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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by saturn on September 12, 2006, at 11:08:05
A while back I recall an article and some debate regarding EPA dosages in depression. There was initially a study stating that 1 gram EPA daily was better than higher doses (or something along this line)...and then there was mention that the same researcher stated that he later found that he started at around 1 gm EPA daily and then increased weekly until a certain dosage.
Does anyone know what I'm talking about? I'm curious as to how high it was suggested you could go with the EPA? Thanks. Saturn.
Posted by qqqsimmons on September 12, 2006, at 13:59:03
In reply to how high can you go with epa, total fish oils?, posted by saturn on September 12, 2006, at 11:08:05
i think it depends on the individual. 1 gram a day gives me insomnia and restlessness (akathisia). i used to take 1g every other day, but i found a smaller capsule that i can take every day.
Posted by TENMAN on September 12, 2006, at 14:39:25
In reply to Re: how high can you go with epa, total fish oils?, posted by qqqsimmons on September 12, 2006, at 13:59:03
The blend I take gives me a total of 1.8 grams of EPA and 4.2 grams of DHA. It's working well.
Posted by Ed O`Flaherty on September 14, 2006, at 14:06:40
In reply to Re: how high can you go with epa, total fish oils?, posted by TENMAN on September 12, 2006, at 14:39:25
The FDA reckons that 3g of fish oil daily is safe.Inuit (Eskimos) get about 16g of fish oil daily in their regular diet with no obvious problems. They appear to suffer little depression and I note that the level of bipolar in Iceland is 0.2% as compared to 7% in Germany.The incidence of schizophrenia is similar in Iceland and Germany though.One of the benefits of fish over fish oil is that you get selenium,a good antioxidant. On the other hand you get mercury in fish but not in fishdoil.Probably some fish and some fish oil would be best.
Posted by Jlx on September 14, 2006, at 18:11:32
In reply to how high can you go with epa, total fish oils?, posted by saturn on September 12, 2006, at 11:08:05
This page is a summary of research to date. http://www.psycheducation.org/depression/meds/Omega-3.htm#FishTable
Note that sometimes gram doses are EPA/DHA and sometimes grams are of fish oil.
EPA and DHA amounts per softgel may differ widely brand to brand, but are often 180/120 respectively.
I take Natural Factors, RxOmega-3 Factors Pharmaceutical Grade, which contains 400 mg EPA and 200 mg DHA per capsule. 240 capsules is $23.05 at iherb, approximately 10 cents per capsule. http://www.iherb.com/store/ProductDetails.aspx?c=Herbs&pid=NFS-35491
High doses of fish oil increasing chance of stroke has been one adverse consequence I've read about in the past, but in this article...
Fish oil: what the prescriber needs to know
Arthritis Research & Therapy 2006http://arthritis-research.com/content/8/1/202
the "Safety" discussion of this article notes that the bleeding tendency in Inuits with their high Omega-3 consumption occurs within a context of low dietary Omega-6.
"Within the Western context, fish oil supplements have not been associated with an increased bleeding tendency, even in patients taking aspirin or warfarin for antithrombotic effect."
That article also notes that to obtain the inflammatory effect of fish oil such as for arthritis, as many as nine capsules may be needed (to provide 2.7 gm EPA).
A safety discussion from the Mayo Clinic: http://www.mayoclinicproceedings.com/inside.asp?AID=1472&UID=26644
SAFETY
There have been 3 possible adverse effects of ?-3 FAs: an increase in low-density lipoprotein cholesterol (LDL-C) levels, excess bleeding, and worsening of glycemic control in patients with type 2 diabetes. The increase in LDL-C levels is typically less than 5% to 10%,61 but in patients with severe hypertriglyceridemia, an increase of up to 30% can occur.62 In such cases, however, levels are depressed at baseline and usually do not increase above 130 mg/dL. If this becomes a clinical problem, combination therapy with ?-3 FA and a statin is a safe and effective strategy for patients with elevated levels of both LDL-C and triglycerides.70 At doses of 1 g/d, no effects on LDL-C have been noted. Increased bleeding times have been reported in humans consuming very high quantities (>20 g/d) of ?-3 FAs.71 However, no bleeding complications were reported with 7 g/d of ?-3 FAs in a large restenosis study,30 and the combination of ?-3 FAs with either aspirin or warfarin produced no adverse effects.32 At dosages of 2 to 3 g/d, ?-3 FAs have little effect on bleeding times.72 Some studies have suggested worsening glycemic control in patients with type 2 diabetes when large amounts of fish oil are used.73 However, studies providing more moderate dosages (eg, <3 g/d) have not reported adverse effects.74-77
That was the best info I found.
