Do you work for the pharmaceutical industry?

In response to my post, Lovaza Rip-off, I received this angry comment:

Very high triglycerides, as you all know, is a very serious and life-threatening condition. Therefore, it is very important that any medication you take for treatment must be FDA proven and scientifically backed. This is true for a few reasons. First, there have been zero studies done to show the effects of Costco brand fish oil pills on patients with high triglycerides. So, you cannot assume, simply because the pills you are taking "claim" to have a certain amount of Omega 3 in the them, that they actually do (supplement labeling is self-submitted by the company, and not regulated by any external or 3rd party agency).

Secondly, the other components in fish oil, and maybe in Costco brand (no one knows because it isn't on the label) can actually inhibit the bioavailablity of Omega 3, most notably, Omega 6. And, nowhere on the Costco label does it tell you how much Omega 6 is in it. We also cannot underestimate the importance of purity with these compounds: a top selling brand of fish oil found stores like CVS was recently recalled because it was found to have large amounts of fire retardant in it! These supplements are NOT regulated by the FDA.

Thirdly, be careful when you compare costs. The cost of hospitalization due to acute pancreatitis (a risk of very high triglycerides) far outweighs the cost of taking Lovaza for even several years. If you have a real disease, you need a real drug. And, until Costco does a prospective long-term clinical trial to show that it lowers triglycerides, it should not be used in place of Lovaza.

Finally, I am a living example of how taking a high-potency supplement form of Omega 3 barely lowered my triglycerides, yet within 2 weeks of being on Lovaza there was a significant difference. I am now at my goal. So, before you knock a company, that, in my opinion, has saved my life, please do your research and do not mislead people into thinking that an Omega 3 is an Omega 3 is an Omega 3. If your insurance covers the most potent, the most pure, and the ONLY proven Omega 3 pill on the market, you should be thankful.

The comment was posted anonymously, so I don't know who it came from. But I can tell who I think it is: Someone who works for the drug industry.

This is a common phenomenon: Large corporations are fearful of the comments that are generated on internet conversations and other media. On the internet, there are actually people whose job it is to do "damage control." I suspect this came from one of them.

Why bother? Surely there are better things to do? Well, that's easy. There are billions of dollars at stake. Lovaza, in particular, is sold on the perception that it is somehow superior. If word gets out that maybe you can achieve the same results at a fraction of the cost . . .

Perhaps the "commenter" should also question whether omega-3 fatty acids can come from eating fish.

As part of my cardiology practice, I provide consultation on complex hyperlipidemias, or unusual lipid abnormalities. I have many patients with something called familial hypertriglyceridemia, a genetic condition that permits triglyceride levels of 500, 1000, even many thousands of mg/dl, levels that, as the anonymous commenter points out, can be dangerous.

I virtually never prescribe Lovaza for these people. In their treatment program, I use simple fish oil supplements, such as that from Costco, Sam's Club, or other retailers. I have not witnessed a single failure in treating these people and reducing triglycerides. People with lesser triglyceride abnormalities likewise respond very nicely to inexpensive fish oil that we can buy at the health food store. (I do rely on useful services like Consumer Reports and to reassure us that no pesticide residues, mercury, or other contaminants are in the brands we use.) Excellent, high-quality fish oil supplements are sold by Carlson, Life Extension, Barlean's, even the Members' Mark brand from Sam's Club.

So, the notion that only prescription fish oil is capable of reducing triglycerides is, in a word, nonsense.

Take that back to your CEO.

Comments (30) -

  • Jenny

    3/24/2009 7:18:00 PM |

    The drug industry seems to have put a full time anonymous troll at work  replying to posts my blog.

    They always appeal to authority, along the lines of "How dare you say .... I'm a medical professional and what you are saying is dangerous...." They don't seem to get the part about how no one is going to believe their authority since they're posting anonymously.

    I occasionally post one of their screeds as my forum regulars enjoy bashing them. But my blog policy is that I don't make anonymous posts public if they are without merit.

  • Anonymous

    3/24/2009 8:26:00 PM |

    I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug.  I suppose he considers himself smart and ahead of the game? Hah!!! Mother nature always wins!

