Something Fishy About Omega-3 Supplements

Fish oil capsules. Via Wikimedia.

The Huffington Post recently published an article by Dr. Neal Barnard, MD. It is titled “New Study explodes the Eskimo Myth” and it makes some very salient points about the development of the supplement fish oil, its historical roots, and subsequent evaluations of its benefits. This was a pleasure to read—a rare science-based examination by the Huffington Post. Dr. Barnard points out that the original conclusions from investigating fish oil appear to be tainted by researcher error. The seminal 1976 survey  had demonstrated abnormally low rates of heart disease among Inuit despite a high fat diet. But further research has shown that the original study was in fact poorly done and did not properly evaluate the true health history of the Inuit. A recent study in the Canadian Journal of Cardiology reviewed the original 1976 research and outlined its major flaws. In  2003 and 2009  follow-up studies demonstrated higher levels of cardiovascular disease among the Inuit peoples, essentially invalidating the hypotheses. If Inuit diets are not cardio-protective what does that say about diets high in Omega-3 fatty acids overall? What does this mean to fish oil supplementation?

Fish oil was developed out of the so-called “Eskimo Anomaly”: the observation that Inuit consumed a relatively high-fat diet rich in blubber and fatty fish, yet also appeared to have low rates of heart disease. As with the “French Paradox,” scientists proposed a possible cardiovascular protective benefit from diets high in Omega-3 fatty acids, a proposition that has formed the basis of fish oil supplementation. The idea that fish oil can help prevent heart disease is has now become entrenched conventional wisdom. But if the original study has been invalidated, we must reconsider whether or not fish oil is actually beneficial. Is the discovery of fish oil a lucky accident or is it just snake oil?

A label from a bottle of snake oil liniment. Via Wikimedia.

It would seem highly improbable that an incorrect guess about the Inuit’s health would lead to an effective cardiovascular treatment, but it’s not impossible. Science is filled with happy accidents. The fact that fish oil was discovered due to an erroneous evaluation actually says nothing about the effectiveness of the treatment. Fish oil is one of the very few supplements in the United States to have been developed into a prescription drug, called Lovaza. Its active ingredient is Omega-3-acid ethyl esters, which are metabolized by the body into Omega-3 fatty acids. This drug is prescribed to lower serum triglycerides. Randomized, controlled research does show that it seems to be of moderate benefit for hypertriglyceridemia, a condition that predisposes people to cardiovascular disease and prancreatitis.

Unfortunately, proponents of complementary and alternative medicine (CAM) often suggest that fish oil treats a variety of related and unrelated illness. In CAM, the uses for supplements seem to always exceed the evidence; fish oil is no different for them, and has been recommended to treat everything from cancer to headaches. Despite the large amount of research surrounding fish oil, CAM proponents always seem to find areas that haven’t been studied, using what I call the “drug of the gaps argument” and using what we don’t know about supplements to make wild speculation about benefits. In other words, if we haven’t done any studies for fish oil’s effect on stubbed toes, their assumption is that it will probably cure stubbed toes. Fish oil has tons of research, a lot is known about it and it is safe to say that we have a good grasp of what it can and cannot do. I think it is useful to review what is currently known about the supplement, highlighting what it is most commonly purported to treat as well as its problems.

Inflammation—Potential anti-inflammatory effects of fish oil have received much attention in review articles and the lay press, given the role of EPA and DHA as precursors to specific eicosanoids and other inflammation mediators. However, production and breakdown of these inflammatory metabolites is highly regulated, and thus it is unclear that consumption of EPA or DHA (from either diet or supplements) has major effects on these pathways in humans. Controlled trials have generally not detected significant effects on C-reactive protein levels from fish oil intake. Conversely, fish oil supplementation does appear to inhibit production of cytokines, small proteins important in cell signaling that can affect inflammation. However, to achieve these effects, relative high doses (>2 g/day) of fish oil may be necessary, and it is not clear that such doses produce substantial anti-inflammatory effects. Bottom line: fish oil is not a good anti-inflammatory!

