Something's fishy.

In addition to prescription medications, one of a pharmacists most important jobs is to steer people to the right over the counter vitamins and supplements. At times, this can be a difficult task because there are so many different varieties to choose from. Fish oil is one of the most commonly asked about products. Most people have heard about the potential benefits of fish oil supplements, but which specific product is the “best”? Here are the basics on fish oil supplementation.

When people talk about fish oil supplements, they are really interested in the DHA and EPA omega-3 fatty acids. A person could get these from flax seed, walnuts, and of course fish but usually supplementing with a fish oil capsule is the less expensive and more practical solution.  I did the math and fish oil supplementation is far less expensive than sushi supplementation (say that five times fast). 

The most common fish oil is 1,000mg

Fish oil supplements have many potential benefits for people. People concerned about heart health take them to help reduce blood pressure, slow development of plaque in arteries, and overall reduction of heart attack and stroke. Another potential benefit is eye health and to help with macular degeneration. Benefits have also been seen in asthma, diabetes, movement disorders, obesity, kidney disease, psoriasis, and osteoporosis.

40 year old Cod Liver Bottles

The most studied (and scientifically proven) benefit of fish oil is to help lower triglycerides, one of the factors that impact cholesterol. In fact, there is a prescription version of fish oil used for this very reason. This highly purified form may mean less capsules per day, but it is very expensive. The good news is that the generic version of the medication is now available. We can expect the price to decrease over the upcoming months.

There are thousands of different non-prescription fish oil supplements from which to choose. The one that will work best for you depends a lot on personal preference. The standard fish oil capsule is 1,000mg. A lot of companies also make 1,200mg. If you have difficulty swallowing large pills, there are also smaller, lower strength choices.

Besides size, one of the common complaints about fish oil is the “fishy aftertaste/burps”. Because of this, there are many enteric coated products. This means that the capsules do not dissolve until further along the digestive tract to prevent this. People also say that keeping the capsules in the freezer can also help.

Krill Oil (red capsules) vs regular fish oil

A high tech version of fish oil is krill oil. Krill oil is attached to phospholipids that mimic the ones in our body, making it more easily absorbed as compared to traditional fish oil. Because of this, a person should not have the same fishy aftertaste or fishy burps. Another advantage of the increased absorption is that the pills are smaller. However, these benefits come at a price. The average bottle of krill oil costs about three times as much as a fish oil product. Still, they may be the perfect choice for some people.

So, what is the correct product to choose? If money is no object, then go ahead and try the krill oil capsules. For everyone else, I suggest trying the regular 1,000mg capsules. If you get the fishy aftertaste, first try freezing the capsules. If that does not work, bump up to the enteric coated fish oil capsules.

With any vitamin, supplement, or prescription, there are dangers and interactions that must be addressed. Be sure to talk to your pharmacist or doctor before starting anything new.

Vitamins and Supplements 101: At least know this! ---Brandon Health Mart Pharmacy

Vitamins and Supplements 101: At least know this!  

---Brandon Health Mart Pharmacy

Thomas Wullstein, PharmD

I opened Brandon Health Mart Pharmacy in the fall of 2010.  In case you are not familiar, Health Mart is a group of independent pharmacies that work together offer the same sort of prices and technology of the big box stores.  I soon came to realize that in my area, people thought that Health Mart was an organic food or vitamin store.  Apparently people stopped reading the name of my store after the word "Mart".  Anyway, because of poor brand awareness, I fielded many, MANY questions about vitamins and supplements.  They are big business but there are some things that you should know.  If you don't want to read any farther at least remember this one thing:

HERBAL DOES NOT MEAN SAFE

Today, about 187 million Americans turn to dietary supplements as a way to feel better, stay healthier, and complement the effects of their medications. Dietary supplements include much more than the ubiquitous one-a-day multivitamin on kitchen tables. They also include herbs, botanicals, metabolites, amino acids, and other substances you can take by mouth to enhance your diet. They’re classified as food products, not drugs. But they can interact with drugs in good—and not so good—ways.

Some supplements can cause negative effects during surgery, such as increasing the risk of bleeding or working against the effects of anaesthesia and painkillers. Others may cause adverse reactions when taken with medications. For example, Ginkgo biloba, ginger, or St. John’s wort may increase blood pressure or interfere with blood pressure medications.

That’s why it’s so important to have a conversation with your pharmacist and physician before using any supplements—especially before using them with either prescription or over-the-counter medications. But the good news is this: research is showing that some supplements may help certain medications do their job even better, help replace nutrients that are lost from medication usage, and in some cases, even work better than the medications themselves.

Here are just a few examples.

Calcium + Vitamin D are required with some prescriptions

Bisphonates such as Fosamax, Actonel, and Boniva treat osteoporosis, a disease of low bone mass, which leads to fragile bones. These drugs help by increasing bone formation and decreasing bone turnover. However, they can’t work effectively unless your body contains the right level of the mineral calcium and vitamin D. That’s because calcium is integral to bone structure and vitamin D aids its absorption. In fact, 99% of the calcium in your body is found in your bones and teeth. So, if you don’t have enough, that’s where supplementation plays an invaluable role.

Fish Oil have many benefits.

If cardiovascular disease (CVD) is a concern, you might consider supplementation with omega-3 fatty acids—whether or not you take medications. Research trials have shown that this supplement reduces the risk of CVD in healthy people, people at risk for the disease, and those who already have it. Depending upon your level of risk, you may benefit from more omega-3 fatty acids than you can get from foods alone, such as fatty fish like salmon and albacore tuna. Though researchers are continuing studies on omega-3 fatty acids, so far they’ve found that this supplement helps by decreasing triglyceride levels and the growth of plaque in arteries, among other things.  My wife and I both take fish oil.  I use it for its anti-inflammatory effects as well as cardiovascular health.  It has so many possible benefits, they should put it in the water.  Wait.  Fish are in the water.

A study in the New England Journal of Medicine showed that two common supplements—glucosamine and chondroitin sulfate—when taken together produced significant pain relief in people who were experiencing moderate-to-severe pain from osteoarthritis. The six-month National Institutes of Health (NIH) study involved 1,500 people taking the two supplements, an arthritis medication called celecoxib, or a placebo. In this case, the supplements actually produced even greater results than the commonly used arthritis medication.

As a pharmacist, I am extremely sceptical about most herbal supplements.  I am, however, a firm believer in glucosamine and chondroitin.  The reason is simple: when I take it, my knees don't hurt after working out.

If you are interested in vitamins and supplements, check out the Health Mart vitamin finder.  It is a free questionnaire that will help you determine what categories you may be lacking.