Jim Thornton's latest article: SIPE and fish oil

RE: Jim Thornton's latest article: SIPE and fish oil

no200fly — Mon, 12 Nov 2012 10:24:17 GMT

I will note that Texas did not make the Top 10 list here, though I suspect that's because they have thus far managed to import college graduates from the Northeast. ...allowing the Lone Star State to once again ascend in the pantheon of know-nothing-ism! Wait, what? Next you Yankees will tell us know-nothing Texans that the Earth is not 6,000 years old.

RE: Jim Thornton's latest article: SIPE and fish oil

Allen Stark — Sat, 10 Nov 2012 12:49:50 GMT

There are a lot of myths put out by Big Pharma hoping to convince the credulous that generic substitution is a horrible idea that imperils the public health. Since even active medications benefit from a kind of placebo halo that turbocharges its efficacy above and beyond the primary physiological effect, this kind of poor-mouthing by Big Pharma most likely does have some effect at making generics work less effectively than their brand name equivalents. However, brand name equivalents, as well, show a steady decline in efficacy from their initial release, when doctors and patients alike are excited about the latest and greatest new thing. As a psychiatrist, did you once have more excitement, for instance, about Prozac than you do today, and did you manage to communicate this excitement to your patients? The bloom is off the Prozac rose not because generic fluoxetine is really any different from its brand name predecessor, but because it's no longer benefiting from patent protection, and drug makers have moved on to the latest "new and improved" variations to hype and extort profit from. As far as the 80 to 125 percent bioavailability, three responses: 1) this is most likely important only in a very slim number of drugs, like anti-seizure medications, were the therapeutic window can be quite thin--a slightly low dose might not work, and a slightly high dose might cause side effects. Most drugs don't have this problem. If you have a headache, you can take either 1, 2, or 3 aspirins, and it's not going to have a huge deleterious effect. 2) many generics end up being too strong in dosing because the FDA doesn't require that manufacturers use the same inert filler materials. There have been cases where the generic maker is told to, in effect, make their drug weaker so that it is closer to the original brand name drug. 3) most big pharmaceutical companies make generics themselves--it's not only the Mylans of the world (and other dedicated generic manufacturers) that specialize in this. The Brand Name companies very often make their own generic forms of brand name drugs, hoping to capture at least some of the generic market while at the same time continuing to mean-mouth generics in the hopes patients will demand the Brand Name originals at many multiples of the cost. Bottom line: Big Pharma is part of the Solution. It is, alas, a bigger part of the Problem. I am not saying "Big Pharma" is great(they don't even give me free pens anymore.) I am saying the government could make generics better by tightening up the definition of equivalent.Once a med has gone generic for several years the quality of the generics is generally pretty good,but I had many patients with depression who were doing great on Wellbutrin XL who had a recurrence of symptoms when it went generic.

RE: Jim Thornton's latest article: SIPE and fish oil

jim thornton — Sat, 10 Nov 2012 10:59:39 GMT

Your Pharmacy will say that they can substitute a generic equivalent to your medication.What they don't say is that goverment declared that equivalent is"not less than 80% nor more than 125% as bioavailable as the brand name.That is a very low bar to clear. There are a lot of myths put out by Big Pharma hoping to convince the credulous that generic substitution is a horrible idea that imperils the public health. Since even active medications benefit from a kind of placebo halo that turbocharges its efficacy above and beyond the primary physiological effect, this kind of poor-mouthing by Big Pharma most likely does have some effect at making generics work less effectively than their brand name equivalents. However, brand name equivalents, as well, show a steady decline in efficacy from their initial release, when doctors and patients alike are excited about the latest and greatest new thing. As a psychiatrist, did you once have more excitement, for instance, about Prozac than you do today, and did you manage to communicate this excitement to your patients? The bloom is off the Prozac rose not because generic fluoxetine is really any different from its brand name predecessor, but because it's no longer benefiting from patent protection, and drug makers have moved on to the latest "new and improved" variations to hype and extort profit from. As far as the 80 to 125 percent bioavailability, three responses: 1) this is most likely important only in a very slim number of drugs, like anti-seizure medications, were the therapeutic window can be quite thin--a slightly low dose might not work, and a slightly high dose might cause side effects. Most drugs don't have this problem. If you have a headache, you can take either 1, 2, or 3 aspirins, and it's not going to have a huge deleterious effect. 2) many generics end up being too strong in dosing because the FDA doesn't require that manufacturers use the same inert filler materials. There have been cases where the generic maker is told to, in effect, make their drug weaker so that it is closer to the original brand name drug. 3) most big pharmaceutical companies make generics themselves--it's not only the Mylans of the world (and other dedicated generic manufacturers) that specialize in this. The Brand Name companies very often make their own generic forms of brand name drugs, hoping to capture at least some of the generic market while at the same time continuing to mean-mouth generics in the hopes patients will demand the Brand Name originals at many multiples of the cost. Bottom line: Big Pharma is part of the Solution. It is, alas, a bigger part of the Problem.

