To Supplement or Not to Supplement–Are Fish Oil Capsules Effective?

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Seafood of all kinds--but particularly salmon and anchovies--are packed with omega-3 fatty acids. But if you don't like seafood, are fish oil capsules a good replacement?

A September article in the Boston Globe reviewed the case for taking fish oil supplements as a prophylaxis against heart disease and found the evidence lacking. The Globe story was based on the results of a review paper by Dr. Moses Elisaf of the Lipid Disorders Clinic at the University Hospital of Ioannina in Greece published in the September 2012 Journal of the American Medical Association. Not long after, the New York Times posted a story on how you might be better off just eating fish.

Fish oil supplements have been touted as a remedy from everything from heart attack to Alzheimer’s disease and Packaged Facts, a website that does market research and analysis, “projects the market value of EPA/ DHA omega-3 products to reach $34.7 billion in 2016,” So clearly, fish oils and omega-3 are big business and people believe in their usefulness.

But are they effective?

Physicians have recommended fish oil supplements as a treatment for the reduction of triglyceride levels (TG) for many years- the FDA supports the use of fish oils for the reduction of TGs in pancreatitis- but they and their at risk patients have also used them as a possible deterrent to future heart attack and stroke.

Epidemiological studies of fatty-fish eating populations solidly point to an association between high intakes of fish and lower rates of heart disease. However, proof of a causal link between the two has remained inconclusive with some studies finding a benefit and others unable to support a link.

Dr. Elisaf and colleagues reviewed 20 well-designed studies dating from1989 to 2012 involving 68,680 participants. The subjects were taking fish oil supplements or placebo every day for at least a year. They were followed for heart events, including death, heart attack and stroke.

The participants who took the omega-3 supplements did show a reduction in the rate of heart attack and heart-related deaths but it did not reach statistical significance.

Does this mean you should throw out your omega-3 pills bottles? Not necessarily. The study didn’t find any harm from taking the supplements. And there was a reduction in cardiac events in the supplement groups—just not a statistically significant one. Also, many of the studies in the review were not long-term trials and were looking at different doses of omega-3s.

Your decision to take fish oil supplements should also depend on who prescribed them (did you decide to take them or did your doctor recommend them?) and the reason you are taking them (is it for general cardiac health or is it to reduce triglycerides?). You should also consider whether or not you are able to incorporate adequate quantities of fatty fish into your diet. Regardless, it is always best to check with your health care provider before stopping or starting any supplement.

Whether you decide to take supplements or not, eating fish is still a healthy thing to do. Neither the study’s authors or major health care organizations have backed away from their recommendations of eating two servings of fish per week; preferably fatty fish like salmon and mackerel. Whole foods contain a mixture of nutrients that are not available in single-nutrient supplements. It may be that there are other components in fish that work in concert with the EPA and DHA (the active components of fish oils) to promote their benefits.

If you are interested in participating in a Joslin clinical trial on the benefits of fish oils for people with diabetes, please contact Katie Brooks at 309-2646 to find out more about the study or schedule an appointment.

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