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PharmNotes Nov-Dec 2014
PharmNotes Nov-Dec 2014
Volume
Volume 17,
12, Issue
Issue 62
November/December
2014
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Fish Oil:
An Overview
Conclusion:
Differentiating
Between Dementias
Hi-Dose Insulin:
Risk vs Benefits
Orthostatic
Hypotension:
A Review
NMG Contact
Information
Fish oil supplements are often low in mercury and other pollutants. For most people, mercury in fish is not a health concern, but the FDA has this advice for pregnant women, nursing mothers, and young children: Limit albacore tuna to 6
ounces/week; limit fish lower in mercury to 12 ounces/week;
avoid shark, swordfish, king mackerel, and tilefish; remove
skin and fat before cooking fish. It is best to choose fish oil
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Lovaza is a prescription drug used to treat high triglycerides and comes as a 1 gram softgel capsule and consists of
EPA 465mg and DHA 375mg. It is expensive and may cost
up to $165 per month. The recommended dose of Lovaza
is 4 grams as a single 4 gram dose by mouth once a day or as
2 grams by mouth twice daily. It is a concentrated form of
fish oil so you will take fewer capsules compared to over-the
-counter fish oil.
Uses and Effectiveness
Fish oil is primarily used to lower
triglycerides, a blood fat thats
linked to heart disease. Omega-3
fatty acids may help other cardiovascular effects such as lowering
heart rate and blood pressure, decreasing the risk of arrhythmia,
reducing inflammation, inhibiting
atherosclerosis, and reducing
thrombosis. Studies suggest omega-3 fatty acids could improve joint symptoms such as pain
and stiffness from rheumatoid arthritis by preventing production of pro-inflammatory signaling molecules. Additionally,
they may also boost the effectiveness of anti-inflammatory
drugs. A recent study also suggested that higher omega-3
fatty acid levels may improve brain health and hold promise
for delaying cognitive aging and dementia. To get to a high
enough level, people would have to eat oily varieties of fish
at least five times a week or eat it twice a week and take fish
oil supplements daily. Fish oil could protect against depression, cancer, and help with menstrual pain as well, but more
research is needed to determine the usefulness of these reported benefits.
Birth Control Pills: Birth control pills may decrease the effectiveness of fish oil supplements by affecting their ability
to lower triglycerides.
Other Omega-3 Fatty Acid Products
There are other products that contain omega-3 fatty acids as
well, such as krill oil (ex: Mega Red Omega-3 Krill Oil capsules). Krill are small crustaceans similar to shrimp. The
composition of krill oil varies depending on which species of
krill from which it is extracted. Krill oil is promoted to have
similar benefits as fish oil, without the fishy taste and without
the necessity of taking as many capsules as fish oil, but there
is no evidence it reduces cardiovascular disease. Additionally, the amount of omega-3 fatty acids in krill oil products is
generally less than in fish oil products. Krill oil supplements
can cost five to ten times as much as fish oil supplements for
the same omega-3 fatty acid content. There is less research
on the use of fatty acids from krill oil compared to fish oil, so
for now, it is best to recommend fish oil supplements or Lovaza if the fishy taste isnt a problem.
Flaxseed is another source of omega-3 fatty acids. Flaxseed
contains the short chain omega-3 fatty acid called alphalinolenic acid. (Alpha-linolenic acid is also found in soybean
and canola oil and English walnuts). Unlike fish oil, flaxseed
does not lower triglycerides but can have a modest effect on
LDL cholesterol. Flaxseed is not a substitute for fish oil as it
is not a significant source of EPA and DHA (even though the
body can convert alpha-linolenic acid from flaxseed into EPA
and DHA). Flaxseed contains significant amounts of soluble
fiber and as with any source of fiber, may cause gas, bloating,
diarrhea, constipation, nausea, and dyspepsia. These side
effects are usually dose-dependent. Flaxseed may best be
viewed as part of a healthy diet and not necessarily a supplement. One teaspoon of flaxseed oil or 1 tablespoon of flaxseed daily should provide enough alpha-linolenic acid in the
diet.
A diet high in omega-3 fatty acids, such as fatty fish, does
have some cardiovascular benefits and is a reasonable health
measure, but the amount needed is not definitive. For most
healthy people, a variety of baked or broiled fish is a better
choice than fish oil supplements. Fried fish is unlikely to
have health benefits and may increase cardiovascular risks.
Fish oil supplements are a good choice for hypertriglyceridemia or secondary prevention. Fish oil may have a variety
of other health advantages from mental health and arthritis, to
blood pressure and aging, but more studies are needed to
know the true benefits.
Article by: Heather Eaton-Erskine, PharmD, CGP, FASCP
Regional Clinical Manager
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Louisville, KY 40223
Phone 866-601-2982
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Mooresville, NC 28115
Phone 800 578-6506
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