Volunteer to become a HealthWeb Navigator Reviewer.

Your Guide to Medical Websites

Category: Drugs

Vitamin Supplements—Cure-All, or Snake Oil?

By Mark A. Kelley, MD |2/15/18
Founder, HealthWeb Navigator

Vitamins and other over-the-counter supplements are extremely popular in the United States. In fact, it’s estimated that Americans spend $21 billion on these products every year—a few billion dollars more than NASA’s entire annual budget.

Over the last century, there has been extensive research to understand the importance of vitamins and minerals in maintaining good health. Essential vitamins and minerals are chemicals that our bodies cannot manufacture on their own. Usually they’re introduced to our bodies by the food we eat.

There are some great stories surrounding the discovery of certain vitamins and minerals. Three centuries ago, sailors on long voyages often became very ill, many of whom died. The cause was lack of vitamin C in their diet, a condition known as scurvy. To provide vitamin C, these sailors were given limes to eat on the voyage. Miraculously the condition disappeared.

Another example comes from the early twentieth century, when patients were mysteriously dying from anemia despite an adequate diet. Studies showed that they lacked a protein that is necessary to absorb vitamin B12. When the patients were given vitamin B12 by injection, their anemia vanished.

Over time medical science has learned much more about how vitamins and minerals keep us healthy. Yet even in this era of health supplements, the average person still wonders, “What should I be doing to maintain good health?”

Below, we’ll look at a few of the consensus recommendations for vitamin use based on clinical studies to date.

Are Vitamins and Supplements Necessary?

For a healthy person, a well-balanced diet will supply the necessary minerals and vitamins. A balanced diet should include fruits, grains, vegetables, protein, and some dairy products. These foods have the right nutrients that our bodies are designed to absorb to keep us healthy.

Folic acid supplement during pregnancy has been shown to reduce neural tube (spinal) defects in infants. This major advance may save many infants from a lifetime of disability.

Strict vegans may need vitamin supplements. A completely vegetarian diet may lack vitamins B12 and D, and the patient may require oral supplements to correct these deficiencies. The same approach applies to anyone on a poor or restricted diet.

Vitamin D may require some supplement. Vitamin D is necessary for bone growth and strength and comes from two sources. The first is from food, and the second from our skin, which produces vitamin D in response to sunlight. Low vitamin D levels can be seen in patients whose diets are poor or who rarely go out in the sun. For this reason, many experts advise oral vitamin D supplements for older patients who may be at risk for osteoporosis or bone fracture.

Multivitamins are safe, but usually aren’t necessary. Patients with poor diets or digestion may benefit from multivitamins or other supplements. However, for an average person, the consensus is that these products are unnecessary. Nonetheless, multivitamin doses are generally modest and likely won’t harm healthy patients who want to use them within the usual recommended doses.

Beware of high doses of certain vitamins. High doses of the following vitamins can cause lasting damage to your health:

• Vitamin A: Birth defects, osteoporosis, increased cardiac mortality

• Beta-Carotene: Lung cancer

• Vitamin C: Kidney stones

Based on current research, there is no evidence that supplemental vitamins or antioxidants prevent or improve the outcomes of cancer or cardiac disease.

Vitamin and mineral supplements can sometimes be helpful. But for those of us who take prescription medications, they can also cause dangerous interferences. This field is complex, and the science behind it is constantly evolving. Before taking any supplements, it is wise to consult your physician and discuss what is best for you.

An internist and pulmonologist, Dr. Kelley is a faculty member at Massachusetts General Hospital and Harvard Medical School.

A Permanent Vaccine for the Flu?

By Mark A. Kelley, MD |2/5/18
Founder, HealthWeb Navigator

The current flu season is the most severe in nearly a decade. In a typical year, influenza causes 3 to 5 million cases of severe illness, and anywhere from 290,000 to 650,000 deaths around the globe.

But this year may be even more worse because the flu vaccine has been only 10-20% effective in preventing the flu—less than half its usual protection.