JL
Posted by saturn on September 14, 2006, at 19:16:30
In reply to Re: how high can you go with epa, total fish oils? » saturn, posted by Jlx on September 14, 2006, at 18:11:32
> This page is a summary of research to date. http://www.psycheducation.org/depression/meds/Omega-3.htm#FishTable
>
> Note that sometimes gram doses are EPA/DHA and sometimes grams are of fish oil.
>
> EPA and DHA amounts per softgel may differ widely brand to brand, but are often 180/120 respectively.
>
> I take Natural Factors, RxOmega-3 Factors Pharmaceutical Grade, which contains 400 mg EPA and 200 mg DHA per capsule. 240 capsules is $23.05 at iherb, approximately 10 cents per capsule. http://www.iherb.com/store/ProductDetails.aspx?c=Herbs&pid=NFS-35491
>
> High doses of fish oil increasing chance of stroke has been one adverse consequence I've read about in the past, but in this article...
>
> Fish oil: what the prescriber needs to know
> Arthritis Research & Therapy 2006
>
> http://arthritis-research.com/content/8/1/202
>
> the "Safety" discussion of this article notes that the bleeding tendency in Inuits with their high Omega-3 consumption occurs within a context of low dietary Omega-6.
>
> "Within the Western context, fish oil supplements have not been associated with an increased bleeding tendency, even in patients taking aspirin or warfarin for antithrombotic effect."
>
> That article also notes that to obtain the inflammatory effect of fish oil such as for arthritis, as many as nine capsules may be needed (to provide 2.7 gm EPA).
>
> A safety discussion from the Mayo Clinic: http://www.mayoclinicproceedings.com/inside.asp?AID=1472&UID=26644
>
> SAFETY
>
> There have been 3 possible adverse effects of ?-3 FAs: an increase in low-density lipoprotein cholesterol (LDL-C) levels, excess bleeding, and worsening of glycemic control in patients with type 2 diabetes. The increase in LDL-C levels is typically less than 5% to 10%,61 but in patients with severe hypertriglyceridemia, an increase of up to 30% can occur.62 In such cases, however, levels are depressed at baseline and usually do not increase above 130 mg/dL. If this becomes a clinical problem, combination therapy with ?-3 FA and a statin is a safe and effective strategy for patients with elevated levels of both LDL-C and triglycerides.70 At doses of 1 g/d, no effects on LDL-C have been noted. Increased bleeding times have been reported in humans consuming very high quantities (>20 g/d) of ?-3 FAs.71 However, no bleeding complications were reported with 7 g/d of ?-3 FAs in a large restenosis study,30 and the combination of ?-3 FAs with either aspirin or warfarin produced no adverse effects.32 At dosages of 2 to 3 g/d, ?-3 FAs have little effect on bleeding times.72 Some studies have suggested worsening glycemic control in patients with type 2 diabetes when large amounts of fish oil are used.73 However, studies providing more moderate dosages (eg, <3 g/d) have not reported adverse effects.74-77
>
> That was the best info I found.
That's it? Just kidding--that is awesome information. Thank you very much...Saturn
Posted by SLS on September 15, 2006, at 10:27:27
In reply to Re: how high can you go with epa, total fish oils?, posted by saturn on September 14, 2006, at 19:16:30
> -that is awesome information. Thank you very much...Saturn
Yes. Thank you.
- Scott
Posted by Jlx on September 15, 2006, at 12:13:51
In reply to Re: fish oils? - Thanks » Ed O`Flaherty » Jlx, posted by SLS on September 15, 2006, at 10:27:27
There has been a lot of research on fish oil, but a lot of it is very specific and/or too scientific for me to comprehend. Some interesting sounding stuff is only available in subscription journals too.
I found the 2.7 gram EPA dose (not less) for inflammation as pertaining to arthritis to be especially interesting as depression is linked with inflammation. Yet it's hard to draw a firm conclusion from the varying amounts of EPA that have been used in the depression fish oil studies.
And it's apparently DHA that's linked with Alzheimer's, not EPA. (I tend to look at anything that seems related to "brain health" or the lack thereof as potentially relevant to mood disorders.)
http://www1.va.gov/resdev/news/press_releases/fish-oil-032505.cfm
http://www.supplementquality.com/efficacy/DHA_alzheimers.html (The
DHA is also essential for brain development. http://www.biopsychiatry.com/dha.htm
And is it DHA or EPA that's most important for depression?
