Wednesday, July 17, 2013

Fish Oil Reviews - The Evidence Behind Omega-3 Fatty Acid Supplements

Like many individuals, my day starts with an eagerly awaited trip to the kitchen after a quick hop in the shower. By this time, the alarm clock haze has finally worn off long enough to realize the neurotic taste buds in my mouth are going crazy. They need their morning bowl of cinnamon oatmeal with mixed berries or else!

In the past, I'd always follow breakfast with a handful of vitamins and some fish oil supplements before heading out the door. I was off to fill prescriptions and make the world a healthier place! As a pharmacist, I dispense pills and educate others on all the benefits they have to offer, including a few over-the-counter supplements. Fish oil is one of these supplements. In school I learned that pills equal health. Pharmacists dispense pills. Therefore, pharmacists dispense health.

Since I am the expert on pills, I deem it my responsibility to keep up with the scientific literature behind all of these pills as best I can. After all, medicine is a constantly changing environment and if you snooze you lose (and so do your patients). Today I present you with the evidence behind fish oil supplements, known widely for benefiting cardiovascular health and many other chronic diseases, or so they say.

To do this I scoured numerous scientific studies in highly respected medical journals like the New England Journal of Medicine and The Journal of the American Medical Association (JAMA). I also turned to The Cochrane Reviews. The Cochrane Reviews—if you're unfamiliar with them—provide the most comprehensive, credible, and impartial analysis on the available scientific evidence in health and medicine. They do this by upholding very strict commercial sponsorship policies, which prohibit contributions from pharmaceutical and medical device companies. Here's what I found.



Omega-3 Fatty Acids For Asthma


Fish Oil For Asthma in Adults and Children
Cochrane Review (July 2010) - "There is little evidence to recommend that people with asthma supplement or modify their dietary intake of marine n-3 fatty acids (fish oil) in order to improve their asthma controlEqually, there is no evidence that they are at risk if they do so." [1]



Omega-3 Fatty Acids For Inflammatory Bowel Diseases


Fish Oil For Treating Active Ulcerative Colitis
Cochrane Review (October 2008) - "The current data does not allow for a definitive conclusion regarding the efficacy of fish oil. There is no adequate information to make recommendations for clinical practice. More research is required." [2]

Omega-3 Fatty Acid Supplementation For Maintenance of Remission in Ulcerative Colitis
Cochrane Review (October 2008) - "No evidence was found that supports the use of omega 3 fatty acids for maintenance of remission in UC. Further studies using enteric coated capsules may be justified." [3]

Omega-3 Fatty Acid Supplementation For Maintenance of Remission in Crohn's Disease
Cochrane Review (January 2009) - "Omega 3 fatty acids are safe but probably ineffective for maintenance of remission in CD. The existing data do not support routine maintenance treatment of Crohn's disease with omega 3 fatty acids." [4]



Omega-3 Fatty Acids in Brain/Cognitive Health


Fish Oil For Prevention of Dementia in Healthy Older People (> 60 years old)
Cochrane Review (September 2012) - "Direct evidence on the effect of omega-3 PUFA on incident dementia is lacking. The available trials showed no benefit of omega-3 PUFA supplementation on cognitive function in cognitively healthy older people. Omega-3 PUFA supplementation is generally well tolerated with the most commonly reported side-effect being mild gastrointestinal problems.
Further studies of longer duration are required. Longer-term studies may identify greater change in cognitive function in study participants which may enhance the ability to detect the possible effects of omega-3 PUFA supplementation in preventing cognitive decline in older people." [5]

Omega-3 Fatty Acid Supplementation For Bipolar Disorder
Cochrane Revew (January 2009) - "Results from one study showed positive effects of omega-3 as an adjunctive treatment for depressive but not manic symptoms in bipolar disorder. These findings must be regarded with caution owing to the limited data available. There is an acute need for well-designed and executed randomised controlled trials in this field." [6]

Omega-3 Fatty Acid Supplementation For Autism Spectrum Disorders (ASD)
Cochrane Review (December 2011) - "To date there is no high quality evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of ASD. Given the paucity of rigorous studies in this area, there is a need for large well-conducted randomised controlled trials that examine both high and low functioning individuals with ASD, and that have longer follow-up periods." [7]

Omega-3 Fatty Acid Supplementation For Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents
Cochrane Review (October 2012) - "Overall, there is little evidence that PUFA supplementation provides any benefit for the symptoms of ADHD in children and adolescents. The majority of data showed no benefit of PUFA supplementation, although there were some limited data that did show an improvement with combined omega-3 and omega-6 supplementation.
It is important that future research addresses current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, short follow-up times and other methodological weaknesses." [8]



