In our last blog, we discussed JAMA and how their most recent study on the effectiveness of Omega 3’s as supplements for cardiovascular health may not be as accurate it states. Below, I’ve broken down the possible errors and why you shouldn’t rule Omega 3’s of your diet too quickly:
The authors excluded studies with fewer than 500 participants and duration of less than a year with no justification. There has to be a reason to exclude data. It isn’t proper to make a note that some data was excluded without justification. Why were smaller studies, that are generally easier to manage and sometimes with higher quality supplements, excluded? Why was only American literature reviewed? Often studies from other countries show a greater knowledge of nutritional topics and are often less influenced by drug companies. Excluding European studies perpetuates medical and cultural blindness and ignorance of superior treatment options.
The inclusion of studies that employed nontherapeutic dosing. The authors stated that no minimum dose of EPA or DHA was specified. Reading this should give you serious pause. Here is a study that is supposed to draw important conclusions with no control of the active ingredient being tested. You don’t have to be an experienced scientist to see how ridiculous this study is just from this point alone. It follows that subtherapeutic dosing should lead to subtherapeutic results. Too many studies that try to demonstrate a negative outcome use less than therapeutic dosing and this study is one of those. To put a fine point on this concept, to get therapeutic results, we should study therapeutic doses. It is easy to shortchange a nutrition supplement by using either low doses and/or low-quality supplements and/or short durations.
Therefore ERROR 2 demonstrates a serious study design error and not an effectiveness problem of omega-3 supplementation. Any researcher knows that a thorough pharmaceutical study will have strict definitions of dosages with body weight and sex and age are taken into account. Likewise, a credible nutritional supplement study will begin with target dosages and not leave this as an undefined variable.
Therefore, this study has deviated from the basic norms of science and isn’t worth the paper it is written on so to speak. A study like this highlights the inherent bias of a journal like JAMA Cardiology and the bias of the editors to allow a flawed study like this move through the screening system. It makes you wonder how a serious scientist would put their name on something as flawed as this without some career and/or financial incentive.
Let’s continue with ERROR 2. The majority of people involved in the study were elderly people with conditions such as metabolic syndrome, obesity and a history of cardiovascular disease like post-myocardial infarction. It is not appropriate to use a preventative therapy like fish oil as a disease treatment. These high-risk people would naturally need higher doses than might be appropriate for younger, healthier people. Many authors would recommend a minimum of 1800 mg of EPA + DHA, not one or the other. DHA is not specified in one study and this is critical for lower inflammation and balancing blood lipids. (Am J Clin Nut 10.3945/ajcn.116.131896).
Only three of the ten of the studies analyzed used even a minimum therapeutic, prevention dose. A pharmaceutical study would NEVER say that 10 mg was a therapeutic dose and then gather several studies that used only 3 mg and then decide based on the collection of those studies that the drug was ineffective.
The article “Supplementation with high-dose docosahexaenoic acid increases the omega-3 index more than high-dose eicosapentaenoic acid” Prostaglandins, Leukotrienes and Essential Fatty Acids, Vol 120, May 2017, indicates that DHA supplementation is more important than EPA for raising the O3 Index that relates most positively to CV risk.
To say this more simply, DHA has been shown to be more cardioprotective than EPA. In this JAMA study, 6 of the 10 studies has little or no DHA supplementation so we can expect little or no cardioprotective activity from this dosing. See ishnfm.org/d.
Nutritional interventions such as fatty acid supplementation function via changes in structure and function in cell membranes and gene expression, not the drug blocking effects of enzymes and receptors. Therefore it takes time to see physiological changes to reach a new steady state and that can easily take 5 months of constant treatment.
Note the article: “Determinants of Erythrocyte Omega-3 Acid Content in Response to Fish oil Supplementation: A Dose-Response Randomized Controlled Trial.” J Am Heart Assoc 2013. O3I (omega -3 index) which is the sum of EPA-DHA content in red blood cell membranes is a biomarker of omega-3 fatty acid status, that is highly correlated with myocardial EPA-DHA content. An O3I of >8% (10% is better) has been recommended as a cardioprotective level on the basis of associations with reduced risk of primary cardiac arrest, sudden cardiac death, coronary atherosclerosis and acute coronary syndrome. Studies of people not taking omega-3 fatty acid supplements mean O3I values range from 4-5%.
Study participants who took 900 mg/day raised their O3I to 6.6% to 8.3%. Those taking 1800 mg/day achieved O3I to 8.9% to 10.5%. Again 3 studies of 10 of the original article provided something like 1800 mg/day of omega-3 fatty acids. So how does a study of omega-3 fatty acids in a cardiology-based journal get published without even mentioning the omega -3 indexes (O3I)? This is the intentional perpetuation of nutritional ignorance in a clinical population that receives little or no nutritional education.
9 if the 10 studies analyzed used a synthetic ester form of fatty acids in contrast to the natural triglyceride. This is similar to a study a few years ago that supposedly found a negative response in the prostate health of men using vitamin E. Instead of natural E, a synthetic form was used that was not vitamin E at all but was called vitamin E for the purposes of this study.
The conclusion stated that no significant associations with coronary heart disease death, nonfatal myocardial infarction or any coronary heart disease events. Looking at the actual data, however, even with the subtherapeutic dose and poor-quality omega-3 fatty acids, we see actual improvements in those three cardiac categories listed. Most of the graphs actually show more data points favoring fish oil supplementation.
Authors were associated with medical schools with a history of being hostile toward nutrition or were paid directly by pharma that provides drug therapies for CV disease.
A good option for you might be Nordic Naturals ProDHA. It comes in two strengths with 2 softgels containing 205 EPA/480 DHA or 410 EPA/960 DHA. For a minimum therapeutic dose, you would need 3 of the larger dose soft gels or 6 of the lower dose version. You can always start with the lower dose and work up to give your body a chance to adapt. We don’t see many problems with taking fish oil but if you are highly sensitive to supplements there is no harm in working up to that higher dose.
You might imagine that we are going full steam ahead with recommending things like DHA and EPA and L-arginine and L-citrulline for those with heart issues or those with any kind of family history of heart problems and want to stack the deck in your favor. For more on these types of supplements and other supplements for cardiovascular health, visit us at OVitaminPro.com or give us a call and one of our helpful team members will help find you a supplement that fits your health needs.