Here’s the context of why I incorporated the supplements into my routine.

Fish oil supplements have been hailed as a wonder weapon for heart health for decades.

Doctors routinely recommended them, and health-conscious individuals faithfully popped their daily dose.

My Goals

In this article, we will delve into the recent study published in BMJ Medicine that challenges the long-held belief about the benefits of fish oil supplements for heart health.

We will explore the potential impact of this new research and its implications for individuals who have incorporated fish oil capsules into their daily routines.

Additionally, we will discuss the traditional benefits associated with fish oil supplements and examine the study’s surprising findings, offering a comprehensive analysis of the implications for heart health.

First, a look at the potential benefits of fish oil supplements.

Fish Oil: Supporting Heart Health

Fish oil supplements, which boast high omega-3 fatty acids, EPA, and DHA, have been a mainstay in heart-healthy routines for years.

Traditionally, many viewed fish oil supplements as beneficial for heart health due to their high content of omega-3 fatty acids, particularly EPA eicosapentaenoic acid) and DHA (docosahexaenoic acid).

Here’s a breakdown of some potential benefits:

• Reduced triglyceride levels: There’s growing evidence that omega-3 fatty acids can significantly reduce blood triglyceride levels, a type of fat associated with an increased risk of heart disease.
• Lower cholesterol levels. The effect on cholesterol is more nuanced. While there may be a slight increase in “good” HDL cholesterol, some studies suggest a possible increase in “bad” LDL cholesterol.
• Better mental health. Omega-3 fatty acids might help prevent the onset or improve the symptoms of some mental health conditions like depression.
• Potential anti-inflammatory effects: Omega-3s possess some anti-inflammatory properties, which may be helpful in conditions like rheumatoid arthritis.

• Improve brain function: Some studies suggest omega-3s play a role in cognitive function and benefit brain health as we age.
• Pregnancy support. While some research suggests fish oil supplements during pregnancy and breastfeeding might benefit a child’s cognitive development, vision, and allergy risk, more studies are needed to confirm these effects definitively. It’s important to discuss any supplement use with your doctor before starting them, especially during pregnancy or breastfeeding.

Fish Oil, Heart Disease, and Stroke Risk

Given my current use of fish oil supplements, a recent British Medical Journal Medicine study on its pros and cons caught my eye.

Here are the research objectives:

• Participants: Over 415,000 individuals from the UK Biobank study, aged 40–69, were included.
• Objective: To assess the link between fish oil supplements and the risk of major cardiovascular events, including atrial fibrillation (irregular heartbeat), heart attack, stroke, and heart failure. Researchers also tracked deaths from any cause.

Study Follow-up

Researchers surveyed participants between 2006 and 2010 to gather baseline information on their health habits, including fish oil supplement use, dietary fish intake, and other lifestyle factors.

They then used medical records to track participants’ health outcomes until March 2021 or their death.

About one-third (31.5 percent) of the participants reported taking fish oil supplements regularly. This group tended to be:

• Older
• White
• More likely to be female
• Have higher alcohol consumption and oily fish intake
• Less likely to be current smokers or live in deprived areas

Key Findings

The study revealed a surprising association between fish oil supplements and heart health in individuals with no prior cardiovascular issues.

The findings indicated that using fish oil supplements had different roles in cardiovascular health, disease progression, and death.

Fish oil hurts those with no known cardiovascular disease

For those with no known cardiovascular disease at the start of the monitoring period, regular use of fish oil supplements was associated with:

• A slightly (1.13 times) heightened risk of developing atrial fibrillation
• A 1.05-fold rise in stroke risk.

Fish oil helps those with known cardiovascular disease.

Among those who had cardiovascular disease at the start of the monitoring period, regular use of fish oil supplements was associated with:

• A one-seventh (15 percent) lower risk of progressing from atrial fibrillation to a heart attack
• A one-tenth (9 percent) lower risk of progressing from heart failure to death.

In-depth Analysis

Further in-depth analysis revealed that age, sex, smoking, consumption of non-oily fish, high blood pressure, and use of statins and blood pressure-lowering drugs changed the associations observed.

Regular use of fish oil supplements and the risk of transitioning from good health to heart attack, stroke, or heart failure was 6% higher in women and 6% higher in non-smokers.

