fish oil; DHA and EPA amts

[maddy99]

I am taking Dry Eye Omega Benefits fish oil softgels. Doctor said I needed only 3 pills a day (bottle says take 6). But the amt of EPA and DHA doesn't seem high enough according to other posts on this list.

Omega benefits has EPA (1260) and DHA (420) in 3 softgels.

Has anyone noticed they feel better with higher amounts or how do you figure out what and how much to take?

Elaine

[jebe1]

If you go to the PRN website, they are marketing the same omega-3 gelcap in different packaging. The 120 Count Dry Eye Omega Benefits tells you to take four a day for a one month's supply (120/4 = 30)
http://www.prnomegahealth.com/s.nl/it.A/id.117/.f

and the 180 Count Dry Eye Omega Benefits tells you to take six a day for a one month's supply (180/6 = 30)
http://www.prnomegahealth.com/s.nl/it.A/id.102/.f

or if you even want, you can even take their formulation for "Joint Health" called Flex Omega Benefits as its the same gelcap:
http://www.prnomegahealth.com/s.nl/it.A/id.114/.f

Regardless of which one you take, each gelcap has 420mg of EPA and 140mg of DHA. My doctor has me taking four a day and after six weeks my doctor has noticed a small but noticeable improvement in my blepharitis -- better tear consistency and less inflammation. My eyes do feel a little better and the redness has really decreased. So, I'd say listen to your doctor who can increase or decrease your dosage based on his or her examination.

Also, I found this article of Tryglyceride (TG) versus the Ethyl Ester (EE) form of Omega-3 very informative. My doctor said he was seeing a wide range of results from Omega-3 and thinks it is because of the varying rate of absorption based on your diet with the EE form. I think the TG form gives you a more consistent absorption so you can clinically tell if it is working or not.
http://www.dryeyezone.com/talk/showthread.php?t=9618

BTW, if you sign up for monthly shipments of the PRN Omega-3, you get a better price and free shipping. If you give them a magic doctor code, they will take off another 10% so my 120 count bottle was $36.90. If you weren't referred by your doctor, they might give you 10% off if you call and sign up for monthly shipments.

Jebe

I am taking Dry Eye Omega Benefits fish oil softgels. Doctor said I needed only 3 pills a day (bottle says take 6). But the amt of EPA and DHA doesn't seem high enough according to other posts on this list.

Omega benefits has EPA (1260) and DHA (420) in 3 softgels.

Has anyone noticed they feel better with higher amounts or how do you figure out what and how much to take?

Elaine

[willwork4tears]

Also, I found this article of Tryglyceride (TG) versus the Ethyl Ester (EE) form of Omega-3 very informative. My doctor said he was seeing a wide range of results from Omega-3 and thinks it is because of the varying rate of absorption based on your diet with the EE form. I think the TG form gives you a more consistent absorption so you can clinically tell if it is working or not.
http://www.dryeyezone.com/talk/showthread.php?t=9618

I know we're not supposed to criticize doctors here...but buyers beware...this article raised a lot of red flags.

When he posted the article he didn't post the references that are supposed to go with it.

A quick google search located the article which revealed LOTS of new concerns: 1) The article was NOT published in a peer-reviewed scientific journal. 2) The article was "published" on an optometry office's website. http://www.mainoptical.com/pdf/TG_vs_EE.pdf 3) The references used for the article are extremely outdated (almost every single one of them is 10-20 years old) and many are irrelevant to dry eye.

Basically, I feel this article is a glorified advertisement.

Also, you can find Dr. Murray arguing the exact OPPOSITE position using many of the same points Dr. Gross used to argue HIS position! http://www.doctormurray.com/index.ph...m-of-fish-oils His references were also outdated and irrelevant (ulcerative colitis, anti-thrombotic effects, blood cholesterol - nothing on dry eye). Interestingly, Dr. Murray "plugs" a fish oil which happens to be an EE version. I personally feel these doctors are finding "evidence" to support why you should buy the product in which they are personally affiliated/invested. I personally have no idea which one is better, but I haven't been able to find a single journal article in a peer reviewed journal that explains why triglyercide forms are better. My final point: if the TG versions are so much better, why are the prescription fish oils EE? Again, I have no personal opinion or recommendation. These are just my suggestions for trying to make a decision based on impartial evidence.

Good luck deciding people! I haven't been able to make a decision either way!

[jebe1]

My final point: if the TG versions are so much better, why are the prescription fish oils EE?

Willwork4tears,
Thanks for the links and I think I understand your point.