RE: Jim Thornton's latest article: SIPE and fish oil

jim thornton — Sat, 10 Nov 2012 10:45:17 GMT

global what? I thought that was over when Al Gore lost the election and quit flying around in a private jet. :D Judge Matysek, permission to respond? The defendant has opened the door to this line of questioning! static.happyplace.com/.../509bedacdc6e5.jpeg I will note that Texas did not make the Top 10 list here, though I suspect that's because they have thus far managed to import college graduates from the Northeast. The choking wildfires and West Nile virus pandemic will no doubt soon put an end to this, however, allowing the Lone Star State to once again ascend in the pantheon of know-nothing-ism!

RE: Jim Thornton's latest article: SIPE and fish oil

no200fly — Sat, 10 Nov 2012 10:31:05 GMT

...and global warming deniers? global what? I thought that was over when Al Gore lost the election and quit flying around in a private jet. :D

RE: Jim Thornton's latest article: SIPE and fish oil

Former Member — Sat, 10 Nov 2012 07:12:58 GMT

I am not saying "Big Pharma" is great(they don't even give me free pens anymore.) I am saying the government could make generics better by tightening up the definition of equivalent.Once a med has gone generic for several years the quality of the generics is generally pretty good,but I had many patients with depression who were doing great on Wellbutrin XL who had a recurrence of symptoms when it went generic. If I'm not mistaken, a generic of Wellbutrin just got pulled from the market. As someone who (unfortunately) has to take a lot of medication, I am always delighted when they go generic but it is frustrating when the particular generic changes at the pharmacy. This has been happening a lot lately. I don't notice any change in the medication's effects, but there are two in particular that are prone to turning to powder. :bitching:

RE: Jim Thornton's latest article: SIPE and fish oil

ourswimmer — Fri, 09 Nov 2012 12:42:23 GMT

The article raises the possibility of a link between fish oil overdose and pulmonary edema. The individual whose story is in the article was indeed taking enormous doses of fish oil. But the statistical research the article describes has more predictive or explanatory value than the single-person anecdote. That research found a significant association between fish-oil supplementation and SIPE, but the article does not say whether or not the study showed that association to be dose-dependent in any way. The study design may well have asked only "yes" or "no" on fish oil, not how much. I doubt every fish-oil-taker in the sample was taking 9 capsules per day.

RE: Jim Thornton's latest article: SIPE and fish oil

aztimm — Fri, 09 Nov 2012 11:37:04 GMT

I doubt every fish-oil-taker in the sample was taking 9 capsules per day. But the story only gives the one example of the 1 individual who took 9 capsules a day--over 4 times the recommended dosage. While I've been taking fish oil capsules for years, I only ever take 1 per day. Heck even during peak marathon training I never take more vitamins. It would be interesting to know more about this sample group and how many capsules they actually took. As I indicated above, I should be at risk to develop this; I fit the bill nearly every step of the way, including past history of hypertension, and a family history of cardiac problems. Yet I've never had anything remotely close. I read a similar story somewhere else recently that pointed to wetsuits as the culprit.

