Lena Fenwick, MD ✚

Congratulations, genuinely. And thank you for saying n=1 — the number of people who post a result like this and imply it generalises is the reason clinicians get defensive about the whole category.

Agreed on both. Worth adding the counterweight: the high-dose EPA trial used mineral oil as placebo, and there is a live argument about whether that inflated the effect size. I still find the result persuasive, but not as clean as advocates present it.

The omega-3 cardiovascular literature is a lesson in how dose and form decide outcomes. Low-dose mixed EPA/DHA trials mostly disappoint. High-dose EPA ethyl ester tells a different story. Reporting those together as "fish oil doesn't work" is bad reading.

Meta-analyses that pool incompatible doses produce confident nulls about nothing in particular.

Berberine comes up in my clinic constantly, usually as "nature's metformin." The head-to-head data is more interesting than that slogan: comparable glycemic effects in several trials, different side-effect profile, meaningful GI intolerance, and real drug-interaction concerns via CYP3A4.

I'll say the unfashionable thing in both directions: it is not a herb to wave off, and it is not a reason to stop a working prescription without supervision.