[00:00:00] Carl Lanore: [00:00:00] welcome back to another episode of super human radio. We have a really important show today because it's about disease prevention. Uh, today is April 8th, 2020. We are still deep into the Corona virus. people are staying home, uh, social distancing and, uh, but we are doing great. And, uh, there was a lot of hope on the horizon now that some of the statistics are showing that some of the States, including New York, have had a drop.
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[00:02:05] So for a long time, we've heard a lot of discussion about the benefits of. Uh, fish oil. And my guest today is Dr. Nathan Wong, and he is the professor and director of heart disease prevention program at the, uh, in the division of cardiology over at UC Irvine. Welcome to the show, Dr. Wong, how are you?
[00:02:27] Dr. Nathan P. Wong, PhD: [00:02:27] Oh, I'm doing great.
[00:02:29] And, uh, it's an honor to be on your show. Caro. Um, thank you for inviting me.
[00:02:33] Carl Lanore: [00:02:33] Oh, do your work is important. It really is. Because, you know, we always, people love to say, Oh, well, you know, there's no money in prevention. You know, medical, uh, the medical orthodoxy doesn't care about prevention, but your research shows that prevention is effective when you follow the science.
[00:02:52] So let's talk about your science. First of all. Purified fish oil could prevent thousands of cardiovascular events. What [00:03:00] research pointed you in the direction to start to even look at this.
[00:03:04] Dr. Nathan P. Wong, PhD: [00:03:04] Okay. Well, that's a very good question, Carl. And I think that, um, one thing, uh, that's important to understand is that until now there has, or until actually rather follow up 2018 there had not been a clinical trial that.
[00:03:24] Actually showed the cardiovascular benefits of any fish oil product, whether it be a dietary supplement or a prescription, um, fish oil products. So they're purified. ETHO was examined in something called the reduce it trial. That was a multinational study of, um, thousands of individuals, um, studied, studied around the world.
[00:03:56] And, um, and these come people who [00:04:00] had cardiovascular disease, preexisting cardiovascular disease, such as a prior stroke or a prior heart attack, or. Or, um, significant atherosclerosis that was documented or they had diabetes and other risk factors that often accompany diabetes such as hypertension or, or, um, or, or, or, um, elevated, um, uh, elevated levels of cholesterol, et cetera.
[00:04:30] And so, um, these, um, these people were, uh. We're actually given randomized on top of, um, a Staton therapy, which, you know, is widely used in the United States. And it is really the, uh, the, the goats, the standard of care. So in the clinical trial, um, look at. Prevention. These days has to be on top [00:05:00] of the accepted standard of care.
[00:05:02] So this trial, um, randomized people to, um, flora grams of this purified, I close a pen product. It's a prescription product.
[00:05:13] Carl Lanore: [00:05:13] So it was the air. So it was the FLS defied not the triglyceride form. Correct.
[00:05:19] Dr. Nathan P. Wong, PhD: [00:05:19] Right? This is that. It's just the ICO slip at ETHO purified. I close a pen fo and um, and it, it the, so the people either took this or they took a placebo on top of, um, they're already preexisting statin therapy.
[00:05:37] So, um, so the bottom line is that, um, there was a 25% relative risk reduction in the . Occurrence of subsequent cardiovascular death, myocardial infarction, stroke revascularization, or unstable angenous. So what they called a primary [00:06:00] endpoint was a composite of all of those that that I mentioned, and this has never been shown, and to date, still has not been shown with any other fish oil product.
[00:06:14] Carl Lanore: [00:06:14] That was my next question. So this is the, uh, the same thing as in the prescription Lovaza I believe, correct.
[00:06:22] Dr. Nathan P. Wong, PhD: [00:06:22] No, this is actually a SEPA, so, yeah. Yeah. So Lovaza is a different product and, and they, um, do, do not have any, uh, proof of showing cardiovascular event reduction from their product. Um, the product here that was studied in the reduce it trial is a pure EPA.
[00:06:49] I close a pen. Oh, I call some 10 to know WIC acid.
[00:06:54] Carl Lanore: [00:06:54] Okay. But could, I understand it hasn't been studied, but is it [00:07:00] fair to say that EPA plays a, an important role in mitigating, uh, some of these downline effects that lead to ischemia, uh, both cardiac and, and, and brain? Or does it have to be isolated by itself?
[00:07:17] Dr. Nathan P. Wong, PhD: [00:07:17] Well. Um, this is the, the only study that has shown, um, uh, benefit, uh, in, in reaching the, um. Primary endpoint in the clinical trial. Um, so we, um, and prior prior trials, including those that have, um, included mixtures of the other, uh,
[00:07:43] Carl Lanore: [00:07:43] fish oil, DHA,
[00:07:46] Dr. Nathan P. Wong, PhD: [00:07:46] um, have not. Shown a benefit. So there has been some, um, suspicion among experts that possibly DHA, uh, might be counterbalance in some [00:08:00] of the benefits that we're seeing with, um, with pure EPA, such as we know that actually DHA.