The protective effect of these supplements on the transition from good health to death was greater in men (7% lower risk) and older participants (11% lower risk).

Study Problems

The researchers acknowledge this is an observational study, meaning it can’t prove cause and effect.

For example, people who take fish oil supplements might also have other lifestyle habits that influence their heart health. Observational studies are a lower-quality type of research.

Additionally, the study needed more information on the dosage or specific formulations of the fish oil supplements used by participants.

This omission makes it difficult to draw precise conclusions about the impact of different fish oil types or amounts.

Finally, the study population was predominantly white.

The findings may not be generalizable to people of other ethnicities.

We require additional research with more diverse participants to confirm these results across different populations.

Fish Oil: Potential Risks

The National Institutes of Health gives a recommended daily dietary intake (RDI) of 1,100 mg for women and 1,600 mg for men.

WebMD explains:

While fish oil supplements have generally been considered safe at recommended doses (around 3 grams daily), this study raises questions about their impact on heart health, particularly those without pre-existing cardiovascular conditions.

Here are some general safety points to remember about fish oil supplements:

• Dosage matters: Taking with daily consumption of more than 3 grams might increase their risk of bleeding.
• Potential side effects: Common side effects include heartburn, loose stools, and nosebleeds. Taking fish oil with meals or freezing capsules can help minimize these.
• Dietary sources vs. supplements: Consuming high amounts of fish from your diet (due to potential mercury and contaminant risks) differs from taking fish oil supplements, which are typically processed to remove these impurities.

Considering fish oil supplements, it’s wise to have an open conversation with your healthcare provider to determine if they’re right for you, given your health.

Be Careful With Other Medications

Fish oil supplements can interact with certain medications, so it’s important to be aware if you take any of these:

• Blood thinners: Fish oil, like blood thinners (medications or supplements), can reduce blood clotting. Taking them together might increase your risk of bleeding.
• Blood pressure medications: Fish oil might slightly lower blood pressure. If you take blood pressure meds already, combining them with fish oil could lead to your blood pressure dropping too low.

• Birth control pills: Some birth control pills might interfere with how fish oil affects your triglycerides (a type of fat in the blood).
• Alli or Xenical (weight loss drugs): These medications might reduce your absorption of the beneficial fatty acids from fish oil. If you take both, consider taking them a few hours apart.
• Vitamin E: Fish oil can lower your vitamin E levels. Talk to your doctor if you take both.

My Take

I don’t eat enough fish (even though I live in the Pacific Northwest of the United States), so taking supplements should help, right?

Not so fast, Michael.

The recent BMJ Medicine study throws a curveball into my thinking.

I must now consider that fish oil supplements might slightly increase my risk of suffering from a first-time heart attack or stroke.

Benefits Review

The study also hints that fish oil might offer protection against disease progression and even death for those already battling cardiovascular issues.

On the other hand,

Those without known cardiovascular disease might increase their relative risk of atrial fibrillation and stroke.

I have been using fish oil to lower my triglycerides (successfully, although I ramped up my exercise and improved my diet).

Now, I will get the omega-3s my body needs by eating reasonable amounts of oily fish. Broiled or baked, not fried.

I live in the Seattle area, after all.

The post Fish Oil Reversal: New Study Says Supplements Might Not Be What You Think for Heart Health appeared first on Medika Life.

We’ll look at health claims and the evidence regarding fish oil.

If you don’t care to read anything more, here is my key takeaway: The EPA dose analysis of 255 fish oil supplements across 16 major brands found “substantial variability.”

Moreover, multiple randomized clinical trials have shown no cardiovascular benefit to fish oil supplements.

Here is principal author Dr. Joanna Assadourian’s take on fish oil:

“As a preventive cardiologist, I tell my patients — that are taking fish oil to try to avoid heart disease — they can stop taking it because it’s not helping them. Their money would be better spent on something that will prevent a heart attack, like more fresh vegetables, their blood pressure or cholesterol medication, or a gym membership.”

Supplements Bring in $$$

Dietary supplements are a huge business in the United States. The industry is worth over $50 billion.

