Sunday, April 5, 2009

Dental Anecdotes

Here are a few anecdotes gleaned from past comments that describe improvements in oral health due to a change in diet. Please feel free to add your own (positive or negative) experience to the comments. I may add it to the post.

Stan: My teeth stopped decaying and some breakage (broken tooth due to mechanical damage, 5 years ago) begun sealing itself with new enamel on my high animal fat, low carb diet of the last 10 years. I still have all my teeth including wisdom teeth. My teeth no longer develop plaque/scale and thus no need to descale, and I no longer develop cold sores on my gums. I haven't been to a dentist since 1999 (I am 53). [From another comment] I can fully confirm the astounding effect of a diet very high in animal produce and low in plants, on my teeth. My tooth decay has totally stopped! I wrote about that before but it is worth repeating: - my teeth would not decay even if mechanically damaged, broken in half etc. The broken exposed parts of a tooth, even if the core is open, just seals itself over time.

Dave: Our family has had similar experiences. In particular, my daughter had a poorly formed molar (she was a spring baby, before we started Vitamin D, hmmmm). The tooth had quite a large crater in it. I put her on D3 and cod liver oil/butter oil. We finally got a dentist she'd cooperate with enough for X-rays. The result was exactly as described above: a thick layer of dentin had formed. The dentist was thoroughly puzzled, which I enjoyed immensely :-)

Arnoud: For years my dentist has been insisting on more frequent and more aggressive cleaning techniques.... to no avail. Last year I started Vitamin D supplementation, and a more Paleo style of diet, and the 'chronic' inflammation of my gums resolved themselves within days, literally. My dentist claims it is a coincidence. I think not!

Martin: Once I changed my diet to one close to what is listed in this entry, and added a vitamin D3 supplement, my dental health greatly improved. No more cavities, and beyond that, no more rapid build-up of dental plaque. To prevent gum problems, I used to have to get my teeth cleaned four times a year, now, once a year is enough, and it seems to me, even that might not be necessary.

Thresshold: I am a cavity-every-six-months person, who arrested decay for 3 years by going on a Protein Power-like diet. No limit on non-starchy veggies, lots of meat-- turkey, beef --lots of nuts, olive oil, egg a day. No grains. Very little fruit, no sugar. Plenty of supplemented vitamin A and D, E, C, Bs, some dolomite.

Jeff: I just had a dentist visit, first in almost 3 years. No cavities for the first time in a while. Your advice and a Paleo diet are the reason, in my mind.

Dr. Dan: Before paleo I had bleeding gums and sore teeth. Now that I have been on it I have not had them and my flatmate just commented how white my teeth are looking.

Cheeseslave: I have also eliminated cavities since I changed the way I eat. I avoid all phytic acid (I try to only eat sprouted bread or naturally fermented sourdough) and I soak or sprout all my grains, legumes, nuts and seeds. I also take cod liver oil, and eat a nutrient-dense diet consisting of mostly meat and dairy.

Dr. B. G.: Myself, I had periodontal disease (esp immed after pregnancy and lactation -- wonder W-H-Y ??!) however at the last check up -- I have no more pockets of '5' and am released to come in only 2x annually instead of all the extra (painful) de-planing and cleanings. This was improved by: vitamin A, vitamin D 5000 IU every am, high dose fish oil, flaxseed and egg yolks and saturated fats and some K2 supplements. [From another comment] I have to admit -- my dental problems reversed prior to total Paleo eating (eg, wheat-free). On vitamin D and fish oil alone my cavities sealed. In fact I had gone back to see the DDS but he couldn't find one tiny 'sticky' spot. When he decided to fill it irregardless (and I was an idiot to not walk out b/c who knew that cavities could heal/seal...on their own??), then I had to leave him. At that point, the dental hygienist had already let me return to a 'normal' insured 2 cleanings/yr schedule, instead of the $$ 4/year (where 2 were out-of-pocket). With going 100% wheat-free, vits ADEK and adding a little (fresh highquality) flaxseed oil, my gums are super healthy and no throbbing at all for the last 9mos!

