The ACR Institute’s Take on Fish Oil Supplementation

Statement

Need to Change Standard of Care ASAP with regard to Fish Oil Supplementation

Randomized clinical trials (RCTs) and meta-analyses of these trials should influence clinical practice because they represent the highest level of evidence, and all the more so that they are have been published in peer reviwed  high-impact journals.

Health care behaviors based on less robust evidence are often established before such RCTs are conducted. If the results of high-quality RCTs contradict established practice,  it is more than reasonable for the care provider to change practice.

As a consequence thereto, fish  oil supplements that are commonly used for the management of cardiovascular, neurocognitive, ophthalmic, and inflammatory disorders like cancer  should be replaced with more holistic gentle interventions like plant based foods rich in ALA and-or algae or eventually krill, both of which have an abundance of DHA-EPA. On occasion, wild small ocean fish could also be acceptable.

Presentation of the Evidence for Cardio-vascular conditions

FIsh Oil supplementation not only does not help cardio-vascular conditions, but these supplements can worsen these conditions.

Exhibit A

Meta-Analysis of RCTs published in JAMA (2018)

“Conclusions and Relevance: This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease”

Reference

Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, Geleijnse JM, Rauch B, Ness A, Galan P, Chew EY, Bosch J, Collins R, Lewington S, Armitage J, Clarke R (March 2018). “Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals”. JAMA Cardiology. 3 (3): 225–34. (Source)

Exhibit B

Meta-analyses and RCTs in JAMA (2012)

Conclusion 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”.

Reference

Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS (September 2012). “Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis”. JAMA. 308 (10): 1024–33. doi:10.1001/2012.jama.11374. (Source)

Exhibit C

Fish Oil supplements worsened the risk of cardiac death

“Advice to eat more fruit was poorly complied with and had no detectable effect on mortality. Men advised to eat oily fish, and particularly those supplied with fish oil capsules, had a higher risk of cardiac death. This result is unexplained; it may arise from risk compensation or some other effect on patients’ or doctors’ behaviour” (Source)

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Presentation of the Evidence for Malignancies

FIsh Oil supplementation not only do not help cancer conditions, but these supplements can worsen this condition.

Exhibit D

Meta-Analysis of RCTs published in JAMA (2006)

“Conclusions A large body of literature spanning numerous cohorts from many countries and with different demographic characteristics does not provide evidence to suggest a significant association between omega-3 fatty acids and cancer incidence. Dietary supplementation with omega-3 fatty acids is unlikely to prevent cancer”.

Reference

MacLean CH, Newberry SJ, Mojica WA, Khanna P, Issa AM, Suttorp MJ, Lim YW, Traina SB, Hilton L, Garland R, Morton SC (2006-01-25). “Effects of Omega-3 Fatty Acids on Cancer Risk: A Systematic Review”. JAMA: The Journal of the American Medical Association. 295 (4): 403–15.

Exhibit E

Journal of the National Cancer Institute provides further evidence that men with high concentrations of omega-3 fatty acids in their blood are more likely to develop prostate cancer.

“This study confirms previous reports of increased prostate cancer risk among men with high blood concentrations of LCω-3PUFA. The consistency of these findings suggests that these fatty acids are involved in prostate tumorigenesis. Recommendations to increase LCω-3PUFA intake should consider its potential risks”. (Source)

Exhibit F

“The medical community suffered three significant fish oil failures/setbacks in 2013. Claims that fish oil’s EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy) released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention-both primary and secondary. Another major 2013 setback occurred when fish oil’s DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) analysis by Brasky et al. Another monumental failure occurred in 2013 whereby fish oil’s EPA/DHA failed to improve macular degeneration. In 2010, fish oil’s EPA/DHA failed to help Alzheimer’s victims, even those with low DHA levels. These are by no means isolated failures. The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology”. (Source)

 

Exhibit G

Expert Opinion from Dr Dewine of Harvard Medical School

“But the evidence for improving heart health is mixed. In May 2013, for example, Italian researchers reported in the New England Journal of Medicine that omega-3 fatty acid supplements did nothing to reduce heart attacks, strokes, or deaths from heart disease in people with risk factors for heart disease.Evidence linking fish oil and cancer has been all over the map. Some research suggests diets high in fatty fish or fish oil supplements might reduce the risk of certain cancers, including prostate cancer. Other research shows just the opposite, a  link between eating a lot of oily fish or taking potent fish oil supplements and a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer”. (Source)

AvocadoPD

TENTATIVE CONCLUSION

According to two of the most credible nutrition authorities, the World Health Organization and the European Food Safety Authority, we should get at least a half a percent of our calories from the short-chain omega-3 ALA, which is around one teaspoon of flax seeds..  Chia seeds, purslane and walnuts would also work.

Because some people have difficulty convering ALA into DHA and EPA,  it may be recommended to take 250 mg daily of pollutant-free (yeast- or algae-derived) long-chain omega-3’s (EPA/DHA). Krill oil would also work. (1) But the algae would be more at the bottom of the food chain. As a result, there would be less stress on the Oceans, thanks to which the Ocean would be in a better condition to self-regenerate while humans would be healthier with plant-based omega 3s.

Affordable DHA algae oil from Life Extension, on SALE for 8 dollars: (Source)

Foot Note

(1). While krill are not for now an endangered species, krill are a mainstay of the diets of many ocean-based species including whales, causing environmental and scientific concerns about their sustainability if krill were to massively  replace fish oils.

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