According to the U.S. Centers for Disease Control (CDC):

Six out of 10 adults regularly take a supplement to support their health.

The CDC discovered that from 2017 through 2020, 35 percent of children and adolescents took at least one dietary supplement in the previous 30 days.

Use appeared higher among females than males (except among children 12 to 24 months). Supplement use rose with income and education among adults.

Supplement use, in general, increased with age among adults. This finding is in accord with what I find with my patients.

Fish Oil Supplements — Qualified Health Claims

Many manufacturers make claims that fish oil supplements have health benefits. My patients who take them tend to do so to improve their heart health.

A new analysis from the University of Texas Southwestern Medical Center, Dallas (USA) examined data from on-market fish oil (and non-fish omega-3 fatty acid) supplement labels.

The researchers reviewed the prevalence of two types of claims regarding cardiovascular disease: qualified health claims and structure/function ones.

The study revealed two cardiovascular-related qualified health claims for fish oil:

• Coronary heart disease benefits
• Blood pressure benefits

Here is an example the study offers: “Supportive but not conclusive research shows that consumptions of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

Fish Oil — Structure/Function Claims

The U.S. Food and Drug Administration explains that a structure/function claim “describes the role of a nutrient or dietary ingredient intended to affect the structure or function in humans.’’

Such claims cannot declare that the supplement prevents, treats, or cures any illness or disease.

You probably have heard some structure/function claims: “Supports heart, mind, and mood” or “promotes heart health.”

How Common Are Fish Oil Health Claims?

My patients frequently take fish oil supplements based on second-hand information. Are claims for fish oil supplements common? Absolutely.

Here are the numbers for cardiovascular disease: About six in 10 (62 percent) related to heart health.

Of over 2,800 unique fish oil supplements assessed, 74 percent had at least one health claim, mostly structure/function. Another 19 percent made qualified health claims, mostly relating to coronary heart disease.

Are These Fish Oil Claims Problematic?

Let’s get back to why I no longer take fish supplements. It all boils down to this statement from the study authors:

“Multiple randomized clinical trials have shown no cardiovascular benefit to fish oil supplements.”

Moreover, they add that the pervasiveness of structure/function claims could lead to misinformation among consumers.

The researchers observe that one in five adults over 60 take fish oil supplements for heart health despite no high-level evidence to support the practice.

Oh, it gets worse: After examining the dose within 255 fish oil supplements (across 16 major brands), the scientists discovered “substantial variability” in the daily dose of EPA (median 340 mg; range 135–647), DHA, and total EPA + DHA (median 600 (300 to 1100) mg/day.

Over nine percent contained a daily dose of two grams or more EPA _ DHA.

Why I Stopped Taking Fish Oil

Are you using fish oil for brain, joint, or eye health? Again, no data from randomized clinical trials supports any such benefits. That’s why I stopped taking fish oil.

If you’re considering fish oil supplements, they are not harmless for everyone. Please check with a valued healthcare professional before adding it to your wellness routine.

To learn more about the potential side effects of fish oil, here’s a link to WebMD:

FISH OIL: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

www.webmd.com

My Strategies to Improve My Heart Health

I use these approaches to optimize my heart health, ones endorsed by the Mayo Clinic (USA):

1. I don’t use tobacco.
2. I move, aiming for at least 150 minutes of moderate-intensity activity weekly and two resistance training sessions.
3. I eat a heart-healthy diet.
4. I maintain a healthy weight.
5. I get quality sleep (most of the time).
6. I manage stress.
7. I get regular health screening tests.

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Interest has increased so much that one course in nutritional psychology at a major university had over 100 students sign up. Many major universities in the US are offering master’s degree programs in this subject area.

Nutritional psychiatry is a relatively new and developing field that investigates the link between diet and mental health (including schizophrenia and psychotic disorders). Researchers and experts in mental health are starting to investigate how certain foods and eating habits can affect mood, cognition, and general mental health.

The gut-brain axis is one of the major topics of study in nutritional psychiatry, and the gut microbiota, which is made up of billions of different bacteria, resides there. Recent studies point to the importance of gut bacteria in affecting mental health and brain function. Having a healthy, diversified gut flora may boost mood and lessen anxiety and depressive symptoms.

