Tuesday, April 10, 2012

Et tu fish pills?

In his tragic play Julius Caesar, William Shakespeare created a powerful scene that has given many pause for thought. In the scene, Julius Caesar, the Emperor of Rome, is set upon by assassins (senators of Rome) that includes his friend Marcus Brutus. Although Caesar initially resists the attempt on his life, he relents when he discovers his close friend is among the conspirators. At that point, he utters the classic Latin phrase, "Et tu Brute, then fall Caesar." The loose translation is that Caesar is asking, "you too, Brutus?" This is widely understood to represent Caesar's acknowledgement that if his close friend is involved he knows that the nefarious deed against him must succeed. It is an utterance of sheer capitulation.

A reader of this blog knows that I am not a fan of supplementation. Notwithstanding, one dietary supplement that I have been kind to has been fish oil pills. It has been my understanding that these pills generally do good and in the absence of eating actual fish, are the next best thing.  It turns out I was too generous. I too now cry out in capitulation, "Et tu fish oil?"

Fish oils (omega 3s) are often recommended, even by many in the medical establishment, as a natural means to lower cholesterol and prevent cardiovascular disease. Given the prevalence of heart disease in our society, it's not surprising that pills containing it are among the most widely used dietary supplements. Many fish oil marketers make claims that fish oil is not only good for preventing disease, but also reversing it. In addition, many marketers of fish oil sell mega-doses with the implication that the more you take the better.

Two recent reports shed some meaningful light on these two assertions.

In a Nutritional Research Report developed by Tufts University (Boston, MA) and prepared for the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, Tuft's researchers concluded that the maximal positive effect of eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), the two fatty acids known as Omega-3s, appears to plateau at a mean daily intake of 0.20 grams or 200 milligrams. There is no evidence that the effect of EPA and DHA on mortality phenotypes differs across populations and settings. In plain-speak, this means these findings hold true for all populations and that above 200 mg per day there is no additional benefit (it does make you fatter, however) from taking extra fish oil.

The second study looked at the benefits of taking fish oil when heart disease already exists. The study published in the Archives of Internal Medicine throws the theory into doubt: based on an analysis of 14 controlled trials in which nearly 20,500 patients with a history of heart disease were randomly assigned to take omega-3 supplements or placebo. It turns out that those taking the fatty acid pills had about the same rates of heart disease, including dying from heart attacks, congestive heart failure and stroke as did those who took placebos.  The authors of the study were quick to caution that this applies to fish oil supplement pills, but may not apply to consuming fish oil by eating fish that naturally contain these fatty acids..

Slowly but surely, every known dietary supplement, as it is subjected to closer scrutiny falls by the wayside as a viable product. Yet, sales continue to grow. Like many of Shakespeare's plays, this should be construed as a tragedy because money is being wasted on false hopes and possible harm. 
If you don't like what you are hearing, please don't shoot the messenger. I am not ignoring the studies that show the benefits of such supplementation. They simply don't exist or are not being published in any reliable peer reviewed journal. I will faithfully report any that I come across. In the interim, I find the mounting evidence against dietary supplementation to be convincing and in the case of fish oil pills, this new data merits serious consideration.

The bottom line remains that you should get your vitamins and minerals from vegetables and fruits, and you should get your fish oil from fish, preferably Wild Alaskan Salmon. Otherwise, you may find out one day, as Caesar did, that the dietary supplement(s) you held dear was actually not your friend.

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