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. 

Vitamin C for Colds?

Okay, since I talked again about vitamin D last week, why not talk about a few more vitamins? What about Vitamin C for colds? Should it be taken as prevention, or as a cure? Can you get too much?


Honestly, the medical literature has gone back and forth on vitamin C and colds. Large studies have shown little benefit in prevention, unless you are an extreme athlete or living in very cold temperatures. For people in those categories, it appears Vitamin C in doses greater than 200mg per day can indeed decrease the frequency of upper respiratory infections. Skiers, perhaps you should start your morning with a big glass of juice instead of hot chocolate or coffee!

Where there does seem to be benefit across the board is when Vitamin C (again in doses greater than 200mg per day) is taken once you develop cold symptoms. At that point, Vitamin C seems to decrease the duration of symptoms.

How much is too much? The RDA is 75mg for women and 90mg for men. Supplements come in 100, 200 and 500mg tablets, plus I'm sure you've seen and maybe taken the mega-dose vitamin C packets that come in powder packets. These typically have 1000mg of Vitamin C (along with a handful of other vitamins). While C is water-soluble, which means that "extra" vitamin C not used by your body will simply exit in your urine, it is possible for megadoses (often exceding 2000mg per day) to cause kidney damage by precipitating a special type of stone formation in the kidneys.

What type of Vitamin C is best? As always, you are better off getting your vitamin C from whole foods-fruits like berries, red peppers, guavas, kiwis, and yes, oranges. You will NOT overdose from these natural sources!

BOTTOM LINE: Vitamin C may help shorten the duration of a cold, and could help with prevention for those in cold climates or if you will be doing "extreme" physical activity.

Supplements for Alzheimer's Disease

Bummer- another study that shows a specific supplement does NOT, in fact, delay or halt progression of Alzheimer's Disease. This study is titled Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease, better known as DHA. We believe that DHA, a fatty acid used in the brain, has beneficial effects when taken as a supplement in humans. The question was whether or not taking this supplement would help to delay the progressive memory loss and other dysfunctions in Alzheimer's.

The completed study involved around 300 people with mild to moderate Alzheimer's disease. They randomly received either a placebo or 2g of DHA daily for eighteen months (it was randomized and double-blinded- our gold standard in research.) Cognitive tests were given at the onset and a year and a half later. Unfortunately, the people in the trial who received the DHA supplements were no better off on cognitive tests nor on brain atrophy at the end of the study.

We have been through this same process with Vitamin E, estrogen, and a number of other over the counter supplements. I remain optimistic that there may be a dietary or behavioral modification that does make a difference, as well as new medications that will not only stop the progression but some day reverse the dreaded decline of dementia with Alzheimer's.

BOTTOM LINE: Let's continue to support Alzheimer research, as we now have yet another supplement (DHA) proven to NOT be successful.