- Does this really help to keep me healthy?
- What leads me to think that it is beneficial?
If you are self-medicating, have embraced the advertising, but have not really given it too much thought, then the one benefit that we can be truly sure about is that it will help transfer your wealth to the manufacturer of the supplement.
Latest Update: Fish Oil (Omega-3) supplements
There is a new Cochrane review of the use of Omega-3 fatty acids that looked specifically into the idea that these were good for your heart. When it comes to the best possible evidence-based medical guidance, then a Cochrane review is the gold standard, so in essence this is as good as it gets when it comes to knowing if it will or will not help.
They not only have the full technical details, but they also very helpfully have a plain language summary.
(Spoiler alert: The supplements don’t work)
Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease
Omega-3 intake for cardiovascular disease
Review question
We reviewed randomised trials (where participants have an equal chance of being assigned to either treatment) examining effects of increasing fish- and plant-based omega-3 fats on heart and circulatory disease (called cardiovascular diseases, CVD, which include heart attacks and stroke), fatness and blood fats (lipids, including cholesterol, triglycerides, high-density lipoprotein (HDL – ‘good’ cholesterol) and low-density lipoprotein (LDL – ‘bad’ cholesterol)).
Background
Omega-3 fats are essential – to stay healthy we must obtain some from food. The main types of omega-3 fats are alpha-linolenic acid (ALA), a fat found in plant foods, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both found in fish. There is a common belief that eating more fish or taking omega-3 supplements reduces our risk of heart disease, stroke and death.
Study characteristics
The evidence is current to April 2017. The review included 79 trials involving over 112,000 people. These studies assessed effects of greater omega-3 intake versus lower or no omega-3 intake for heart and circulatory disease. Twenty-five studies were very trustworthy (well-designed so as not to give biased results). Participants were adults, some with existing illness and some healthy, living in North America, Europe, Australia and Asia. Participants increased omega-3 fats, or maintained their usual fats for at least a year. Most EPA and DHA trials provided capsules, few gave oily fish.
Key results
Increasing EPA and DHA has little or no effect on all-cause deaths and cardiovascular events (high-quality evidence) and probably makes little or no difference to cardiovascular death, coronary deaths or events, stroke, or heart irregularities (moderate-quality evidence, coronary events are illnesses of the arteries which supply the heart). EPA and DHA slightly reduce serum triglycerides and raise HDL (high-quality evidence).
Eating more ALA (for example, by increasing walnuts or enriched margarine) probably makes little or no difference to all-cause or cardiovascular deaths or coronary events but probably slightly reduce cardiovascular events, coronary mortality and heart irregularities (moderate/low-quality evidence). Effects of ALA on stroke are unclear as the evidence was of very low quality.
There is evidence that taking omega-3 capsules does not reduce heart disease, stroke or death. There is little evidence of effects of eating fish. Although EPA and DHA reduce triglycerides, supplementary omega-3 fats are probably not useful for preventing or treating heart and circulatory diseases. However, increasing plant-based ALA may be slightly protective for some heart and circulatory diseases.
Cochrane also published responses from Subject matter experts
Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield:
“Previous experience has shown that although some types of diet are linked to lower risk of heart disease, when we try to identify the beneficial element of the diet and give it as a supplement it generally has little or no benefit. This was the case for vitamins; we know a diet rich in vitamins is associated with lower risk of heart disease, but studies giving people vitamin pills showed that these gave no benefit and indeed may have caused harm.
“This analysis of many studies shows clearly that omega-3 supplements do not reduce heart disease This is in keeping with medical practice; although there was a period where people who had suffered a heart attack were prescribed these on the NHS, this stopped some years ago. Such supplements come with a significant cost, so my advice to anyone buying them in the hope that they reduce the risk of heart disease, I’d advise them to spend their money on vegetables instead.”
Bottom Line
The fish oil supplements don’t work.
If you are wondering if there is anything that you can do, then the answer is yes there is. No, I’m not about to try and flog you some alternative supplements, or a book, or … well basically none of that. I’m a not-for-profit blog, my only interest is in finding out the things that are really true and then sharing that insight.
So what can you do that has been scientifically proven to work?
Basically pay attention to these 5 things and you will harvest some real benefit …
healthy diet, regular exercise, lean body mass, not smoking, and limited alcohol use
… and I’m not making that up, there is good solid robust evidence that those five really do work and are highly effective.
For reference, here is the latest of many studies that confirms that these five basic lifestyle factors really do have a dramatic impact on longevity and the risk of death from heart disease, cancer, or other causes.
This is something you probably know, and yet many of us don’t pay attention to it. If you are not doing these now, then pause and consider them because the evidence is both clear and robust that this is your best bet.