Omega 3 supplements — increasing the evidence base

I have written on numerous occasions about the push from orthodox medicine to prove that complementary medicine is of no value and in some cases may even cause harm. It is my view that many conservative researchers cherry-pick evidence to suit their rather weak argument and ignore multiple papers which demonstrate a variety of benefits, if you look at the evidence objectively.

One of the most researched complementary medicines are Omega 3 fatty acids. There have been numerous studies performed over the past few decades which have suggested extremely conflicting results. The early studies of Omega 3 supplementation suggested a significant reduction in cardiovascular events e.g. GISSI trial showed around a 30% reduction in heart attack and close to a 50% reduction in sudden cardiac death in people after a heart attack treated for 12 months with 1 g/day of Omega 3 oil. But, there have been a number of meta-analyses showing no significant benefit from the use of Omega 3 supplementation.

In the January 2017 Mayo Clinic proceedings, a large meta-analysis suggested Omega 3 studies over less than 5 years showed no benefit from supplementation but when the data examined patients studied over 5 years was considered, there was an 18% reduction in cardiovascular events. The most recent meta-analysis from the Journal of the American Heart Association published by the Harvard study group looked at 13 trials of 127,477 patients demonstrating an 8% reduction in heart attack and coronary heart disease death. The average age of the people in the trial was 64 years old of which 60% were male with an average BMI of 28. The follow-up only went for 5 years. The dose range was somewhere between 376–4000 mg of Omega 3 fatty acids per day. Most trials were greater than 850 mg of Omega 3 fatty acids per day.

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A particularly powerful and interesting trial published recently in the New England Journal of Medicine, again from the Harvard group was known as the REDUCE-IT trial. This was a trial of 8179 patients followed up for 4.9 years. 70% of the patients in the trial were for secondary prevention (i.e. they already had existing heart disease) whereas the remainder were at high risk for heart disease. All had abnormal blood fats and in particular high triglyceride levels. It was a placebo-controlled trial where the active treatment was 2 g twice daily of the purified form of EPA, one of the key Omega 3 fatty acids.

The results showed a 25% reduction in the following events: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularisation such as bypass surgery or stenting and unstable angina.

It is my opinion that most trials of complementary medicines use too little, too late to reduce these hard end points mentioned above, but if the trial is well-designed with the correct dose of Omega 3 fatty acids then the benefits are really quite obvious such as we see in the REDUCE-IT trial. All of this data clearly shows that it is not enough to consume one standard fish oil capsule per day which typically contains around 300 mg of Omega 3 fatty acids. If you want a true benefit from fish oil supplementation it is important that you take at least 1 g/day of Omega 3 fatty acids and if you are at very high risk for cardiovascular events, even more. Many doctors will say that all supplementation does is give you expensive urine but it is my view that if you take the correct dose for a prolonged period of time that the supplements also give you expensive blood, which is exactly what you want.

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