  • Dr. William Davis

    3/24/2009 9:46:00 PM |

    Hi, Jenny--

    Good for you to stand up to them.

    I agree: They're very clever about crafting their comments to make you feel small. I find it funny. Here we are, David vs. Goliath, and they resort to deception, subterfuge, and smear to make their points.

    Anonymous (above): Excellent point! I failed to mention how effective diet is for high triglycerides.

  • Michael

    3/25/2009 12:57:00 AM |

    The argument that the vitamin industry is self-regulated and answers to nobody is genuine.  Look what happened to the financial industry with self regulated derivative products!  Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.  My triglycerides were 800+ ... now they are 300.  My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins.

  • Michael

    3/25/2009 1:03:00 AM |

    Re:  "I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug."

    So you've set up a hypothetical situation and trash the person on the basis of your assumption/wondering?  And that makes you smarter than ... who?

  • Andrew

    3/25/2009 3:27:00 AM |

    lol OUCH, Dr. Davis.

    I think the CEO's Mama is going to feel that one.

    Excellent reply.  Although, I do think that one positive thing that can be taken away from what the "anonymous" person wrote is that it is very true that supplements are not regulated.  It is extremely important that everyone researches where their supplements come from and if they do meet some kind of quality control standards.

  • Anonymous

    3/25/2009 3:29:00 AM |

    I was thinking the same thing, what is he eating that nothing less than a prescription(?) drug has any effect?

    Regarding purity...  What?  Like no one else has ever had any recalls?

    What about all of the drugs that garnered FDA approval and were then recalled due to long term effects that did not show up in trials?

  • Anonymous

    3/25/2009 4:12:00 AM |

    I agree that person was probably affiliated with Big Pharma in some way.

    In early 2006, my triglycerides were 432mg/dl with no supplements. After taking four Life Extension Super Omega-3 capsules (which yields 2.4 grams of EPA/DHA) once daily and absolutely NO changes in my diet or added exercise, my triglycerides dropped to 157mg/dl when I retested a little over 3 months later, so I know their fish  oil works at reducing triglycerides. Life Extension brand costs me about 63 cents per day at that dosage and it has a 5 star rating from the International Fish Oil Standards. Here is a snip it from their website:

    "The International Fish Oil Standards (IFOS) is an international program concerned with the quality of omega 3 products, as it relates to the international standards for purity and concentration established by the World Health Organization and the Council for Responsible Nutrition."

    I also like the fact the Life Extension fish oil has sesame lignans & olive fruit extract in it as well.

  • Anonymous

    3/25/2009 1:56:00 PM |

    Supplements are not FDA regulated?  It kinda ruins your point when you make a completely false comment like this.

    Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:

    Oh, to be a complete buffoon....

  • JPB

    3/25/2009 2:42:00 PM |

    I have noticed that any time I leave a comment that challenges any part of the current dogma that inevitably someone claiming to be a doctor steps up to tell me that I don't know what I am talking about....

  • Anonymous

    3/25/2009 2:53:00 PM |

    I eat tons of saturated fat and sometimes I take my fish oil but my trigs are 104  because I dont't eat any sugar or starch. Why take drugs when you can control the entire spectrum of cholesterol values and other health issues with diet?

    People you dont' need to take any drugs. You've been brainwashed big time.

  • mtflight

    3/25/2009 7:49:00 PM |

    OOps Dr. Davis, I accidentally published my last comment before proofing it and messed up a link. here it is as it was intended (post this one instead of the other one please).

    I can think of one instance where fish oil won't reduce triglycerides / VLDL:  in the presence of antioxidants.

    I know it sounds strange, but the mechanism by which VLDL/triglyceride reduction takes place depends on peroxidation products of n-3 polyunsaturated fatty acids.  

    It was noticed that when people take antioxidants with their fish oil, for instance vitamin E, the plasma TG/VLDL reductions did not take place.  I experienced this first hand... and I was baffled why the fish oil was "not working" at reducing my triglycerides.

