Omega-3 Supplements Don’t Lower Heart Disease Risk After All

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If you want to protect your heart, stick to exercise and a healthy diet, and pass on the fish oil pills, says a new study.

For years, doctors and health experts have recommended taking fish oil supplements, rich in omega-3 fatty acids, to lower the risk of heart disease. But the latest study on the issue — an analysis of previous clinical trials on the effects of omega-3s — shows that the supplements don’t lower users’ risks of heart attack, stroke, sudden death or death from heart disease or any cause. Although the rates of these events were lower among those taking omega-3 supplements compared with those not taking them, the differences were not statistically meaningful, the authors said.

It’s not the first time that the cardiovascular benefits of fish oil have been questioned: another recent analysis of previous research found that the supplements didn’t prevent heart attack or stroke in people with heart disease. (Separately, other research has suggested that that pills have little effect on boosting memory in Alzheimer’s patients, reducing symptoms of the disease or improving thinking and verbal skills compared with placebo.)

(MORE: Fish Oil for Heart Attack Prevention: Is It a Myth?)

In the current analysis, published in the Journal of the American Medical Association and led by Dr. Moses Elisaf of the Lipid Disorders Clinic at the University Hospital of Ioannina in Greece, the scientists reviewed 20 studies dating back to 1989 that involved 68,680 participants. Volunteers in the studies, most of whom were heart patients, were randomly assigned to take either 1.5 g of omega-3 supplementation or a placebo every day for about two years. They were followed for heart events, including death, heart attack and stroke.

While the omega-3 users showed a 9% lower rate of heart-related death compared with the controls, and an 11% lower rate of heart attack, these differences were too small to attribute to the omega-3 pills.

The findings may lead to some confusion among people — both heart patients and those who are healthy but trying to avoid heart disease — who may be taking omega-3 supplements daily. While some early studies did show a significant benefit from taking fish oil pills, data from newer clinical trials weakened that effect. That may be because at least one early, important study did not blind participants or researchers, meaning that everyone knew who was taking omega-3s or placebo. Further, inconsistencies between the included trials, such as the dosages of supplement used or preexisting conditions among participants, may have contributed to the discouraging findings.

(MORE: Study: Fish Oil Pills Don’t Stall Alzheimer’s)

Much other past data showing benefits of omega-3s also came from studies that did not randomize participants into fish oil and placebo groups, and instead retrospectively compared heart events in people who chose to consume more omega-3 fats than others.

Another reason the current study failed to find a benefit may be that more people are using better treatments for heart disease these days, including cholesterol-lowering statin drugs. Elisaf says he wasn’t able to eliminate the potential influence of these medications in lowering rates of heart attack and death from heart disease overall. “We need more data in order to have a clear answer about the role of omega-3 fatty acid supplementation in everyday clinical practice,” he says.

The authors acknowledge that additional research may help determine whether omega-3 supplements may still benefit people depending on their individual risk of heart disease, or if their diets are low in foods that are naturally rich in the fatty acids.

(MORE: Fish Oil Fail: Omega-3s May Not Protect Brain Health After All)

Currently the American Heart Association (AHA) advises people with high triglyceride levels to eat more fatty fish — the omega-3s in oily fish help boost good cholesterol and lower triglycerides — but to discuss supplementation with their doctor if they can’t get enough from their diet. The organization does not recommend the pills in general as a way to protect the heart.

Both the AHA and many doctors recommend eating more fish, however: everyone, including healthy people and heart patients, should eat at least two servings of fish per week to benefit from the omega-3 fats. “If people are taking supplements because their physician prescribed them, they should consult with their physician before stopping,” says Dr. Donna Arnett, president of the AHA and professor of epidemiology at the University of Alabama at Birmingham. “But I would tell them they should not stop eating fish. The results of this study are about dietary supplements. So dietary sources of omega-3s may be different than supplements. They should not assume that dietary sources are not useful.”

Which means that the advice you’ve been hearing all along remains the same — eat more fish. It’s good for your heart.

MORE: Brain Food: Eating Fish May Lower Your Risk of Alzheimer’s

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

19 comments
Siryeast
Siryeast

Not a big fan of meta-analyses for assessing therapeutic benefits.  In the service of accumulating larger sample sizes and thus greater statistical power, results from multiple small trials are combined. Unfortunately, the rigor of those studies gets compromised as the prior careful match-up of patients in control and test groups can get skewed and the various forms of the test substance used in the different studies often get treated as equivalent.  In the case of omega-3 fatty acids (oFA's), it matters a great deal whether subjects consumed oFAs as fish oil versus pharmaceutical grade (>95% pure) material.  All unsaturated fatty acids, including oFAs are very prone to rancidity (oxidation) in the presence of oxygen and such products can negate any potential benefit of oFAs. As a rule-of-thumb, if you can smell or taste a fishy odor, there are likely substantial levels of rancid fatty acids present.  The conclusions of the study above should be treated very cautiously until someone conducts a well-controlled study employing pharma grade material that is protected in foil-wrapped, single-use packaging.

