Summary of the Story
A recent journal article on the Journal of Canadian Cardiology (JCC) questions the legitimacy of the history of how we fell in love with the health benefits of fish oils. Dr. George Fodor, the primary author, disputes the false notion of fish oils having protective heart benefits is based from research by two Danish nutritionists, Hans Olaf Bang and Jørn Dyerberg who studied the diet and health of Eskimos (Inuits)in Greenland. Bang and Dyerberg falsely concluded, according to Dr. Fodor, that the Greendland natives had much lower heart disease due to their high consumption of fatty fish compared to other Greenland natives who did not consume much fatty fish. Fodor argues that, when looking at the research carefully, the Inuits have as much cardiovascular events than any other Western culture.
HERE’s an Abstract of the article from the JCC.
HERE’s a nice summary of the article with comments from other experts
My Take On This
For the last 40 years there has been thousands of scientific research articles written on the health benefits of fish oils – most indicating favorable results.
Here are a few:
- Fish oils (Lovaza) lower Triglycerides by 30 to 40%at 4000mg a day but does not lower ‘bad’ cholesterol (LDL).
- The potential benefits of omega-3 fatty acids have been extended to the prevention and treatment of Heart Failure (HF). The Cardiovascular Health Study, involving 4,738 men and women over 65 years of age, found an inverse association of baked or broiled fish intake and incident congestive Heart Failure. (Mozaffarian et al. 2005)
- A Japanese study by Yamagishi et al. in a prospective study of nearly 60,000 Japanese followed up for nearly 13 years showed an inverse association between fish and omega-3 fatty acit consumption and CV mortality, especially for HF.
- A randomized, double-blind, placebo-controlled trial with chronic hemodialysis patients found that 1,700 mg of omega-3 fatty acids daily was associated with a 70% reduction in the relative risk of myocardial infarction. (Svensson et al. 2006)
- A randomized, controlled trial using 3,300 mg of EPA and DHA (and then a decreased dosage) found a trend toward lower cardiovascular event occurrence with fish oil supplementation. Seven cardiovascular events occurred in the placebo group (not given fish oil) while only two cardiovascular events occurred in the fish oil-supplemented group during the study. (Von Schacky et al. 1999)
- A meta-analysis with an average fish oil dose of 3,700 mg found lowered systolic blood pressure by an average 2.1 mmHg and diastolic by 1.6 mmHg. (Geleijnse et al. 2002)
- In a large intervention study, 18,000 patients were randomized to receive either a statin medication alone or a statin plus 1,800 mg of EPA-fish oil daily. After 5 years, those with a history of coronary artery disease had a 19% lower rate of major coronary events in the statin-plus EPA-fish oil group compared to the statin-only group. (Yokoyama et al. 2007)
The study that’s most highlighted by fish oil critics is the New England Journal of Medicine, 2013 Italian study looking at over 12,000 patients. Fish oil supplements did not prevent heart problems in people taking one gram of fish oil supplement who hadn’t had a heart attack yet, compared to those taking one gram of olive oil every day as a placebo.
Patients in the study had risk factors for heart disease, such as high blood pressure, high cholesterol, a history of smoking or narrowed arteries. Certain factors did seem to improve slightly more in the fish oil recipients, such as levels of fat and good cholesterol (HDL) in the blood.
Also there was modest protection with women treated with fish oil having 18% lower risk of the cardiovascular event when compared with women treated with placebo. (Roncaglioni et al. 2013)
Why did the Italian study have such a poor outcome on those taking fish oils? Actually, the outcome was not that bad for women but you would expect better results for sure. Or maybe 1 gram a day is too low of a dose. The antiplatelet, anti-inflammatory, and triglyceride-lowering effects of omega-3 fatty acids require relatively higher doses of DHA and EPA at about 3 to 4 g/day, whereas some of the antiarrhythmic effects, and improvement in HF can be achieved at lower doses (500 to 1,000 mg/day). (Lavie et al. 2009) I typically start my patients at about 3,000mg a day.*
Doggy Bag Message
If one looks at the research as closely as Fodor, yes, maybe there’s are flaws with how we started the fish oil craze. But thousands of studies later, we have compelling data showing us the benefits of fish oils. Fish oil supplements, in my opinion, are essential to good health. The benefits by far out way the risks.*
But wait a minute, why can’t we get our fish oils from eating fish? You ask.
You can but it is not that easy.
First off, salmon farms of some kind make up about 80% of salmon on the market today. (In the United States, the number is higher – 90% by some estimates.) Farmed salmon are largely confined and fed a steady diet of formulated protein pellets which make them fattier. However, Many assessments have found fewer omega-3s per ounce in farmed salmon compared with wild salmon, and higher omega-6 fatty acids (bad fat when too high). Lastly farmed raised fish contain high levels of environmental toxin like PCB’s and dioxins (really bad stuff).
So if you get the Alaskan, wild variety you are in good shape… sort of. The majority of “wild”-labeled salmon isn’t 100% wild. Most wild-caught salmon originate from hatcheries where they’re raised for the first half or so of their lives before being released into the wild for harvest later. Unfortunately, these fish are considered wild by regulating agencies, and no explanation is required for the “wild” label.
Can you get 100% wild fish? Yes you can but you will pay a premium and its not easy to find. Is it worth it? Oh yea.
One should never be cheap with food.
The best source of getting high quality 100% wild fish is from Vital Choice. They simply do things the right way. There are probably other sources out there but I don’t know of them.
So, if you consume 100% wild fish, cooked in lower temp, not over cooked 4 times a week, you may not benefit from additional fish oil supplements.
This reminds me, I have to put in my fish oil order.
Yokoyama M, Origasa H, Matsuzawa M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090-8.
Lavie CJ1, Milani RV, Mehra MR, Ventura HO. Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol. 2009 Aug 11;54(7):585-94.
Geleijnse JM, Giltay EJ, Grobbee DE, et al. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002;20(8):1493-9.
Von Schacky C, Angerer P, Kothny W, et al. The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1999;130(7):554-62.
Svensson M, Schmidt EB, Jørgensen KA, et al. N-3 fatty acids as secondary prevention against cardiovascular events in patients who undergo chronic hemodialysis: a randomized, placebo-controlled intervention trial. Clin J Am Soc Nephrol. 2006 Jul;1(4):780-6.
K. Yamagishi, H. Iso, C. Date, et al. Fish, omega-3 polyunsaturated fatty acids, and mortality from cardiovascular diseases in a nationwide community-based cohort of Japanese men and women. J Am Coll Cardiol, 52 (2008), pp. 988–996
D. Mozaffarian, C.L. Bryson, R.N. Lemaitre, G.L. Burke, D.S. Siscovick. Fish intake and risk of incident heart failure. J Am Coll Cardiol, 45 (2005), pp. 2015–2021
G. Zhao, T.D. Etherton, K.R. Martin, P.J. Gilles, S.G. West, P.M. Kris-Etherton. Dietary alpha-linolenic acid inhibits proinflammatory cytokine production by peripheral blood mononuclear cells in hypercholesterolemic subjects. Am J Clin Nutr, 85 (2007), pp. 385–391
Roncaglioni MC, Tombesi M, Avanzini F, Barlera S, Caimi V, Longoni P, Marzona I, Milani V, Silletta MG, Tognoni G, Marchioli R.The Risk and Prevention Study Collaborative Group. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med. 2013;368:1800-
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