Omega 3

[cbrons]

Advertisement - Members don't see this ad

When we're talking about Omega-3 as augmentation therapy for depression, is there a specific formulation/brand people prescribe?

 

[firedoor]

I usually recommend a reputable OTC preparation (which typically consist of an EPA/DHA ratio of about 1.5) for a total of 1-3 grams omega-3 daily. This is due to cost considerations and lack of overwhelming evidence toward a specific preparation. That said, when feasable, I prefer to prescribe 1-2 grams of ethyl-EPA daily adjunctively for MDD.

In the past year there was a good article summing up the evidence on omega-3's in mood disorders, I think perhaps in the American Journal of Clinical Psychiatry. The jist I got was that omega-3's may be helpful adjunctively in mood disorders, but are ineffective as monotherapy.

In addition to the general debate about omega-3's in mood disorders, there is controversy over the EPA/DHA ratio and the triglyceride vs ethyl ester formulations.

A colleague of mine once advised against relying on meta-analyses, but these are worth reading:

J Clin Psychiatry. 2011 Sep 6. [Epub ahead of print]
Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression.

Sublette ME, Ellis SP, Geant AL, Mann JJ.
Source

New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA. 10032 [email protected].

Abstract

OBJECTIVE:

Randomized trials of omega-3 polyunsaturated fatty acid (PUFA) treatment for depression have differed in outcome. Recent meta-analyses ascribe discrepancies to differential effects of eicosapentaenoic acid (EPA) versus docosahexaenoic acid (DHA) and to diagnostic heterogeneity. This meta-analysis tests the hypothesis that EPA is the effective component in PUFA treatment of major depressive episodes.
DATA SOURCES:

PubMed/MeSH was searched for studies published in English from 1960 through June 2010 using the terms fish oils (MeSH) AND (depressive disorder [MeSH] OR bipolar depression) AND randomized controlled trial (publication type). The search was supplemented by manual bibliography review and examination of relevant review articles.
STUDY SELECTION:

The search yielded 15 trials involving 916 participants. Studies were included if they had a prospective, randomized, double-blinded, placebo-controlled study design; if depressive episode was the primary complaint (with or without comorbid medical conditions); if omega-3 PUFA supplements were administered; and if appropriate outcome measures were used to assess depressed mood.
DATA EXTRACTION:

Extracted data included study design, sample sizes, doses and percentages of EPA and DHA, mean ages, baseline and endpoint depression ratings and standard deviations for PUFA and placebo groups, and P values. The clinical outcome of interest was the standardized mean difference in the change from baseline to endpoint scores on a depression rating scale in subjects taking PUFA supplements versus subjects taking placebo.
DATA SYNTHESIS:

In a mixed-effect model, percentage of EPA in the supplements was the fixed-effect predictor, dichotomized into 2 groups: EPA < 60% or EPA &#8805; 60% of the total EPA + DHA. Secondary analyses explored the relevance of treatment duration, age, and EPA dose.
RESULTS:

Supplements with EPA &#8805; 60% showed benefit on standardized mean depression scores (effect size = 0.532; 95% CI, 0.277-0.733; t = 4.195; P < .001) versus supplements with EPA < 60% (effect size = -0.026; 95% CI, -0.200 to 0.148; t = -0.316; P = .756), with negligible contribution of random effects or heteroscedasticity and with no effects of treatment duration or age. Supplements with EPA < 60% were ineffective. Exploratory analyses supported a nonlinear model, with improvement determined by the dose of EPA in excess of DHA, within the range of 200 to 2,200 mg/d of EPA.
CONCLUSIONS:

Supplements containing EPA &#8805; 60% of total EPA + DHA, in a dose range of 200 to 2,200 mg/d of EPA in excess of DHA, were effective against primary depression. Translational studies are needed to determine the mechanisms of EPA's therapeutic benefit.
________________________________________________________________________________________________________________

J Am Coll Nutr. 2009 Oct;28(5):525-42.
EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials.

