Omega-3 evidence fishy… or not?


fish oil

A recent Cochrane review found little evidence to support omega-3 supplements, but CMA urges consumers to look at the “large body of evidence” for their use

Results of the recent review, including 79 randomised controlled trials (112,059 participants) of moderate‐ and high‐quality evidence, suggested that increasing omega‐3 polyunsaturated fatty acids has little or no effect on mortality or cardiovascular health.

Trials were of 12 to 72 months’ duration and included adults at varying cardiovascular risk, mainly in high‐income countries.

Most studies assessed long‐chain omega‐3 supplementation with capsules, but some used long‐chain omega‐3‐ or alpha‐linolenic acid‐rich or enriched foods or dietary advice compared to placebo or usual diet.

The Cochrane researchers found that increasing long-chain omega-3 provides little if any benefit on most outcomes they examined, and had little or no meaningful effect on the risk of death from any cause.

According to the results, taking more long-chain omega 3 fats, primarily through supplements, probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities.

However increased alpha‐linolenic acid (from plants) may slightly reduce risk of cardiovascular events, and probably reduces risk of CHD mortality and arrhythmia.

In response to the findings, Complementary Medicines Australia (CMA) pointed to the “large body of evidence” that it says supports omega-3 fish oils in contributing to good health.

“Nutrients really shouldn’t be treated like they’re drugs,” said Mr Carl Gibson, CEO of CMA.

“This review was still only looking at short-term trials, running for 2-3 years on average, and using low doses of omega-3 supplements.

“It’s no shock that you might not be able to replicate the beneficial effects of consuming fish or taking omega-3 supplements over time.”

He  continued: “Industry experts noted that the doses of omega-3s typically used in the studies were unlikely to produce a cardio-protective omega-3 blood level, noting that if you are going to treat omega-3s like a drug then a high enough dose needs to be used and blood levels monitored.”

CMA strongly advocates the use of a high quality fish oil supplement to ensure that the intake amount and efficacy is assured.

Associate Professor Karam Kostner, Director Cardiology at Mater Hospital in Brisbane, and Associate Professor of Medicine, University of Queensland, says some recent studies have not demonstrated significant effects of the long-chain omega-3 polyunsaturated fatty acids found in fish oil on cardiovascular disease outcomes, in contrast to several large earlier trials in patients with coronary artery disease and heart failure.

“This might impact on how you answer questions from customers in the pharmacy,” says Associate Professor Kostner, who has written an article on the topic for pharmacists.

“But it is important to bear in mind that these findings do not mean that long-chain omega-3 polyunsaturated fatty acids are ineffective in general, rather that they were not found to be effective in the context of the trials in which they were tested.”

Heart Foundation chief medical adviser, cardiologist Professor Garry Jennings, said the Cochrane review found omega 3 supplementation was neither helpful nor harmful for heart health in people with or without heart disease.

“This aligns with the Heart Foundation’s current position, which does not advise that health professionals routinely recommend omega-3 supplements for heart health.

“However, omega-3 supplements can be of value in people with high triglyceride levels and there is some evidence for considering their use in heart failure.”

Want more information? See: Fact versus fiction: Understanding the evidence base supporting vitamin and mineral supplementation, written by Associate Professor Karam Kostner, MD, PhD, Director Cardiology at Mater Hospital, Brisbane, and Associate Professor of Medicine, University of Queensland.

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