Fish Oil By Prescription?

If you’ve read much about natural supplements, you know that fish oil has many health benefits.

The benefits of fish oil include:

  • Reducing Inflammation
  • Extending Lifespan
  • Increasing Cardiac Health
  • Supporting a Healthy Immune System
  • Improving Metabolism
  • Decreasing Pain
  • Increasing Memory & Learning
  • Supporting Healthy Breathing
  • Increasing Sexual Health
  • Improving Skin Health

In fact, fish oils are so beneficial, pharmaceutical companies want to get in on the action. Of course, the only way they can justify doing so is if they tweak fish oil a bit to make it proprietary. That way they can charge more for essentially the same thing you can buy over the counter.

And that’s just what Reliant Pharmaceuticals has done.

Reliant has released a ‘drug’ that is basically fish oil. And they’ve tweaked it just enough to make it proprietary. The name of this proprietary fish oil is Lovaza (formerly Omacor).

The kicker is that a prescription for this version of fish oil costs around $200 per month. Compare that to the cost of high-quality fish oil. For even the highest quality fish oil, you wouldn’t pay more than $35 to $40 a month.

Their point of view seems to be that if some is good, then a lot is better. To that end, they’ve devised a proprietary distillation process that concentrates the amount of EPA and DHA in the oil. EPA and DHA are the components of fish oil that have verified health benefits.

After extensive testing, the FDA approved this new form of fish oil for reducing high triglycerides.

What’s the Difference?

Why do they charge so much for this? And more importantly, is the higher price justified by additional benefit?

Normal fish oil has around 30% EPA and DHA. Lovaza has 80%. Because of this, you might think that Lovaza is almost 3 times more potent. But the devil, as they say, is in the details.

To pack that much EPA and DHA into a pill small enough to swallow, they have to modify it into a different form than normal. Naturally occurring Omega-3 is in the triglyceride form. That’s 3 fatty acids connected. This new version breaks this down into individual, disconnected fatty acids called ethyl esters.

Breaking the fatty acids down this way allows for cramming more EPA and DHA into the capsule than would otherwise be possible. It has the additional benefit of leaving less room for impurities like dioxin. Dioxin can contaminate fish oil to one degree or another, depending on how they distill the fish oil.

So far, it sounds like this new form might be better, doesn’t it? After all, it provides a larger amount of the beneficial ingredients and it reduces impurities. That means to make a fair comparison to high quality fish oil we need to ask questions about purity and effectiveness.

Let’s look closer at this to see if it’s better or not.

The Purity Issue

Experts consider a safe level of dioxins to be below 2 parts per million. Certainly, this new form of fish oil is far below that. It is highly distilled.

Normal, high quality fish oil goes through a process called molecular distillation. Basically, this means the fish oil is distilled under high pressure using short exposure to minimal heat. This form of distillation insures a high quality product and reduces toxins that might have been in the original substance.

Molecular distillation leaves fish oil with as low as 0.3 parts per million of dioxin. This is 85% lower than the safety level recognized by the World Health Organization.

I don’t have exact numbers for dioxin in Lovaza, but we can assume they are somewhat lower than those for molecularly distilled fish oil. This assumption comes from the higher concentration of EPA and DHA in the pharmaceutical product. Higher concentration means less room for contaminants.

It the difference significant? Given how far below the safe level both forms of fish oil are, it is probably not significant.

The Issue of Effectiveness

To find out if this new, “improved” form of fish oil was really worth the cost, a group of researchers recently ran tests to determine the bioavailability of Omega-3 fatty acids in various forms of fish oil.

Two studies explored this issue.

The first study, published in 2010, found that modified omega-3 ethyl esters had less bioavailability than conventional fish oil (-27%). That tells us that the prescription version is no better than conventional fish oil.

The second study, published this year, lasted for six months. Again, they compared the modified and conventional forms of fish oil. They measured the presence of EPA and DHA in the membranes of red blood cells to determine how much was actually available.

In this study, the high quality conventional fish oil resulted in notably faster and better bioavailability than the “new and improved” prescription form. This was true 3 months into the study and also at the 6-month point when the study concluded.

This means that to the degree bioavailability equals effectiveness, conventional, high-quality fish oil is better than the modified prescription version.

What about the issue of concentrated doses?

If you think that the concentrated doses offered by Lovaza are worth the cost, here is another way to think about it. Even if you took 3 times the amount of conventional, high-quality fish oil than normal, it would still cost you much less than the prescription version. And it would be more effective.

Like any other supplement or food, the exact best dose for each person will be different. So if you start taking fish oil, take one a day the first few days. Then take two. Gradually increase the dose up to as much as six per day. If you pay attention to your body’s response, you’ll know the best amount for you.

Of course, we can’t expect a large, double-blind study any time soon to prove that conventional fish oil is medically better. After all, who would pay for it? But given that high-quality fish oil costs one-fifth as much, it seems like a safe bet to stick with the tried and true conventional form.

All the best to you for your health and happiness,

Dr. Bruce Eichelberger

Dr. Bruce



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The Truth About Prescription Fish Oils,

Dyerberg J, Madsen P, Mller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins, leukotrienes, and essential fatty acids 2010;83:137-141.

Neubronner J, Schuchardt JP, Kressel G, Merkel M, von Schacky C, Hahn A. Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacylglycerides versus ethyl esters. European journal of clinical nutrition 2011;65:247-254.

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