The flu virus mutates rapidly, so creating an effective vaccine is largely a game of chance. The process requires scientists to decide in advance which strains they think will be the most prevalent each flu season. That decision determines how the flu vaccine is manufactured, a process that takes about six months.

This year the H3N2 virus emerged unexpectedly. It is particularly nasty and tends to be more resistant to flu vaccines.

The flu virus, particularly type A, can also blend its genes with other viruses, including those infecting animals like pigs and birds. These changes produce new surface coatings on the virus, which pose a major challenge for our body’s defenses. If our immune system recognizes a virus from a previous infection or vaccine, it can quickly kill it. However, new forms of the virus are hard to recognize and can make it difficult for the immune system to react quickly. Such a delay can be deadly if it allows the infection to gain a foothold.

Compared to vaccines for polio, smallpox, and measles, the current flu vaccine falls considerably short:

• It offers limited protection that changes year to year.

• It does not provide lifelong immunity.

• It is unlikely to protect against more dangerous strains of flu like the 1918 pandemic that killed 50–100 million of the world’s population.

Can we produce a better and more effective flu vaccine? The short answer is yes—but only if we have the will to do it.

Scientists have known that certain parts of the flu virus do not change their genetic profile. These areas hide from our immune system. A more effective vaccine would expose and target those areas so that our immune system can always recognize the virus and eliminate it. Other approaches include reengineering some of our own cells to look like the flu virus and making the immune system better prepared to reject it.

These and other innovations are aimed at developing more effective and predictable protection against the influenza virus. Although it will likely take years and considerable funding to develop, the costs are paltry compared to the estimated $8.4 billion in lost productivity every year in the U.S. resulting from the flu. A new vaccine that uses modern technology and offers better protection would be a bargain.

Influenza has plagued mankind for centuries. Every winter, this disease reappears around the world. It may spread even more rapidly with population growth, international travel, and urbanization.

There are reasons to be optimistic about a new vaccine. In this era of “precision medicine,” the science of virus biology has advanced far beyond the 70-year-old technology used for the current vaccine. If the nations of the world choose to accept this challenge, we may be able to protect millions of people who suffer or die from influenza every year.

An internist and pulmonologist, Dr. Kelley is a faculty member at Massachusetts General Hospital and Harvard Medical School.

Hospitals Take Aim at Generic Drug Companies

By Mark A. Kelley, MD |1/22/18
Founder, HealthWeb Navigator

In a previous blog, I mentioned how the prices of many generic drugs have skyrocketed. In some cases the price of a single pill has increased over 500%.

But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.

Why has the price of generics skyrocketed?

Some large drug companies have purchased (or outcompeted) generic drug manufacturers. This has created a monopoly for some widely used and long-standing products, such as the EpiPen and the albuterol inhaler. In effect, the companies can set whatever price the market will bear. In many cases, the market (i.e patients) has no choice but to accept these prices since no one else makes the drugs.

As if that strategy were not enough, some analysts have suggested another motive. By raising the price of generics and controlling the supply, monopolies could also introduce new “copycat” drugs that resemble the generics and are protected by patents. Both of these maneuvers could improve the stock market value of these drug manufacturers.

The issue is that prescription drugs operate in a market that does not include the patient. Health insurance companies negotiate drug prices and then pass them on to employers and their employees. Compared to hospital costs, most generic drugs are minor costs for the employer. Furthermore, through deductibles, any new drug costs can be passed on to the patient.

Federal regulation might seem like be a good way to solve this problem. Most other developed countries set drug prices for their national health programs. However, Congress has historically forbidden the federal government to set drug prices for Medicare. Regulating the pharmaceutical industry seems unlikely.

What can a hospital consortium do? The hospital industry spends billions of dollars on drugs to treat patients in the hospital and in ambulatory practice. Most insurance plans pay hospitals a fixed price per hospital admission. If drug prices rise, either the insurance company must pay more or the hospital loses money. Lately the drug prices have jumped, especially for generics.

On the ambulatory side, the scenario is no different. Hospitals with outpatient practices are under increased pressure to reduce costs. Among the largest is prescribed drugs.

