COMMENT:

I'm been a fan of the antiinflammatory and antiarrhythmic and
antiseizure properties of the w-3 fatty acids in cold water fishoil
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 whicha 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 fishoil 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
fishoil 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 Eskimo 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) antiinflammatory as compared
with the series-2 prostaglandins derived from arachadonate (in meat
and dairy fat). Adding fishoil 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. Fishoil 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 antiinflammatory 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 antiinflammatory 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 lamanted
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