RE: Jim Thornton's latest article: SIPE and fish oil

Allen Stark — Fri, 09 Nov 2012 10:50:38 GMT

I do stand corrected, thanks for the info. Used to work for small pharmaceutical gig that manufactured new drugs for trials and testing. I witnessed the required standards that at times seemed extreme but gave me trust in quality. I have also seen some stuff that would make you avoid generic unless it was absolutely necessary:afraid: I just assumed that supplements were less regulated, maybe a better thing in some cases l Mollie is correct, to a point. But the FDA's authority was considerably weakened by the Dietary Supplement Health and Education Act of 1994, also known as DSHEA. You have Senator Orrin Hatch and the state of Utah, home to a disproportionate share of supplement makers, to thank for this. Isn't it great when science is controlled by anti-evolutionists and global warming deniers? Keep this in mind the next time you chug down your favorite miracle Ergogenic Elixir! www.quackwatch.org/.../dshea.html I am not really an expert on supplements,but it was my understanding that since DSHEA supplements could not make false claims of efficasy,but they did not have to prove efficasy and only had to prove safety if the safety was called into question,not before marketing. I know more about generics.Your Pharmacy will say that they can substitute a generic equivalent to your medication.What they don't say is that goverment declared that equivalent is"not less than 80% nor more than 125% as bioavailable as the brand name.That is a very low bar to clear.

RE: Jim Thornton's latest article: SIPE and fish oil

jim thornton — Fri, 09 Nov 2012 04:48:09 GMT

If I understand the article correctly, the headline is misleading. The article raises the possibility of a link between fish oil overdose and pulmonary edema. The athlete profiled in the article was taking 9 capsules per day. Most good things end up being bad for you if you take them to excess. Even oxygen is toxic if you breathe it in 100% concentration. Katie, I absolutely agree with what you have said here. And the teammate I profiled in my article did indeed take whopping doses. However, the study itself did not ask about dose levels. See following. The individual whose story is in the article was indeed taking enormous doses of fish oil. But the statistical research the article describes has more predictive or explanatory value than the single-person anecdote. That research found a significant association between fish-oil supplementation and SIPE, but the article does not say whether or not the study showed that association to be dose-dependent in any way. The study design may well have asked only "yes" or "no" on fish oil, not how much. I doubt every fish-oil-taker in the sample was taking 9 capsules per day. You are correct. The number of SIPE victims was relatively low, and the questionnaire did not ask about dosing levels, just whether the athlete took fish oil or not. Here is part of the interview transcript with the lead author, Dr. Miller: We cast a wide net on supplement use, as you correctly suspect, to see if we could identify any patterns there. We were indeed surprised to find not only that fish oil use was statistically associated with SIPE, but that the association persisted after multivariable adjustment, which means it wasn’t just following along with something else already measured. We did not ask dose questions, so don’t have that information. I am not a hematologist and do not claim to understand the mechanisms by which an effect of fish oil might occur. I do know that aspirin, which is also an antiplatelet agent, has been associated with blood tinged pulmonary secretions following apnea dives, so there is at least some empirical support for some kind of platelet function effect. It could just be an incidental finding, but would be worth looking into further. If Jeremy was powering down mass quantities of fish oil anything is possible, though I would expect diarrhea more than pulmonary edema in that situation. But you never know. I suppose you could put a lot of platelets to sleep that way. As I said earlier, it certainly bears watching. But the story only gives the one example of the 1 individual who took 9 capsules a day--over 4 times the recommended dosage. While I've been taking fish oil capsules for years, I only ever take 1 per day. Heck even during peak marathon training I never take more vitamins. It would be interesting to know more about this sample group and how many capsules they actually took. As I indicated above, I should be at risk to develop this; I fit the bill nearly every step of the way, including past history of hypertension, and a family history of cardiac problems. Yet I've never had anything remotely close. I read a similar story somewhere else recently that pointed to wetsuits as the culprit. The wet suit link has certainly been reported, but it remains a bit controversial. I think that SIPE is rare enough that even the majority of those with all the identified risk factors (a hypertensive female who takes fish oil and is swimming a long distance) probably still have a low absolute risk, though their relative risk would be elevated. To illustrate the distinction: Say Condition X strikes, on average, 1 person in a 1000. The absolute risk of getting it would be .1 percent. Say you have a risk factor that doubles your risk for Condition X. Scary, right? Yes, but not that scary. Your absolute risk only goes from 1 in 1000 to 1 in 500--still a very, very long shot of having the problem. This is a completely false statement, one that's being perpetuated both by the media and government. There is an entire section of the CRF (Code of Federal Regulation) that was written specifically for dietary supplements. The problem is, the FDA has too little money, manpower, or authority to do anything about the shady, fly-by-night places that are making some of the supplements out there. There are plenty of companies that are following the rules the government has put in place, and care about customers, following the law, and generally doing things right. You just never hear about them, because they're not getting in trouble. Because they're doing things by the book. Mollie is correct, to a point. But the FDA's authority was considerably weakened by the Dietary Supplement Health and Education Act of 1994, also known as DSHEA. You have Senator Orrin Hatch and the state of Utah, home to a disproportionate share of supplement makers, to thank for this. Isn't it great when science is controlled by anti-evolutionists and global warming deniers? Keep this in mind the next time you chug down your favorite miracle Ergogenic Elixir! www.quackwatch.org/.../dshea.html

