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Summer, 2013


Dear Patients


I hope this finds you well!




The best source of antioxidants are plant based food. Particularly live! Antioxidants are substances that may protect your cells against the effects of free radicals. Free radicals are molecules generated as your body breaks down food, or by environmental exposures like tobacco smoke and radiation.

Free radicals can damage cells and play a role in  aging, heart disease, cancer and other diseases. The more antioxidants we get the better. So eat plenty of fresh vegetables and fruit, green tea and hibiscus tea are excellent sources. Date sugar (pulverized dates) is an excellent natural sweetener that also has antioxidant activity.


Coenzyme Q10 (Ubiquinone) and Ubiquinol


CoQ10 is required for your cells to produce energy, and is an integral part of helping cells take fat and other substances and convert them into energy. CoQ10 can also help protect your body from free radical damage. Free radicals are oxygen atoms deficient in electrons that become highly reactive. This in turn causes potential damage to your tissues and DNA.It is because of its powerful antioxidant protection that CoQ10 is often recommended for a wide variety of heart-related conditions, in particular congestive heart failure.As we age we may loose some of our abilty to reduce Coenyzme Q 10 to the active form ubiquinol.

There are a number of  studies demonstrating that statin drugs used for cholesterol reduction (lipitor-atorvastatin, crestor-rousvastatin,pravachol-pravastin,zocor-simvatstin,mevacor-lovastain) are associated with lower Co Enzyme Q 10 levels. I am now recommending this supplement if you are taking a statin drug. The dose would be 100 mg per day. It may help if you are experiencing muscular complaints such as achy and pain on these medications.  Statin drugs are safe and effective in lowering cholesterol and risk for future cardiovascular issues. Nevertheless, the primary treatment is a healthy diet and regular exercise to attain optimal health, once reaching that optimal weight I always challenge the need for medications that a that point are often not needed or can be reduced.

Should I take Omega 3 Fatty Acids as a supplement?

Omega Fatty Acids


Omega fatty acids are poly-unsaturated essential fats. There are 2 types: omega-3 fatty acids and omega-6 fatty acids. The American diet is deficient in omega-3 fatty acids. The average American consumes less than 200 mg per day, however, the recommended daily allowance (RDA) is greater than 220 mg.  It is my personal opinion that we need more omega-3 fatty acids. Moreover, we need to consume both types in the correct ratio to maintain our health. These fatty acids are called “essential acids” because they are essential for normal growth and development, and they cannot be manufactured by our body.


The correct ratio of omega-3 fatty acids to omega-6 fatty acids is less than 1:5. The American diet presently is greater than 1:15.  Omega-3 fatty acids and omega-6 fatty acids are converted into hormone-like substances called eicosanoids, which can have a profound influence on our health.  They affect our cardiovascular risk as well as our immune function. Omega-3 and omega-6 fatty acids have opposite functions; for this reason, you can greatly influence your health simply by choosing one type of vegetable oil over another.


Omega-3 fatty acids are anti-inflammatory in nature. They are cardio protective, decreasing our risk for problems related to heart disease and may, in fact, be neuro protective, decreasing our risk for dementia and improving cognition. Omega-6 fatty acids are inflammatory therefore a proper balance of both omega-3 and omega-6 is important.


Sources of omega-3 fatty acids are nuts, flax seeds and fish. Sources of omega-6 fatty acids are animal products, corn oil, soybean oil, safflower oil, sunflower seed oil and cottonseed oil. Omega-6 fatty acids are relatively inexpensive and therefore abundantly present in processed foods. 


To further understand the importance of getting adequate omega-3 fatty acids, consider this. In America, our risk for sudden death is 340/100,000 people. In Japan, where fish consumption is extremely high, the risk for sudden death is 40/100,000 people. If we look at the Omega index (a blood test which measures the amount of omega-3 fatty acids) in America, the omega index is less than 4%. In Japan, the omega index is greater than 7%. The cardio protective effect of omega-3 fatty acids has been well studied, the American Heart Association, in 2001, suggested that anyone with heart disease should consider consuming 1000 mg supplement of omega-3 fatty acids daily.


I recommend that my patients take omega-3 supplements; usually the source is fish oil. Fish oil contains 2 types of omega-3 fatty acids: DHA + EPA.  I usually recommend 1000 milligrams a day, unless there is significant ingestion of fish. The healthiest fish to consume is wild salmon.


Flaxseed is another source of omega-3 fatty acids. Alpha-linolenic acid (ALA) is the source of omega-3 fatty acids in flaxseed.  ALA is converted to active omega-3 in the body (DHA+EPA) however only 13% is converted, making this a less desirable source of omega-3 fatty acids. However it is a good source of lignans a phytonutirent that may be helpful for prostate and breast cancer prevention and reduction of benign prostatic hypertrophy symptoms in men. You might find the link interesting about flax seed.





So what about the recent study that found a correlation with fish oil consumption and prostate cancer. To me it smells a little fishy. Most prostate cancer is low grade and men die with it rather than of it. It is for this reason that monitoring PSA has become so controversial. In the near future I will devote more time to discussing again this important topic. The bulk of the evidence medicine published in referred perr reviewed reputable journals favors a reduction in risk in those men that take omega-3 fatty acid supplements.  I continue to believe that these supplements are heart and brain healthy.Below is an easy read from the web I found that discusses the issues and below that is a link that also concludes that the study is flawed.