    In a nutshell, the liver determines the presence of peroxidized [hopefully glycated as well] polyunsaturated fatty acids (PUFA), is not ideal for release into circulation, so through a process dubbed PERPP, the VLDL particle that never was is aborted and is instead kept inside the liver.

    The article is called "Hold The Antioxidants and Improve Plasma Lipids?" by Ronald L. Krauss, M.D. Ph.D. can be read at
    PubMed or
    The Journal of Clinical Investigation

    Peter genially deconstructs the described process in detail at AGE RAGE and ALE: VLDL degradation and Fish Oil

    So probably the best way to reduce triglycerides is to cut out the wheat/starch/sugar/honey/fructose.

    I still take fish oil (with antioxidants) but I eat low-carb so my triglycerides are below 100.

    R.L. Krauss is one of the researchers responsible for recognizing that small dense LDL  are the atherogenic LDL.  yet as an advisor to the AHA, well... not much progress there, unfortunately.

    Thanks for your blog Dr. Davis!


  • moblogs

    3/25/2009 11:17:00 PM |

    ...And if they don't work for the industry, they probably should and collect their commission! Smile

    It just shows desperation. You can paste posters and ads everywhere but when it comes down to it, you can never beat word of mouth which will always help you achieve minimal cost and max. benefit. And word of mouth just expanded with the net.

    People like to help each other. Industries don't.

  • Shreela

    3/26/2009 2:14:00 AM |

    Dr. Davis: Did you and Jenny compare IP addresses between your emailer and her commenters by any chance?

    I searched for the following keyword combinations:

    fish oil recall
    cvs fish oil fire retardant
    cvs fish oil recall
    cvs omega fire retardant recall
    cvs fish oil PBDE recall
    cvs fish oil PCB recall

    I would hope that news of the nation's number 1 chain pharmacy having a very popular supplement recalled because of toxic contamination would be heavily represented in search results. But NO!

    Except that last keyword combo's first result did have "lab tested for contaminants", and surprise, CVS's fish oil caps passed (and they sourced Consumer Lab, so extra cred for their article):

    One of the emailer's other claims intrigued me, so I searched these keyword combos:

    omega 6 inhibits bioavailablity of omega 3
    omega 6 decrease bioavailablity of omega 3

    I haven't found much on omega 6 affecting bioavailability of omega 3 yet, but I did find a 97 study about "inadequate intake of vitamin E results in a decreased absorption of omega-3" at least.

  • Andrew

    3/26/2009 8:04:00 AM |

    "Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:"

    Sadly, that's not really regulation.  

    From the FDA website:
    "Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.* Manufacturers must make sure that product label information is truthful and not misleading."

    It's the classic case of police oversight (actively looking for violators) vs. fire-alarm oversight (only responding when an alert has been raised).  So while it's true that regulation exists, it's not where it needs to be.

    If you have time, check out the documentary "Bigger, Faster, Stronger."  They show how absurdly easy it is to produce, promote and sell supplements that are complete and total garbage.

  • Trinkwasser

    3/26/2009 7:08:00 PM |

    Who needs fish oil supplements when you can eat the whole fish???

    In all seriousness there may be quality control issues with supplements, but I *decimated* my trigs simply by not eating excess carbs. I can't think of a way that something you don't eat could be adulterated

  • Dr. William Davis

    3/26/2009 9:43:00 PM |

    Hi, Shreela--

    Sorry, but it didn't even occur to me. We'll have to do that next time (and I'm sure there will be a next time).

  • Dr. William Davis

    3/26/2009 9:44:00 PM |

    Remember: We take fish oil to accomplish more than reduce triglycerides.

    It also reduces cardiovascular events, accelerates clearance of post-prandial abnormal particles, and modifies plaque composition.

  • Nameless

    3/27/2009 6:45:00 AM |

    My cardiologist tried to prescribe me Lovaza over the fish oil I normally take, using the argument that OTC brands may have mercury in them. I of course declined her offer, and tried to tell her that OTC brands are rather unlikely to have mercury.