Martins JG.
Source

Academy of Nutritional Medicine, 80 Commercial End, Swaffham Bulbeck, Cambridge CB25 0NE, UK. [email protected]

Abstract

BACKGROUND:

Epidemiologic and case-control data suggest that increased dietary intake of omega-3 long-chain polyunsaturated fatty acids (omega3 LC-PUFAs) may be of benefit in depression. However, the results of randomized controlled trials are mixed and controversy exists as to whether either eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or both are responsible for the reported benefits.
OBJECTIVE:

The aim of the current study was to provide an updated meta-analysis of all double-blind, placebo-controlled, randomized controlled trials examining the effect of omega3 LC-PUFA supplementation in which depressive symptoms were a reported outcome. The study also aimed to specifically test the differential effectiveness of EPA versus DHA through meta-regression and subgroup analyses.
DESIGN:

Studies were selected using the PubMed database on the basis of the following criteria: (1) randomized design; (2) placebo controlled; (3) use of an omega3 LC-PUFA preparation containing DHA, EPA, or both where the relative amounts of each fatty acid could be quantified; and (4) reporting sufficient statistics on scores of a recognizable measure of depressive symptoms.
RESULTS:

Two hundred forty-one studies were identified, of which 28 met the above inclusion criteria and were therefore included in the subsequent meta-analysis. Using a random effects model, overall standardized mean depression scores were reduced in response to omega3 LC-PUFA supplementation as compared with placebo (standardized mean difference = -0.291, 95% CI = -0.463 to -0.120, z = -3.327, p = 0.001). However, significant heterogeneity and evidence of publication bias were present. Meta-regression studies showed a significant effect of higher levels of baseline depression and lower supplement DHAEPA ratio on therapeutic efficacy. Subgroup analyses showed significant effects for: (1) diagnostic category (bipolar disorder and major depression showing significant improvement with omega3 LC-PUFA supplementation versus mild-to-moderate depression, chronic fatigue and non-clinical populations not showing significant improvement); (2) therapeutic as opposed to preventive intervention; (3) adjunctive treatment as opposed to monotherapy; and (4) supplement type. Symptoms of depression were not significantly reduced in 3 studies using pure DHA (standardized mean difference 0.001, 95% CI -0.330 to 0.332, z = 0.004, p = 0.997) or in 4 studies using supplements containing greater than 50% DHA (standardized mean difference = 0.141, 95% CI = -0.195 to 0.477, z = 0.821, p = 0.417). In contrast, symptoms of depression were significantly reduced in 13 studies using supplements containing greater than 50% EPA (standardized mean difference = -0.446, 95% CI = -0.753 to -0.138, z = -2.843, p = 0.005) and in 8 studies using pure ethyl-EPA (standardized mean difference = -0.396, 95% CI = -0.650 to -0.141, z = -3.051, p = 0.002). However, further meta-regression studies showed significant inverse associations between efficacy and study methodological quality, study sample size, and duration, thus limiting the confidence of these findings.
CONCLUSIONS:

The current meta-analysis provides evidence that EPA may be more efficacious than DHA in treating depression. However, owing to the identified limitations of the included studies, larger, well-designed, randomized controlled trials of sufficient duration are needed to confirm these findings.
_________________________________________________________________________________________________________________

Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder

Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M (2008) Australian and New Zealand Journal of Psychiatry 42(3) 192-198 Web URL: View this and related abstracts via PubMed here Abstract: Objective: To compare therapeutic effects of eicosapentaenoic acid (EPA), fluoxetine and a combination of them in major depression.

Method:Sixty outpatients with a diagnosis of major depressive disorder based on DSM-IV criteria and a score of at least 15 in the 17-item Hamilton Depression Rating Scale (HDRS) were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or their combination for 8 weeks. Double dummy technique was used to double blind the study. Patients were assessed at 2 week intervals. Change in HDRS was the primary outcome measure.

Results:Analysis of covariance for HDRS at week 8 across treatment groups was performed in 48 patients who completed at least 4 weeks of the study, with the last observation carried forward. Treatment, age of onset and baseline HDRS had a significant effect on HDRS at week 8. EPA + fluoxetine combination was significantly better than fluoxetine or EPA alone from the fourth week of treatment. Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms. Response rates (50% decrease in baseline HDRS) were 50%, 56% and 81% in the fluoxetine, EPA and combination groups, respectively.