Brock:
When I went to my dentist for the first time in a while last September I was told I had six cavities. My dentist told me to schedule to get them filled in, but I never did. I just had the intuitive feeling that the human body ought to be able to heal itself, and that for some reason my dentist just didn't know how. So, I started Googling. My search lead me here and to the Weston Price Foundation. I bought Dr. Price's book and changed by diet months ago. I eat mostly paleo but mainly just focus on avoiding wheat, corn, sugar and n6 fats. I supplement with Vitamins A, C, D, E and K2. Long story short, my six cavities have closed up and my teeth have noticeably improved in color and "feel". Swelling in my gums is down. I can often go for weeks now without brushing my teeth without any noticeable side effects. It's great.

Andrew S.:I had a lot of cavities growing up, and as a young adult. I started up a new company, didn't have health insurance, and didn't go to the dentist in a while -- and started eating whole, natural foods, with a bit of supplementation (mostly cod liver oil). I was surprised when I visited the dentist for the first time in years to not have any decay.

Robert Andrew Brown: I too have gone from regular cavities, indifferent gum health, sensitive teeth, and a host of dental work to prove it, to none since balancing the Omega 3s and 6s, and regular 'industrial' cod liver oil. Small carries that were sensitive and on the list for restorative work have re mineralised and skinned over but not refilled. I have only recently started seriously increasing vitamin D and reintroducing grass fed butter.

29 comments:

Unknown said...

When I went to my dentist for the first time in a while last September I was told I had six cavities. My dentist told me to schedule to get them filled in, but I never did. I just had the intuitive feeling that the human body ought to be able to heal itself, and that for some reason my dentist just didn't know how. So, I started Googling.

My search lead me here and to the Weston Price Foundation. I bought Dr. Price's book and changed by diet months ago. I eat mostly paleo but mainly just focus on avoiding wheat, corn, sugar and n6 fats. I supplement with Vitamins A, C, D, E and K2.

Long story short, my six cavities have closed up and my teeth have noticeably improved in color and "feel". Swelling in my gums is down. I can often go for weeks now without brushing my teeth without any noticeable side effects. It's great.

Charles R. said...

"I got your anecdotal evidence right heah..."

Growing up I never had a cavity. Not one. And (this is kinda disgusting) I never brushed my teeth, and I certainly never flossed. And even though that sounds disgusting, I never had bad breath.

We ate a lot of meat in our household, and I drank a LOT of milk--maybe as much as a half-gallon a day. But I also ate a lot of sweets and sugar. And a fair amount of bread. But I never had a cavity or gum disease--my dentist couldn't understand why.

It seems unlikely it was genetic. My mother had terrible teeth. And so did my sister. And I wasn't that healthy. I got a lot of colds and sore throats, and was overweight.

But then in my late teens and early 20s, I flirted with vegetarianism, and was very strictly macrobiotic for a while to the point of becoming very malnourished. And even after that I stopped drinking milk. And then cavities appeared. Not that many, but after having none, it was very weird to have any.

I never put this together until recently when I started eating more Paleo, and when I read Weston Price. Then I started to think that maybe this wasn't random, and I didn't just grow out of having good teeth. My teeth only became vulnerable when I stopped drinking milk and stopped eating meat.

This is a fascinating topic, and I'm glad you're taking it up. It seems that as a culture we've accepted that cavities are just a fact of life, like the weather, and we can't really do anything about them. The same way we've accepted diabetes and heart disease and obesity. They just happen, there really isn't a cause.

I'm firmly convinced that cavities are not caused by a lack of flossing or even brushing. If you have a bad tooth environment because of your nutritional intake, those things might help keep things under control. But it all starts with nutrition.

Andrew S said...

I had a lot of cavities growing up, and as a young adult. I started up a new company, didn't have health insurance, and didn't go to the dentist in a while -- and started eating whole, natural foods, with a bit of supplementation (mostly cod liver oil). I was surprised when I visited the dentist for the first time in years to not have any decay.

I still have a bunch of mercury in my mouth, and I want to get rid of it. The standard practice is to replace it with porcelain. Has anyone just had it removed?

Robert Andrew Brown said...

I too have gone from regular cavities, indifferent gum health, sensitive teeth, and a host of dental work to prove it, to none since balancing the Omega 3s and 6s, and regular 'industrial' cod liver oil.

Small carries that were sensitive and on the list fro restorative work have re mineralised and skinned over but not refilled.

I have only recently started seriously increasing vitamin D and reintroducing grass fed butter.

Stephan Guyenet said...

Brock,

Awesome story! I added it to the list.

