>From SBHarris, M.D.
Original on sci.med. Oct 23, 2004

COMMENT:

I'm been a fan of the antinflammatory and antiarrhythmic and
antiseizure properties of the w-3 fatty acids in cold water fish oil
for years.

You don't want to take these w-3 (omega-3) fats as cod liver oil,
however, due to getting too much vitamin A from it. Take them as fish
body oil (which is made from fish minus the guts and livers) so you
miss out on the vit A overdose. Vitamin D is good for you, but there's
a fair literature suggesting that very much pre-formed vitamin A is
not.

The cheapest fish body oil on the market is Costco's Kirkland brand.
All these cold water fish oils are about 30% w-3 oils (DHA plus EPA)
but Costco's costs about $7 for a bottle of 300 1-gram caps. That very
good. According to Consumer Reports, it's the same generic everybody
else is selling for several times the price.

You can get fancy molecularly distilled EPA/DHA products which are
50% w-3, but you're going to pay tremendously higher prices for them
per gram of w-3 than you will the generic cold water fish oil from
Costco.

Even the American heart association has started recommending a gram a
day of w-3 as EPA+DHA, which corresponds to 3 or 4 of the 1 gram
capsules. I personally take 10 grams a day (in capsules) along with my
morning berry+protein smoothie. That takes about 10 seconds once you're
in practice. That's equivalent to the w-3 in one 7 oz. salmon steak, so
it's not all that much. Cost is $7 a month. This much fish oil adds 90
Kcal to your calorie intake. You're probably eating 1000 kcal of fat a
day even on a fairly good diet, so the amount here replaced by w-3 fats
is nothing significant compared with what an traditional Inuit diet
(say) provides. And the traditional {Inuit} diet is not unhealthy-- if
anything, the reverse.

There are a fair number of studies showing a salutory effect of w-3 on
inflammatory-type problems like osteoarthritis, and even on tough
problems like lupus. The w-3 fats are metabolized to series-3
prostaglandins which are (in general) anti-inflammatory as compared
with the series-2 prostaglandins derived from arachadonate (in meat
and dairy fat). Adding fish oil is about like adding one of the
standard disease-modifying drugs, in rheumatoid arthritis. Which is a
pretty good deal for $7 a month and few side effects!

There are many other dietary modifications one can make with chronic
inflammatory diseases. Fish oil and meat/dairy fat restriction is the
easiest, but one can also add the w-6 fat gamma linolenic acid (GLA),
which is most cheaply available from capsules of borage oil (Puritan's
pride or NOW pharmaceuticals). GLA is metabolized to series-1
prostaglandins, which are also less inflammatory than the series-2.

There are also a lot of anti-inflammatory spices and functional foods
available, such as turmeric and all kinds of flavonoid and
anthocyanin-rich produce. All modify and block parts of the
inflammatory response, without being very hard on the stomach.

Inflammation is one subject on which I wish more MD's would take a
page from the naturopaths, and get their patients eating a different
diet and supplementing with the proper oils and spices, before going
down the expensive and somewhat dangerous NSAID highway. Of course,
some patients can't be bothered, and must have a pill. But for the
others, there is a better way to start. One can always *add* NSAIDS if
one must, to such an anti-inflammatory diet. But in that case, fewer
will be needed. For the patient willing to make some lifestyle changes,
NSAIDS can in many cases be avoided entirely, for minor and even
moderate problems. That's good for everybody but the drug companies.

A word about the fancy COX-2 inhibiter drugs like the late lamented
Vioxx and the last man standing, Celebrex. These drugs are in THEORY
anti-inflammatories with less GI bleeding risk. But in PRACTICE this
turns out to be true only for the first 18 months of use (just where
Vioxx started getting dangerous, perhaps coincidentally). After that,
the risk of GI bleeding is similar whether you're on a standard "dirty"
NSAID like aspirin or ibuprofen, or a fancy and expensive drug like
Celebrex.  Just another reason, if you're contemplating long term use
of NSAIDS, to consider the functional food diet and supplement approach
first. What do you have to lose?  The science is good, and
the studies are out there. Go for it.

SBH

********************************



http://www.hsibaltimore.com/ea2002/ea_020227.shtml

Now scientists at Cardiff university in Wales are studying the effects
of cod liver oil on the joints and cartilage. {..}

For several years now, scientists at Cardiff have been researching cod
liver oil. Previously, they found that the omega-3 fatty acids in cod
liver oil can reduce collagen degradation and inflammation. Just
recently, their laboratory tests revealed that cod liver oil can
actually "switch off" or reverse the action of the enzymes that degrade
collagen and break down cartilage. The researchers suggest that taking
cod liver oil can prevent the development of arthritis, and can reduce
symptoms in those already afflicted with this painful disease.

The Cardiff research has yet to be published, but it's on deck for
inclusion in an issue of Arthritis and Rheumatism later this year.

{..}

There are some people who shouldn't use cod liver oil, however. Some
studies have suggested that it can raise blood sugar levels, so it is
not recommended for those with diabetes. And, if you take a
blood-thinning medication like warfarin, you shouldn't take cod liver
oil, as the combined anticoagulant effect could be dangerous. Also, cod
liver oil can interact with immune system-suppressing drugs like
cyclosporine.

*****************************************


http://www.medicationsense.com/arti..ore_safely.html

What Now for Users of Vioxx, Celebrex, and Bextra?
How to Use Anti-Inflammatory Drugs (NSAIDs) More Safely -- and Natural
Alternatives That Work.

J.S. Cohen, M.D.
"Natural Alternatives
Most of my work pertains to medications: how to maximize the
benefits of medications while minimizing their risks.  Over recent
years, I have had the opportunity to research and try a variety of
non-drug alternatives for a variety of medical conditions including
pain and inflammation.  There are several natural alternatives that can
provide anti-inflammatory effects, and there is considerable scientific
evidence supporting their use.  In some cases, natural therapies have
allowed people with arthritis to reduce or discontinue their
prescription anti-inflammatory drugs.  These natural alternatives
include: curcumin, glucosamine with chondroitin, borage oil (containing
high doses of gamma linolenic acid), high doses of omega-3 fish oils,
or high doses of alpha lipoic acid."

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