Conclusions: In the present 8 week trial EPA and fluoxetine had equal therapeutic effects in major depressive disorder. EPA + fluoxetine combination was superior to either of them alone.

(Here's the full link: http://www.orthokennis.nl/images/pagepictures/PDF/PlusEPA study in major depressive adults.pdf)​

__________________________________________________________________________________________________________________

I'm also interested in obtaining access to this article:

Br J Nutr. 2008 Feb;99(2):221-3. Epub 2007 Oct 8.
n-3 Fatty acids and mood: the devil is in the detail.​

Richardson AJ.​

 

[whopper]

The above is a much better post than I would've provided.

Just wanted to add, the OTC brands of fish oil come in a variety that have been molecularly distilled. That is, the toxins such as heavy metals have been removed. I'd recommend those.

 

[MDchouette]

Nordic Naturals is an excellent brand, if your patient can afford it. Physicians can sign up through the website and get free samples and a discount code for patients.

Nature's Made has the >60% EPA to DHA ratio, is low in mercury and PCBs per Consumer Reports, and is often buy-one-get-one-free at Walgreens.

 

[cbrons]

I usually recommend a reputable OTC preparation (which typically consist of an EPA/DHA ratio of about 1.5) for a total of 1-3 grams omega-3 daily. This is due to cost considerations and lack of overwhelming evidence toward a specific preparation. That said, when feasable, I prefer to prescribe 1-2 grams of ethyl-EPA daily adjunctively for MDD.

In the past year there was a good article summing up the evidence on omega-3's in mood disorders, I think perhaps in the American Journal of Clinical Psychiatry. The jist I got was that omega-3's may be helpful adjunctively in mood disorders, but are ineffective as monotherapy.

In addition to the general debate about omega-3's in mood disorders, there is controversy over the EPA/DHA ratio and the triglyceride vs ethyl ester formulations.

A colleague of mine once advised against relying on meta-analyses, but these are worth reading:

J Clin Psychiatry. 2011 Sep 6. [Epub ahead of print]
Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression.

Sublette ME, Ellis SP, Geant AL, Mann JJ.
Source

New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA. 10032 [email protected].

Abstract

OBJECTIVE:

Randomized trials of omega-3 polyunsaturated fatty acid (PUFA) treatment for depression have differed in outcome. Recent meta-analyses ascribe discrepancies to differential effects of eicosapentaenoic acid (EPA) versus docosahexaenoic acid (DHA) and to diagnostic heterogeneity. This meta-analysis tests the hypothesis that EPA is the effective component in PUFA treatment of major depressive episodes.
DATA SOURCES:

PubMed/MeSH was searched for studies published in English from 1960 through June 2010 using the terms fish oils (MeSH) AND (depressive disorder [MeSH] OR bipolar depression) AND randomized controlled trial (publication type). The search was supplemented by manual bibliography review and examination of relevant review articles.
STUDY SELECTION:

The search yielded 15 trials involving 916 participants. Studies were included if they had a prospective, randomized, double-blinded, placebo-controlled study design; if depressive episode was the primary complaint (with or without comorbid medical conditions); if omega-3 PUFA supplements were administered; and if appropriate outcome measures were used to assess depressed mood.
DATA EXTRACTION:

Extracted data included study design, sample sizes, doses and percentages of EPA and DHA, mean ages, baseline and endpoint depression ratings and standard deviations for PUFA and placebo groups, and P values. The clinical outcome of interest was the standardized mean difference in the change from baseline to endpoint scores on a depression rating scale in subjects taking PUFA supplements versus subjects taking placebo.
DATA SYNTHESIS:

In a mixed-effect model, percentage of EPA in the supplements was the fixed-effect predictor, dichotomized into 2 groups: EPA < 60% or EPA &#8805; 60% of the total EPA + DHA. Secondary analyses explored the relevance of treatment duration, age, and EPA dose.
RESULTS:

