If you're trying to follow Dr. Mischley's DHA for dyskinesia protocol, please read this REGARDING DOSING

[1LittleWillow]

EDITING TO ADD: Dr. M says (right at the beginning of the video) that fish oils are often contaminated with heavy metals, and that many supplements don't contain the levels of active components that they claim to contain. She recommends the (relatively expensive) Pharmax oil because she believes it's safe and that the labeling is accurate. If you choose another brand, be sure to verify that it's third-party tested for purity and potency.

There have been so many comments discussing the correct dose of DHA on the other threads for this topic, so I wanted to share what I gathered from her video.

Here's Dr. Mischley's video again:

youtu.be/piDgzpD7oOQ?si=nKh...(Not working as expected?)

Please skip to around the 1:00 mark.

1. Dr. M said that the primate study used 5 grams OF DHA per day (the slide displayed says 100 mg of DHA per kg of body weight, or 7 g of DHA for a 70 kg primate).

2. It wouldn't make sense to discuss "grams of oil" when the DHA content of various oils can vary significantly.

3. Dr. M tried 4 grams OF DHA (not 4 grams of oil) per day on two patients and achieved results that were comparable to those of the primate study.

4. I think some of the confusion stems from the fact that there are several products from Pharmax that all contain different amounts of DHA per teaspoon. The one shown in her video isn't currently listed on the manufacturer's (Seroyal) website, so it may have been reformulated since the video was made.

Yes, Dr. M mentioned a tablespoon of oil; HOWEVER, she also said that the dose was 4 grams. A tablespoon (3 teaspoons) of the product pictured in her video is 15 mL, which is about 13.8 grams of oil, so when she said 4 grams, she HAD to be talking about the total amount of DHA and NOT the total amount of oil.

5. I am using the Pharmax/Genestra brand product called Super DHA Forte Liquid. It is not 4 grams of oil per serving. It is 1 teaspoon of oil (5 mL/4.6 grams) per serving, which contains 2,075 mg of DHA. I take two teaspoons per day, for a daily total of 4,150 mg (4 grams) of DHA.

6. This oil is NOT THE SAME AS STANDARD FISH OIL OR KRILL SUPPLEMENTS. It contains concentrated DHA (2,075 mg per teaspoon) and a much smaller dose of EPA (425 mg per teaspoon).

7. Every brand/formulation of oil has different amounts of DHA and EPA and different serving sizes. You need to look at the supplement facts on the label to see if a particular product has the correct HIGH DOSE OF DHA (NOT EPA) so that you get A TOTAL OF ~4 GRAMS OF DHA PER DAY.

8. The concentrated oil from Pharmax/Genestra does not taste fishy. It tastes like orange as it is flavored with orange oil, but it isn't sweet.

9. Yes, the oil is expensive, but this very high dose is only for 2 months.

Hope that helps! If you find my interpretation to be incorrect, let me know; however, 4 grams of DHA daily is helping me a lot. 😊

[Rufous2]

Good idea to synopsize this way. For those who are unable to tolerate (or afford) the oil you are taking, here's a capsule form; iherb.com/pr/now-foods-dha-...

Dr. Mischley's protocol would require taking four of these a day. I haven't taken this fish oil but have taken many Now products and believe them to be a reputable company.

BTW, I am curious why you say the high dose DHA is "only for two months?"

[1LittleWillow in reply to Rufous2]

Because that's what Dr. M says in the video. DHA @ 4 g/day for 2 months, then switch to the more standard-dose EFA oil or gelcaps. And at that point you also start the CDP choline.

[Rufous2 in reply to 1LittleWillow]

I just rewatched the video 2x and can't find a recommendation to reduce the fish oil dose at 2 months. She definitely says she implements the high DHA oil for a couple of months before adding the citicoline, but that's it....at least in the video I have access to.

