Breaking News: Fish Oil Supplements "Out"?

Today the Journal of the American Medical Association (JAMA) published a study about the Association Between Omega-3 Fatty Acid Supplementation and the Risk of Major Cardiovascular Disease Events. The popular media has picked this up and many headlines are focusing on removing these fish oil supplements from your medicine cabinet- is that the take-home message? Maybe not...

There are a few separate issues to discuss. First of all, note that the reason there was a study to begin with is that it has long been established that populations with primarily fatty fish-based diets have lower rates of heart disease. Being Americans looking for a quick fix, we'd rather pop a pill than change our behavior, so rather than add fish to our diets, we look to taking a capsule filled with fish oil. Supplement studies, however, have not been as robust in demonstrating the same heart benefits as simply changing your diet. This study was a meta-analysis that examined over 3600 previous studies, ultimately including 20 of them that met criteria to eliminate bias and make them truly "evidence based". This included nearly 70,000 patients and their rates of heart attack, stroke, and death. Ultimately, fish oil supplements by themselves were NOT shown to lower the risk of death, heart attack or stroke. Do omega-3 supplements lower triglycerides? Yes- but if you are focusing on patient outcomes and not simply lab numbers, the benefits are not there.

Are there other reasons to consider taking fish oil supplements? Probably so, although I will continue to argue that you are better off adding salmon, tuna, trout or sardines to your diet several times per week. Beyond lowering triglycerides, Omega 3 Fatty Acids have been been recommended for potential benefit against numerous cancers, inflammatory bowel disease, dry eyes, rheumatoid arthritis and even dementia. If you are NOT willing to add fish to your routine diet, then taking fish oil supplements for any of these reasons may be beneficial, and there appear to be no serious negative effects (except for a shrinking wallet.)

BOTTOM LINE: If you are taking fish oil supplements to improve your cardiovascular health, you may be improving your lab values but not decreasing your risk of heart attack or stroke- go for a jog or go fishing (and eat your catch) instead. 

B Vitamins and Omega 3 Fatty Acids vs. Heart Disease

We are always looking for ways to prevent heart disease, the number one killer in the United States. As we gain technology, we are able to look at more and more components in our blood that lead to clot formation and heart attacks. You'd have to be hiding under a rock to not have heard about cholesterol levels, right?

Well, the trick in medicine today is to make sure that we are focusing on PATIENT OUTCOMES more than LAB VALUES. This is the premise behind evidence-based medicine, where we try to look at specific outcomes (did he have a heart attack or stroke) versus did we lower his cholesterol numbers. My patients hear me whine that so many people are willing to spend money on vitamins, supplements and prescription medicines to "lower their numbers" but are NOT willing to change their behavior to eat more fruits and vegetables and to exercise daily. Why do I complain? Because we DO have evidence-based medical data that shows convincingly more exercise and healthier diets not only lower weight, blood sugars and cholesterol numbers, but they decrease the number of heart attacks, strokes and deaths- and isn't that what we're looking for?

Along those lines, a study was published last month in the British Medical Journal that looked at whether or not giving B Vitamins and Omega 3's to patients who had already had a cardiovascular event (heart attack, stroke, or unstable chest pains) would reduce their subsequent numbers of additional cardiovascular events. What they found was that although the supplements worked better than placebo to change some blood tests, there was no difference in actual heart attacks and strokes.

What is the take home message here? Am I saying B Vitamins and omega 3 fatty acids are useless? NO, I am not. It does appear that they don't have great benefit when started AFTER you've already had a heart attack or stroke. Might they help prevent disease in a healthy person? Maybe.

BOTTOM LINE: Let's focus on the common sense changes that we KNOW benefit our health (MORE fruits and vegetables and exercise) and spend less time, money and energy chasing down lab values.