[00:08:09] Can raise levels of bad cholesterol, whereas EPA doesn't do that. Um, and that may be due to certain mechanisms such as, um, D H J, um, possibly stabilize in the cell membrane, whereas. EPA promotes stabilization of this cell membrane that prevents, um, cholesterol crystals to form that, uh, that are believed to then lead to atherosclerosis.
[00:08:44] Carl Lanore: [00:08:44] So how did you, uh, break out, so this was a review or a meta analysis? Is that what this one, yeah.
[00:08:51] Dr. Nathan P. Wong, PhD: [00:08:51] Okay. Okay. So very important question. So my, I'm part of the research, um, uh, actually took the results [00:09:00] from the reduce a trial and basically asked a question if, if Lee give this product to. Oh, adults in the United States that would have qualified for the reduce it trial.
[00:09:15] How many, um, cardiovascular events, heart attacks and strokes might we be able to prevent for every year? Individuals in the United States are on the product. So basically. It was a, what Lee would call a real world extrapolation of the reduce it trial. The reduce a trial was originally published by investigators from the Brigham and women's hospital and Harvard university and many other investigators around the world.
[00:09:48] In late 2018 and my study, which was recently presented at the American college of cardiology scientific sessions that [00:10:00] was originally supposed to be in Chicago, but, um, obviously turned into a virtual conference instead. Um. Basically showed that that approximately 3 million adults in the United States would fit the fairly strict, reduce it eligibility criteria, and then we applied both the treatment and placebo.
[00:10:28] Event rates to estimate the number of, um, cardiovascular events that might occur if people are on to therapy or not under therapy. And the difference being the preventable events. So this is how we came up with approximately 71,000. Cardiovascular events. So heart attacks, strokes, and other, other cardiovascular events could be prevented every year that, um, [00:11:00] that if, if all 3 million people took, um, this.
[00:11:05] There's product
[00:11:07] Carl Lanore: [00:11:07] that you know, and that that's a fair assessment because you're just taking the results of a smaller population and an inlay and overlaying it onto a larger population. And so you would assume that these ratios would continue if there were more people in the original study. That's brilliant.
[00:11:24] So, um, when we, when we, uh, look at these individuals, they were taking stat and drugs plus. The receiver or is this some of them taking just the CFO by itself? Yeah,
[00:11:38] Dr. Nathan P. Wong, PhD: [00:11:38] so, um, so, so the eligibility criteria of reduce it required that people were on a Staton medication. Um, so we, we actually took data, um, or analyzed data from the United States national health and nutrition.
[00:12:00] [00:11:59] Examination survey, that's the most population representative survey of the United States population conducted every two years. And, and, and Lee. Um, so this did include. People who are on, um, Staten medication. Now, you could certainly raise the question. So, for example, um, uh, you know, um, there are some people who cannot tolerate statents and this may be a suitable alternative for.
[00:12:35] Such individuals, um, but, but strictly speaking, the, um, the people that were studied and reduce it were by in large on a moderate or high intensity stat. And for the most part
[00:12:49] Carl Lanore: [00:12:49] cause that, that's what I was thinking. You know, I, I'm wondering if, uh, first of all, uh, individuals not on Statens would benefit from this knowledge, but also there are a lot of people out there who [00:13:00] haven't fallen into the groove yet of being diagnosed.
[00:13:04] Uh, with certain risks because they don't see a physician often enough and, or, uh, an event hasn't occurred to make them go to the doctor in the first place. Uh, who wouldn't benefit from this information as well as a monotherapy.
[00:13:20] Dr. Nathan P. Wong, PhD: [00:13:20] Exactly. Yeah. So I think, you know, that's, um, an, an important question. And many experts do believe that, um, uh, people would benefit from this product regardless of whether, um, you know, they, they were on a Staton and, and you're right that there's, um, you know, even though 70% in.
[00:13:47] Of of people in the actual reduce a trial where people with no cardiovascular disease. There's a lot of people walking around there that. Don't have, um, [00:14:00] known cardiovascular disease, but have something that we call subclinical cardiovascular disease. And this has been a big topic of my research over the last 30 years.
[00:14:11] Um, looking at, uh, what we call the heart scan, if you've heard of that, or coronary calcium. Exactly. Which is a CT scan that can detect, um. Heart disease early and many experts feel, for example, if you have a calcium score of say greater than a hundred you should be treated essentially like somebody who already has preexisting cardiovascular disease.