[1LittleWillow in reply to Rufous2]

It's how I interpreted her plan based on everything she said in the entire video. Listen to the video at 2:10. She says that the high-DHA fish oil is a little pricey and fishy-tasting. She then says that "other fish oil" that she "prescribe[s] routinely" is less expensive and tastes better, but that in order to specifically treat dyskinesia, she prescribes the high-dose DHA oil. Then listen again at 5:20. She says that she routinely tests her patients blood for levels of EPA and DHA and prescribes fish oil to keep levels "adequate," and says "that's probably why I don't see many people develop dyskinesia." So my understanding is that she's saying that those of us who develop dyskinesia don't have adequate levels of DHA to begin with, and the high-dose supplementation is to quickly bring our levels up to a sufficient level to decrease the dyskinesia, and then we would continue with the more common lower-dose oils that she prescribes routinely in order to maintain those optimal levels.

Additionally, I was just reading the questions and answers below the actual "PD School" video. Someone asked (4 years ago), "As a follow up, is there any reason you can’t continue with just DHA [oil] indefinitely?" Dr. M replied, "Cost. The less concentrated fish oils are less expensive and taste better." Definitely sounds like she switches patients to less concentrated versions of fish oil after dyskinesia is resolved.

If my dyskinesia returns when I begin taking the other "normal" fish oil (I'll probably buy this product, sold through her clinic, or something similar: simpharmacy.com/products/or... ), you can be sure that I'll let you know that I was wrong, and I'll resume the high-dose DHA oil! BTW, that's 180 gelcaps for $80, so even if you take 2/day, it's only $27/month, and just $13/month if you take 1/day.

[PixelPaul in reply to 1LittleWillow]

Wouldn’t it be easier to just reach out to Dr. Mischley and ask for some clarification rather than the risk of mistakenly interpretting what you might think she’s recommending?

[1LittleWillow in reply to PixelPaul]

I tried that through the website but never got an answer. Maybe you could try.

[1LittleWillow in reply to PixelPaul]

She has answered many general questions that were posted by viewers of the PD School videos, but she's very careful to say that she can't be too specific about recommendations because she can't provide medical advice unless you're her patient. She says that each patient is unique and should be working with their own doctor on all of this stuff. Since I don't have a doctor to work with me, I do it on my own. I do get blood work periodically through my GP or MDS, but I base almost everything I do on my symptoms and responses. I'm not telling anyone else what to do. I'm just telling you what's working for me. I should probably just post links and quit offering commentary. 😁

[Rufous2 in reply to 1LittleWillow]

Ok, thought I'd missed something, thanks.

I do think it's important for all PWPs to know about her recommendations re fish oil, and wonder if those without dyskinesia are tuning in. Preferable to prevent, if possible.

BTW, the link you posted didn't work. I keep getting a "page not found" message and can't find capsules in her pharmacy, only liquids. Maybe you could post the EPA/DHA amounts so people will know what to look for in a substitute.

[1LittleWillow in reply to Rufous2]

I edited the link. Hopefully it will work now. Here it is again.

simpharmacy.com/products/or...

[gaga1958 in reply to Rufous2]

since she does blood work to determine what level we are at, wonder if she would reduce the amt once bloodwork shows the level is high enough?

[Rufous2 in reply to gaga1958]

Yes, that's what 1LittleWillow is proposing. It would be really good to know what levels Dr. M considers sufficient for preventing/treating dyskinesia. That way one could test and not be guessing.

[1LittleWillow in reply to gaga1958]

I just have a feeling that "high enough" could be unique to each individual. If my dyskinesia reduces significantly, then it's enough. If not, then I'll keep going. If I decrease and it starts to come back, then I'll increase again.

[Rufous2 in reply to 1LittleWillow]

So while we're speculating, my guess is that there is a level at which most people would have a response, but that the amount of fish oil it takes to get there could vary widely. This is certainly the case with vitamin D supplementation, and why testing is routinely done. Some people, like me, have good levels taking 1000 iu/day, or even less if I'm spending a lot of time outdoors. Others require 5000 iu or more on a permanent basis to get and stay at adequate levels. 