Another problem for hospitals is the shortage of many commonly used drugs whose patents have expired. Companies simply are not interested in keeping high inventories to meet the challenges of demand.

A nationwide hospital consortium could have tremendous market leverage since these facilities care for millions of patients. Currently, the consortium has enrolled 300 hospitals. That market power could be used to negotiate reasonable prices with the pharmaceutical industry. However, such a plan is complicated and might face legal and regulatory challenges.

The other option is for the consortium to create a nonprofit company that makes generic drugs and sets fair and reasonable prices. That is bold move that would create a true free market. Generic drugs account for almost 80% of all prescribed medications.

Rather than rely on for-profit manufacturers, hospital systems and their patients would have access to the same drugs at lower prices. In effect the providers would eliminate the middleman by controlling the supply of most drug products.

It is unclear how this proposal will evolve because it threatens the status quo. There is sure to be opposition—but not from patients. They will root for any plan that protects them from more out-of-pocket spending.

We need to reduce health care costs and, for once, here is an approach that offers an innovative and sensible solution for patients everywhere.

It’s an idea whose time has come.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Why Prescription Drugs are Expensive and What We Can Do About It

By Mark A. Kelley, MD |11/28/17
Founder, HealthWeb Navigator

As the healthcare debate drags on in Congress, prescription drug costs continue to rise by almost 10% annually. It is the rare patient who is spared this expense.

Over the years, I have seen how these costs have affected my patients. At first, most patients had little in the way of co-pays. However, once the local economy deteriorated, co-pays skyrocketed as employers tried to curb their healthcare expenses. Now, monstrous co-pays are the norm for health insurance plans across the nation.

The solution to this problem appeared simple. Drugs with expired patents are usually much cheaper for patients. Insurance companies encouraged physicians to prescribe these “generics” and used this practice as a metric to measure quality.

That strategy has indeed worked. Generic drugs now account for 89% of all prescriptions but only 26% of all drug expenditures.

Unfortunately, this success has not prevented drug inflation. Countless new drugs have emerged over the last thirty years. Some have been “blockbusters” that substantially change medical practice, but the rest have had much less impact. All of these new drugs, blockbusters or not, are protected by patents and promoted by aggressive marketing. They command high prices and subsequently drive up the average cost of prescribed drugs.

Recently, several events have given me a deeper appreciation of the reality experienced by our patients.

The first “surprise” was witnessing a 400 percent increase in the cost of the albuterol inhaler, an asthma product that has been around for decades. Because the inhaler propellant was changed, the manufacturer sold this product as a newly patented “delivery system.” This patent loophole is a common tactic in the drug industry. In this case, the FDA predicted that the loophole would cost consumers $8 billion before the patent expired in 2017.

The second revelation was a variation of the same theme. One of my patients watched the market price of a skin medication double in just four years. The reason was that the company’s drug patent was about to expire. The final price tag for the drug was $300 — for a six-week supply. This is another common industry tactic.

But the most surprising outcome has been the emergence of “competitive” generic drugs. Most generics have a low price point. However, if a large generic manufacturer has little competition, it can act like a monopoly and raise prices on its own terms.

A well-publicized example was the dramatic rise in the price of the “Epipen.” This pre-loaded injector of epinephrine can be life saving during severe allergic attacks. In 2007, one injection cost $50. By 2016 the price was $300 — for the same drug and injector. This tactic, termed “price gouging,” is now illegal in the state of Maryland. Other states may soon follow.

These pricing maneuvers have made drug prescribing more complicated for both patients and their physicians. Generics may no longer be “safe bets” for low costs. New and more expensive drugs may not be any better than generics. And drugs may have different co-pays, depending on the insurance plan.

How is one to know? The answer is simple: the patient and the doctor need to communicate.

I learned that lesson with my own new prescription. My doctor explained carefully why she preferred this brand-name product. When I picked up the prescription, the price tag was $420 for a 75-day supply!

