Is it end of October already??
My ambitious plan to post simple summaries of cool research studies every Friday did no go as planned this Fall. Not only have I traveled internationally to collect data (dissertation, here I come!), but I also have 5 fantastic undergraduate apprenticeship students “working” in my lab this semester. So- a lot of time has been spent on training, learning how to train, and organizing/cleaning/analyzing the data they help collect for my work.
Nevertheless, it’s time for another post.
Have you heard that fish is healthy for you? That Omega 3s, the “good” fat, is crucial for health? Or have you heard the opposite and are totally confused?
It wouldn’t be a surprise if you were.. Perhaps you’ve seen news posts like this ->
In my interviews with folks in US and eastern Europe, the conversation includes”healthy fats” quite often. Everybody “knows” fish is healthy and we should all be trying to eat more omega 3 fats that are abundant in fish products for a healthy heart.
Yet in the last several years, many online sources reported on studies that refute these claims.
In this post I’ll briefly summarize a 2014 paper by Grey & Bolland. I believe you can even access it for free by clicking here.
Full reference: Grey, A., & Bolland, M. (2014). Clinical trial evidence and use of fish oil supplements. JAMA internal medicine, 174(3), 460-462.
What Grey & Bolland did was look for the best scientific work on the topic of omega 3 fats and how it affected sales of these supplements. Grey&Bollard summarized18 randomized clinical trials (between 2005 and 2012) that were published in high impact journals (=highest quality journals respected by the scientific community). Randomized clinical trials (RCTs) are considered the gold standard of research and present the highest level of evidence, so if you’re going to look at scientific support for any idea- clinical trials are the way to go!
What did those 18 studies show: well, only 2 studies reported benefits: a 2007 RCT on ~18000 people and using EPA for major coronary events, and a 2005 meta-analysis of RCTs on ~20000 people looking at effect of omega-3 oils and mortality. The other 16- no benefit… Fish oil sales? In the US between 2007 and 2012 fish oil and omega 3 supplements increased from $425 to $1043 million (!). Similar sales pattern were seen in England and Australia+asia. Technically, that’s not logical- if randomized clinical trials are the best and most robust type of scientific evidence, shouldn’t it influence current practices? The authors write:
“Since 10% of adults in the US take an Omega-3 or fish oil supplement, most commonly for heart health or to lower cholesterol, the null results of 9 of the 10 RCTs and 5 of the 6 meta-analyses studying cardiovascular disease might have been expected to influence use”
I have pulled up the 2005 meta analysis- one of 2 studies from the review that showed benefit to supplementation- to get a bit more detail on the results. Studer et al (2005)* analyzed 97 studies to examine the safety & efficacy of various lipid-lowering interventions using mortality data (= they looked at lipid-lowering supplement/drug use and how often people who took them and didn’t take them die. The separated deaths into 1)either from all causes, 2)cardiac events, and 3) noncardiovascular causes). Such large-scale analysis of these randomized controlled trials is a very important tool- it allows to look at the overall benefit of interventions. This meta-analysis found that two supplements/drugs had reduce risk of overall and cardiac mortality (deaths from all causes and deaths from cardiac events specifically): statins and Omega-3 fatty acids.
Sounds wonderful, but again: it was only 1 of the 2 studies that showed statistically significant benefit of Omega-3s, while the other 16 did not. (statistically significant= meaning something happened Not by chance alone)
* Full reference:Studer, M., Briel, M., Leimenstoll, B., Glass, T. R., & Bucher, H. C. (2005). Effect of different antilipidemic agents and diets on mortality: a systematic review. Archives of Internal Medicine, 165(7), 725-730.
So why do more people continue taking the supplements? Well, first of all, we can assume the public doesn’t read original studies and can be victim to “industry spin”. The “spin” used by industry is a strategy to hype findings and distort the results of clinical studies. Wang et al. (2014) in fact looked this: they analyzed 47 supplements industry press releases & 91 non-industry press releases in response to 46 clinical studies of supplements (published between 2005 & 2013). Result? 100% industry press releases contained “spin” while only 55% of non-industry media pieces did. Industry press releases also reported less on study details – outcome, sample size, effect size- specifically for studies that found no benefit of supplements.
Full citation: Wang, M. T., Gamble, G., Bolland, M. J., & Grey, A. (2014). Press Releases Issued by Supplements Industry Organisations and Non-Industry Organisations in Response to Publication of Clinical Research Findings: A Case-Control Study.
So why else? Well, omega 3 supplements aren’t terribly expensive and people don’t associate them with any RISK, so it makes sense that folks would rather be “on the safe side” and take them. Also, the belief that these fats are “good” can be rather long-term and hard to change- I remember my childhood friends in Ukraine suffering through spoonfuls of fish oil given by their parents. So having a strong long-term belief that fish oils/omega 3s are beneficial can create confirmation bias: looking for evidence that you already agree with and dismissing new research that doesn’t fit your view.
Lastly.. how can fish fat not be beneficial? While I, of course, can not answer that question, here is an interesting piece of the puzzle- genetic adaptation. While I was preparing for a lecture on evolution and human diet, I saw a fascinating research piece at the National Institutes for Health website. Originally, the focus on fish oils came from studies with the Inuit and they seemed very healthy on their traditional fat-rich diets (fat coming from marine sources). So it was thought that fish oil would have a protective effect against cardiovascular disease.. But Dr. Nielsen states:
“We’ve now found that they have unique genetic adaptations to this diet, so you cannot extrapolate from them to other populations”; “A diet that is healthy for the Inuit may not necessarily be good for the rest of us.”
Access full article here.
To supplement or not to supplement, then?
Looks like it is not clear whether dietary supplements with omega 3 fats really influence deaths from cardiovascular causes (strokes, heart attacks) or other causes (cancers) in the population. Yet there is also no evidence that we need to advise people to stop taking these supplements. I suppose it doesn’t hurt..unless it hurts your wallet too much.. Your wallet deserves some good support coming from a good number of randomized controlled trials. 😉