Wishing you good health,






New study links omega-3s to prostate risk, implausibly

The authors of the new study – led by Theodore Brasky, Ph.D., of Ohio State University – analyzed data from a controlled clinical study called the Selenium and Vitamin E Cancer Prevention Trial or SELECT (Brasky TM et al. 2013).


Dr. Brasky’s team compared the omega-3 blood levels of 834 men in the SELECT trial who developed prostate cancer over the seven to 12 year span of the trial, with the omega-3 levels in 1,393 men who didn’t develop prostate cancer.


They divided the men into four groups, based on their blood levels of various omega-3 and omega-6 fatty acids. 


The omega-3s examined included the plant-source, short-chain omega-3 called ALA and the three long-chain omega-3s found only in seafood: EPA, DPA, and DHA.


Omega-3 EPA and DHA are essential to life and health and occur in every cell in the human body … especially our brain, nerve, and eye cells. Omega-3 DPA occurs at very low levels in seafood and in human cells, but increasing evidence suggests that it exerts beneficial health effects. 


The Brasky team’s analysis showed that the men with the highest blood levels of seafood-source omega-3s were 71 percent more likely to have high-grade prostate cancer, compared with men possessing the lowest levels.


They calculated that the risk of low-grade prostate cancer was 44 percent higher among the men with the highest omega-3 levels, while these men's risk for any grade of prostate cancer was 43 percent higher.


Each 50 percent increase in total long-chain omega-3s (EPA+DHA+DPA) was associated with a 22-25 percent increase in the risk of developing prostate cancer … but the differences in blood levels were too small to constitute credible "dose-response" evidence that omega-3s promote prostate cancer.


Contradicting earlier studies, they detected no link between higher blood levels of omega-6 fatty acids and increased risk.


Nor did they detect any link between higher prostate risk and higher blood levels of either omega-3 EPA from fish, or omega-3 ALA from plant foods.


Seven reasons for deep skepticism

We do not take the Brasky team’s findings lightly, but we see several reasons for skepticism.


Some of these points were made to us by biochemist Douglas Bibus, Ph.D., a leading international expert in fatty acids and blood analysis:

  1. The authors admit they don’t know why omega-3s – which display anti-cancer effects across the board – would promote prostate tumors. This is especially true given that, in the authors’ words, the men in the study had “very low concentrations of [omega-3s]”.
  2. The authors’ conclusion that omega-3s raise prostate risks is based on a truly insignificant 0.2% difference in the proportion of omega-3 fatty acids in red blood cells between the men who developed prostate cancer (4.66%) and those who did not (4.48%). And the range in those groups nearly overlapped: the range in men who developed prostate cancer ended at 4.55% while the range in men who did not get prostate cancer started at 4.56%, and the range in men who got high-grade cancer started at 4.51%. This may pass a statistical test, but it doesn't pass the "smell test".
  3. The blood measure they used – plasma phospholipid fatty acids – is an unreliable gauge of omega-3 levels, developed more than 50 years ago. According to Dr. Bibus, a single fish meal or fish oil supplement will raise the proportion of omega-3s in a person's total phospholipid fatty acids dramatically ... and the men's blood was drawn only once, at the outset of the seven to 12-year study.
  4. It's entirely possible that the men who developed prostate cancer were generally less healthy, and were taking fish oil supplements.
  5. Although the authors tried to eliminate “confounding” diet and lifestyle factors that would muddy the waters, it is notoriously hard to do that. And it appears that they authors did not account for the confounding effects of selenium and vitamin E, which were the targets of the original SELECT study. These supplements are implicated in prostate cancer. (Alpha-tocopherol is just one of eight parts of vitamin E, but is the most common supplemental form of "vitamin E". It depletes the body of other vitamin E components, which may be why it is linked to higher prostate risks.)
  6. As the authors admitted, “Expressing fatty acids as weight proportions could create spurious results because an increase in the percentage of one type of fatty acid requires a decrease in others”. And their justification for dismissing this factor doesn’t pass muster: “… however, given the very low concentrations of [omega-3s], it is unlikely that their variability, which is strongly related to dietary intake, would be strongly affected by proportions of other phospholipid fatty acids.” But decades of research on fatty acids analysis suggests that this assertion is a stretch, at best.

Together, these flaws seem serious enough to warrant taking the author's conclusions with a big dose of salt, pending more convincing data.

As they note, we lack a plausible explanation why omega-3 fish fats would appear so beneficial for preventing and/or curbing every major cancer except this one.


Frankly, we’re surprised that these researchers gave the results so much more weight than their data and the overall body of evidence on the topic warrants ... a move that will mislead millions of men.


Sadly, we’re no longer surprised by the laziness of major media outlets, whose editors failed to scrutinize and challenge a study that rests on weak evidence, is contradicted by prior research, and defies common sense.




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Harry A. Oken, MD




Harry A. Oken, M.D.

Clinical Professor of Medicine

University of Maryland School of Medicine

Office: 410-910-7500  Fax: 410-910-2310