When I mentioned this cost to my physician, she was even more astounded than me. She quickly changed the prescription to a generic product that cost $29 for the same duration of treatment. She felt the advantage of the first medication was minor compared to its overwhelming cost, which was 14 times more expensive.

Pharmacists have told me that this “sticker shock” is becoming more common among patients picking up their meds. But that situation is preventable. Doctors should know the prices and efficacy of the drugs they commonly prescribe, and patients should ask for the drug prices up front. In my case, both my physician and I should have done that homework. Thankfully, all that was needed to solve the problem was a painless follow-up discussion.

Drug price information is easy to find online, since pharmacies compete fiercely for business. The market price for most drugs is available via a simple Google search of the specific drug name with the term “price.” Here on HealthWeb Navigator, you can find several websites that help patients locate and compare drug prices.

If the drug is expensive (e.g. three digits for a typical 30 day prescription), the out-of-pocket cost (co-pay or deductible) is likely to be significant. If the local pharmacist has the patient’s insurance information, s/he can quickly quote how much the patient must pay. If the out-of-pocket cost is high, a less expensive yet effective drug may be preferable. If the patient cannot afford the drug, there are organizations such as NeedyMeds that can help with discounts.

Healthcare economics may be complicated, but drug cost is where patients and their doctors can team up. Patients want to be healthy but don’t want to go broke in the process. Informed doctors are in the best position to advise patients of the trade-offs between cost and benefit. Working together, doctor and patient can make an informed choice.

There is a lot of room for improvement. In a recent poll, 60% of patients feel their doctor is unaware of how much they pay for drugs. Doctors need to be better informed about drug costs and help patients deal with this challenge. 

If you are looking for a perfect model of patient-centered care, this is it. After all, as my own story illustrates, when doctors become patients, we face the same reality as everyone else.

Rising Costs: The Greatest Threat to Health Reform

By Mark A. Kelley, MD |9/21/17
Founder, HealthWeb Navigator

The main character in the popular film Groundhog Day is caught in a time loop where he must repeat the same day over and over again.

The U.S. Senate is now having its own “Groundhog Day” moment as it debates (yet again) a law to replace the Affordable Care Act. To add to the drama, Senator Bernie Sanders (I-Vt.) is promoting his single payer alternative popularly branded as “Medicare for All.” In a recent TV interview he raises many of the same points I raised in my previous post.

Meanwhile, the average person watches their health care costs spiral out of sight, something our elected officials seldom discuss. How did that happen? Who is to blame?

The answer is no one…and everyone. Human history is full of examples when humans exhausted their resources. This is believed to be the reason why Easter Island’s inhabitants disappeared, eradicated by their own unchecked “ecocide.”

In North America, humans wiped out 50% of the large animal population in the geologic blink of an eye. Of course no one planned these extinctions. But we humans seem to have trouble learning that excessive demand eventually devours resources.

We have the same problem when it comes to health care. Over the last 40 years, health care has become one of the most innovative and profitable sectors of our economy. However, its costs are now taking big bites from the budgets of government, industry, and private citizens.

Until recently, this toxic effect was hidden behind spectacular successes in medicine: new technologies and cures, improved public health, better quality of care, etc.

For businesses, the success has been equally impressive. Health care has been profitable for insurance companies, hospitals, device manufacturers, and the pharmaceutical industry. These sectors thrived because the government and employers could afford to pay the costs, very little of which was passed on to patients.

But those “good times” ended a decade ago when health costs pushed the U.S. auto industry into bankruptcy. After the
Great Recession of 2008, most companies faced the same challenge and were forced to cut their health benefits to stay afloat.

As a result, employees now pay more for health care out of pocket, while the average worker’s income has flatlined. You don’t have to be a math major to figure out that health care will soon be too expensive for most people. Meanwhile, the big business of health care has shown few signs of slowing down. Nearly all companies remain profitable.

However, there are some cracks in the armor. The profits of some hospitals and systems have dropped off, and several have closed as a result. Physician incomes are stable, but the pressures of practice are becoming intolerable. Many physicians are suffering from burnout, causing them to leave practice.