Supplements with EPA &#8805; 60% showed benefit on standardized mean depression scores (effect size = 0.532; 95% CI, 0.277-0.733; t = 4.195; P < .001) versus supplements with EPA < 60% (effect size = -0.026; 95% CI, -0.200 to 0.148; t = -0.316; P = .756), with negligible contribution of random effects or heteroscedasticity and with no effects of treatment duration or age. Supplements with EPA < 60% were ineffective. Exploratory analyses supported a nonlinear model, with improvement determined by the dose of EPA in excess of DHA, within the range of 200 to 2,200 mg/d of EPA.
CONCLUSIONS:

Supplements containing EPA &#8805; 60% of total EPA + DHA, in a dose range of 200 to 2,200 mg/d of EPA in excess of DHA, were effective against primary depression. Translational studies are needed to determine the mechanisms of EPA's therapeutic benefit.
________________________________________________________________________________________________________________

J Am Coll Nutr. 2009 Oct;28(5):525-42.
EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials.

Martins JG.
Source

Academy of Nutritional Medicine, 80 Commercial End, Swaffham Bulbeck, Cambridge CB25 0NE, UK. [email protected]

Abstract

BACKGROUND:

Epidemiologic and case-control data suggest that increased dietary intake of omega-3 long-chain polyunsaturated fatty acids (omega3 LC-PUFAs) may be of benefit in depression. However, the results of randomized controlled trials are mixed and controversy exists as to whether either eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or both are responsible for the reported benefits.
OBJECTIVE:

The aim of the current study was to provide an updated meta-analysis of all double-blind, placebo-controlled, randomized controlled trials examining the effect of omega3 LC-PUFA supplementation in which depressive symptoms were a reported outcome. The study also aimed to specifically test the differential effectiveness of EPA versus DHA through meta-regression and subgroup analyses.
DESIGN:

Studies were selected using the PubMed database on the basis of the following criteria: (1) randomized design; (2) placebo controlled; (3) use of an omega3 LC-PUFA preparation containing DHA, EPA, or both where the relative amounts of each fatty acid could be quantified; and (4) reporting sufficient statistics on scores of a recognizable measure of depressive symptoms.
RESULTS:

Two hundred forty-one studies were identified, of which 28 met the above inclusion criteria and were therefore included in the subsequent meta-analysis. Using a random effects model, overall standardized mean depression scores were reduced in response to omega3 LC-PUFA supplementation as compared with placebo (standardized mean difference = -0.291, 95% CI = -0.463 to -0.120, z = -3.327, p = 0.001). However, significant heterogeneity and evidence of publication bias were present. Meta-regression studies showed a significant effect of higher levels of baseline depression and lower supplement DHAEPA ratio on therapeutic efficacy. Subgroup analyses showed significant effects for: (1) diagnostic category (bipolar disorder and major depression showing significant improvement with omega3 LC-PUFA supplementation versus mild-to-moderate depression, chronic fatigue and non-clinical populations not showing significant improvement); (2) therapeutic as opposed to preventive intervention; (3) adjunctive treatment as opposed to monotherapy; and (4) supplement type. Symptoms of depression were not significantly reduced in 3 studies using pure DHA (standardized mean difference 0.001, 95% CI -0.330 to 0.332, z = 0.004, p = 0.997) or in 4 studies using supplements containing greater than 50% DHA (standardized mean difference = 0.141, 95% CI = -0.195 to 0.477, z = 0.821, p = 0.417). In contrast, symptoms of depression were significantly reduced in 13 studies using supplements containing greater than 50% EPA (standardized mean difference = -0.446, 95% CI = -0.753 to -0.138, z = -2.843, p = 0.005) and in 8 studies using pure ethyl-EPA (standardized mean difference = -0.396, 95% CI = -0.650 to -0.141, z = -3.051, p = 0.002). However, further meta-regression studies showed significant inverse associations between efficacy and study methodological quality, study sample size, and duration, thus limiting the confidence of these findings.
CONCLUSIONS:

The current meta-analysis provides evidence that EPA may be more efficacious than DHA in treating depression. However, owing to the identified limitations of the included studies, larger, well-designed, randomized controlled trials of sufficient duration are needed to confirm these findings.
_________________________________________________________________________________________________________________

Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder

Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M (2008) Australian and New Zealand Journal of Psychiatry 42(3) 192-198 Web URL: View this and related abstracts via PubMed here Abstract: Objective: To compare therapeutic effects of eicosapentaenoic acid (EPA), fluoxetine and a combination of them in major depression.

