Health benefits of Fish Oil? (Or is it snake oil?)

There are a large number of things that people begin to do for healthcare reasons.  Wherein the rationale seems to make sense but ultimately there is very little medical evidence to support such behaviors.  I make this comment particularly referring to taking fish oil which is increasingly something that people do, either buying fish oil over-the-counter as nutritional supplements or actually by getting prescription versions of fish oil which are sold as Lovaza and now the recently approved drug Vascepa.  These drugs are known to reduce triglycerides and high levels of triglycerides are generally bad but that doesn’t necessarily mean that artificially lowering triglycerides is going to yield a protective benefit.

In the July 26th edition of the New England Journal of Medicine, one of the studies evaluated this point specifically.  The trial was one with 12,536 patients called the ORIGIN Trial.  The study was called n-3 Fatty Acids and Cardiovascular Outcomes in Patients with Dysglycemia.  The bottom line is that fish oil did indeed reduce levels of triglycerides but it had no effect whatsoever on preventing death, heart attack, stroke, or any other cardiovascular disease process.

On the heels of that, it is interesting to go back and read what the FDA says about these fish oil drug products that were approved.  Specifically they are approved for the purpose of lowering triglyceride levels but there is no information available to suggest that doing so has any protective benefit for patients.  Either protecting against cardiovascular disease or protecting against pancreatitis (the other problem that is associated with high levels of triglycerides).

There have been quite a few medical fads in the past.  Some of these have included taking vitamin E (an antioxidant) and taking folic acid (which is vitamin B9) but larger studies ultimately showed that both of these interventions had no medical benefit.  It’s always good to collect as much data as possible.  While this was an extremely large and well done study and suggests to me fairly conclusively that fish oil is probably not beneficial, I’m ever mindful of additional information to influence my thinking..

There are three other studies which are ongoing.  The first of these is a 12,000 patient study which will have data relatively soon.  The other two are not expected to have data for several years.  The ASCEND Trial is a 15,000 patient study that will report data in 2017 and the VITAL study is a 12,000 patient study that is also currently underway and should have data later in the decade. However, until I get data that suggests a benefit, I don’t think that fish oil has a role in medical therapy at this time.

Despite the lack evidence of medical benefit for fish oil, the drug Lovaza (prescription form of fish oil) generates sales in the United States of approximately $1 billion per year.  Over-the-counter fish oil supplements are similarly big sellers.  Amazing.

source: New England Journal of Medicine

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