Health care is a major sector of the economy, accounting for 17% of the GDP. It is a field with many powerful constituents who support—and wield substantial influence over—members of Congress. That fact alone makes legislative reform difficult.

How will change occur? Possibly, though not ideally, from America’s most common instrument of change—a national crisis.

Despite what many experts believe, health care is not “too big to fail.” It has few price controls and bears no resemblance to a free market. The industry cannot survive without employer and government subsidies. As a nation, we have become gluttons for health care that is inefficient and becoming prohibitively expensive. There is no clearer path toward extinction.

Left unchecked, healthcare prices will continue to rise. Unless those costs are subsidized or controlled, more consumers will choose to be uninsured and seek care in hospital emergency rooms, leaving other patients to foot the bill.

If employers retreat from health insurance, the consequences will be catastrophic. The uninsured will flood the country’s delivery system of doctors and hospitals. Without federal bailouts, the system will bleed itself dry and suffer a full-blown meltdown.

That may happen no matter what Congress decides in the coming months. If Congress reduces current federal subsidies, more Americans will find themselves instantly uninsured, triggering a political and financial crisis. But even if the subsidies survive, costs will continue to rise, eventually resulting in catastrophe for all.

Unwittingly, with health care we have created a game that the public simply cannot win. The time has come to change the rules in our favor.

The Affordable Care Act: Moving the Public Closer to “Medicare for All”?

By Mark A. Kelley, MD |8/30/17
Founder, HealthWeb Navigator

The Affordable Care Act (ACA) debate resumes when Congress returns from its summer recess on September 4th. In the meantime, the debate has already had major effects on public opinion.

A recent report describes how Americans currently view the ACA. According to national polls, over 90% of Americans would change the current law. Most Democrats would expand ACA coverage while most Republicans would reduce ACA benefits or rewrite the law completely. Only 8% of those polled would repeal the ACA without a replacement.

The most surprising result is the public’s response to the following statement: “It is the responsibility of the federal government to ensure that all Americans have health coverage.”

Last year, 51% of Americans agreed with that statement. In 2017, the approval rate jumped to 60%. It appears that a government health insurance option is gaining popularity.

Meanwhile, contrary to some reports, the ACA program is stable. Most regions of the country still have private insurance plans available through the ACA. Many insurers increased premiums to cover losses, but that one-time intervention seems to have stabilized the markets.

The reality of health insurance is that it must be profitable to cover unexpected losses. The insurance company has several tools to ensure a profit: charge high premiums, select consumers with low risk, or limit the services and/or payments of coverage.

The ACA eliminated most of these options. High-risk consumers could not be denied coverage or be overcharged. Further, every health plan was required to pay for a standard portfolio of services.

To offset losses, the federal government has provided supplements to cover costs on a year-to-year basis. The ACA has proven even more expensive than anticipated because the uninsured have been much sicker. The ACA had plans to offset these costs but they have had no major effect to date.

To force Congress to pass a new law to replace the ACA, President Trump has threatened to stop its federal supplements. That threat has already caused some insurance companies to leave the ACA. Congress, however, does not favor this action since it would leave millions of Americans without health insurance.

This situation has exposed the major weakness of the ACA — its financial fragility.

• The ACA required all Americans to purchase health insurance to create a new funding source. That plan failed because the law was poorly enforced. Now the ACA has no consistent source of revenue to offset costs.

• On the costs, the ACA is also vulnerable. The ACA insurance plans are managed by the private insurance industry. As long as insurance companies can rely on federal subsidies, they have little incentive to reduce costs.

• The bottom line is that the federal government must continue to subsidize the ACA.

This challenge is not new. With Medicare for the elderly, the federal government has a long experience with publicly supported health insurance. Medicare is a popular plan that is predictable, understandable, and accepted across the nation. Because it controls national pricing, Medicare has kept inflation low compared to private insurance.

“Medicare for All” was popular with some voters during the 2016 presidential campaign. Many now wonder why they cannot have the same federal insurance plan as their parents and grandparents.