Some dietary components have demonstrated the potential to promote mental health. Omega-3 fatty acids, which can be found in fatty fish, walnuts, and flaxseeds, have been linked to a lower incidence of depression and may be used to treat the symptoms of some mental disorders.

B vitamins are crucial for the health of the brain and cognitive function. Whole grains, leafy greens, and dairy products all contain them.
In addition, yogurt and other fermented foods, which include probiotics, might support the maintenance of healthy gut flora and may even enhance mental health.

The Mediterranean diet has been associated with a lower incidence of depression and cognitive decline because it emphasizes a high intake of fruits, vegetables, whole grains, and healthy fats like olive oil. This diet might protect against a number of mental health issues.

Studies have proven that what we eat can affect our mental health and mood. For instance, a diet high in whole foods can improve mental health while a diet high in sugary and processed foods has been linked to an increased risk of sadness and anxiety.

Numerous important variables and developing research have contributed to the shift in psychiatry toward including diet as a crucial component of mental health treatment. What has led to this new perspective on the treatment of mental health disorders?

Over time, nutritional science has made significant strides in understanding how various nutrients affect the body and the brain. Researchers began to learn about the potential effects of nutrition on mental health as they dug deeper into the connection between diet and health.

Globally, the prevalence of mental health illnesses is increasing, which has prompted researchers to look for complementary and alternative treatment modalities. Due to the drawbacks and side effects of conventional psychiatric therapies like pharmaceutical interventions, researchers and clinicians are now looking into alternative approaches, including dietary interventions.

Research on the gut-brain axis has become increasingly important in influencing how nutrition is incorporated into psychiatry. We see that research has shown that there is two-way communication between the gut and the brain, underscoring the gut microbiota’s potential impact on mental health. This research has sparked interest in the relationship between dietary choices, the gut microbiome, and, ultimately, mental health.

Depression and anxiety are two mental health problems that have been linked to chronic inflammation. The Mediterranean diet is one dietary pattern that has been linked to anti-inflammatory effects. There has been an emphasis on researching diets that could assist in reducing inflammation and enhancing mental health outcomes.

In recent years, patient-centered care and a more holistic approach to medicine have become more popular. This shift in thinking acknowledges that a variety of biological, psychological, social, and environmental elements, including nutrition, have an impact on mental health. Thus, psychiatrists are increasingly willing to think about and incorporate nutritional therapies into their therapy strategies.

As the research has evolved, so has the attitude of patients. People are becoming more interested in learning about holistic and lifestyle-based methods of managing their mental health. The new interest in these areas has seen a rise in psychiatrists taking nutrition into account as part of treatment as more people become interested in learning how diet can affect their mental health. But can a prescription be written for a diet? Who would fill it and how would insurance view it?

There has been a substantial paradigm shift in the field of treating mental illness as a result of the increased appreciation of food as “medicine” in psychiatry. Nutritional interventions offer a complementary strategy that can improve general well-being, even if they are not intended to replace conventional therapy. As nutritional psychiatry develops, it has the potential to offer patients a comprehensive and individualized approach to mental health treatment.

One stumbling block to the growth and inclusion of nutritional psychiatry/psychology is the financial factor. If a patient doesn’t have the means to buy these foods, how can they be helped to obtain them?

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Here are the numbers — Among patients found to have breast, colorectal, or prostate cancer:

• 40 percent reported dietary supplement use
• 19 percent believed dietary supplements could reduce cancer recurrence risk

Researchers recently reported these findings in the journal Cancer.

There appeared to be differences in supplement use by subgroups. Females appeared nearly 2.5-times more likely to take supplements. Perhaps not surprisingly, a belief in the importance of supplements to reduce cancer recurrence risk led to a 3.1-times higher chance of supplement use. Obese individuals were nearly half as likely to use dietary supplements.

What are the most common supplements? Thirteen percent reported fish oil use, while 9 percent used calcium (with or without vitamin D). Over eight percent consumed multivitamins and minerals. For those with breast cancer, 15 percent used calcium (with or without vitamin D).

Do supplements improve cancer outcomes?