I had asked an internist friend why Lovaza is in the EE form and his answer was he didn't care. He was only concerned about actual clinical results and not factors such as human body absorption rates. So I guess the only thing you can conclude is that Lovaza, which is a particular EE formulation (which I'm sure is patented), has been clinically proven to lower triglyceride levels. I suppose any study comparing a particular TG formulation with a particular EE formulation would have to show a quantitative result such as comparing triglyceride levels or incidents of heart disease to be publishable in a peer-reviewed article. I would think conducting a study contrasting inflammation levels would be very difficult and costly.

[willwork4tears]

why better absorption of TG fish oil isn't the whole story

Jebe,

Yes, you seem to have gotten my point exactly which is quite a feat on your part considering I wrote it really late and I was exhausted. Probably not the best idea....

I'd like to clarify a few points I made and maybe take some time to critique my own critique. I think I may have come across a bit harsh and would like to explain my thought process a little better.

"The references used for the article are extremely outdated"
Ok...this was a bit unfair. Obviously the 80s and 90s were the birth of this field and this was when all the preliminary and basic research was done. I guess my point was that you would think in the 10-20 years since, someone would have done a study comparing TG to EE in terms of improving dry eye symptoms in patients. I guess my real disappointment is I can't find any studies like this. (Like you said...maybe they're expensive. Or maybe they are having trouble defining a primary outcome that reflects the real improvement - like the recent Prolacria trials).

"many are irrelevant to dry eye."
Again, this kind of goes with my statement above that these studies don't involve dry eye patients or report which one is better for improving dry eye symptoms. These studies were performed in HEALTHY patients. Who's to say healthy patients don't process fish oil differently than patients with inflammatory conditions? Also, these studies are all about absorption. Most of the references say that TG forms are absorbed better than EE. (This one said the absorption was the same: Absorption of the n-3
eicosapentaenoic and docosahexaenoic acids as ethyl esters and triglycerides by humans. Am J Clin Nutr. 53:1185-90.). Also, I think instead of describing the articles as "irrelevent" I would like to say they have been overextrapolated. How do you know that increased absorption actually decreases dry eye symptoms? Here's where my pharmacology brain starts spinning.

There are lots of other pharmacokinetic and pharmacodynamic principles that come into play for drug efficacy than just absorption. Metabolism, distribution, mechanism of action and elimination are all important as well. Let me give an example: Let's pretend that Drug A is absorbed better than Drug B. After 2 hours the concentration in your blood of Drug A is 100 where the concentration in your blood of Drug B is only 50. Now let's say I tell you Drug A is eliminated (filtered out of the blood and excreted by the kidneys) twice as fast as Drug B. So Drug B will have a lower concentration in your blood but it will stick around twice as long. Which one do you pick?

Let's throw a wrench in it even more. Let's talk about effective concentrations [EC]. Now I tell you that the EC of fish oil for improving dry eye symptoms is 10. This means you only need a level of 10 in your blood for your symptoms to improve. Do you really care which one is abosrbed better? Both A and B will get your blood levels beyond the EC. So now if I tell you Drug A costs 4X as much as drug B....which one would you pick?

Basically, absoprtion isn't the whole story. And while the TG form probably really is absorbed better I would like to see some proof that this directly translates into better symptom improvement. This may be asking a lot!

[Rebecca Petris]

I know we're not supposed to criticize doctors here...but buyers beware...this article raised a lot of red flags.

Thanks for noticing but you can criticize their research and writing to your heart's content.

[willwork4tears]

calling Dr. Lange!

Fantastic!

This is good to know...I was worried my brain might have hijacked my fingers and that my midnight ramble might have "toed the line" of the rules.

[rhad]

alright...so we are told that Fish oil is good for us as Meibomian Gland dysfunction sufferers and dry eye in general...but then why doesn't it work as well in real life as in theory...

my question is, if Fish oil helps improve Meibum or oil composition, and is a powerful anti-inflammatory and Omega 3's are so hyped to be so...then why do "normal" people who do not have this disease, have never taken omega 3's in their lives, and don't have this disease...? And they supposedly eat a high Omega 6 diet which supposedly promotes inflammation??? i mean seriously, Omega 3's are in alot of foods, in very small amounts, what makes you guys think that taking large amounts of this is going to improve our eyes? am i missing something here...I think logically, and this doesn't make sense to me logically...

someone please shed some light on this for me..
I mean sure, omega 3's are supposed to be good for our overal health, but obviously in nature, their in very small quantities in foods...very little..

rhad

[Rebecca Petris]

Being more of a pragmatist than a theorist, here's my very simple take on Omega 3s - that is, as regards dry eye specifically:

We do what works. What works for each one differs as is amply evident here. I know a great many people for whom fish oil, flaxseed oil or another supplement is consistently their 'tipping point' with controlling dry eye symptoms, and some for whom it even seems to be the sole effective treatment. I wouldn't be surprised if those individuals couldn't care less about the logic or the absence thereof, let alone the question of why it works for them and not everybody else.