That is a timely question. For most Americans, employee health insurance has become too expensive and unwieldy. Our U.S economy rewards workers who have geographic mobility and job flexibility. For such employees, finding health insurance in differing local markets can be a nightmare. A national health plan, like Medicare, solves that problem.

Companies see the rising cost of employee health insurance as a threat to the bottom line. Many businesses pass these costs to their employees through higher deductibles, co-pays, and co-insurance. That maneuver may reduce company costs, but it puts economic stress on employees and does little to curb medical inflation.

Americans are beginning to understand these issues and envision a future where the federal government ensures access to health care for everyone. During the ACA debate, voters sent several strong signals to Congress:

• Do not repeal the ACA without a replacement plan in place.

• Do not reduce current benefits.

• Do not interrupt or threaten any current insurance.

The message seems clear: most Americans want Congress to improve the ACA and move forward—not backwards. The only institution with the experience, power, and resources to lead the way is the federal government. If that happens, the country will be on the path to a “public option” like Medicare where the federal government is the insurer.

That option was proposed for the ACA in 2010 but was withdrawn due to political pressure from the insurance industry. Reviving the public option will likely provoke the same industry reaction. However, if voter support continues to grow, the public option could prevail. That will be a game-changer.

What Does Medical Science Say About Fish Oil Supplements?

By Nathan Blake |11/23/16

A recent survey of over 11,000 consumers revealed that fish oil is currently the second most popular nutritional supplement on the American market today, with annual spending exceeding $1.2 billion for over-the-counter fish oil pills and related supplements.

Fish oil has long been touted for its supposedly positive effects on a variety of bodily functions including lowering blood pressure, triglycerides, and cholesterol levels; preventing heart disease; inhibiting the formation of cancer cells; combatting depression and mood disorders; reversing the effects of macular degeneration; and countless others.

But what does medical science have to say about these claims? Is fish oil the cure-all it’s advertised to be, or would consumers be better off spending their money elsewhere?

Fish Oil’s (Not So) Secret Ingredient

Fish oil capsules contain concentrated amounts of omega-3 polyunsaturated fatty acids. Omega-3 fatty acids are necessary for human health, playing a crucial role in brain health and the regulation of inflammatory responses. There are three main types of omega-3 fatty acids, two of which can be found in fish oil capsules.

Eicosapentaenoic acid (EPA) is absorbed into the body by eating oily, coldwater fish like salmon, menhaden, sardines, mackerel, albacore tuna, halibut, and herring. EPA is also found in edible strains of seaweed as well as human breast milk.

Docosahexaenoic acid (DHA) is an important structural component of the human brain and is essential for its proper functioning. It also plays a primary role in maintaining the health of the eye, cerebral cortex, skin, sperm, and testicles. The human body can produce a small amount of DHA on its own, but like EPA, we get the majority of our DHA from cold-water ocean foods. DHA can also be found in organ meat, poultry, and egg yolks, though in small amounts.

Cardiovascular Health

The positive effects of fish oil on the human cardiovascular system have well been established, but that’s not to say no controversy exists. After evaluating the potential benefits of fish oil supplements for patients with multiple pre-existing cardiovascular disease factors, scientists concluded that DHA and EPA had neither a positive nor a negative effect on cardiovascular health. However, an early meta-analysis of fish oil studies revealed a possible correlation between fish oil supplementation and lower blood pressure. Further, scientific data indicates that fish oil consumption can reduce the risk of coronary heart disease, decrease mild hypertension, and prevent certain cardiac arrhythmias. Other studies show that fish oil capsules can be effective in the prevention of primary and secondary cardiovascular disease. In multiple clinical trials, fish oil supplements have been linked to the suppression of major coronary events. The most conclusive benefit of fish oil supplements seems to be that fish oil capsules are effective in lowering triglycerides in the blood. One study found that a prescription dose of EPA + DHA (2x the normal amount) lowered patients’ triglycerides by 27%.