Charles,

I've heard similar stories from many people. Chris Masterjohn had the same thing happen when he went vegetarian, according to his bio.

Andrew,

Thanks, I've added your story to the list.

Robert,

Thanks, I'm addin' it!

Monica said...

I've noticed much smoother teeth, and a lack of a toothache in the rearmost upper right molar a few months after starting cod liver oil last year. I'll be getting X rays on Wednesday, so it should be interesting to see what is going on, or went on, in that tooth.

Come to think of it, I realized something else today. I don't have sensitivity to cold and heat anymore in my teeth. I wonder if that has anything to do with an improved diet (modified paleo, WAPF over the past year or so).

Dr. B G said...

Great post Stephan!

I love Stan's story :)

I have to admit -- my dental problems reversed prior to total Paleo eating (eg, wheat-free). On vitamin D and fish oil alone my cavities sealed. In fact I had gone back to see the DDS but he couldn't find one tiny 'sticky' spot. When he decided to fill it irregardless (and I was an idiot to not walk out b/c who knew that cavities could heal/seal...on their own??), then I had to leave him. At that point, the dental hygienist had already let me return to a 'normal' insured 2 cleanings/yr schedule, instead of the $$ 4/year (where 2 were out-of-pocket).

With going 100% wheat-free, vits ADEK and adding a little (fresh highquality) flaxseed oil, my gums are super healthy and no throbbing at all for the last 9mos!

-G

Stephan Guyenet said...

Monica,

Let us know how your X-ray turns out!

G,

Neat. You know, I think anecdotes are worthwhile for something like this. They can't give us any solid numbers, but they can demonstrate that certain things are possible, like healing cavities. It's amazing to me that people have forgotten the fact that cavities can heal. It's a testament to just how out of line our diet is with the design of our bodies.

Aaron Blaisdell said...

Regarding gum health, there are a number of anecdotal reports at Seth Roberts' blog (http://blog.sethroberts.net/) of people's gums healing and periodontis completely reversing within months after daily ingestion of flaxseed oil. Taking a couple of tablespoons of oil, in particular flaxseed oil, within at least a 2-hour taste-free window appears to have helped a lot of people control hunger and loose excess weight. All part of his Shangri-La Diet.

Dr. B G said...

Aaron,

Thanks -- in fact, it was after reading Seth that I started flaxseed oil. I didn't understand all the bugaboo about it... (though Dr. Davis loves that stuff). Since it was the only variable that I had changed and sequentially the throbbing quickly improved (I was off wheat for 6-7 mos already), I deduced it was the flaxseed oil. I've tried stopping (eg, I ran out and no time to refill) and a very VERY gentle throbbing re-emerged.

I think Seth is very cool...and has great anecdotes at his site :)

In the end, thought we're all n=1, we actually are not. That's why I love this brilliant BADASS Paleo community!! *haa*

-G

Monica said...

My X rays were completely clean this AM. No decay in the rear-most molar, or any other tooth. That gum is slightly recessed, so I suspect it resolved last March when I started switching to a WAPF type diet and started on cod liver oil, and in July, cut carbs very low. I've been avoiding vegetable oils most of that time. I suspect a lack of omega six and an increased ratio of n3 to n6 really helped.

They were totally surprised I hadn't been to the dentist in 5 years. (I originally thought it was 3 years but thinking back it's been more like 5.) It took them all of five minutes to clean some minimal tartar and polish them up. I wonder if I'll ever need another cleaning.

The dentist actually seems somewhat enlightened, and suggested that I remove the amalgams. (OK, he'll stand to profit from it, but it's still probably a good idea.) He seemed a bit less enlightened about diet but I told him he should check out Nutrition and Physical Degeneration. He'd never heard of it. With the bucketloads of money I making straight out of grad school I can't really afford to buy him a copy right now, but might in the future... if we could just get this information in the hands of more people!!

Stan Bleszynski said...

Hi everyone!

Fascinating stories! Until we started talking about it, I thought it's only me, a once off case, genes etc, but now I know that there is a pattern!

Notice that WAPF, Paleo, Atkins or Optimal D. share 1 common theme: more animal fat and meat!