[00:14:41] Carl Lanore: [00:14:41] Interesting. Yeah. And all three of sclerosis and homocysteine are closely tied together. Correct.
[00:14:49] Dr. Nathan P. Wong, PhD: [00:14:49] Um, yeah, so there has been a strong epidemiologic relationship established over the years between elevated homocysteine levels and [00:15:00] incidents of cardiovascular disease. Um, and um, now the, um, the fewer people in the population have.
[00:15:10] Elevated homocysteine in particular because our, our bread products are, are, are now florid fortified, so we have less of a problem with them. Exactly. Yeah. And, and, um, um, but what, yeah, what you got are fortified with them actually folic acid. So that keeps, yeah. Keep the, um, levels of homocysteine under control.
[00:15:33] But the, the fact that the matter is, is about, um, 15 years or so ago, there were a number of clinical trials that, that attempted to test whether lowering homocysteine levels, um, primarily in patients who had known cardiovascular disease would prevent. Future cardiovascular events and those trials were basically negative.
[00:15:58] So, um, so [00:16:00] because of that, um. We w there we don't, um, have recommendations, uh, you know, to say everybody should take X milligrams of folic acid to prevent heart disease because those trials largely failed. So sometimes we oftentimes see. Yes, there's an epidemiologic link, but the proof of the Putin always has to do with doing randomized clinical trials and proven that a particular factor such as a I Cosa pen ETHO, um, can actually lower, um, cardiovascular events or, or, or, or that EPA in this case, um, is.
[00:16:47] Uh, you know, uh, a strong predictor and lowering it. Well, um. Reduce the events, and in fact, I'm the principal investigator of the reduce the trial. [00:17:00] Dr Deepak Bhatt, um, presented a late break and clinical trial also at the Chicago meet, and it turned out to be virtual, as I said, um, the other week that showed that, that it, it really was the increase in the level of, of, of.
[00:17:22] Of an EPA ended up blood that was responsible for the results of reduce it. So that was a very. In part in finding that really proves that, that the, the, um, increases and the levels of EPA that you get from this product, that was really what was responsible for defined .
[00:17:47] Carl Lanore: [00:17:47] Has anyone ever gone back and looked at, uh, retrospectively at the individuals in the, in the, uh, original trial?
[00:17:55] And do we have any blood work showing, uh, Omega three fatty [00:18:00] acid levels broken out. By subcategory in these individuals to go, wow, look at that. These people all were also low in EPA.
[00:18:08] Dr. Nathan P. Wong, PhD: [00:18:08] Yeah, absolutely. That's a very good question. Yes. They did have, um, majors of EPA both at baseline and throughout the follow up period.
[00:18:19] And, and, um, by and large, um, levels of, uh, EPA in the United States are, um, very, very low say, compared to Japan because we simply don't eat a lot of, um, seafood. In general here, you know, in America. Um, you know, and even though it is a dietary recommendation that, you know, one really should be consuming at least two fish meals a week, but, um, but a lot of people don't do that.
[00:18:52] So we have much lower EPA levels than do people in Japan and, and the, the, um, UPenn [00:19:00] ETHO purified EPA product. Actually increased EPA levels on average, close to 400%. Wow. During, during the followups. So, um, so there were, and this of course required that people take four grams of the purified product. So that was the dosage that was studied.
[00:19:25] In the trial itself, this, this, um, requires you take four capsules per day of the product, but, um, but that's a lot easier. And we know. Um, that the proof is in the put in with this, this particular product. Um, compared to, um, many, um, for example, dietary fish oil products where you might have to take 15 or 20 or 30 capsules to get that EPA level [00:20:00] exactly.
[00:20:00] To get the same amount of EPA. Um, because many of the over the counter products are. Are are not absolutely not pure EPA. And they contain, um, a mixtures of, eh, lot of impurities, including, uh, people don't realize this, but, um, but many, some of the lead in over the counter, um, or, or I should say dietary fish oil supplements are about a third saturated fat.
[00:20:35] So you take, you know, 15 or 20 or so of those capsules, you're getting as much saturated fat as you would in a hamburger. So why on earth would somebody. Wanna take, um, these products, uh, these seas, um, unproven nutritional fish oil products that [00:21:00] end up getting a fair amount of saturated fat in them, which of course is not not good.
[00:21:08] Carl Lanore: [00:21:08] So, uh, the EPA portion of fish oil is known to be a resolving, which implies that it resolves. Uh, it brings an end, a constructive end. It doesn't blunt inflammation, but it coaxes it to a resolution, which is what we want from a inflammation. Cause inflammation, inflammatory response to the body is a critical response.