Study author Rana E. Conway, BSc (Hons), Ph.D., RNutr, research fellow in the obesity group at the research department of behavioral science and health at University College London, offers this:

“There is no evidence that self-prescribed supplements reduce the risks of cancer coming back, and they could interfere with treatment.”

There is good evidence that a healthy diet and physical activity are beneficial; supplements appear to be an easier option, but we don’t have evidence that they prevent cancer from coming back.

On the other hand, mixing supplements with chemotherapy comes with peril. While common, such supplement use can lead to serious potential medication interactions. A 2021 study demonstrates this problem.

Prescription medications are most often associated with drug interactions, followed by herb and supplement-related interactions. Over one-third of potential medication interactions are considered significant.

Moreover, supplements may lead to poorer outcomes for those receiving chemotherapy for cancer. In a study of patients with breast cancer, patients who took vitamin B12 before and during chemotherapy had poorer disease-free and overall survival odds.

Iron consumption before and during chemotherapy appeared associated with a higher probability of a return of cancer. On the other hand, multivitamin use did not seem linked to changes in survival.

Certain antioxidants may help you fight cancer (or provide protection for your normal cells). However, we know that some supplements may make cancer treatment less successful. If you have cancer management, please ensure that your care team knows about any supplements you are taking.

Do supplements improve life length?

Moving beyond the realm of cancer, do supplements improve mortality? Do we live longer if we add this form of nutrients into our diets? While adequate intake of specific nutrients derived from food appears associated with lower all-cause mortality, nutrients derived from supplements are not helpful.

When Fang Fang Zhang, MD, Ph.D. (of Tufts University) evaluated data from the 1999 to 2010 National Health and Nutrition Examination Survey (NHANES) and National Death Index to determine how dietary supplement use and levels of nutrient intake from foods affect all-cause, cardiovascular disease, and cancer mortality among adults in the U.S. aged 20 years or older, she discovered:

• There appeared to be no association between the ever-use of dietary supplements and mortality outcomes.
• Participants with adequate vitamin A, vitamin K, magnesium, zinc, and copper via foods, not supplements, had lower all-cause and cardiovascular disease mortality rates.

Dr. Zhang offers this: “The general U.S. population should aim for achieving adequate nutrition through a healthy and balanced diet rather than counting on dietary supplements.

She adds: “For certain subgroups such as individuals with medical conditions that lead to malabsorption of nutrients from foods or those who have specific dietary practices that could cause nutritional deficiency, their nutritional needs including the use of dietary supplements shall be evaluated separately.”

These findings remind us that we health care professionals should review the use of dietary supplements with our patients. Thank you for joining me today.

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I want to share with you some of my concerns. There appears to be a dose-related risk for a heart condition (atrial fibrillation, a condition characterized by an irregular and often rapid heartbeat) with omega-3 fatty acid intake, at least with high doses of the supplement.

There have been three historic (and one recent) randomized clinical trials that support the supplement and atrial fibrillation connection. The VITAL-RHYTHM study is the latest clinical trial to evaluate the association. Led by Christine M. Albert, MD, MPH of Cedars-Sinai Medical Center (Los Angeles), the research team discovered no effect of omega-3 fatty acid supplements on the risk of atrial fibrillation.

The researchers also believe the VITAL-RHYTHM study is the only randomized trial to assess the effect of vitamin D3 supplementation on atrial fibrillation risk. They found no connection of vitamin D with Afib.

Researchers recently published these findings online. As noted, the current study points to no omega-3 fatty acid/atrial fibrillation connection. Still, taken in concert with the other three randomized clinical trials, we get hints that there may be a dose-related effect of omega-3 fatty acids on atrial fibrillation risk.

In the previous STRENGTH and REDUCE-IT trials, both of which evaluated high doses (4 grams per day) of omega-3 fatty acids in patients with heart disease (or at high risk for it), there appeared to be an increase in risk for atrial fibrillation in the omega-3 groups (versus control) in both trials.

The takeaway message? If you choose to take omega-3 fatty acids in high doses, you may increase your risk of common and potentially hazardous heart rhythm abnormalities. Vitamin D3 at 2,000 IU appears not to increase risk.

Thank you for joining me today. As for me, I am off for a walk to use a truly safe way to decrease my risk of heart disease.

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