Other interesting connection to research (sorry for directing this at you Stephan, but since Peter retired, you seem to have the most time, skills and energy to do this 8-:) ) is a presumed link between dental health and a health status of other organs:

Teeth <--> bones <--> kidneys <--> cardiovascular<-->skin

I would also recommend to look up some threads on the vegan fora, for a comparison. You may find that virtually every thread discussed by new vegans dealing with dental health, is reporting some worsening, often dramatic worsening of their situation!

I remember one vegetarian expert (Jeff N.), first denying any connection whatsoever (quoting J.Dwyer's paper) but later admitting in another thread, of dealing with his own osteoporosis (aged ~50). He refuses to connect that with his diet, and is trying to remedy it through exercising with an extra weight on his back (backpack and/or weight-loaded jacket).

Regards,
Stan

arnoud said...

Stan,

"a presumed link between dental health and a health status of other organs:

Teeth <--> bones <--> kidneys <--> cardiovascular<-->skin"

During the last couple of months I have seen several popular stories (magazines, papers) pointing out this link, usually suggesting that we ought to improve dental hygiene (brushing after each meal, etc) to improve cardiac health...

I struggle with that suggestion. Wouldn't it be more logical to look for a common factor improving all those aspects of health? I doubt we can ignore diet, and we somehow will achieve optimal health by brushing our teeth every few hours....

Based on what we know now, Vitamin D, K2 and A are fundamental in optimal health in all those: teeth, bones, kidneys, cardiovascular, heart, brain, and the list continues......

Steve's recent post on the topic of epidemiology ties in nicely with this discussion.

Stephan Guyenet said...

Monica,

Awesome!

Stan and Arnoud,

There's definitely an association between dental health and overall health. I tend to agree with Arnoud that teeth and other organ systems are probably responding to the same lifestyle factors, rather than tooth decay causing ill health. Although both may be true. I do believe Price thought dental health had a direct influence on overall health.

Matt Stone said...

My experiences are almost the exact opposite of Charles R. His childhood diet, overweight, etc. sounds exactly like me, except I had every single molar decay. Then my adult teeth grew in and I had every single molar decay again, and get filled with metal.

As I got older, all my health problems went away at once. It coincided with hitting puberty, not with any dietary or lifestyle change. I lost weight, allergies went away, teeth became healthier. Going vegetarian for many years didn't bring any harm to my teeth. I didn't visit the dentist at all during those times. When I went through a dramatic cleansing phase based on juicing with even less animal products, my teeth became even healthier. My dentist made comments after not seeing me for years.

When I first went full-throttle on Weston A. Price I did well. I was so confident in Price's research that I began brushing my teeth only once per week. Everything was fine for a while, but then began to turn south after being on low-carb (100 grams per day or so) for many, many months.

I cut carbs to 50-60 grams per day and my tooth pain became very severe.

Recently I let loose a little bit while visiting family for 3 weeks and my tooth pain is now gone. I'm back to brushing every other day, sometimes without toothpaste. Changes in my diet included massive binge eating (2000 calorie meals) consisting of tons of white flour products. I ate more grains. I ate tons of carbs. I even ate some ice cream, fruit, and fruit juices which had been largely excluded from my diet for 2 years. I ate fast food burgers. You name it. Now my teeth are fine. Digestion is also improved.

My conclusions:

It is all about internal biochemistry as Melvin Page noted, specifically the action of the endocrine glands - aka the metabolism as a whole. The nutrient theory is wrong, and so is the fiber theory. Good health leads to healthy teeth, and there are many paths to improving health, including the age-old protocols of Price, Pottenger, and many others.

Unknown said...

Matt,

I'm not sure what to make of your post, but I notice that you speak only of of macronutrient ratios, and not vitamins or food quality. As Stephan has mentioned often, you can eat quite a few carbs and maintain good health if they are prepared right and have rich vitamins and minerals.

Just as a for instance, you can "low carb" on skinless chicken breast and canola oil, but I think that would kill you eventually. Likewise Weston Price "cured" many of his American patients on a diet that included fresh ground whole wheat porridge. I think there's a lot of leeway in the macronutrient ratios (as long as you get enough protein and essential fats to meet basic needs), but much less so in the vitamins and minerals.

Stephan Guyenet said...

Matt,

If you don't have enough vitamin D, you can't absorb calcium from your food. If you can't absorb it, you can't deposit it in your teeth. The only way to circumvent that is to give very high doses of calcium in the food. Balancing your thyroid and other endocrine organs will not help you if you don't have enough calcium. There's no getting around the critical importance of micronutrients to dental health.

