Prescription Fish Oil – Beware

Big Pharma is going natural with big dollar signs in its eyes. With the exploding popularity of all things natural, this market was simply too big and potentially profitable for drug companies to pass up. But there’s one problem — most natural products are naturally inexpensive. The solution: Tweak a molecule, create a synthetic version, patent it and charge a high price — as it turns out, however, this may hurt patients in ways other than just denting their wallets.

For example, we have the “prescriptionization” of fish oil. Fish oil contains the two omega-3 fatty acids — EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) — that studies show reduce the blood fats called triglycerides and provide a variety of heart benefits. Lovaza is a potent version of fish oil that has been chemically manipulated by GlaxoSmithKline, which markets it as a prescription drug treatment for profoundly high levels of triglycerides. That’s fine, and it can be beneficial to those rare individuals whose triglycerides soar over 500 mg/dL, but I learned from Daily Health News contributing editor Andrew L. Rubman, ND, that Lovaza is now being widely prescribed “for every condition that might be helped by taking the real stuff — with no scientific proof whatsoever that doing so is either safe or effective!”

Dr. Rubman said that only a very few people need this expensive prescription version of fish oil — the rest of us are far better off staying with the real thing.

Rx: Caution

There is no question that fish oil has cardiovascular benefits. In addition to moderating triglycerides, evidence demonstrates that it lowers blood pressure, slows the buildup of atherosclerotic plaque and reduces heart attack risk. For people with heart disease, the American Heart Association recommends consuming one gram of combined EPA and DHA, preferably from eating fish, but says it’s fine to get it from a supplement. For people with high triglycerides (200 to 499 mg/dL), the AHA recommends taking two to four grams of combined EPA and DHA daily, in capsule form, under your physician’s care.

Isn’t Lovaza just a powerful way to get fish oil? You might think so — but you’d be wrong, said Dr. Rubman, noting that there’s little difference in the beneficial components you get from over-the-counter (OTC) fish oil versus Lovaza — and the pricy, prescription version is also potentially harmful. We did a side-by-side comparison…

Lovaza is no purer than reputable fish oil. A recent Consumer Reports comparison tested virtually all commercially available fish oil supplements, verifying that none contained significant levels of mercury, PCBs or dioxins. Purity was a selling point of the synthetic Lovaza, notes Dr. Rubman: “These supposed ‘contaminants’ have been used to sway the public in favor of the drug over fish oil,” he explained. While this used to be an issue, it’s no longer anywhere near as relevant.

Lovaza is way more expensive. While there’s no difference in the quality of the ingredients in OTC fish oil supplements and Lovaza, there’s a huge difference to your pocketbook. Lovaza is expensive. Depending on where you fill your prescription and assuming that you take the typical dose of about four capsules daily (840 mg of EPA/DHA are in each one-gram capsule), an average one-month prescription could cost you as much as $315… versus less than $10 for an OTC fish oil supplement.

Lovaza may be stronger than needed. Though the FDA approved Lovaza for treatment of triglycerides higher than 500 mg/dL, the truth is that even people with heart disease rarely have such high levels and require such powerful medication, observes Dr. Rubman. He pointed out that diet and nutritional modification often can bring these levels down quickly, making this medication just plain unnecessary.

Lovaza has worrisome side effects. Even though excessive doses of fish oil, whether from the OTC kind or Lovaza, can cause side effects — especially bleeding — the additional side effects listed by the manufacturer of Lovaza are of concern. ” Lovaza is an engineered chemical, and we just don’t know how it will act long term,” said Dr. Rubman. Lovaza’s listed side effects include flulike symptoms, infections, back pain, skin rashes, burping, upset stomach and changes in taste. And then there is one more side effect that Dr. Rubman finds particularly worrisome — there have been numerous reports of unexplained extreme fatigue in patients taking Lovaza. It’s not clear why, but he speculates that it may be related to the processing that plasticizes (or, in chemical terms, “esterifies”) the oil, which essentially creates a new compound that behaves differently in the body than naturally- derived fish oil.

Netting it out: For people who have tried controlling triglycerides with nutritional and supplemental approaches but have been unable to get their exceptionally high levels under control, Lovaza might be helpful — even with its higher cost and greater risk for side effects. For the vast majority (e.g., the rest of us), OTC fish oil supplements are safe, effective and way less expensive.

Buying Advice

When buying fish oil, look for the “USP Verified” label, which means a product has been tested by the US Pharmacopoeia for purity and potency. Consumer Reports gave two fish oil supplements their “CR Best Buy” rating: Kirkland Signature Fish Oil (from Costco) and Member’s Mark Omega-3 Fish Oil (from Sam’s Club). Dr. Rubman said that his two favorite brands are Nordic Naturals (the brand I take) and Pharmax.

Don’t be bamboozled. For the vast majority of people, OTC fish oil is just fine. Why contribute to Big Pharma’s bottom line when you could be protecting your own?

Source: Andrew L. Rubman, ND, founder and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut. www.SouthburyClinic.com.