Omega-3 Fatty Acids For Type 2 Diabetes


Omega-3 Fatty Acid Supplementation For Type 2 Diabetes
Cochrane Review (January 2009) - "Omega-3 PUFA supplementation in type 2 diabetes lowers triglycerides and VLDL cholesterol, but may raise LDL cholesterol (although results were non-significant in subgroups) and has no statistically significant effect on glycemic control or fasting insulin. Trials with vascular events or mortality defined endpoints are needed." [9]



Omega-3 Fatty Acids For Cardiovascular Diseases


Omega-3 Fatty Acid Supplementation For Intermittent Claudication (pain in legs due to poor circulation)
Cochrane Review (October 2008) - "Omega-3 fatty acids appear to have limited haematological benefits in people with intermittent claudication but there is no evidence of consistent improved clinical outcomes which are the primary outcomes of this review (quality of life, PFWD, MWD, ABPI, angiographic findings). Supplementation may also cause adverse effects such as increased total and LDL cholesterol levels. Further research is needed in this area, to evaluate short- and long-term effects on more clinically relevant outcomes." [10]

Omega-3 Fatty Acid Supplementation For Cardiovascular Disease
Cochrane Review (January 2009) - "It is not clear that dietary or supplemental omega 3 fats alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population. There is no evidence we should advise people to stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm suggestions of a protective effect of omega 3 fats on cardiovascular health.
There is no clear evidence that omega 3 fats differ in effectiveness according to fish or plant sources, dietary or supplemental sources, dose or presence of placebo." [11]

Omega-3 Fatty Acid Supplementation and Cardiovascular Events after a Heart Attack
New England Journal of Medicine (November 2010) - "Low-dose supplementation with EPA-DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy." [12]

Omega-3 Fatty Acid Supplementation in Secondary Prevention of Cardiovascular Disease
Archives of Internal Medicine (May 2012) - "Our meta-analysis showed insufficient evidence of a secondary preventive effect of omega-3 fatty acid supplements against overall cardiovascular events among patients with a history of cardiovascular disease." [13]

Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events
The Journal of the American Medical Association [JAMA] (September 2012) - "Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association." [14]

Omega-3 Fatty Acid Supplementation For Patients with Multiple Cardiovascular Risk Factors
New England Journal of Medicine (May 2013) - "In a large general-practice cohort of patients with multiple cardiovascular risk factors, daily treatment with n-3 fatty acids did not reduce cardiovascular mortality and morbidity." [15]



Conclusion


I graduated pharmacy school and practiced pharmacy for many years believing that omega-3 (fish oil) supplements benefited the patients I served. As I mentioned before, I also took fish oil capsules myself, faithfully for many years, due to this long-held belief. I recommended fish oil to all my patients looking for an anti-inflammatory supplement, especially those suffering from heart disease. Unfortunately, I was led astray, taking for granted what I had been taught early in my career regarding the so-called health benefits of fish oil pills.

An in depth look at the evidence makes one thing clear. Fish oil pills and other omega-3 fatty acid supplements DO NOT work. Data from the highest authority (The Cochrane Collaboration) and major medical journals have all come to this same conclusion. Omega-3 supplements don't work because cardiovascular disease, type 2 diabetes, inflammatory bowel disease, and many other chronic illnesses are largely, if not completely, due to our rich, Western diets. They exist because of multiple daily servings of meat, dairy, eggs, and junk foods. Not only do omega-3 supplements not work, but recent data from an article published in the Journal of the National Cancer Institute last week shows that supplementing with omega-3 fish oil pills actually increases the risk of prostate cancer in men [16].

The only reason anyone has ever suggested supplementing with omega-3's is because omega-3 fatty acids are considered essential fatty acids. That is, omega-3 fats are not naturally made by our bodies. We must obtain them from dietary sources. Hence, the recommendations to eat fish and/or supplement with fish oil pills or other sources of omega-3 fatty acids. However, when it comes to our health (especially long term) eating fish and swallowing fish oil pills is not in our best interest. To learn more about the topics of fats in the human diet please read my article - The Essentials On Fats In The Diet.

So where does all this leave us? It leaves us with the question of how to effectively manage the litany of chronic diseases people are suffering from. To adequately and responsibly address this we MUST start with the food, NOT with our medicine cabinets. No human being on Earth has ever been able to medicate or supplement their way out of a chronic disease. While medications and supplements may provide temporary relief to some individuals, they are no substitute for a healthy diet centered on whole, plant-based foods. It starts with the food! You can't fix your health if you don't fix your diet. To learn more about how to do this visit my page on nutrition or utilize the many other resources I've made available at Pursue A Healthy You. You have nothing to lose by doing so.