[00:21:28] Chronic inflammation is something that goes on and on and on, and that's a problem. So we also know that most authorial, sclerotic plaque begins first with, uh, inflammation in the intima. Of the artery. So it is the mechanism of action that obvious that we're just reducing inflammation in the artery and hence we are stopping the first domino of plaque buildup.
[00:21:53] Dr. Nathan P. Wong, PhD: [00:21:53] Yeah. So, um, so yeah, so your point about inflammation is very important and um, [00:22:00] many experts, uh, do do agree that inflammation is a very important part of the atherosclerotic process. And um, with the, um, uh, purified, I close a pet ETHO we are getting, um, substantial reductions in inflammatory. Parameters such as M, C reactive protein, you've heard of many times as, um, a marker of systemic inflammation and, and literacy and, uh, reductions from this, this product, anywhere from like 20 to 30% or more.
[00:22:42] And. Levels of C reactive protein. Also a more vascular specific inflammatory factor called, um, um, called cut. An LPPL 82 is actually, um, reduced as well. And, and [00:23:00] we know that, um. That, uh, you know, the other thing we know is that inflammation can promote oxidation of LDL cholesterol, which is, um, which, which renders it harmful.
[00:23:15] So what, what, what happens with this product is that it actually lowers, um, levels of oxidized LDL. So it. Prevents oxidation. So prevention of oxidation as well as, um, as, as well as a reduction of inflammation are felt to be some of the important mechanisms by which this, um, product may help to prevent cardiovascular events.
[00:23:48] Carl Lanore: [00:23:48] I want to take our first commercial break. When we come back, I want to ask you to, uh, maybe share any. Interesting things maybe that you weren't looking for, but you learned [00:24:00] from reviewing the reduce it, uh, information. And that was unexpected. And then I also want to ask you about any inter interesting stratification of, uh, of, uh, the people who see benefits and, and, and those who, who did not.
[00:24:13] We're talking right now with Dr. Nathan D. Wong about purified fish oil and how it could prevent thousands of cardiovascular events a year. And some of those cardiovascular events are probably happening to people that didn't even know they had heart problems in the first place. Uh, so this is very important.
[00:24:30] We talk about preventive medicine. Uh, people say it doesn't exist. Well, here's an example of its existence. Stay tuned. We'll be right back. This is the superhuman channel evolution. Just got kicked up a nudge.
[00:24:47] Welcome back. Real quick. Acknowledgement. You know, I've talked a lot over the years about the importance of electrolytes for so many different reasons. And. A lot of people think [00:25:00] hydration is about drinking more and more water. It's not, in fact, if you drink too much water, you can actually disrupt the electrolytes in your body.
[00:25:08] We've see this in a lot of different instances where people drink too much water and they actually end up with hot arrhythmias. As we're talking about the heart today with Dr. Wong, you have to add minerals. To your water, you can even spring water today. I actually emailed the folks at deer park one time and asked them to send me the information on their spring water, and there's virtually nothing in them.
[00:25:33] No, no minerals in them. So it's just minuscule amounts. And when I emailed them back and asked why, they said that the method that they use to purify the water and process the water removes a lot of the minerals unintendedly okay. That's why you have to take minerals into your own hands and put them back in your water because just drinking water without minerals, it is not hydrating you.
[00:25:56] And I'll tell you what I love. I mean, I love [00:26:00] hydrant because they have nice flavors that are very, very enjoyable. You don't feel like you're drinking Koolaid. Uh, they have all the important minerals in them, sodium, potassium, magnesium, zinc, and they come in these neat little packets that you could just drop into your water bottle and drink on the go.
[00:26:17] And I really think everybody should be adding minerals for their water. In fact, I had a doctor on the show and we were talking about renal function one time and he told the truth. He said, the more more minerals you have coming in, the your, your kidneys don't have to work as hard because they only have to work hard when they have to embargo and keep minerals in the bloodstream from escaping.
[00:26:41] When you don't have enough minerals coming into your body day in and day out, you can take control of being hydrated. And getting all the electrolytes you need by using the coupon code superhuman at checkout at. I think the website is get hydrant or drink, hydrant.com I'm [00:27:00] sorry if drink hydrogen.com if you use the code super human at checkout, you'll save 25% off your first order.
[00:27:06] This is not necessarily a sexy supplement to take, but it's important today because we are not getting enough of a full balance of minerals in our diets any longer, and it's something you'll have to take control of yourself. Getting back to the subject at hand. So Dr. Wong, was there anything interesting that you didn't happen to be looking for, but kind of surprised you when you started to look at the reducing research information for your study?
[00:27:39] Dr. Nathan P. Wong, PhD: [00:27:39] Well, um, well, I think if anything, I, I would have, um, expected perhaps, uh, more, um, adults in the United States to, um. To be identified, uh, as potential candidates for this, um, therapy. But, um, you know, [00:28:00] I, I think as we, um, understand from clinical trials, many times there are fairly strict exclusion criteria.
[00:28:10] So, um. You know, there, there were restrictions and triglyceride levels people on could not have severely elevated hemoglobin a one C or actually blood crusher and the LDL cholesterol, um, had to be, um, well controlled. Uh, between 40 and a hundred. Now. Um, what's interest and, uh, that's important for, um, our audience to know is that the FDA actually, um, approve this.
[00:28:46] Therapy in late December, um, for a slightly wider range of patients. So they're not, for example, requiring that you have to have [00:29:00] LDL cholesterol levels between 40 and a hundred, and, and they were a little bit, um, more lenient in terms of allowing you, allowing the doctor to really decide, you know, what.
[00:29:14] What are, um, different risk factors among patients with diabetes who could, could, um, make them, um, eligible for Florida product. So if you consider the, um, wider FDA criteria, we actually estimate perhaps, um. Six to six and a half a million adults rather than the 3 million, which, which I identified that that would actually be, um, suitable and recommended for this, this, this product.
[00:29:52] So ultimately, if all those people were placed on therapy, we might get almost, perhaps [00:30:00] Dabo. The number of preventable cardiovascular events. Then I identified in my study, so probably, you know, over a hundred thousand events could be prevented on an annual basis.
[00:30:15] Carl Lanore: [00:30:15] And you kind of answered the question I was gonna ask next.
[00:30:18] You know, when I hear this, I think, you know, I'm going to contact my physician and see if I can get a prescription for this as a prophylaxis. Uh, you know, a, a type of an approach and it sounds like the broadening or the more lenient, uh, prescribing, uh, um, that the FDA is approving would probably let more people call their doctor and have that conversation.
[00:30:38] The doctor will go back and look at their file, say, well, you know, your LDL is getting up there, or something like that. Yeah, we can, we can do that for you. It's not, that kind of sounds exciting to me.
[00:30:47] Dr. Nathan P. Wong, PhD: [00:30:47] Exactly. Yeah. And, and then, you know, I think we, we also have to recognize that, um, that, you know, even if a person is on a Staton, their LDL [00:31:00] may still be above a hundred, so they may not be, um, be, um, adequately controlled.
[00:31:06] So, um. And then there are, of course, people, you know, it's approved based on max maximal tolerated stat. And so the idea is that, um, that some people can't tolerate a stat. And so, um, you know, this may of course be an alternative. So those people are not even counted in our estimates as well. Um, so yeah, so, so I think, you know, but it ultimately.
[00:31:38] Boils down to, you know, the, the patient having a discussion with their physician about, you know, are, are my risk, um, sufficient to warrant this therapy and how can I best lower my risk? And, and we always have to remember that of course, diet, [00:32:00] dietary, and and physical activity considerations are very, very important and are still the.
[00:32:07] Foundation in prevention, you know? But, um, but we also have to recognize that there are evidence base therapies that, um, when appropriate can be added on top of diet and exercise and, and standard of care therapies such as, and stet. Whoa. Further lower. What we call this residual or persistent risk.
[00:32:36] Because what a lot of people don't realize is that, you know, they think, Oh, well, you know, I'm taking a, and so I'm, I'm going to be fine. But the fact that a matter is that there's still a lot of. Cardiovascular events that are occurring, particularly in our higher risk individuals, even if they are on Audi, evidence-based [00:33:00] therapies such as Statens, ACE inhibitors, ARBs, um, , you know, as well as aspirin, you know, so, um, so there's still, um, a lot of people will still suffer events.
[00:33:12] So. Trials such as reduce it have been revolutionary. And, and being able to chip away further at what we call this persistent or residual risk.
[00:33:26] Carl Lanore: [00:33:26] Uh, someone watching live on Facebook asked, uh, Jeff Clifton. He says, does the doctor believe all saturated fats are created equal? For example, coconut oil, there's a, there's a large groundswell.
[00:33:37] That coconut oil actually has some real great benefits, uh, because it produces ketones, uh, cognitive effects, and that it seems not to be as harmful and pro-inflammatory as, say, saturated fat from, from beef, for instance. Do you, do you, do you prescribe to that or do you feel that all saturated fat is a bad idea?
[00:34:00] [00:34:00] Dr. Nathan P. Wong, PhD: [00:34:00] Well there, there, there are, are, are of course, very, very indifferent, different degrees of severity. Um, B, we certainly do not have good evidence that, um, that. That coconut oil is, I'm going to have a longterm health benefit. So, for example, reductions in, you know, like cardiovascular events. Um, and it does, um, of course can, um, you know, raise levels of certain risk factors.
[00:34:36] So I think where, uh, there, there is the general concern among the, um. The nutrition community and the Academy of nutrition and dietetics, that we should not be, um, promoting the use of coconut oil. Um, uh, certainly, um, saturated fat and in particular [00:35:00] trans fats, um, uh, you know, are, are by far the. The worst, you know, the saturated fat that you're getting from a meat products, particularly processed meat products.
[00:35:14] So, you know, like your bologna and your salami, things like that. The saturated fat that you're getting from the consumption of those red meats is even worse than, um, say a what you would get from a lean, uh, steak, for example. Okay.
[00:35:33] Carl Lanore: [00:35:33] Okay. So, um. Getting back to the actual fish oil product. A lot of
[00:35:39] Dr. Nathan P. Wong, PhD: [00:35:39] people who
[00:35:40] Carl Lanore: [00:35:40] take over the counter fish oil, they end up burping up this fish taste, and it has to be the way the fish oil is being processed.
[00:35:50] My good friend Adele Moosa wrote a blog years ago saying that the fish burps from fish oil because of the lack of proper purification. Do people [00:36:00] complain. Taking four grams of a day with any GI issues at all or burping or anything like that?
[00:36:09] Dr. Nathan P. Wong, PhD: [00:36:09] Um, no, believe it or not, that, uh, was, was not a, um. Significant, um, side effect of this neurotic.
[00:36:18] So it, it is, um, very well tolerated. And, um, and, and, you know, that's, that's what I think is kind of special about this product that it is, um, in general, very well tolerated.
[00:36:34] Carl Lanore: [00:36:34] So you're looking at a person who eats four to five pounds of fish a week. I eat a pound of salmon, at least three or four days for lunch.
[00:36:48] Right after my show, I'll, I'll go up to the, this a restaurant that I like and I get two large, uh, eight ounce pieces of salmon, grilled, plain, nothing else. So [00:37:00] I do eat a lot of fatty fish, and then I eat other fishes as well, you know, uh, tilapia, uh, all sorts of stuff. So. Am I going to negate the benefits of using the sifaka?
[00:37:12] Because if we go back to our earlier discussion about the EPA, DHA and EPA seems to be beneficial and DHA isn't or not necessarily isn't, but may not contribute to the desired outcome we want for cardiovascular events or vascular events. Really, if we want to. Of course it could be brain as well. Am I? Am I this disabling the VC to do what it's supposed to do if I eat all this salmon, which has DHA, EPA, and a lot of other omegas that we don't even think about.
[00:37:42] Dr. Nathan P. Wong, PhD: [00:37:42] Yeah. Well, it's certainly great that you're consuming that. That much, much fish. So you certainly see that in a great example for your audience here. Um, now what, what we do know, um, that partly answers your question, is [00:38:00] that there was a trial done prior. To reduce it in Japan called the actually jealous trial.
[00:38:09] So those, that Tryo involved people in Japan who had much higher baseline EPA levels, and then in the reduce it trial and, um, and they did find from, uh, and they use less than. Flora grams, uh, of, of, of their purified, of, of, uh, of, of their purified EPA product and, and that, um, and they did show significant reductions in cardiovascular events.
[00:38:44] So it does not appear that if you consume fish, that's going to blunt the effect, you know, certainly, um, you know, we, we don't. Um, and people who are in the higher, [00:39:00] um. I would say the higher of, um, EPA levels in the most recent analysis that I had mentioned, it was reported, um, at, at, at the ACC. Those people had the same benefit as people that were in the lower Chartio of EPA levels.
[00:39:22] Um, however, granted, um, overall the. You know, the EPA levels and, uh, reduce it population were much lower than that in the jealous trial in a Japanese. But it would seem, you know, that we don't have any evidence to suggest that the, um. That that if, if you're consuming a lot of fish, that the, um, that that product would be any less effective.
[00:39:55] Carl Lanore: [00:39:55] Was there any interesting stratifications between gender or age, [00:40:00] uh, in the reduce it trial when you ran it through, um, your analysis.
[00:40:09] Dr. Nathan P. Wong, PhD: [00:40:09] Yeah. So, um, well, you know, well, we essentially, we, we would get a, um, you know, the, the, the effects would, you know, be proportional to what was studied in the, reduce it trial itself.
[00:40:26] And, and, um. And, and to reduce a trial actually did a number of, um, stratifications, uh, by gender, um, uh, presence or absence of diabetes or other risk factors. And, and the results were, um, very, very consistent among. Definitely it's stratification. So we don't have any evidence that, um, you know, certain types of patients, whether they're male or female, would or have [00:41:00] certain ethnicities, for example, would derive, um, uh, uh, you know, would have different, different benefit.