Mood Disorders

Fish oil is not considered to be an effective replacement for mental health treatments, but when used in conjunction with other therapies, fish oil seems to provide beneficial effects to patients diagnosed with borderline personality disorder, unresponsive depression, and schizophrenia. EPA in particular has been studied for its possible use in regulating mood disorders, and researchers found that EPA-heavy omega-3 supplements appear to be effective against primary depression when used alongside prescription medications and other treatment. There is some evidence, however, that fish oil supplementation does not improve mood when tested against a placebo.

Alzheimer’s Disease

In a double-blind study spanning 26 weeks, researchers found that neither high nor low doses of fish oil had an observable effect on cognitive performance in patients age 65 and older. A much longer study, however, found that fish oil intake is associated with lower rates of Alzheimer’s disease. That being said, in a study of 174 Alzheimer’s patients, fish oil supplementation was not shown to reduce cognitive decline in patients with mild or moderate Alzheimer’s disease, though some positive effects were shown in a small group of patients with very mild Alzheimer’s. Other trials confirmed these finding that omega-3 supplementation is beneficial only for patients with mild cognitive impairment. While it’s still too early to make firm recommendations regarding the potential benefits of fish oil intake, daily DHA supplementation in excess of 180 mg is associated with a 50% decrease in dementia risk.

Eye Health

Regular consumption of EPA and DHA fatty acids significantly reduces the risk of developing age-related macular degeneration in women. Other findings suggest that increased omega-3 intake via fish oil capsules can prevent age-related macular degeneration in all subjects, sometimes by an estimated 22%. While the precise role of omega-3 fatty acids in eye health is unclear, there is some evidence that suggests DHA supplements can prevent cell damage and eye stroke injury in the retina.

Inflammation

A study of 250 patients with neck or back pain revealed that fish oil supplements are an equally effective but safer treatment for reducing arthritic pain compared to NSAIDs like ibuprofen and aspirin. Some studies suggest that EPA, independent from DHA, is a potential therapeutic treatment for arthritis-related inflammation in mice, and that EPA has a stronger anti-inflammatory effect than DHA. While another study’s findings suggest that fish oil supplements are not as effective in reducing chronic low-grade inflammation in obese men compared to weight reduction, multiple studies seem to suggest that omega-3 fatty acid supplements can decrease inflammation in patients, particularly those diagnosed with rheumatoid arthritis or ulcerative colitis.

Cancer

Some evidence points to the benefit of fish oil’s anti-inflammatory effects on reducing the overall number of cancer cells in the colon. Another investigation found that EPA + DHA are good candidates for primary and secondary breast cancer prevention due to their abilities to reduce inflammation. Strangely enough, one recent study has shown a correlation between elevated levels of omega-3 fatty acids and an increased risk for developing aggressive prostate cancer; men with the highest DHA levels were 2.5x more likely to develop high-risk prostate cancer, though similar studies proved inconclusive. Further, other studies revealed opposite findings, that fish oils are actually helpful in reducing the risk of prostate cancer in healthy individuals, as well as preventing colorectal and breast cancer formation.

The Last Word

Ultimately, the health benefits of fish oil supplements are still unclear. Studies surrounding omega-3 supplements, as we have seen, are conflicting at best, contradictory at worst. That being said, multiple organizations agree that the potential benefits of fish oil capsules outweigh the potential risks for generally healthy people, though more evidence is needed before making a definitive claim.

Continue taking fish oil capsules if they have been prescribed to you by a physician. If you are planning to begin a fish oil regimen, consult with your primary care physician beforehand to make sure you are healthy enough and that they will benefit you. General consumers should be aware that while many of the findings referenced above are interesting, it’s entirely possible you may not be receiving the benefits you’ve been paying for.

What Do You Know About Diabetes?

By Nathan Blake |11/9/16

November is designated National Diabetes Awareness Month.

In 2012, over 9% of the American population—roughly 29 million people—had some form of diabetes. Worse, one in four people with diabetes do not know they have the disease. With over 1.5 million new cases of diabetes being diagnosed every year, this disease is quickly becoming one of the nation’s fastest growing and most serious epidemics. In fact, diabetes was the seventh leading cause of death among Americans in 2010. That number, if current trends continue, is sure to rise.