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Photo credit: Freedigitalphotos.net

References:
1 Thien FCK, De Luca S, Woods RK, Abramson MJ. Dietary marine fatty acids (fish oil) for asthma in adults and children. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001283. DOI: 10.1002/14651858.CD001283
2 De Ley M, de Vos R, Hommes DW, Stokkers PC. Fish oil for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005986. DOI: 10.1002/14651858.CD005986.pub2
3 Turner D, Steinhart AH, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006443. DOI: 10.1002/14651858.CD006443.pub2
4 Turner D, Zlotkin SH, Shah PS, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006320. DOI: 10.1002/14651858.CD006320.pub3
5 Sydenham E, Dangour AD, Lim W-S. Omega 3 fatty acid for the prevention of cognitive decline and dementia. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD005379. DOI: 10.1002/14651858.CD005379.pub3
6 Montgomery P, Richardson AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005169. DOI: 10.1002/14651858.CD005169.pub2
7 James S, Montgomery P, Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD007992. DOI: 10.1002/14651858.CD007992.pub2
8 Gillies D, Sinn JKH, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD007986. DOI: 10.1002/14651858.CD007986.pub2
9 Hartweg J, Perera R, Montori VM, Dinneen SF, Neil AHAWN, Farmer AJ. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003205. DOI: 10.1002/14651858.CD003205.pub2
10 Sommerfield T, Price J, Hiatt WR. Omega-3 fatty acids for intermittent claudication. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003833. DOI: 10.1002/14651858.CD003833.pub3
11 Hooper L, Harrison RA, Summerbell CD, Moore H, Worthington HV, Ness A, Capps N, Davey Smith G, Riemersma R, Ebrahim S. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003177. DOI: 10.1002/14651858.CD003177.pub2
12 Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010 Nov 18;363(21):2015-26. doi: 10.1056/NEJMoa1003603.
13 Kwak SM, Myung SK, Lee YJ, Seo HG; Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012 May 14;172(9):686-94. doi: 10.1001/archinternmed.2012.262. Review.
14 Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012 Sep 12;308(10):1024-33. doi: 10.1001/2012.jama.11374. Review.
15 Risk and Prevention Study Collaborative Group, Roncaglioni MC, Tombesi M, Avanzini F, Barlera S, Caimi V, Longoni P, Marzona I, Milani V, Silletta MG, Tognoni G, Marchioli R. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med. 2013 May 9;368(19):1800-8. doi: 10.1056/NEJMoa1205409.
16 Brasky TM, Darke AK, et al. Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial. J Natl Cancer Inst. 2013 Jul 10. [Epub ahead of print].

5 comments:

  1. Why can't news like this be presented in the mainstream media, Dr. Oz in particular? He recently had an "expert" touting the benefits of fish oil. They both smilingly dismissed the claim that fish oil supplements are a waste of money.

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  2. They need more studies regarding prostate and fish oil - double blind placebo etc. Not enough info. I don't take fish oil but eat walnuts, pumpkin seeds and flax etc and let my body convert what it can of ala into dha/epa.

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  3. I'm confused now. Isn't it necessary for a vegan/veganist to supplement DHA/EPA due to the body's inability to convert enough ALA? I'm using a plant-based supplement Ovega-3. Is that no good either?

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    Replies
    1. You'll find some great information on this topic in my article The Essentials of Fats in the Diet. Watch the videos included within that article. The link is listed above at the end of this article.

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  4. From all I've read Omegas can be a bit unstable and require antioxidants such as natural Vitamin E (not synthetic -dl) to counteract the oxidation effects. For that reason I take ground flax seed and flax oil along with a minimal amount of Omegas. This allows my body to convert the flax to the EPA/DHA that it needs and reduces the amount of pure omegas that my body may require. Should I have difficulty with the conversion of flax I still get my omegas as a safety net. This way I get the best supplementation and I am not in a holding pattern until all the data shakes out.
    It is my understanding that krill has naturally occurring antioxidants and thereby may be a better source of omegas.
    I am in full agreement that the establishment Is much too quick to discredit supplementation with questionable data while totally overlooking the preponderance of evidence on the beneficial aspects from past studies and demographic analysis.
    This leads me to question the integrity of the scientists doing these studies and their motives as well as the media reporting it.

    - James from New York City Body

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