RE: Jim Thornton's latest article: SIPE and fish oil

__steve__ — Fri, 09 Nov 2012 04:41:22 GMT

RE: Jim Thornton's latest article: SIPE and fish oil

swimmieAvsFan — Fri, 09 Nov 2012 01:58:49 GMT

Suppliments are unregulated... This is a completely false statement, one that's being perpetuated both by the media and government. There is an entire section of the CRF (Code of Federal Regulation) that was written specifically for dietary supplements. The problem is, the FDA has too little money, manpower, or authority to do anything about the shady, fly-by-night places that are making some of the supplements out there. There are plenty of companies that are following the rules the government has put in place, and care about customers, following the law, and generally doing things right. You just never hear about them, because they're not getting in trouble. Because they're doing things by the book.

RE: Jim Thornton's latest article: SIPE and fish oil

smontanaro — Thu, 08 Nov 2012 10:31:48 GMT

Many of us open water swimmers prefer natural fish oil instead of taking supplements. Is that a fillet knife in your swim bag, sir?

RE: Jim Thornton's latest article: SIPE and fish oil

Rob Copeland — Thu, 08 Nov 2012 10:29:08 GMT

Maybe triathletes have a tendency to use more supplements, in general, and fish oil, in particular, than open water swimmers?Many of us open water swimmers prefer natural fish oil instead of taking supplements. 3667

RE: Jim Thornton's latest article: SIPE and fish oil

Former Member — Thu, 08 Nov 2012 08:04:04 GMT

RE: Jim Thornton's latest article: SIPE and fish oil

Former Member — Thu, 08 Nov 2012 06:10:26 GMT

I am not sure how many blue marlins Jeremy would need to eat a day to get the equivalent of 9 x 1200 mg capsules, but I daresay he'd weigh a bit more if he consumed his fish oil by eating actual fish as opposed to swallowing lozenges! Wiki has some useful information. en.wikipedia.org/.../Fish_oil "The FDA says it is safe to take up to 3000 mg of omega-3 per day. (This is not the same as 3000 mg of fish oil. A 1000 mg pill typically has only 300 mg of omega-3; 10 such pills would equal 3000 mg of omega-3.) Dyerberg studied healthy Greenland Eskimos and found an average intake of 5700 mg of omega-3 EPA per day." I'm guessing it wouldn't be too hard to get that level of omega 3's if you like salmon. There might be some issue where levels that are OK for most people to take are not OK for ironmen triathletes. Intuitively, I would think the opposite - exercise burns toxins away- but this stuff is very complicated.

RE: Jim Thornton's latest article: SIPE and fish oil

__steve__ — Thu, 08 Nov 2012 01:49:40 GMT

Suppliments are unregulated, and there's little proof each dose stacks up to its lable claim and quality.