    But it got me interested in the differences, if any, between Lovaza and OTC fish oil. I originally contacted GlaxoSmithKline, which was a waste of time, no response. So I went right to the source, Pronovo, the company that actually makes Lovaza for Glaxo. I had two questions, why are transfats listed as being in the product, and what about oxidation, which is the real potential problem with fish oils, not mercury contamination.

    Response from Pronovo for the transfats question:
    However I can assure you that Lovaza has never contained partially hydrogeneated oil. This is simply a mistake. I agree, it is not good marketing - and we are working on it.

    -- Okay, weird answer, but I guess it's believable... kinda. I still don't see why they wouldn't have fixed it by now though. It's sort of like marketing Lipitor -- now with extra trans-fats!

    And regarding oxidation, which i consider the main issue with fish oils, they say that Lovaza is stable at room temperature, even after its opened. They went on to say they don't recommend refrigerating it, as the shelf life may not have been determined in refrigerator conditions.

    Huh? To the best of my knowledge, after fish oil has been opened it's always been considered safest to refrigerate it, to limit potential oxidation. If a liquid is used, it's even more important. And the higher the percentage of omega 3s, the greater the potential for oxidation. So why wouldn't it be suggested to refrigerate Lovaza?

    The only reason I can come up with relates to the last thing they said to me:

    Anyway, you can store Lovaza toghether with other medications. I gues this may be considered a
    good thing when it comes to patient compliance.


    And then I thought about how pharmacists store medications. Or say, mail order places, which ship 3 month supplies, where they will ship using their own bottles -- meaning they had to use open Lovaza bottles. So this basically means patients will be getting fish oil that has been sitting around for god knows how long, open, and non-refrigerated... and then finally shipped in the Medco (or whatever mail order) bottles, to be used for the next 3 months. And this whole time the fish oil has been exposed to air with no refrigeration.

    So how is Lovaza better than OTC fish oil again? At least I can count on OTC fish oil being sealed and not exposed to air when I buy it.

  • Dr. William Davis

    3/27/2009 1:04:00 PM |

    Hi, Nameless--

    The pharmacist opening the bottle of Lovaza hadn't occurred to me. Excellent point.

    Yet another reason to avoid using this overpriced product.

  • mtflight

    3/27/2009 4:10:00 PM |

    We're missing this:

    the peroxidation is what allows the liver to abort the production of VLDL/triglycerides and through the subsequent delipidation cascade the other particles that would result. See my post above!

    The plaque composition and reduction of cardiovascular events "probably" due to it affecting the omega balances (6:3) and therefore the eicosanoid production.

    I take generic, enteric-coated fish oil. The one I buy has some tocopherols (to prevent peroxidation).

  • Anonymous

    3/27/2009 6:18:00 PM |

    The anon poster made a grave mistake fish oil is not a "drug" it is a food!

  • Nameless

    3/27/2009 6:47:00 PM |

    The only advantage to Lovaza I can see, assuming the patient gets sealed bottles of the stuff, is the reduction in pills daily. And I guess that'd be good for those with stomach issues where they can't tolerate too many pills a day. Although even there we are only talking about like 1 or 2 less capsules daily.

    What would be interesting are studies comparing high dose capsules vs low dose in patients, and see if there is any difference in outcomes. I am curious if Dr. Davis has noticed any difference between patients on fish oil with higher omega 3 content (ex: 600mg/capsule vs 300mg/capsule). In theory, the additional non-EPA/DHA fats in the capsule of lower strength fish oils could have some negative effects. But without studies, who knows?

    Same with the forms of fish oil, which tend to be ignored. Are ethyl esters as effective as triglyceride forms? The current studies are mixed... some show no difference, some show the triglyceride  form of Omega 3s absorbing a lot better.

    For Lovaza to back up any of their claims, they need to do a head-to-head study with a good OTC fish oil, say like Carlson's or Nordic Naturals. But we know that'll never happen. Generic Lovaza may hit the market by years end too, depending on what the courts rule, which will be weird. Companies like the ones I mentioned above, or Meg-3, could cash in by licensing with a drug maker and just reselling their OTC fish oil as a new 'drug'. Which would completely obliterate any notion that Lovaza is different than OTC fish oils too.