Method:Sixty outpatients with a diagnosis of major depressive disorder based on DSM-IV criteria and a score of at least 15 in the 17-item Hamilton Depression Rating Scale (HDRS) were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or their combination for 8 weeks. Double dummy technique was used to double blind the study. Patients were assessed at 2 week intervals. Change in HDRS was the primary outcome measure.

Results:Analysis of covariance for HDRS at week 8 across treatment groups was performed in 48 patients who completed at least 4 weeks of the study, with the last observation carried forward. Treatment, age of onset and baseline HDRS had a significant effect on HDRS at week 8. EPA + fluoxetine combination was significantly better than fluoxetine or EPA alone from the fourth week of treatment. Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms. Response rates (50% decrease in baseline HDRS) were 50%, 56% and 81% in the fluoxetine, EPA and combination groups, respectively.

Conclusions: In the present 8 week trial EPA and fluoxetine had equal therapeutic effects in major depressive disorder. EPA + fluoxetine combination was superior to either of them alone.

(Here's the full link: http://www.orthokennis.nl/images/pagepictures/PDF/PlusEPA study in major depressive adults.pdf)​

__________________________________________________________________________________________________________________

I'm also interested in obtaining access to this article:

Br J Nutr. 2008 Feb;99(2):221-3. Epub 2007 Oct 8.
n-3 Fatty acids and mood: the devil is in the detail.​

Richardson AJ.​

Thanks alot for this

 

[firedoor]

Thanks alot for this

My pleasure...glad you found it informative 👍

These are excellent too:

http://www.thorne.com/altmedrev/.fulltext/8/4/410.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576273/

 

[ShrunkenHeads]

As for OTC brands, I've used a couple.

While in Canada, I've been routinely taking Life brand Omega 3, EPA 300mg DHA 200mg, 1000mg capsules.

It's hard for a person to notice changes in mood and such, but I was more regular in taking vitamins in conjunction with exercise and other vitamins (two a day multivitamins), so I can't attest to any improvements in mood being solely as a result of Omega 3 use.

But one place I did notice a noteworthy improvement was my quality of sleep improved tremendously if I took 2 capsules right before bed. There were some days I only slept 4 or 5 hours, but I would feel completely refreshed as if i had slept over 8 hours. Does anyone have an explanation for this?

A brand I picked up while in the US for 3 months is Sundown Naturals, extra strength fish oil, 1200mg.

It mentions being purified to eliminate merury, PCBs and dioxins. This particular brand didn't provide the breakdown of EPA/DHA, and I havent used it routinely or frequently enough to have noticed any changes or help with sleep.

 

[whopper]

Just wanted to add, some studies point to EPA but not DHA as actually having the alleged psychiatric benefit. Several omega 3 fatty acid supplements such as flax seed only provide the DHA but not the EPA.

 

[firedoor]

Just wanted to add, some studies point to EPA but not DHA as actually having the alleged psychiatric benefit. Several omega 3 fatty acid supplements such as flax seed only provide the DHA but not the EPA.

Flaxseed contains primarily alpha-linolenic acid (ALA), which is converted to EPA and then eventually DHA. It does appear that EPA but not DHA* (or more likely a high EPA/DHA membrane ratio) confers the antidepressant/anxiolytic/cognitive benefits. In fact DHA supplementation may be counterproductive in these respects as it competes with EPA for membrane integration, and sufficient DHA is efficiently produced from EPA in vivo.

 

[whopper]

Oops you're right..thanks for the correction.

 

[firedoor]

Oops you're right..thanks for the correction.