RE: Jim Thornton's latest article: SIPE and fish oil

smontanaro — Wed, 07 Nov 2012 12:34:20 GMT

The lead researcher of the paper on swimming-induced pulmonary edema has had a lot more luck finding cases among triathletes than dedicated OW swimmers. Maybe triathletes have a tendency to use more supplements, in general, and fish oil, in particular, than open water swimmers? Or maybe the population is a whole lot larger. Skip

RE: Jim Thornton's latest article: SIPE and fish oil

jim thornton — Wed, 07 Nov 2012 12:23:51 GMT

The lead researcher of the paper on swimming-induced pulmonary edema has had a lot more luck finding cases among triathletes than dedicated OW swimmers. If you are an Open Water swimmer who has had problems in the past with pulmonary edema (basically, coughing up foamy, pink-tinged sputum), please post something here on it. I personally wonder if running and cycling has a training impact on your lungs that is different and possibly deleterious to the lung training you get from dedicated swimming alone. Not many runners or cyclists get pulmonary edema, and it's possible not too many open water swimmers do either, in which case perhaps there's something about the combined demands of water and land sports in triathlons that's triggering the problem. PS the link to my other articles that Anna Lea mentioned only include piece written specifically for the online edition of the magazine. The print articles are on there, too, though not always that easy to ferret out.

RE: Jim Thornton's latest article: SIPE and fish oil

jim thornton — Wed, 07 Nov 2012 12:10:49 GMT

The Hidden Danger of Fish Oil Supplements By our very own Jim Thornton Other Men's Health articles by Jim Thornton Why thank you ever so kindly, Anna Lea!

RE: Jim Thornton's latest article: SIPE and fish oil

aztimm — Wed, 07 Nov 2012 11:23:59 GMT

Just a wild possibility, chronic exhaust fume inhalation? My lungs would burn after a hard bike ride. Many rides were took us through areas of traffic while pushing the pace. Never experienced any lung burning sensation after swimming. I swim and bike, and regularly ride along busy highways, yes even during rush hour. And I even have asthma. And I've never had an issue from exhaust fumes. I've been taking fish oil for at least 3-4 years, and never had any issues.

RE: Jim Thornton's latest article: SIPE and fish oil

Sojerz — Wed, 07 Nov 2012 10:02:36 GMT

Wet suits can, indeed, girdle the body in such a way as to potentially increase core blood pressure above and beyond what the water and cold already do. I also wondered if SIPE was more likely in fresh water or salt water, but it's rare enough that I don't think they had the data to know for sure. Im thinking like Ellen (ekw). My experience swimming in a wet suit this past year was that the mild increase in pressure on the gut resulted in more burping stuff up, especially after about 2k of swimming. Basically, i experienced indigestion but no SIPE symptoms. Because the wet suit compresses the chest, it would seem the lungs must work harder against this increased pressure. What impact does increased lung pressure have on lung capillaries, oxygen transfer and potential ruptures? Additionally, the wetsuit compresses the extremities and blood pressure increases in response, again what's the impact on capillaries and transfer?

RE: Jim Thornton's latest article: SIPE and fish oil

Bill Sive — Wed, 07 Nov 2012 08:46:21 GMT

Not sure why this was not included in the original article. Seems like a natural next step in research for this topic. Hypervitaminosis www.nlm.nih.gov/.../000350.htm

RE: Jim Thornton's latest article: SIPE and fish oil

Former Member — Wed, 07 Nov 2012 07:06:00 GMT

Maybe it's that triathlete competitions are the msot populoar of "ultra..." sports (here by "ultra" I mean something significantly longer than a marathon.)

RE: Jim Thornton's latest article: SIPE and fish oil

Former Member — Wed, 07 Nov 2012 06:42:36 GMT

The lead researcher of the paper on swimming-induced pulmonary edema has had a lot more luck finding cases among triathletes than dedicated OW swimmers. My (entirely unresearched) sense is that wetsuit use is much more common among triathletes. Maybe that could play a role too? :dunno: