Everything you need to know about fish oil supplements


Ever since researchers discovered that Greenland Eskimos had really low rates of heart disease because of all of the fish they ate, fish oil has been a hot topic.  And once supplement manufacturers realized they could bottle and sell it, fish oil really took off. 

So let’s dish about fish – here’s everything you need to know about fish oil supplements.      

What conditions does fish oil really help?

It’s been proven that the Omega-3 fatty acids in fish oil – eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid – prevent heart disease, improve cholesterol by reducing triglyceride levels, and prevent heart attacks, stroke, and death in people who already have heart disease. 

While Dr. Google will tell you that fish oil will cure rheumatoid arthritis, high blood pressure, depression, bipolar disorder, menstrual pain, and certain kidney problems, there isn’t a lot of good evidence to back that up at this point.

Is taking a fish oil supplement the same as eating fish?

Obviously, the best way to consume fish oil is to eat oily fish.  The American Heart Association (AHA) recommends at least two servings per week for cardiovascular health.  A serving is 3 ounces (the size of a deck of cards, or ¾ of a cup).  So if you can afford, prepare and stomach salmon a couple times per week, you can skip the fish oil capsules.

How much fish oil supplement should you take?

A good target intake is between 250 and 500 mg per day of EPA + DHA.  You could get that in a daily 1 gram fish oil supplement, which contains between 200 and 800 mg of EPA + DHA, depending on the formulation and manufacturer.   

Do fish oil capsules have side effects?

The most common side effects are nausea, heartburn, a fishy aftertaste, and burping.  Taking them with food or refrigerating them helps a lot, but some brands can’t be refrigerated so be sure to check with your pharmacist.  In general, fish oil capsules have an “expiration date” of about 90 days after opening a new bottle.  Capsules with a very strong or spoiled smell should be thrown away.

Can you get mercury poisoning from taking fish oil supplements?

There’s been a lot of concern lately about mercury contamination in the world’s fish supply.  In general, this is more of a concern for pregnant women and young children, but it’s always a good idea to pay attention to what you’re eating.  Fish known to be low in mercury include shrimp, canned light tuna (not albacore), salmon, pollock, and catfish. 

Fish oil capsules are generally low in mercury and other pollutants.  But to be safe, only buy products with the “USP Verified Mark” on the label; these have been tested and found to contain acceptable levels of mercury.    

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

Keep Your Eyes Open at Mirror Lake Tonight!


We know that Mirror Lake Jump-In is a fun and exciting tradition for a lot of students, but it can be a risky proposition.  The combination of cold weather, alcohol, wet clothing and the slippery lake bottom can lead to lots of bad things: hypothermia, frostbite, upper respiratory infections, sprains and broken bones among others.    

And just so we can be a total buzzkill, we thought we’d tell you about another risk of jumping into Mirror Lake that you probably hadn’t thought about – an eye infection known as Acanthamoeba Keratitis.  The bug that causes this disease is commonly found in fresh water sources, such as tap water and our very own Mirror Lake.

This infection can be dangerous because the human immune system is not capable of fighting it off without the aid of specialized and intensive treatment.  The infection isn’t that common but if it goes untreated, it could lead to permanent vision loss.

Signs that you may have the infection include eye pain, blurry vision, light sensitivity or a sensation that something is stuck in your eye.  If you have any of these symptoms – regardless of whether or not you jumped into Mirror Lake – be sure to see your eye doctor or make an appointment with the optometrists at the Student Health Center as soon as possible. 

About 85% of all cases occur in people who wear contact lenses, so the best way to avoid catching this nasty bug is to not wear contacts while swimming or wading in any water source, especially lakes and hot tubs.  And you should never clean or store your contacts in regular tap water.

If we can’t talk you out of jumping into Mirror Lake tonight, at least bring blankets and dry clothes, don’t drink too much, do NOT dive or run when you jump in, and be sure to leave your contact lenses at home before you take the freezing plunge.

For more information on how to stay safe during Mirror Lake Jump-In, check out this great information from our friends at the Student Wellness Center.

Patrick Milleson, Leah Steele
College of Optometry
The Ohio State University

Julia Geldis, OD
Student Health Services
The Ohio State University

Is the Pink Ribbon starting to chafe?

The New York Times

I just read a fantastic essay from this Sunday’s New York Times about the impact that breast cancer Awareness (with a capital “A”) has had on victims of the disease.  The author, Peggy Orenstein, herself a survivor, argues that the real experiences of real women with cancer are getting lost among all of the pink football cleats and teddy bears, and that the “sexualization” of breast cancer is doing more harm than good.

I wrote an essay for Harlot of the Arts (an online journal run by rhetoricians in our very own English Department) that touches on exactly the same themes, but with a focus on how they affect the relationship between patients and their doctors.

Whether or not you have any personal experience with breast cancer – whether or not you have breasts – you should check out these essays.  They’re not really about breast cancer.  They’re about the fact that your relationship to your health, your body, your doctor, even your loved ones can be manipulated in invisible but powerful ways.  And that, my friends, is definitely something to be aware of.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Would you really pee on your cell phone to see if you had an STI!?


Just came across a very interesting article (with some of the best comments I’ve seen in a long time) on MSNBC’s technolog:

Got a funny feeling in your nether-region but too embarrassed to ask your doctor what it might be? If a group of British researchers have their way, your mobile phone will soon be able to tell you if you’ve got an STD.

So scientists in England are developing kits – kind of like home pregnancy tests – that you buy for a couple of bucks at the grocery store or in a vending machine at your favorite bar.  You just put a little saliva or urine on this computer chip, plug it into your phone (or computer) and voila’ – within a few minutes it’ll tell you if you have an STI, which one, and what you need for treatment.   

Who knows if and when this technology will become a reality, but it’s exciting because it addresses a very important issue in young people.  STI’s can be a serious threat to your health, but many students are too afraid/embarrassed/busy/broke to come in and get checked out.  

We are trying to tackle the same issue here at the Student Health Center.  We now offer “OIY” (Order It Yourself) lab testing.  You can get tested for STI’s and certain other medical conditions without having to make an appointment or even talk to a health care provider.  I admit it’s not quite as convenient (or cheap) as the “Dr. Who Hump Drive” but at least we actually exist and the results are monitored by a real live doctor.

Of course, if you think you may have a sexually transmitted infection (or any other medical problem), the safest thing to do is to come in and see us.  We know it’s a little embarassing, but believe me, we do this every day – there’s nothing we haven’t seen before and we don’t have a judgmental bone in our building.  We can answer all of your questions, check for other problems, diagnose and treat you all at once.  And so far, there ain’t an app for that…

John A. Vaughn, MD
Student Health Services
The Ohio State University

Stick a needle in me, I’m done. Or am I?


When I was pregnant I developed tennis elbow, or lateral epicondylitis, in my left arm. It persisted until long after I was pregnant and drove me to distraction. The pain eventually drove me to sticking a needle full of cortisone in my arm, after which I felt much better.  But was I better?  Ever since that fateful jab, I’ve had recurring problems with that devilish elbow.

The conventional wisdom has long been that acute pain in our tendons, or tendinopathy, was the result of dreaded inflammation. Corticosteroids (not anabolic steroids) are just about the most potent anti-inflammatory we have and for certain tendon pain syndromes – like tennis elbow – the standard of care has been to jab a needle near the tendon, infuse the medicine, and let it work its magic.  

Not so fast, Captain Cortisone!  A major review of steroid injections for tennis elbow and other tendinopathies published recently in The Lancet dispels this notion. Inflammation, it would seem, plays much less of a role than we thought; tendon wear and tear probably plays more.  The authors concluded that steroid injections numb the pain in the short term but do nothing to make the underlying problem better.  In fact, 6 and 12 months down the road, patients who’d had injections had more pain and disability than patients who hadn’t received the shots.  The authors suggest that suppression of local healing processes by the steroids probably causes this effect.  In other words, steroids get in the way of your tendon’s ability to repair itself. 

Does this mean that we have nothing to offer?  Not at all.  We’ve always had effective ways of managing the pain and helping to support your sore joints as they heal up.  Non-steroid anti-inflammatory pills like Ibuprofen (Advil, Motrin) and Naproxen (Aleve) can help a lot, and in severe or chronic injuries, physical therapy can work real magic.  There are also some cool new “injectables” under investigation now, including botulinum toxin and hypertonic glucose.  That’s right folks… botox and sugar for your elbows.   

The take-home message?  Bring us your troublesome tennis elbow, your aching Achilles, or your ripped rotator cuff.  We’ll get it sorted out, and we’ll probably do it without poking you with any needles.

Victoria Rentel, MD
Student Health Services
The Ohio State University

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. Coombs, BK; Bisset, L; Vincenzo B. The Lancet, In Press, Corrected Proof, Online October 21, 2010.

When a little night-time grinding is NOT a good thing!


Q: I’ve been waking up with jaw pain and headaches lately.  What could be causing this?

A: You’re probably grinding your teeth.  Teeth grinding – or bruxism – is a very common problem. We used to think it was just caused by misalignment of the teeth or jaws, but we now know that it can also be related to stress, anxiety, depression, changes in sleeping patterns and even diet.  Sound familiar?    

So how do you know if you’re a bruxer?  It can be hard to figure out on your own since most of the clenching and grinding happens when you’re asleep.  You could ask your sleep partner or roommate if they’ve ever noticed you doing it.  If that’s a little too weird for you, you could just come in to the student health center and see one of our fabulous dentists – they can take one look at the wear and tear on your choppers and tell if you’re grinding away or not.  Other signs that may indicate you’re grinding your teeth include:   

  • Jaw pain or tightness which can lead to difficulty eating
  • Headache
  • Earache
  • Oversensitive teeth
  • Indentions in the tongue or damage to the inside of the cheek
  • Pain in your temporomandibular joint (the area right in front of your ear where your jaw hinges)

If you are a bruxer (we just love saying that word), there are some things you can do to give your jaw and pearly whites some relief:

  • Your dentist can fit you with an oral mouthpiece that will protect your teeth and decrease the amount of tension in your jaw while you sleep.  You can try one of those squishy mouth guards you find at sporting goods stores, but they don’t work as well.
  • Stress reduction can go a long way! The more relaxed you are while you’re awake, the more relaxed you will be while asleep!
  • Warm compresses applied to the jaw can help relax muscles.
  • Jaw exercises can also help to loosen up those muscles!
  • Cutting back on the alcohol and caffeine will also help.

Click here to learn more about bruxism, or make an appointment to see one of the dentists at the Student Health Center.  We’re always happy to help.

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

Salvatore Paul Lowry, DDS
Student Health Services
The Ohio State University

I’ve never had this many colds. Is something wrong with me?


The Columbus Dispatch ran a special health section about colds and flu this weekend which included a number of fairly well-done pieces. I found a few informative bits myself, and am going to use this quote from local primary care provider Donna Donati, MD: “Colds spend four days coming, four days here, and four days going.” For those of you keeping score, that’s 12 days. I’d add a few days at the end, actually, for nasal congestion and cough to resolve completely.

It’s pretty typical for the average adult to have five or six colds through the course of cold and flu season, which, if you’re keeping score, means SIXTY-plus days of viral misery. In other words, two-plus months of snot does not necessarily mean you’re dying or have a “weak immune system” (a common complaint). It means you’re normal.

For more great information from the Dispatch on how to handle cold and flu season:

This year’s flu vaccine

How to wash your hands

Sick at work? Health experts say ‘Go home’.

Vitamins? Zinc? Soup? Everyone has a ‘cure’.

Fighting patients’ pleas for antibiotics

Your head says cold but your body says influenza

Can you jog when your nose runs?

Victoria Rentel, MD
Student Health Services
The Ohio State University

How well does the flu shot work?

Q: BuckMD, can you share some information of flu vaccine efficacy?

A: Thanks for your question.  Vaccine efficacy is measured in a number of ways. Depending on the organism, sometimes we can measure antibody or other immune response markers in the blood of vaccinated vs. unvaccinated people.  Sometimes, we compare clinical outcomes, such as death or hospitalization rates, or missed work or school days, in the two populations. 

With flu vaccine, most experts look at the level of a particular antibody (hemagglutination inhibition antibody, or HI) to say whether the vaccine gives enough response to protect a person against getting the flu.  Most of this year’s flu vaccines produce a protective level of these antibodies in 90% or more of human test subjects. 

However, this percentage is inflated somewhat due to pre-existing immunity.  If I get vaccinated against a particular strain this year, and it happens that I also was vaccinated against that strain 3 years ago, then I might have a higher antibody level than if not previously vaccinated. 

Looking more at how many people get sick as a measure of efficacy, the vaccines protect about 60-70% of those immunized. (Am. J. Epidemiol. (2008) 168 (12): 1343-1352. doi: 10.1093/aje/kwn259 First published online: October 29, 2008, accessed 11/2/10) These studies are much more difficult to perform. 

For more details, take a look at each vaccine’s package insert information at the FDA website:


For an intricate discussion of viruses, read:

Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., 2009.


Virology, in Microbiology and Immunology Online, University of South Carolina, 2009, http://pathmicro.med.sc.edu/mhunt/flu.htm, accessed 11/2/10.

Roger Miller, MD, OSU Student Health Services


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