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Suggest fish oil dosage for cardiovascular and brain health

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Practicing since : 2004
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I'm wondering your opinion on fish oil dosage for cardiovascular and brain health, as well as help for joints, dry eye, blood pressure, anxiety, etc. This is largely preventative - I'm overweight (but exercising), trying to eat healthy, getting my blood pressure down (I'm pre-hypertensive currently, though sometimes reading normal...sometimes a tad high), and generally trying to live a healthy lifestyle. I'm currently taking 1.8g/day of fish oil (that's active DHA/EPA; it'd be more like 3g of actual total oil in 4 capsules). 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 (the antioxidant) right in the Krill oil (plus I take 200mg CoQ10 and 100% RDA Vitamin E as part of my vitamin regimen). Since starting this, my cholesterol numbers have improved a great deal over the last year+. I've been considering doubling this (so it'd be 3.6g/day DHA+EPA or closer to 4g with the 600mg Krill oil taken into account), which sould also up phytosterols to 1,600 mg (as it's a combined supplement). This is essentially the same dosage as prescription grade fish oil, like Lovaza. Unfortunately, I've read a lot of opinions on both sides. Some tend to argue 1g is beneficial, but more than that is a waste (or could potentially be harmful via oxidative damage or prostate cancer risk). While I've seen others recommend 4g per day to get the maximum benefit for cardiovascular protection, blood thinning, join health, anxiety management, etc.) I'm especially concerned about possible oxidative damage from too high a dose of fish oil. Some studies (for example see WWW.WWWW.WW and WWW.WWWW.WW ) seem to indicate that high doses (in the latter case, 6g, which is higher than I'm considering) can lead to oxidative stress damage from long-term usage. On the other hand, I've seen arguments that the anti-inflammatory effects and other benefits outweigh this risk, and if you take antioxidants like CoQ10 (200 mg for me) and astaxanthin (50 mcg in my vitamin + whatever amount is in the Krill oil), that helps ameliorate any oxidative damage concerns. I also know fish oil has been recently linked to prostate cancer, but I'm less concerned with this as there's not yet any causality proven...just an association with higher plasma levels of DHA and EPA and prostate cancer. Unfortunately, getting the proper amount of oily fish in my diet is very difficult where I live. At best, I only eat oily fish very occasionally (1-2 times a month, and that's probably generous). Finally, I know while several early studies showed fish oil is very beneficial, some more recent ones have cast some doubt on the benefit, so the jury is still out in some regards. But some of the other benefits (lower BP, anxiety alleviation, dry eye, anti-inflammation affects) are more well-established. My main two questions are: 1.) Would you recommend I stay at 2g or increase the dosage to 4g (my doctor gave the OK if I want to, but I don't see her for another 3 months and wanted to ask more questions after doing some of this research)? 2.) If I did increase dosage, and oxidative damage was indeed happening, would that show up in blood tests? For example, would my LDL go up if oxidative damage was happening, letting me know there's a problem, or could I be doing damage "silently" over the long term and not realize it? I'd like your opinion on what I'm doing and what you think as an expert in the field. Thank you! (I appreciate your time as I know this was a lot to read. =oP)
Posted Mon, 10 Mar 2014 in Hypertension and Heart Disease
Answered by Dr. Benard Shehu 3 hours later
Brief Answer: Advised to keep on taking 2 g of fish oil/daily... Detailed Answer: Hi, Thank you for sharing your concern with HCM. 1) I have read your medical history, and can admit that your risk for cardio-vascular problems is very low. So, to my opinion, I'd suggest not to increase the actual dose as you tend to use it for longer time. Please bare in mind that everything comes to a balance in our body. Furthermore, our body has its own mechanisms to clear up what is considered as "waste". When this balance is damaged (high cholesterol levels), you have helped your body to settle such balance back to normality. The dose of 2 g has helped you so far, so, now you need to take maintance dose (to my opinion 2 g or 1 g is ok). Otherwise, if the dose is increased, there will appear the opposite effect (oxidative stress). Furthermore, bleeding is another side effect of prolonged use of fish oil. 2) If the damage from oxidative stress would have taken place, it is done gradually. No routine test can give evidence of oxidative stress. For the time being, I suggest to go on with 2 g until the next appointment with your doctor when your health condition will be further evaluated. Hope it was of help! Dr.Benard
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Follow-up: Suggest fish oil dosage for cardiovascular and brain health 1 hour later
Thanks much for the detailed reply! One more thing I should mention - I had been taking 400mg additional EPA+DHA before the recent labs, but this supplement also included a substantial amount of soy and ALA, and my doctor advised discontinuing it as she's not a fan of soy. So all in all, I was taking a little more than this (~2.4g) for a short period but have changed to only-fish/krill oil. Based on your recommendation, I will not increase any further at this time (taking any followup advice into account). =) So in your opinion, is it safe for me to continue taking 1.8g/day of EPA+DHA, equating to 613mg DHA and 1187mg EPA, plus the 300mg of Krill (so probably about 2g EPA+DHA total since Krill doesn't list separately) as a maintenance dosage? Is this unlikely to cause any significant oxidative damage? Also, is the 800mg/day of phytosterols (included in the fish oil) enough for now? Thanks!
Answered by Dr. Benard Shehu 11 hours later
Brief Answer: Stop taking supplements until you see your doctor. Detailed Answer: Hi again, Thank you for following up. I am happy to know that you want to keep healthy. As mentioned earlier, everything comes to a balance in our body. Furthermore, our body does have its own mechanisms to clear off what is considered as "waste". So, my principle is "to supply your body what it really misses or cannot use properly". In other words, if the tests you did had normal results, then, it means that your body is working properly. There is no need for extra supplementation. Otherwise, such supplementation would be useful. At the end, I suggest to stop taking all these supplements (except for fish oil up to 2 gr or less/day) until you see your doctor and run the suggested tests. If everything is ok, there is no need to take extra supplements. Try to take the necessary nutrients from the food you consume daily in order to supply your body with what it really needs naturally. Hope it was of help! Dr.Benard
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