In re-listening to the video again, at 6:35 she says "we don't wait for the dyskinesia to start to give this huge dose of fish oil." So even though she may be using a less expensive formulation when dyskinesia isn't present, it seems she often uses quite a hefty dose.  I'll bet Dr. M has a pretty good idea where blood/red cell levels need to be to get adequate brain saturation, and those who are looking to prevent dyskinesia could really benefit from knowing what those are.

It's all academic though, since she won't disclose this kind of information. That's too bad, since one can test omega 3 levels pretty easily now through this company; omegaquant.com/about/

[lbrussell in reply to gaga1958]

Yes, Dr Mischley did reduce my fish oil dosage when my blood levels go unnecessarily high. She has also recommended different proportions of EPA vs. DHA over time. Things seems to fluctuate for me. She bases it all on current blood labs and types of oil used.

[1LittleWillow in reply to lbrussell]

Thanks so much for that information! That is so helpful to know. I get my labs done about every six months through my GP. I'd like to do it more often but it's limited a bit by insurance.

[1LittleWillow in reply to Rufous2]

Good find (the capsules). I'm so sick of swallowing pills that I prefer the liquid, but there are many who prefer the capsules!

[garygjs]

Wiley's Finest does a less expensive alternative. (The bottle is smaller but it still works out cheaper). Readily available in the UK and US. One teaspoon provides:

2140mg DHA

1000mg EPA

UK: dolphinfitness.co.uk/en/wil...

[park_bear]

You are right. Corrected my post accordingly.

[1LittleWillow in reply to park_bear]

Thank you. I was hoping that I had interpreted everything correctly!

[Smittybear7]

thank you for sharing!

[gaga1958]

isn't this the same oil she stated tastes a little fishy? or since you say is orange tasting, is it different? I'm a really big sissy when it comes to consuming nasty tasty things and I end up wasting money, so thought I'd ask

[1LittleWillow in reply to gaga1958]

Her video is from at least 4 years ago, and the company that makes the oil she shows in the video has apparently reformulated their products somewhat since then. Take a look at the Seroyal website. Their brands are Genestra, Pharmax, and UNDA. The product in her video is labeled "High DHA finest pure fish oil" by Pharmax. That product isn't available anymore, but if you look through all of their EFA/fish oil products, the one that I'm using (the Super DHA Forte Liquid) is the closest when it comes to the amount of DHA per serving. Apparently the old product tasted fishy, but this current product does not.

[gaga1958 in reply to 1LittleWillow]

that's great news, I ordered it. thxs for sharing your knowledge

[1LittleWillow in reply to gaga1958]

And by the way, I had my 17 year old who has a ridiculously great sense of smell check the oil for me, and she says there's no fishy smell either, just orange

[gaga1958 in reply to 1LittleWillow]

excellent

[Allypally49]

Spot on and very helpful

[Allypally49]

Is this worth a try from iHerbs

DHa

[1LittleWillow in reply to Allypally49]

Looks good!

[Allypally49 in reply to 1LittleWillow]

£28.93 forget to say

[1LittleWillow in reply to Allypally49]

I just looked at the serving size and servings per container. That would only be enough for ten days at the four grams per day dose.

[Allypally49 in reply to 1LittleWillow]

Free delivery and i got a 24% discount code though as first time customer

[1LittleWillow in reply to Allypally49]

Yay! 😊

[LAJ12345]

I have been giving my hubby fishoil with the higher EPA level /lower DHA.

This recent paper says

“The Polyunsaturated Fatty Acid EPA, but Not DHA, Enhances Neurotrophic Factor Expression through Epigenetic Mechanisms and Protects against Parkinsonian Neuronal Cell Death”

ncbi.nlm.nih.gov/pmc/articl...

Interesting Laurie is suggesting to take the DHA and not the EPA?

[1LittleWillow in reply to LAJ12345]

The high-dose DHA she recommends is specifically for treating dyskinesia and is based on a primate study and her own experience with her patients. She also says she puts all of her patients on an EFA supplement.

[LAJ12345 in reply to 1LittleWillow]

I see.

[Ep0522 in reply to 1LittleWillow]

What kind of EfA supplement? What do you take please?