The quality of digestion will also affect nutrient absorption. For example, celiac patients can't efficiently absorb fat-soluble vitamins and certain minerals. They have a very high rate of dental problems. You had to resolve your digestive issues before you were able to make use of the nutrients in your food. That doesn't detract from the importance of fat-soluble vitamins and minerals to dental health.

Matt Stone said...

Stephen,

My point was simply that there are kinks in the theory. I grew up drinking a couple gallons of whole milk per week, even when I was only 5 or 6 years old. I was a huge eater and a quick developer. I ate eggs at least twice a week, ate whole grains, lots of fresh fruits, quite a lot of vegetables for a young kid, some red meat, and seafood was my favorite. I ate tons of fish, scallops, shrimp, etc.

Yet I was a cavity machine.

When living off of mostly coconut, fruit, vegetable juices, lean fish, brown rice, raw vegetables, and salad greens my teeth were in excellent condition (hardly any dairy, no organ meats - i.e. low calcium and low vitamin D).

Brock,

I wasn't eating chicken breast and canola oil on a low carb diet. I was eating raw, grassfed butter, cream, and cheese, organic organ meats, vegetables, and a little potatoes, yams, etc - all from organic and biodynamic local farmers. In other words, I followed a low-carb diet using only the highest quality artisinal ingredients that money can buy. My diet was sugar free - no fruit or sweets of any kind. I was trying to eat as much calcium and vitamin D as I could get my hands on, raw calories, activator X, and so on.

Melvin Page cured tooth decay by removing dairy products from the diet (except for a little butter), and made no mention of vitamin D or minerals. Sure, we need some of those elements, but he knew that the body regulated mineral levels hormonally, and intake was only important up to the point that deficiency was overcome. He focused instead on glucose metabolism (hormonally regulated) and calcium to phosphorous ratios (hormonally regulated).

And if you have a hormonal imbalance, you are prone to bone loss and tooth decay no matter what. Eating more calcium is likely to give you kidney stones, as none of it is absorbed.

Vitamin D and calcium are important, but management of those elements is primary above calcium and vitamin D intake, which is secondary. I don't even think about vitamin D and calcium intake, oblivious to them as mankind has been for millenia, and my health is much better for it.

Stephan Guyenet said...

Matt,

I agree that the endocrine glands are important for mineral metabolism, and just about everything else. But proper endocrine function is also highly dependent on micronutrient status. That's basically what McCarrison showed in his animal experiments. I think it's worth mentioning in this context that rats and certain other animals are better than humans at extracting minerals from unfermented whole grains because they express phytase in their small intestine.

The pancreas contains the second-highest concentration of vitamin K2 in the body. It turns out, there's a K2-dependent protein that's required for normal beta cell proliferation. The thyroid requires an unusually large amount of iodine compared to other organs. The kidneys secrete calcitriol, but only if there's enough 25(OH)D3 in the blood. The adrenals concentrate vitamin C. The endocrine glands are highly dependent on micronutrient status.

I don't dispute your personal experience with tooth decay, but it doesn't line up with what I've heard from most people or read in the scientific literature. One possibility is that you don't digest lactose well. That could have led to dysbiosis and malabsorption when you were drinking a lot of milk. Or perhaps you have a sensitivity to casein, which could also have led to malabsorption. It sounds like the diet on which your cavities healed de-emphasized dairy.

I don't advocate a one-size-fits-all solution. Everyone has to figure out which foods they function best on, and figure out their own optimal macronutrient ratios. Whatever solution you choose, I believe it has to be rich in micronutrients for long-term success, particularly fat-soluble vitamins and minerals.

Matt Stone said...

Yes, but rural Zulus ate a diet of 93% carbohydrates without tooth decay. Obviously this didn't leave much for vitamin D and calcium from their miniscule amount of dairy products.

All I argue is that getting the amount of micronutrients you need to get by without causing tooth decay (which is an infectious illness causes by a crappy immune system), is very limited.

I ate stupendous amounts of micronutrients as a young child (compared to most) and it offered me no protection against tooth decay or life-threatening illnesses in need of emergency medical intervention.