  • Anne

    3/28/2009 12:40:00 PM |

    I am prescribed Lovaza, though it's called Omacor here in the UK. I used to buy my fish oils from the health food store and it was costing me around £25 ($36) per month - obviously fish oils are much dearer in the UK - so I asked my cardiologist to prescribe me Omacor and he did. My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

    I was very puzzled that the manufacturers say not to store Omacor in the refrigerator and on pressing them, saying that in the summer I could not be sure that the temperature in my house would stay under 25 C they conceded that I could store the Omacor in the fridge: "If you feel that a temperature rise may affect your Omacor, then it is possible to store the product in the fridge."  !


  • Trinkwasser

    3/30/2009 3:10:00 PM |

    Has anyone found differences between brands (or between the same brand at different times, they may come from different sources) in their palatabily?

    I tend to feel bloated and get fishy belches with the capsules I've tried (not Costco or Lovasa but various OTC and mail order types) which doesn't happen with the whole fish, except for elderly mackerel or stale kippers. You don't know how old the capsules might be or how they've been stored.

    My theory is, by reducing the carbs and Omega 6s a lower dose of Omega 3s will probably work. I'll let you know if I'm right or not after I'm dead (grins)

  • Bill

    3/31/2009 5:21:00 PM |

    Michael said: "The argument that the vitamin industry is self-regulated and answers to nobody is genuine."

    Comment: Some easily identifiable companies self-regulation is far superior than the FDA's regulation of drug companies Michael considering the FDA's record on such matters. If one were to take the time to look for reliable providers of high-quality supplements they would be far ahead of the game and have zero the risk of the myriad of side effects caused by pharmaceutical drugs which are often times rehashed toxic byproducts of the manufacturing process put in pill form instead of being paid for to dispose of.

    Michael said:" Look what happened to the financial industry with self regulated derivative products!"

    Comment: Relevance?

    Michael said: "Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.

    Comment: Have at it Michael and take with it the dozens of risks for side effects that go with it vs. the safety of the fish oil supplements.

    Michael said: "My triglycerides were 800+ ... now they are 300. My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins."

    Comment: Just what you would expect from a doctor who is PROGRAMMED to view vitamins or other nutritional supplements as worthless from YEARS of programming efforts by Big Pharma and virtually no classes on Orthomolecular medicine which has been widely studied for decades upon decades with great results and few risks at even high levels of dosing to deal with serious nutritional deficiencies (aka-"chemical" imbalances).

    Chalk another one up to the propoganda machine Michael - you seem to have bought in hook line and sinker or maybe you're just a paid propogandist?

    In health and in truth,


    4/5/2009 7:45:00 PM |

    Anne... I must pick at a nit.  Yu said:

    My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

    They are far from free.  I understand you do not seem to have to pay for them, but we are all paying, even on this side of the sea, for the "free percriptions" folks receive.

  • Anne

    4/7/2009 7:44:00 AM |

    Hi Capslock,

    The money I am charged in my taxes goes towards the cost of the National Health Service so from that point of view my prescriptions are not free, but I am paying my taxes regardless of whether I buy the fish oils from the health food store or get them at no cost on prescription. Since the fish oils are *extremely* expensive from the health food store and since I pay my  taxes this seems the best deal to me.


  • Anne

    4/9/2009 7:04:00 AM |

    Hi Capslock, a PS to my previous message - I'm thinking you must be thinking that the UK system is similar to the American one and that only low income people don't pay prescription charges ? No, everyone under 18 and over 60 gets their prescriptions free, and anyone who has one of certain chronic conditions gets them free too, doesn't matter what your income is or even if you're a millionaire !

    If I did pay for my prescriptions then the maximum charge for anyone is £7.20 per prescription, no matter the price of the medicine, no matter the income of the patient....and £7.20 for a prescription of Omacor fish oils is still much cheaper than buying fish oils from the health food store !


  • Fda Regulatory Affairs

    4/17/2009 11:40:00 AM |

    Thanks for this informative post