What is Diabetes?

Diabetes is a group of health conditions that makes it difficult for the human body to properly control the level of sugar in the blood. When we eat, our bodies convert food into sugars, one of which is called glucose, which our cells rely on as a main source of energy to carry out the basic bodily functions of our muscles, brain, heart, liver, and more.

Because of the importance of glucose in everyday health, there are very intricate biological processes at play to regulate glucose in the blood. These processes ensure that our glucose level does not rise above or fall below a healthy range.

The Importance of Insulin

The cells in our body cannot use glucose directly and must rely on a hormone called insulin. After eating, insulin is released into the bloodstream by the pancreas. Insulin attaches to cells and prompts them to absorb glucose from the bloodstream. The cells then turn the glucose into energy.

When there is an overabundance of sugar in the blood—for instance, after a big meal—insulin stores this excess glucose in the liver to be used later when blood sugar levels drop, such as during the period between meals or while exercising. Normally, glucose is kept under tight control by the pancreas which uses insulin to regulate the blood levels. Diabetes occurs when this regulation system fails to control the levels of glucose.

Types of Diabetes

Type 1 diabetes (formerly called “juvenile-onset diabetes”) occurs when the body cannot create its own insulin. This is because the body’s immune system has destroyed the insulin–producing “beta cells” in the pancreas. Without insulin, glucose cannot enter cells. The cells must then use other inefficient sources of energy while glucose levels rise. This metabolic imbalance can be life–threatening. To prevent this problem, patients with Type 1 diabetes must receive insulin injections daily in order to regulate their blood sugar levels.

Type 2 diabetes (formerly called “adult-onset diabetes”) occurs when the body continues to create insulin but the cells have a sluggish response to its effects. The result of this “insulin resistance” is elevated levels of glucose in the bloodstream. Over time, the high glucose level can also affect the pancreas and reduce its production of insulin.

Gestational diabetes, occurring in roughly 4% of pregnancies, results from hormonal changes during pregnancy that inhibit insulin’s ability to regulate glucose levels.

Risk Factors

While the risk factors for developing type 1 diabetes are still being studied, research shows that having a family member with diabetes can increase your risk for developing the disease. Type 1 diabetes occurs most commonly in children and young adults, accounting for roughly 5% of all people diagnosed with diabetes.

More is known about what causes type 2 diabetes, as it is the disease’s most common form. Several risk factors include a family history of diabetes, being overweight, not getting enough regular physical activity, an unhealthy diet, high blood pressure, and increasing age.

Pregnant women at risk for developing gestational diabetes include those over the age of 25, people with a family history of diabetes, and women who are overweight. For reasons that are not fully understood, gestational diabetes occurs more frequently among black, Hispanic, Asian, and Native American populations.

Treatment

Many diabetics require treatment with insulin or other medications that help control glucose. Equally important are lifestyle habits that can be helpful in preventing diabetic complications. Diabetes can be managed by taking the following precautions:

• Eat meals balanced in starches, fruits and vegetables, proteins, and fats.

• Make physical activity a daily routine.

• Monitor blood sugar levels to be sure they are under control.

• Manage blood cholesterol and lipid levels by eating healthy and taking prescribed medications as recommended by a healthcare provider.

• Control blood pressure to a healthy range (below 130/80).

Prevention

Type 1 diabetes cannot be prevented, although many studies have shown that patients can take a few simple steps to drastically reduce their risk for developing type 2 diabetes.

The Diabetes Prevention Program was a federally-funded project that monitored over 3,000 individuals who were at risk for type 2 diabetes. Researchers discovered that adults at risk for the disease were able to reduce their susceptibility by half by following two practices: healthy eating and regular exercise.

Adhering to a low-calorie, low-fat diet and getting at least 30 minutes of physical activity for five days a week were shown to be effective markers for lowering the risk for diabetes.

To learn more about diabetes diagnosis, treatment, and prevention, visit the National Institute of Diabetes and Digestive and Kidney Diseases, supported in part by the National Institutes of Health.

Health Web Navigator