[00:41:10] Carl Lanore: [00:41:10] I talked about a study about seven years ago, uh, on this show that showed that. Uh, using fish oil, um, products was better utilized by the body by taking bolus a bolus doses in an irregular pattern, opposed to taking the same dose day in and day out. Because what ends up happening is the research showed that when the body is accustomed to getting this day in and day out, it starts to use the fat.
[00:41:47] As a substrate for energy as opposed to for other purposes, like lowering inflammation or storing it in fat and fat cells for later, later utilization. [00:42:00] Do you think there would be any benefit that instead of taking four grams a day, if you would take 12 grams every third day or something even more unpredictable, given the fact that we know that when the body sees this amount.
[00:42:13] Or this, uh, this molecule regularly, it starts to treat it discretionarily and says, well we'll just burn it for energy cause we're going to get more later.
[00:42:23] Dr. Nathan P. Wong, PhD: [00:42:23] Yeah. Um, that's a very interesting question. It's how I eat, I'm not aware of, has been, you know, been ever asked, uh, with respect to, to reduce it trial.
[00:42:34] Um, so, uh, they, they only studied a floor four gram per day dosage. So. We don't have, um, information on whether there would be any more or less benefit if, if people took, um, 12 grams every three days. I, I think though, it, it, um, you know, as, as far as what should the public, do, you know, [00:43:00] um. I, I think that we generally prefer people take a consistent dose, which is going to be better for adherence, right?
[00:43:10] It's much easier to remember, Oh, I got to take four of these every day, rather than, Oh, on Monday and Thursday, or, you know, or what, I should take 12 of these capsules plus 12 is a lot to take and. We don't know whether certain, um, side effects might be greater if somebody took a bolus of 12, 12 grams.
[00:43:34] That's, that's quite a bit.
[00:43:35] Carl Lanore: [00:43:35] Yeah. I know. Uh, we're going to take our last commercial break. When we come back, we, I'm going to ask you to provide to, uh, our audience. Uh. Both, and we have a lot of clinicians that listens to show clinic clinicians and lay people what to take away from your research. Well, the right, we use oxygen for the power of good.
[00:43:57] We lost Dr. Wong, but he's going to come by fat [00:44:00] and we still have a, we have a comment here that I'm going to put up here. As soon as he reconnects, I put my handsome mug. That was great. Oh, here he comes here. Oh, he was almost saying almost it. One more time, doc. We'll get him back. We've had trouble with technology today.
[00:44:21] It's all over. I mean, it's amazing. There's a big red message on the top of my screen. Whoa. High loads at service providers may cause some performance issues. Um, you know, everybody's home. Everybody's on Facebook. Everybody's on Instagram. Everybody's doing something with their phone and their internet connection, and it's just bogging down America.
[00:44:45] It's just amazing. Um, this was an unintended or unforeseen issue, I guess. Well, I'm hoping he gets back. Uh, he tried to connect and he, I saw him coming in. Let me try something. Hold on. [00:45:00] Bear with me.
[00:45:14] Yeah, but then you dropped out again. Just reconnect again cause we have a couple. Oh, here you come. Here you come. Okay. There you go.
[00:45:22] Yeah, you're on now. Sit tight. Here we go. Okay, here we go. Eh, you go, okay, let's get rid of that. Yeah. Okay. So, uh, we have, we actually have, uh, a question or comment from someone in the audience, and, uh, I'll read it to you. He says, uh, taking your regular doses may be less tolerated as far as I know, there is some accumulation of Omega threes, particularly in the liver.
[00:45:52] And peak doses will not make much difference. This is how I see this. I guess I, I think he's a clinician and he's making this [00:46:00] comment because of the question I asked. So he concurs with you basically is what that is. Um, so what do you hope that clinicians and lay people take away. Um, from this research,
[00:46:12] Dr. Nathan P. Wong, PhD: [00:46:12] Dr.
[00:46:12] Wong. Yeah. So I think the bottom line, um, uh, Yana bottom line Caro is that if people, what our, um, project shows is that if people in the United States, uh, who are suitable for this product based on, you know, the eligibility criteria, um, uh, actually use it, we can prevent, um, at least 70,000 and. Based on the, uh, the, um, actually FDA, uh, criteria for, um, this, this product probably well over a hundred thousand cardiovascular events.
[00:46:50] So heart attack, strokes and other cardiovascular events. Every. Year. So this is a dramatic number. Um, but I, [00:47:00] I think what's even more important is that both clinicians and the public understand that, um, that this, uh, purified, I Cosa pen ETHO product is the only product FDA approved. To reduce FDA indicated to reduce cardiovascular events.
