Source, Strength and Sustainability

There has been a resurgence of criticism for omega three fatty acid supplementation recently. Some of the buzz has looked at old data while other articles are speaking to more recent concerns related to the consumers pocket book asking, “should I or shouldn’t I spend money on an Omega III Fatty Acid supplements?” The recent analysis was a January 2018 synopsis in JAMA Cardiology looking at data from 10 randomized trials. The trials evaluated both men and women with high risk for, or current cardiovascular disease. Combined the trials looked at nearly 78,000 individuals. Impressive numbers, right?
Before taking an ultimate stand on the “Will we or won’t we continue recommending omega III fish oils to our patients?” debate, I thought it prudent to first look at the study. Sixty-One percent of the collective study individuals were men, 39% women, with an average age of 64 years for both genders. While I do not need to tell you the study participants are prime candidates for the question, “Should I take an omega III?” What this study group is not, is a prime group to ask, “Do omega III fatty acids prevent heart disease” as the majority of participants already had heart disease and a previous cardiac event.
Let me put some color on that for you. The studies included participants where 66% percent were treated for Coronary Heart Disease, 27.6% had a previous stroke and 36.9 % had comorbid Type II Diabetes making prevention a somewhat distant question. Still, when deciding to approve or disapprove of omega three fatty acid supplementation, prevention was the question the JAMA analysis asked.
Of course these studies, except for one, which was a study on age related macular degeneration, had a similar goal – to weigh the benefits of omega-3s on cardiovascular risk, potential for myocardial infarction or recurrence of a cardiovascular event. The “pro” to the study analysis: it evaluated a large collective group of people, just about 78,000 individuals. The “con” to any review of this type, however, is that some of the studies included were based on a small group of individuals and were treated as if their results represented a large group.
Because the study size ranged in size from 563 individuals to 18,645 individuals, we could expect potential for a large sway in comparing endpoints based on the age, gender, health, etc. of the participants. Additionally, omega III fatty acid takers in the study were taking inconsistent amounts and different forms of fish oil. With some consuming as little as 226 mg and some as much as 1800 mg, while some took just EPA and others took a combination of EPA and DHA. Only three of the ten trials included amounts of omega III fatty acids that are the minimum amount recommended by the American Heart Association for prevention, let alone amounts for treatment of Coronary Heart Disease.
The American Heart Association recommends the consumption of two to four grams of EPA and DHA for those with documented heart disease. This is as much as three times the consumption reported in the majority of the studies included. Furthermore, the authors state a limitation of the analysis was smokers were not disqualified from participation in the chosen studies, which would make it difficult to answer the question “why do these people have heart disease and what would have the strongest effect for prevention?”
Why is prevention of the next event not a worthy question? I would say it is. The study authors did note, while the media did not, the meta-analysis did show a 7% reduction in major vascular events and a 10% reduction of risk of Coronary Heart Disease association with those that take an omega III supplement.
What may be missing from the conversation is the importance of dietary intake of omega III fatty acids as they are essential, meaning the body cannot synthesize them so they must be consumed. If not consumed in diet, then supplementation is a prudent if not an essential step toward better health. At this time, less than one in five people in the United States eat fish two or more times per week which is necessary to get the minimum amount recommended by the current Dietary Guidelines for Americans and by the American Heart Association.
“So omega-3 supplementation is a viable option, especially for anyone who doesn’t eat fatty fish, like salmon and sardines, regularly. Omega-3s help lower triglycerides and support healthy blood flow—two factors which play a role in coronary heart disease.”- Duffy MacKay, N.D., senior vice president, scientific and regulatory affairs, Council for Responsible Nutrition
Omega III fatty acids, specifically EPA and DHA from high quality supplementation, is not be the only step one can take toward better heart health, but it may be a one step closer to prevention and should be taken along with regular exercise, sleep and a diet that is customized for you. Take into consideration your gender, age and activity level. When you reflect on the “cost” of heart disease, small steps like supplementation can lead to large rewards such as improving the quality of your health and an outcome continually confirmed by science.