Siryeast
Siryeast

I'm not a big fan of meta-analyses like the one reported.  In in the pursuit of combining large groups of study subjects, these analyses frequently sacrifice the original studies' careful matching of test and control subjects and standardization of their treatments, done to mitigate the confounding effects of age, sex, weight, race, and type of supplement taken.  For an omega-FA study it is critical to know whether all test subjects were taking fish oil or pharmaceutical grade omega-3 fatty acids (>96% pure).  Fish oils typically contain a variety of different fatty acids and usually a sizable percent of rancid (oxidized) ones; the rule-of-thumb is that if the oil tastes or smells fishy there are sufficient amounts of harmful products present to negate any beneficial effects of omegas.  Even pharma grade omega-FAs will oxidize rapidly if they are not sufficiently protected from oxygen; this is true of all unsaturated FAs.  It is critical to use omega-FAs that are foil- wrapped (or otherwise protected) and in single-use portions to prevent oxidation.  Given the likely mix of unstandardized treatments used above, I doubt the results mean anything and I will wait till a single carefully controlled study using well-defined and protected omega-FAs gets tested.  

Murtaza Khan Durrani
Murtaza Khan Durrani

Omega 3 is more beneficial for improving the health and maintaining the fitness level.

It burns the fat more effectively and lose the extra body weight, and it also controls the cholesterol level to keep the heart healthy.

It is also an ideal supplement to remove the body pain.

yoga in Rutherford

Murtaza Khan Durrani
Murtaza Khan Durrani

Omega 3 is more beneficial for improving the health and maintaining the fitness level.

It burns the fat more effectively and lose the extra body weight, and it also controls the cholesterol level to keep the heart healthy.

It is also an ideal supplement to remove the body pain.

yoga in Rutherford

 

Matt Chanko
Matt Chanko

I find it hard to believe that this article says nothing about DHA, which after reading other sources, is a proven source to  building blocks of the brain cells. I think it is too vague a study to have any true understanding.  If Omega 3 has DHA, and it has been proven in the medical community to help build higher function, then this article  should have a different tone. 

GoldenHu
GoldenHu

Quite simply: Follow the money. Studies such as this are mostly flawed for the simple reason that the sponsors of the study (usually the pharmaceutical industry) have no interest in cheaper supplements that can do the job of more expensive cholesterol medicine without the harmful side effects that they can bring. Cholesterol medicines now come with a warning label on these harmful side effects much like cigarettes do. One must ask, what dosage did they use? Did it have enough vitamin E in the capsule to prevent oxidation in the body? How long was the study? I have several patients with high cholesterol levels which I immediately put on a high quality, high potency dosage omega-3 fish oil capsules (that I do not myself sell). Without exception almost all have lowered there LDL cholesterol levels significantly. Many to the point where they no longer have to use their medicine anymore. I do warn them however that when they begin with taking this supplement together with their medicine that they have to be careful that their cholesterol levels do not fall too low and to have it checked after a couple of months. One of my patients to which this happened stumped the cardiologist with this. When the doctor asked the patient how this could happen the patient told him about the fish oil to which the cardiologist replied, "Stop with the fish oil." Unbelievable! I am not against medicine. I have to use it myself and it has its place. But statins can be one of the most harmful things that you can do to your body and heart. Statins do lower cholesterol but make the heart weaker in other ways. I always invite my patients to be skeptical over my claims and to take the time to find a reputable website(s) that will give the full story on statins and cholesterol. I invite you to do the same.But always remember: Follow the money...

multitudes
multitudes

please consider the people who are allergic to fish when you write these articles.

what are the good substitutes that have equivalent nutritional value?

mike galsworthy
mike galsworthy

Listen people, the food supplements industry is $50bn annually and engages in a lot of quality evocative packaging and general marketing regardless of scientific evidence - and there are tons of nutritionist websites peddling myths and selling supplements; note that "nutritionist" is not a regulated profession.

