Every couple of months, TV news trashes fish oil. Usually after a negative study is published. It happened again in Sep 2012 after this study said fish oil was virtually useless."Fish oil doesn't work!" "Fish oil is a waste of money!" "Fish oil doesn't prevent heart attacks!"
The general message about fish oil was: folks, you've been had.
Never mind that there are 22,000 POSITIVE studies about fish oil benefits. The news media chose to focus on one negative study.
Bad news is juicier and gets more eyeballs.
This study was very poorly designed. Let me explain why it was certain to provide no insight right from the get go.
But first, a little self awareness: I get it. I work for OmegaVia. We sell fish oil. Self-interest. Biased. Not a third-party. All true. Like I said, I get it.
But...what if TV news got it wrong? And what I'm about to say is even partially right?
I'll explain in everyday English what TV left out and why you should ignore this study.
This is not an original study.
This was a review of other published studies, many of which were very positive about using fish oil for heart health.
These review studies are called 'meta-analyses.'
Meta-analyses are only as good as the studies that were included in them.
Lumping flawed studies give you flawed results. It's garbage-in, garbage-out.
It is also apples-n-oranges in, apples-n-oranges out. Studies included in a meta-analysis need to be similar.
This study didn't just include apples and oranges. It had pears, pineapples and a few kiwis thrown in for good measure and guaranteed confusion.
There was a study of patients with leg muscle pain caused by blood flow problem. And two studies where patients were given little else besides dietary counseling. These are not 'fish oil studies.'
"The studies didn't have enough power to conclude that the Omega-3s had no effect. They could only have the ability to conclude that they couldn't detect an effect. That's not the same thing, but that subtlety is lost on most folks, including many doctors."
- Dr. William Harris, Sanford School of Medicine, University of South Dakota, commenting on this publication in NutraIngredients.
As designed, this study, at best, could have only produced inconclusive results. Not positive, not negative but inconclusive.
But inconclusive is boring. So the authors slanted it negative and the media ran with it for maximum impact. (I should point out that this was the lead author's first ever publication on Omega-3.)
Low dosage.
Half the studies used in this meta-analysis used less than 1 gram (1000 mg) of Omega-3 per day.
That's less than one OmegaVia pill per day!
The average dose of Omega-3 in these studies was a mere 1.5 grams.
Not enough, folks. Not even close!
You can't give tiny amounts of fish oil to your patients and then claim that fish oil does nothing. Little bits of Omega-3 after a lifetime of donuts will not make a difference.
Dosage makes a difference. A big difference.
This is a HUGE problem with comparing drugs and supplements.
Drugs are taken at the right dosage. Supplements are, well, not.
No one points this out.
Certainly not the expert doctor, Dr. Richard Besser that Dianne Sawyer was talking to. See TV clip below.
Dr. Besser's take on this study essentially was 'See! I've told you once, I've told you a thousand times - supplements don't work. Unless your doctor diagnoses you with severe Omega-3 deficiency, fish oil is a waste of money.' Easily satisfied, Diane replied something to the effect of 'Oh Doc, you're so wise for continually steering us away from supplements. Thank you so much!'
If I were Diane, I would have asked:
Hey Doc, how much Omega-3 are people getting?
(Answer: about 150 mg)
How many of us are really deficient?
(A: well, it causes 84,000 deaths every year.)
Do doctors measure Omega-3 deficiency?
(A: no)
Is there a standard test for this deficiency?
(A: no)
Diane, these questions are called 'follow-ups' in your news business. It's basic journalism. Look into it.
Anyway, in all the confusion and negativity, it's the supplement that gets taken out back and shot. Whether they work or not.
Drug cocktails and modern preventive procedures.
Patients in some of the included studies were taking other drugs, in addition to fish oil, to prevent heart attacks.
Some of these drugs are quite effective and may mask or dilute fish oil's ability to prevent repeat heart attacks - at least on paper, from a statistics perspective.
Also, doctors nowadays use invasive procedures on heart attack patients (like inserting catheters to open up clogged arteries) that are highly effective at preventing a repeat attack. Similarly, angioplasty may also wash out the additional potential benefit of fish oil.* Fish oil is not a drug. Nor is it a physical procedure. It is merely a nutrient.
If fish oil is one of several combined therapies, then fish oil's benefit alone is unlikely to be detected by statistics as head-and-shoulders above the rest. Especially when all therapies are combined.
When you mix all therapies and throw it at the wall...and it sticks, then it's hard to pinpoint which therapy made it stick. This x-factor is called a confounding factor. There are plenty of them in this publication.
Confounding factors mask and wash out benefits.
"We know from the studies that have shown a benefit that future research in this area should only analyze studies that do not include confounding medications, are longer than two years in duration, and use dosages greater than 1-2 grams of Omega-3s per day. Very few of the studies included in this meta-analysis met these criteria."
- Dr. Harry Rice, Vice President Regulatory & Scientific Affairs, Global Organization for EPA and DHA Omega-3
Fuzzy math.
OK I said I'd keep this to plain English.
The following point is not plain English. Please cut me some slack. This is mostly for fellow geeks like me.
The P-value used to gauge statistical significance was 0.06. Very unusual for a meta-analysis with liberal inclusion criteria and a well-tolerated intervention with very low risk.
This highly conservative statistical hurdle becomes even more result-neutralizing given the low dosage explained above.
When facts get in the way of a good story
If I wrote the study's conclusion...I'd have said something to the effect of:
'If you're about 70, have had a heart attack or two or cruisin' for a bruisin', and are taking a cocktail of cardio drugs, adding just a dab of Omega-3 to your routine may or may not make much difference.'
Because that's what the facts show.
Instead the authors confidently concluded, "Our findings do not justify the use of Omega-3 in clinical practice."
Tsk, tsk. That's not what the data showed.
We live in a bumper sticker world where TV news takeaways must fit neatly on a bumper sticker. Nuance does not play well on TV. If a producer has to make a call, it will get slanted towards the sensational.
Your health pays the price. Again.
*Individual results may vary. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Clinical research suggests the omega-3 dosage needed to help maintain healthy triglycerides is 2000-3000 mg per day when used as part of healthy diet and exercise.
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