Tooth decay can be improved by eating a rice diet or juice fasting (which enhance immune system function) just as easily as it can by eating a nutritious diet based on fat soluble vitamins and minerals.

Stephan Guyenet said...

Matt,

I don't know where that 93% figure comes from, but it's basically impossible. Even if you ate nothing but corn, which history has proven is a recipe for early death, you would only be getting 83% of your calories from carbohydrate. Corn is 9% fat and 8% protein by calories. Other grains are pretty similar.

Basically the only way to get up to 93% carbohydrate would be to eat nothing but cassava or plantains. Given that diets that rely too heavily on cassava result in protein malnutrition (which is a big problem in parts of S America and Africa that rely on cassava), no culture was surviving on 93% carbohydrate.

I'm all for the hormone theory, but it doesn't replace proper nutrition.

Unknown said...

No cavities or missing teeth. Only been to the dentist once in 20 years (I'm 34). I'd always put it down to a low sugar diet, genetic luck and using a non fluoride toothpaste. Now I am wondering how much my being a coeliac has to do with it. Because I can't eat gluten, I eat less grains than most people, although I do eat some wholegrain rice and maize. I only eat meat about once a week and am intolerant of dairy (except butter), so that has not been a great part of my success.

Stephan Guyenet said...

SystemicPlural,

Very interesting!

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. said...

NATURAL TOOTH CLEANSERS:

SOAP:
(WITH NO ADDED GLYCERIN/GLYCEROL WHICH MIGHT COAT THE TEETH AND NOT ALLOW THE TOOTH CAVITIES TO REFILL THEMSELVES NATURALLY)-GREAT FOR REMOVING STICKY OILY FOOD.

WASHING SODA:
(GUARANTEED FREE OF ADDITIVES)AVAILABLE VERY CHEAPLY FROM THE SUPERMARKET'S LAUNDRY AISLE.JUST AS GOOD,OR BETTER,THAN SOAP.

EXPOSING THE GUMS TO THE SUN?:
GOOD WAY TO ABSORB SOME MORE HEALTHY VITAMIN D?

Imran Ali said...

I wanted to add a tip for the best teeth whitening. This is the use of dried bay leaves with orange peels. Just take the dried bay leaves and dried orange peels and grind them together. You will get a powder. Now just brush your teeth with this powder using your toothbrush. This will make your teeth cleaner.

imran.

Dr. David Cheng said...

It is true that diet and not just oral hygiene plays a big part on our dental health. A diet high in sticky and sugary foods will lead to higher risk of cavities. Sticky being a major factor as the longer the food sticks to your teeth, the higher probability it will result in cavity formation. A diet rich in Vit D also helps make your teeth stronger.
Dental Thornhill

amalhator said...

I have celiac disease and I'm sensitive cross contamination. It caused slight but noticeable fat malabsorption. My enamel looked normal but I have 5 filled teeth and will need to fill 2 more. I'm 21.

It is not easy to be 100% gluten free. You don't even have to eat it. You can be exposed by inhaling aerosolized flour, using wheat based cat litter, play dough, and visiting a bakery.

Are there any celiacs almost without teeth problems?

I'm so confused when I heard of some people eating lots of sugar but with no decay and on the other hand, people seem to eat healthy and have lots of cavities.

Unknown said...

Stephen, if you, or anyone else has any suggestions, I am totally open. Thanks in advance.

My teeth as worse than they've ever been since I started a Weston A Price diet for a year now. I have to say I am dumbfounded considering my devotion to copious amounts of seafood, soup stocks, pastured eggs, pastured organ meets, raw pastured milk grass fed cheeses, FCLO/HVBO, little to no grain, absolutely no processed food, and reasonable amounts of dark veggies. I can go through a stick of Kerrygold or other pasture butters in about 2 days. It is worth noting that my teeth are yellowish and my biggest concern is my receding gums, with only one seemingly small cavity. The gums are receding faster since I started the diet than anytime in my 25 year existence and frankly I do not know what else to do. Maybe the answer is just more fat soluble vitamins but I am already eating liver 3 times a week now and fatty fish probably 7 times (including wild salmon, roe, oysters, the good stuff). Frankly I'm concerned about my total PUFA just from all the fish and FCLO. Plus liver three times a week? It sucks when your anecdote is the exact opposite of everyone else's. Any help is greatly appreciated. I'm also in the California sun at least 30 minutes a day.