As to the science, it's varied. Vitamin C does not prevent colds, but it will accelerate recovery if you have a cold. Supplemental antioxidants are even dangerous, promoting cancers slightly in many large studies. In fact, with antioxidants the story started out very promising in the 80's as cancer patients were seen to have lower levels of antioxidants in their blood (starting the "they mop up dangerous free radicals" theory) - however, antioxidant supplements were quickly shown to not be anti-cancer protective factors at all. That has not stopped the marketing machines. Similarly with Omega-3 oils; great evidence for joints, some decent evidence for cardiovascular (but this current JAMA paper seems to undermine that) - but the whole brain story that was peddled particularly strongly in the UK was deliberate evidence-free b.s. from start to finish.

Pickel Green
Pickel Green

If fluoride can harden teeth then it might be hardening your arteries. 

wdmll
wdmll

I will continue to exercise, eat a healthy diet, daily take high quality fish oil capsules (plus other supplements) and eat salmon when I eat out or at other times, at home.  I have my blood tested each year and review the results with my doctor. Over the years, I have been seen by a number of doctors and this may be Anecdotal evidence, but I will take my chances with what I’m doing.

So you can stick this article in the trash can with all of the other articles, trashing supplements.

tomee llman
tomee llman

I guess there is no reason to eat fish anymore, meat is the best food after all. I should be more cautious when reading any nutrition information from now on.

Visit this site for health solution: http://www.medsempire.org/

tomee llman
tomee llman

That is sad, considering the only reason I eat animal from sea is just because their omega-3 nutrition. From now on, I should eat more meat than fish, Its no different right (nutritional value speaking). Visit this site for health solution: http://www.medsempire.org/

Guest
Guest

The real question is: "What's in your pill?" Many supplements contain ingredients that are known to be harmful: for example palmitic acid and stearic acid... saturates that have been shown in studies to increase insulin resistance and cause inflammation that clogs arteries. There's a new supplement Cardia 7 that has been especially formulated with Purified Omega 7 Palmitoleic Acid that's stronger than the EPA in Omega 3 without the saturates. Dr. Roizen and Dr. Oz are calling it the "new" good fat.

http://www.cardia7.com 

NoeticGhost
NoeticGhost

Isn't there a potential for confounds in *this* study? Such as people who take fish oil to lower risk of heart troubles but at the same time are not improving their diet in regards to heart health (still eating foods high in cholesterol and other such unhealthy food products)?

That is a potential reason for the insignificant results in this study.

The limitations from the previous studies were listed in this article, but none were really addressed in regards to the study showing insignificant results. The only thing they mention is..

"The authors acknowledge that additional research may help determine

whether omega-3 supplements may still benefit people depending on their

individual risk of heart disease, or if their diets are low in foods

that are naturally rich in the fatty acids."

Which addresses the fact that they need to do more research and that they should consider the diet of participants in regards to eating food not containing fatty acids; but this is something that all Research papers should address. Although, there is still no mention as to whether or not these participants had a diet that could have skewed the results, at least not in this representation of it. Which I think is an important factor to assess and make mention of when discussing the results.

The only reason I mention this is because News articles like this can be so misleading, most of the general public remains unaware of the technical details in regards to scientific studies and they end up just taking the results at face value. The point is it takes more than just eating fish or taking supplements to reduce the risk of heart problems, it requires doing that plus eating a healthy diet, exercising and monitoring yourself.

Anyway, just a thought, this study seems fine otherwise, I was just slightly bothered by the title of the article being misleading and the lack of limitations discussed in this portrayal of the study, which is important because THIS is what the public will read.. or er... most likely, skim through and then draw conclusions from.

Read more: http://healthland.time.com/201...

wholefed
wholefed

Fish do not actually produce omega-3 fatty acids, but instead accumulate them by consuming either algae or other fish that have accumulated them. 

Fish Oils have received an enormous amount of attention in recent years as a cure-all for a number of chronic diseases; including heart disease, cancer, depression all the way to dementia. As with any supplement that is heavily marketed and associated with large corporations the benefits of taking a fish oil supplement have to be examined.

Supplements are not a substitute for good nutrition. In regards to fish oil; a couple of tablespoons of flax-seed, a green leafy salad, and a handful of chia seeds should do the trick. No issues: no PCB’s, no environmental stress on the world’s fisheries, no mercury and no added expense.

A “Good” Cholesterol Fish Story:  http://wholefed.org/2012/05/17...

Ian Welch

AlanInAZ
AlanInAZ

Another over the top headline that does not reflect the much more cautious content of the study as well as its many limitations and possible flaws.  In the end the group taking omega-3's were healthier.  Also, the benefits of omega-3 could be asked by other therapies.   

DavidCameron
DavidCameron

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