A recent study in the New England Journal of Medicine (NEJM) recruited 25,000 subjects, average age 67 and was split into four groups:
- One group took 2,000 IUs (international units) of vitamin D3 and 1 gram of omega-3s every day. (1 g per day as a fish-oil capsule containing 840 mg of n−3 fatty acids, including 460 mg of eicosapentaenoic acid [EPA] and 380 mg of docosahexaenoic acid [DHA])
- A second group was given vitamin D and a dummy pill in lieu of omega-3.
- A third group got omega-3s and a vitamin D placebo.
- And the final group received two placebos.
Researchers concluded that omega-3’s and vitamin D supplementation do not lower cancer rates in healthy adults, nor reduce the risk of heart attacks, strokes, and deaths from cardiovascular disease. (part of the story published in the New York Times)
The results of the NEJM was not all negative. There seemed to be a reduction in cancer deaths for people who took vitamin D for at least two years, and fewer heart attacks (28% less) in people who consumed omega-3 supplementation.
African-Americans who ate a little fish and took fish oils, in the NEJM study, experienced a 77 % reduction of cardiovascular disease.
So, now what?
Firstly, the trial was well designed: it was a randomized controlled trial (RCT), which is gold-standard (particularly when studying single agents), it studied healthy people (not diseased), and it was the largest-ever RCT of vitamin D supplements.
Many patients and nutritionally minded people are taking fish oils and vitamin D. Is that a waste of money? Is the take of supplements simply expensive urine?
Let’s start with this; The idea that participants in the NEJM trial were “healthy” is incorrect.
The average BMI was 28. A person with a BMI ≥ 25 is overweight or obese.
Larger people, for example, need more vitamin D than slimmer people. The amount used in the study (2000 units) will not get most to the optimal range of 40ng to 60ng/ml. I almost never clinically see 2000 units a day of vitamin D work in getting patients to the optimal range of 25- hydroxyvitamin D (how vitamin D is measured in blood).
Also, almost 50% of participants were on hypertensive drugs, and over 7% smoked. What’s healthy about that?
Secondly, eating clean, exercise and healthy behavioral habits are key to prevent and manage disease successfully. Dietary supplements do not replace that.
Lastly, we should consider the preponderance of research, not just the latest study before applying changes to our nutrition regimen.
For example, another study showed among cancer patients, higher 25-hydroxyvitamin D levels at diagnosis lived longer.
Published in one of the most prestigious journals in the world, the Lancet, a dose of 1 g or more of omega−3 fatty acids per day showed significant protection against coronary events.
The Takeaway on Vitamin D and Fish oil supplements
Vitamin D and Fish oils work best with a lifestyle and behavioral practices that support optimal human functioning. However, many research papers show these nutrients support human health on their own.
Here are some examples:
- Vitamin D helps with reducing Lower Urinary Tract Symptoms (LUTS)
- Vitamin D and Fish oils can help with depression.
- Vitamin D deficiency can lead to aggressive prostate cancer. Though intake of vitamin D was not tested, the implication is it lowers the risk of deadly prostate tumors.
- Vitamin D helps in men with an enlarged prostate (BPH)
- Dietary supplements complement that kind of lifestyle very well; it does not replace.
- Fish oils help lower blood pressure
- Lastly, a derivative of the Omega-3 EPA recently showed a decrease in lower triglycerides and decrease the risk of cardiovascular events at 4 grams a day. This likely means that a measly 460mg (0.46 g) a day of EPA as studied in NEJM is not enough for protection.
What Should You do?
Consider seeing a nutritionally oriented doctor. Such physicians are trained in naturopathic and functional medicine and are experts in prescribing lifestyle practices and quality supplements therapeutically.
Also, there are numerous factors to consider when taking dietary supplements:
- Manufacturing practices matters. Not all dietary supplements are created equal. The good ones are regulated by cGMP(Good Manufacturing Practices). The better ones go beyond cGMP testing.
- Consume the right ingredients that are specific to your needs. I can’t tell you the number of patients I see taking more supplements than what they need. Some take toxic amounts of certain vitamins. For example, high vitamin E intake (400units) in the form of dl-alpha tocopherol (not high in gamma tocopherol or mixed tocopherol) can increase the risk of prostate cancer. To be clear, vitamin E, high in gamma tocopherol may protect against prostate cancer while alpha-tocopherol alone is unnatural and can increase its risk.
- The dose is important. And there’s a difference between a maintenance dose and a therapeutic dose. For example, when taking vitamin C to fight a cold, about 500mg every two to three waking hours work best. The body cannot absorb more than 500mg at one time. So, taking 1,000mg of vitamin C at one time might be a good maintenance dose but will not do the trick.