👍

 

[cbrons]

So one of these bad boys BID is sufficient? Kind of pricey but looks like it has the favorable EPA-DHA ratio.

http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1414

 

[cbrons]

So one of these bad boys BID is sufficient? Kind of pricey but looks like it has the favorable EPA-DHA ratio.

http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1414

bump

 

[Fastball32]

The best omega 3 supplements would come from a well balanced natural diet. Supplements such as Whey protein is not as good as eating protein from real meat.
Omega 3 is a great topic and even beats out antipsychotics for attenuated psychotic syndrome in the current literature.

 

[whopper]

In general I'd agree, but most people don't consume fish to the degree needed for a psychiatric benefit to get what can be taken in supplements. As for whey protein, it could provide benefits over real meat, especially if that meat is laden with fat, arachadonic acid, etc.

I briefly touched upon this in another thread. A colleague of mine started a practice in the hospital I'm currently in. Every single person now gets a serum vitamin D level on admission. Pretty much every single patient is deficient--I'm talking on the order of over 95%. Even when patients are given "well-balanced" diets in the hospital they remained deficient. Only after supplementation to a degree of 5000-10000 IU Q daily did they start getting values in the normal range.

We've been doing this for months now, and it's to the degree where if we did a study, we'd literally have hundreds of patients in the data pool.

 

[cbrons]

In general I'd agree, but most people don't consume fish to the degree needed for a psychiatric benefit to get what can be taken in supplements. As for whey protein, it could provide benefits over real meat, especially if that meat is laden with fat, arachadonic acid, etc.

I briefly touched upon this in another thread. A colleague of mine started a practice in the hospital I'm currently in. Every single person now gets a serum vitamin D level on admission. Pretty much every single patient is deficient--I'm talking on the order of over 95%. Even when patients are given "well-balanced" diets in the hospital they remained deficient. Only after supplementation to a degree of 5000-10000 IU Q daily did they start getting values in the normal range.

We've been doing this for months now, and it's to the degree where if we did a study, we'd literally have hundreds of patients in the data pool.

So what brands do you give and in what dosage amount?

 

[whopper]

Well whatever brand is in the state formulary--that's it.

http://www.ncbi.nlm.nih.gov/pubmed/9539254

There is data suggesting that vitamin D3 can reduce seasonal affective disorder and reduce weight gain that typically happens in the fall and winter months.

I started asking all my patients in private practice if their mood has gotten consistently worse over the fall and winter and about 3/4 said yes. Now mind you this wasn't happening in NJ, where only about 2 patients total out of all my patients I've seen (hundreds) had this problem, and these are from a group of people already wanting psychiatric care.

Ohio (where I am) is in a lake-effect weather zone, so I suspect the poor levels of vitamin D may be related to the weather here. Several studies suggests SAD is linked distance from the equator, but the bottom line IMHO is sunlight. If you're trapped in a room with no sunlight, doesn't matter where you are, you won't get needed sunlight and your risk of SAD goes up.

I don't know if my colleagues findings would hold up in a state with plenty of sunlight such as Florida, Hawaii or Arizona.

 

[cbrons]

http://www.psycheducation.org/depression/meds/Omega-3.htm#FishTable

found this neat research summary

 

[DynamicDidactic]

Hot of the presses, each meta-analysis painting a different picture

http://www.ncbi.nlm.nih.gov/pubmed/21931319

http://www.ncbi.nlm.nih.gov/pubmed/21939614

I am not sure if we have a good theory as to why the different species of Omega-3 would have differential effects. Or this could be an early artifact in the research.

 

[cbrons]

Nordic Naturals is an excellent brand, if your patient can afford it. Physicians can sign up through the website and get free samples and a discount code for patients.

Curious... how did you go about getting a wholesale deal from Nordic Naturals?

They have a product called "EPA Xtra" which has 4:1 EPA. It is a great product, but it costs about $36/month from the local Vitamin Shoppe.

