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A Reply to an expert

I occasionally happen across expert blogs and columns by other doctors who are called on for their expertise. Recently one such physician surprisingly skipped the whole fish oil and prostate cancer nonsense and dug up another negative study” Fish oil No Good for Heart Disease” from way back in the Spring.

Now in this guy’s defense I saw a posting today from him where he actually says “We all know fish oil is good for your heart!”  Wow talk about a turn around. In less than 24 hours we have a complete reversal of point of view.

One thing you have to admit about me: I am consistent!

Here is my response to the negative comments about fish oil and heart disease.

 

Sir, I read with interest your blog conclusion that fish oil has failed to demonstrate benefit in numerous clinical trials. I wonder if you could answer the following for me concerning the Harvard study:

 

1) What was the dose of supplementation?

2) What was the format of supplementation – ethyl ester or triglyceride. It makes a difference since the actual bio active molecules EPA and DHA are found in significantly different percentages in the two different formats

3) What was the omega3/6 ration achieved in the trial

4) Was said ratio anywhere near what the epidemiologic data suggests is expected to reduce cardiac disease and stroke e.g. 60-70% omega 3 with 40 to 30% Omega 6

5) What other medications might have interfered with the effects of Omega 3’s

6) How long did these people carry the diagnosis of heart disease before they were exposed to fish oil supplementation

7) Were any follow up levels done to see if there was compliance and continuation of the supplement other than the word of the participants?

 

There has been a finger stick test(s) available cheaply with 95% accuracy compared to tissue sampling (tissue sampling not just venopuncture!) for the past 5 years at least so cost and accuracy are not an issue for any study with even minimal funding.

 

I am just guessing that the answers to the above are no or I don’t know since I saw that study and actually read it front to back and I do not recall one of those things was addressed other than the dosage which while it fits the party line recommendations was essentially too low to impact the Omega 3 content of a human body especially if it was 30% triglyceride based.

 

If this were a prescription drug and you were told it was added to see what it did to already maximal therapy in already sick people in a dose that was most likely nowhere near what was needed to have an impact and no clinical measurements were done to follow dosing/compliance of that drug would you consider that a valid study?

 

If you take the time to investigate the 2 fish meals a week recommendation and what it will actually do to Omega 3 levels you will find there is no basis for this either. Similarly if you take the time to investigate whether there are any relevant clinical end points concerning fish oil and bleeding, fish oil and immunosuppression and or immune surveillance you will also find there is no clinical human data to support those recommendations.

 

You will find Omega 3 supplementation being used to suppress Vtach, post op malnutrition, no risk with anti-platelet agents such as clopidegrel, no increased risk of bleeding complications in cardiac surgery etc. You will also find NK and cyto toxic T cell suppression which is extrapolated to mean an increased risk of infection. They leave out the fact that the average American in the study has an O3 level of 1/20 that in non diseased populations and the suppression of T cells etc is the result of restoring the normal level of inflammation in an inflamed population. You will not find any increases in infection rate. You will find a study that made headlines recently interpreted as “Fish oil could worsen High Blood Pressure” If you look at that study you will find the “scientific” basis for the myth that ethyl ester omega 3’s are not worthwhile and other formats might be. You will find that study was done with DHA only not EPA and DHA and that the warnings are based on the extrapolation of rat data to human disease. What you will not find is any comment that suggests the authors of the study researched the difference between omega 3/6 processing in omnivores (people) and herbivores (mice and rats). Similarly you will not find any mention that they consulted prior studies that showed that the metabolism of these fats in the two different species yields different ratios of eicosanoids, AA, resolvins iso prostanes and tissue stores and all of the attendant differences one would expect to find in animals that use food sources that are different from ours and have a different biochemistry attached to them than we do. You will merely find a conclusion that spread often by doctors that ethyl ester fish oil might be dangerous in people with HTN. You will also not find the conclusions of the numerous GISSI studies that showed completely different findings in studies whose n was over 15.000 each.

 

You will find the now famous and still touted Brasky study of last month equating fish oil to massive increases in prostate cancer did not answer any of the above questions either with one big exception. They did do a one-time level of Omega 3’s on the participants. The actual variation between all groups was 0.2% cancer or no cancer , aggressive or low grade, You will find the actual omega 3 level in all these people was a median of 22% which is the median for the US without supplementation. You will find in the NIH data base a study by W. E. Lands published in 2005 (Lands,  Lipids 2003 (Apr.); 38: 317–321) that shows primary prevention of heart disease starting at Omega 3 levels of 60% with similar epidemiologic data on cancer dementia auto immune diseases, depression anxiety, post-partum issues etc etc. But you will find all of medicine in this country parroting back fear based recommendations or worse, like Dr Brasky:”People need to consume more foods rich in Omega 6″!  I am not sure how much more inflamed as a society we are supposed to be. And yet you will find scores of doctors writing the following” Based on this study more work on this important question needs to be done!” More work may need to be done but it should not be based on this study unless the media now has injected their fear based reporting into the central agendas of science and medicine.

ON the fear based risk side, there is one historical anecdote to consider however. Lieutenant Robert Peary the famous Arctic explorer is reported to have said the following, “We noticed the natives (Eskimos) bleed rather profusely when shot.” So there is potential risk to high omega 3 levels at least when Arctic explorers are in the vicinity!

 

Then again who am I to question the work of the prestigious doctors at Mass General and Brigham Women’s.

 

 

Best,

Dave

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