A recent publication in the Journal of the American Medical Association found no benefit of 1 gram daily of fish oil in a review of 20 previous studies. Numerous major news and media outlets are interpreting these results to show that omega-3 is ineffective as a supplement without also presenting the limitations and deficiencies in the analysis itself. Most physicians disagree.

Why such discrepancies? Supplement studies are plagued by what I call dosage dilemmas. They aren’t standardized like pharmaceuticals, so based on how much of which chemical form of a given supplement is used; the amount absorbed can vary by light-years. Thirty years ago, 30 mg of co-enzyme Q10 which was only 10% absorbable showed marginal benefits at best. Four years ago, 1400 mg of a 90% absorbable form a coenzyme Q10 was shown to reduce the progression of Parkinson’s disease.

So while the JAMA study looked at 1 gram of daily fish oil, most of our patients take 2-4 grams daily, and at that level benefits are clear.

James O’Keefe is a Preventive Cardiologist who has published over 200 papers concentrated on the beneficial effects of both nutrition and exercise on cardiovascular health. Below are his comments on this recent newsworthy publication.  As one of the most popular health supplements and one of the most extensively studied, omega-3 has benefited the lives of millions of people.  Dr O’Keefe:

“The item of greatest contention for me, and some fellow physicians, was that the study actually showed a statistically significant reduction in cardiovascular mortality. In addition, borderline significant reductions were seen in all-cause mortality and sudden death. The researchers focused on the lack of statistically significant reduction in all-cause mortality, which led the media to report that omega-3 is not beneficial. However, as noted in the illustration below, the reduction in cardiac death was significant (if the confidence interval line does not cross the 1.0 line the result is by usual standards deemed statistically significant).

Examples of the limitations in the meta-analysis:

  • The dose of omega-3, specifically the beneficial DHA and EPA fats, was less than 1 gram daily, which is not optimal for conferring maximal benefits, especially for lowering triglycerides and reducing inflammation.
  • Many of the studies included in this analysis did not have a long enough follow-up. The average follow-up was only 2 years when prevention studies involving heart and stroke patients typically span 5 years.
  • Researchers picked twenty of the thousands of studies on this topic, as many studies vary with types of patients and the doses of fish oil studied. Omega-3 is nearing the top of the list for most studied substances in modern medicine.
  • Many of the studies covered participants who were already sick, not accounting for the wide range of effects their medications could cause. Heart patients are often prescribed a multitude of drugs, from beta-blockers to diuretics, creating a significant challenge in determining omega-3 effectiveness.
  • Many of the studies didn’t test to see if people were starting out with diets very low in fatty fish and therefore omega-3s. If one is consuming a high daily dose of omega-3 in his or her diet, the benefits of an omega-3 supplement for that person are likely to be less apparent or maybe even nonexistent.

Over the past 40 years, omega-3 essential fatty acids have been demonstrated to provide health benefits in multiple settings for many types of individuals. New studies are continually conducted, thus furthering our understanding of who is most likely to benefit from this nutrient, and what the ideal doses of omega-3 are in targeting various diseases and complaints.

In Good Health,
James O’Keefe, MD, FACC

James Katz MD

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