 

[zenman]

I use this one:http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1661

 

[freaker]

You're better off taking the liquids than you are the capsules. Speaking from personal experience and from feedback from numerous patients, the pills go rancid and cause fish burps far more frequently than the liquid. I take fish oil and essentially never get fish burps. Most of the liquids come in lemon or orange flavors and are molecularly distilled. A teaspoon or two per day works wonders. Just keep it in the fridge.

I started taking omega 3s when I realized my HDL levels were low despite the fact I was exercising (and not smoking--ever needed a reason to drink? I've got one!). They've actually slowly risen (also supplementing with Vitamin D) and LDLs have continued to drop.

I'll second Whopper's findings even a bit further south: nearly every one of my outpatients is Vitamin D deficient. It's especially common in black populations, where I routinely see single digit Vitamin D levels.

 

[whopper]

The head IM doctor at the state hospital I used to work at made it mandatory to get Vit D 25,OH levels on everyone coming into the hospital.

About 99% of the people coming in were deficient on Vit D3 with several African-Americans being at levels way below the recommended guidelines. This was after literally hundreds of people's serum D levels were taken.

The only thing that got most of them on the normal range was 5000-10,000 IU Q daily. This flies in the face of FDA recommended 400 IU a day. It got to the point where after hundreds of these tests were done, they just added 5,000-10,000 a day without the lab tests on the rationale that the tests were expensive and people weren't getting toxic unless around 25,000 IU + a day anyway.

I don't know if this would occur everywhere. Given that when sunlight hits skin it causes production of Vit D3, and that Cincinnati is in a lake-effect weather zone may have something to do with this. I'd guestimate that living in Miami, Fl would cause people to have higher levels of Vit D. Cincinnati is on the outer edge of lake-effect. The weather here isn't great but it's not bad. I've been where it's bad (Syracuse and Buffalo) and trust me, it's nowhere near as bad as it is there.

A psychiatrist now in my department is doing studies on Vit D3 and psychiatric disorder. I referred him to the doctor in the state hospital because there were data-sets from hundreds of patients. Unfortunately the state IRB is a slow as a turtle so he decided to forego them.

 

[digitlnoize]

The head IM doctor at the state hospital I used to work at made it mandatory to get Vit D 25,OH levels on everyone coming into the hospital.

About 99% of the people coming in were deficient on Vit D3 with several African-Americans being at levels way below the recommended guidelines. This was after literally hundreds of people's serum D levels were taken.

The only thing that got most of them on the normal range was 5000-10,000 IU Q daily. This flies in the face of FDA recommended 400 IU a day. It got to the point where after hundreds of these tests were done, they just added 5,000-10,000 a day without the lab tests on the rationale that the tests were expensive and people weren't getting toxic unless around 25,000 IU + a day anyway.

I don't know if this would occur everywhere. Given that when sunlight hits skin it causes production of Vit D3, and that Cincinnati is in a lake-effect weather zone may have something to do with this. I'd guestimate that living in Miami, Fl would cause people to have higher levels of Vit D. Cincinnati is on the outer edge of lake-effect. The weather here isn't great but it's not bad. I've been where it's bad (Syracuse and Buffalo) and trust me, it's nowhere near as bad as it is there.

A psychiatrist now in my department is doing studies on Vit D3 and psychiatric disorder. I referred him to the doctor in the state hospital because there were data-sets from hundreds of patients. Unfortunately the state IRB is a slow as a turtle so he decided to forego them.

I did some rotations in Sarasota, FL and it was just as bad down there. Most people simply aren't in the sun enough. In Virginia, pretty much everyone is deficient.

I've started taking the Vitacost Vit. D drops, which are incredibly cheap and effective. 2000 IU per drop. 900 drops per bottle. $9.99 per bottle (plus a 2nd one half price if you want it). I take 2-3 drops/day. I've seen patients do VERY well with their Vit. D labs on this regimen, plus it's cheap.

http://www.vitacost.com/vitacost-vitamin-d-drops

My wife and I have actually started taking a liquid multivitamin, liquid vita cost fish oil, and the vit. D drops as a "shot" in the morning. I hate taking those giant vitamin pills and this seemed like a reasonable alternative.