Synesthesia, fortunately, there's no iron in my multivitamin (or any of my other supplements), probably for the reasons you mention, but this is information I didn't know, so thank you for that! (There is a little bit of copper, but not a lot).

Thanks again for all the help sorting this out. =)