Plate or Pill? Fish Oil Revisited.

   I feel a personal responsibility to respond on the results from the omega 3 fatty acids study that is published this week in the peer reviewed journal of the American Medical Association or JAMA.
   You may have already heard the 'news'  that there is a lack of evidence to suggest a health benefit from the use of fish oil supplements.  That would be an accurate headline that does align with the study results.
    My need to address the study here comes from my post in 2009 after I returned from an truly enjoyable and educational week at the Cooper Institute in Dallas Texas.  Dr. Kenneth Cooper is a strong advocate for fish oil supplementation and after hearing him speak, and share research, I was convinced of the positive effect.  If you are familiar with my blog you know that I strongly and emphatically endorse nutrient intake in the form of food not pills.  It was a departure for me to share his recommendation on supplementation. 
   So what happened to change the consensus?  Past research did  show a positive benefit from fish oil. (and Dr. Cooper made his assessment based on the research that was available at the time) Some of the studies used fish oil capsules,  others tracked dietary omega 3s,  and a few studied fish oil supplementation in animals.  
   The current research is a review.  It began with a screening of over 3600 study records.  Of those, the scientists used only 20 which met strict inclusion criteria.  The ones included were considered sound research studies.  They had to be randomized and include control groups.  People who were different only by random chance and not in any systematic way were given pills or not given pills.  The studies that were included had to last more than one year.  Most of them were blinded - people did not know what they were being given in order to reduce the chance of a placebo effect.  The scientists considered the design of the study, the actual robustness of the data collected and how the data was analyzed.  All of this is spelled out in their research article allowing other scientists to challenge or confirm their conclusions.  The outcomes that were studied include, death from any cause, sudden death, cardiac mortality, heart attack and stroke.  
   Of these 20 studies, two of them were a comparison of dietary intake not pills.  Those 2 studies cancelled themselves out and were not discussed further in the article. 
   On a separate note, the Mediterranean diet has been the subject of much research and eating fish has been associated with positive health outcomes.  It was this association that led to supplementation in the first place.  
    The authors conclude that there is no evidence to support the  use of fish oil supplements in clinical practice.  In other words, doctors should not prescribe it to  prevent first heart attacks or to treat heart disease.  
    The pills are very expensive and this is a sad dollar day for the supplement industry.  The pills are out, but the salmon benefit is still very real.
     At the end of the day, in my role as public health professional, that leaves one nutrient/vitamin to consider for supplementation - Vitamin D.  There just isn't any way to get sunshine onto a plate and the best source of Vitamin D is the sun.  Talk to your doctor before starting on any medications or supplements.

The study abstract is available:

Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: A Systematic Review and Meta-analysis

Evangelos C. Rizos, MD, PhD; Evangelia E. Ntzani, MD, PhD; Eftychia Bika, MD; Michael S. Kostapanos, MD; Moses S. Elisaf, MD, PhD, FASA, FRSH