[00:47:23] Okay. There is no other, um, fish oil product, whether it be be, um, uh, those
[00:47:31] Carl Lanore: [00:47:31] version or an over the counter
[00:47:33] Dr. Nathan P. Wong, PhD: [00:47:33] or over or available as a dietary supplement that has been proven to reduce heart attacks. So, if so, you know, the message here is that we. We have to, um. Make sure that our patients understand that, that they're, they're not going to get the same benefit from these other products that many times have.
[00:48:00] [00:47:59] Particularly the actually dietary products have significant impurities that, um, that, that, that, that they need to be conscious of, including the . Saturated fat, even PCBs, and actually dioxins can, can be present in some of these products, and they should never equate that with this purified EPA product that.
[00:48:28] We've been talking about. So that's very, very important.
[00:48:31] Carl Lanore: [00:48:31] Uh, Elisa Profumo says, I've heard if you get the burp from fish oil, that means it's rancid. I've heard that too. But there's another thing that should be addressed here. Um, both fat soluble vitamins and fish oil should be taken with a meal that has some fat in it to trigger, uh, the production of the proper enzymes and capacity to handle fat.
[00:48:55] Some of the problems with fish oil. Uh, people taking fish [00:49:00] oils. If they take 2000, uh, 2000 milligrams, two gram capsule and drop it in their stomach, you know, the bile may not, not be produced. If not, it's not going to trigger the way the body handles the fat. So it just sits in your stomach and you burp it back up for hours and hours.
[00:49:14] I find that if you take this stuff. With, uh, with a fatty meal, you trigger the digestive process that's ready to get rid of the fat in your, in your stomach and move it down into the proper place so that, that could be another problem with people who don't do claim that fish oil, uh, even high quality or even purified versions gives them some sort of a problem because they're, they're, they're taking it by them, by itself on an empty stomach with a cup of coffee or something like that.
[00:49:47] Dr. Nathan P. Wong, PhD: [00:49:47] Yeah. I think, um, that's a very good point. Um, while there are no specific recommendations, whether you should be taking this product with, um, you know, [00:50:00] a certain type of, you know, fatty meal, um, and it would certainly it, you know, I think at it, that point makes sense. Um, I, I will say though, that. That the, um, yeah, the, the issue about rancidity of particularly the dietary products that are unregulated by the FDA, this is a significant concern.
[00:50:28] And, and studies have been done that show that many of these products already are oxidized. So this is . Something that the, um, the purified process and mechanism of a SEPA, uh, you know, prevents, um, their product from being oxidized. So that's a very major distinction.
[00:50:53] Carl Lanore: [00:50:53] And we'll close on Aiden raised comment.
[00:50:56] He says you can store it in the freezer as well to limit fish burps. The only problem with [00:51:00] that aide and is. If, if the fish oil has been mishandled from where it's manufactured to the supplement store, and then the supplement store leaves it on the counter and it gets hot and then you take it home and put it in the freezer, it's not going to solve any problems cause it's already a hyper oxidize.
[00:51:17] It's already rancid. The handling of fish oil, uh, unfortunately it adds to the cost. Uh, but high quality fish oils like Carlson's, they usually keep those in the refrigerator. They shipped them to refrigerator trucks. Uh, their handling of fish oil is critical. And as the doctors pointing out the stuff that is sold by prescription, you know, pharmacies are handling it properly, you know.
[00:51:40] The distributors that they're buying from are handling it properly because it's a drug. It's a, you know, it's a medication at that point in time. It's not an over the counter supplement. It's just the subtle change in attitude that makes you treat the product one way or the other. And it's sad because I bet there are good fish oil products out there that would have some [00:52:00] beneficial effects, but it's just Willy nilly how well they survive on the counter before you buy them.
[00:52:06] So. That's all I want to say about that. Hey, Dr. Wong, I want to thank you so much for being on the show today.
[00:52:13] Dr. Nathan P. Wong, PhD: [00:52:13] While you're very low income, it's been a great pleasure to participate. Thank you. Login.
[00:52:17] Carl Lanore: [00:52:17] You take care of yourself. You
[00:52:19] Dr. Nathan P. Wong, PhD: [00:52:19] too.
[00:52:20] Carl Lanore: [00:52:20] Bye. Bye. And so that's it for today. Uh, we, uh, have a good show for tomorrow.
[00:52:25] I don't want to say what it is yet because I want to make sure we get everything straightened out. Um, it'll either be the renew life RX show or we're going to be having a. Dr McKell blog is going back on the godfather of wrapped miacin, and he's got some really interesting details to talk about wrap mice and for coven.
[00:52:44] So we'll, uh, say goodbye for now and see everyone tomorrow. And thank you for watching and listening today. [00:53:00]