"Geographic areas where consumption of DHA is high are associated with decreased rates of depression. DHA deficiency states, such as alcoholism and the postpartum period, also are linked with depression. Individuals with major depression have marked depletions in omega-3 FAs (especially DHA) in erythrocyte phospholipids compared with controls. These data suggest that DHA may be associated with depression, and the limited data available on supplementation with DHA or other omega-3 FAs seem to support the hypothesis that DHA may have psychotropic effects." http://www.biopsychiatry.com/dhaomega.htm
Most of the time, since there's both EPA and DHA in fish oil capsules, it's probably true that even if one is the most important factor to an individual, taking enough capsules will do the trick. But that's always the basic question -- how much to take? Why the discrepancy in the studies? IS there significance to EPA over DHA, vice versa and does this perhaps vary with the individual? Or some other unknown factor that may be interactive?
I read "The Omega Connection" by Andrew L. Stoll who then developed Omega-Brite fish oil capsules to have a very high EPA to DHA ratio, presumably because he thought that was the most efficacious. But his study was done on bipolar, so is higher EPA more desirable or necessary for bipolar? Is the same or opposite true for unipolar? Or does it make no difference?
Omega Brite has a 7:1 EPA to DHA ratio, each capsule is 350 mg EPA/50 mg DHA. At $21 per 60 capsules, that's 35 cents per capsule. If I wanted to take 2.7 EPA per day, that's about 8 capsules at $2.80 per day versus the Natural Factors I take now, which for an approx comparable amount of EPA, is 70 cents. http://www.omegabrite.com/products/gelcaps_brochure/
If there was that much benefit to the higher EPA/DHA ratio, $2 a day may not be prohibitive, but is there?
Country Life Omega 3 Mood, which has 500 mg EPA/100 mg DHA is, I believe, the next highest EPA/DHA ratio brand available. At 60 cents a capsule at this site, 2.5 gm of EPA per day is $3. http://www.vitacost.com/CountryLifeOmega3Mood
I tried this Omega 3 Mood brand, for a month though I don't remember how much I took. I didn't notice any upswing in mood from my regular fish oil at that time. But as usual, the question is did I take enough?
I've also tried a DHA only brand and had a vague, not definitive, sense that I felt worse. http://www.iherb.com/store/productdetails.aspx?c=Herbs&pid=JRW-16018
Besides the amount, the other consideration is the time factor. A month trial, such as I did with the Omega Mood, is probably not long enough. 6-8 months is probably a better trial, or even a year.
I think I may strive to up my current brand's dose to 7 capsules a day and stick with it for many months.
One reason why I write posts like this is to have a record I can refer back to. :)
JL
Posted by MidnightBlue on September 22, 2006, at 1:13:39
In reply to Fish oil , unanswered questions, posted by Jlx on September 15, 2006, at 12:13:51
Hi,
I take 6 OmegaBrite capsules a day and have for over a year. I DO think it has helped. Recently, with added stress, I've wondered if it is enough and I am considering trying 7 or 8 capsules. The amount I currently take is 2 grams of EPA.
I have problems with GERD, but had had very few fish burps on this brand.
Midnightblue
Posted by tealady on September 24, 2006, at 0:23:54
In reply to Fish oil , unanswered questions, posted by Jlx on September 15, 2006, at 12:13:51
>>
> One reason why I write posts like this is to have a record I can refer back to. :)
>
> JL
Hi JL :)
Twas one of my reasons too...until dr Bob changed the google search to hit his home page or just the main page for the month instead of the post.... couldn't find em then!!
saw lotsa links on my posts (or lar's/others) on net..and you just link back to the babble home page or sometimes the whole main archibed page for about that month.. occasionally one actually gets the posts... rare though;)..wish the way the search functioned hadn't been changed.back on questions the fish oi...unanswered questions
I'm one who got acne from fish oil, but also ..it never was a this "feel good supp".. maybe a slight lesening of overall energy level.. very subtle.. just a "this sure isnt helping" feeling.
anyway, i found this yesterday..
http://tealady-health.blog.co.uk/?tag=fish%20oil
I'm still wondering if maybe fish oil may reduce B1?
It would expalin why one might have reduced energy by a little..maybe peak performance may drop..BUT it still don't explain the ZITS!good to see you around
Jan
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