Blood Pressure and Systemic Vascular Resistance—In a meta-analysis of 36 randomized trials, fish-oil supplementation (with a median dose 3.7 g/day and a median duration eight weeks) among adults older than age 45 lowered systolic blood pressure (BP) by 3.5 mmHg and diastolic BP by 2.4 mmHg. In healthy adults younger than age 45, the BP-lowering effects were less pronounced. Bottom line: fish oil has a tiny effect on blood pressure at high doses.

Anticoagulant (blood thinner)—Randomized trials of fish oil supplementation (often 6 g/day or more) have included patients at relatively high risk for bleeding, including patients undergoing surgeries like percutaneous coronary intervention, carotid endarterectomy, and cardiac surgery. The results of such trials indicate that at doses at least as high as 4g/day (and likely higher) there is probably no clinically significant effect on bleeding risk. Bottom line: fish oil is not a blood thinner.

Cancer—Despite claims of prevention and/or cure there is no known benefit. In related studies, at least one trial has examined the benefit of fish oil for control of cancer-related symptoms in addition to anorexia and cachexia. 60 patients with a variety of cancers were randomly assigned to fish oil capsules or placebo in addition to their conventional treatments. Among the subjects who both began and completed two weeks of their allotted therapy (27 dropped out during treatment because they could not tolerate the regimen), supplemental fish oil did not influence appetite, fatigue, nausea, weight loss, caloric intake, nutritional status or sense of well being. Bottom line: fish oil is not a cancer treatment and doesn’t help with lack of appetite or nausea related to conventional treatment.

Cardiovascular, All-Cause Mortality—This is the important one and has been devoted much more study, and therefore a longer explanation follows. A systematic review and meta-analysis pooled data from 19 large prospective cohort studies and randomized trials, including a total of 5,319 cardiac deaths (CHD) in 356,028 participants consuming either fish or fish oil supplements, and found that consumption of marine n-3 polyunsaturated fats (PUFA) significantly lowered the risk of CHD death and sudden cardiac death. In contrast to the apparent graded dose-response for nonfatal CHD events, the dose-response for CHD death and sudden cardiac death appeared nonlinear: compared with little or no intake, modest consumption (approximately 250 to 500 mg/day EPA+DHA) lowered relative risk by approximately 36 percent, but higher intakes did not substantially lower CHD mortality any further. Effects appeared to be very similar comparing studies of generally healthy populations (i.e., primary prevention; largely prospective cohort studies) versus studies of individuals with established heart disease (i.e., secondary prevention; largely randomized trials).

Subsequent meta-analyses have found smaller reductions in cardiovascular mortality than earlier analyses. A 2012 meta-analysis of 13 randomized trials of fish oil supplementation (N = 56,407) found a reduction in the relative risk (RR) of cardiac mortality. The authors adjusted for multiple comparisons and concluded this RR reduction was not statistically significant; however, this adjustment may have been overly conservative. In this same meta-analysis (seven trials, N = 41,751), there was also a statistically non-significant reduction in sudden death. In contrast to these large trials showing benefits for cardiac death, more recent trials have not found significant effects on CHD mortality. The results of the large Risk and Prevention Study, published subsequent to the 2012 meta-analysis, enrolled 13,513 patients with multiple cardiovascular risk factors or known vascular disease and, after a median follow-up of five years, found no reduction in CHD death with n-3 PUFA supplementation compared with placebo. Bottom line: fish oil at low doses may lower your risk of dying from a cardiovascular event; higher doses show little added benefit; and there’s a lot of very contradictory evidence.

Blood Lipids and Cholesterol—Fish oil consumption lowers serum triglyceride concentrations by 25 to 30 percent, an effect within the range of efficacy of other triglyceride-lowering drugs. The potential cellular mechanisms for this effect have been previously reviewed. The dose-response appears to be fairly linear: little triglyceride lowering is seen with dietary doses or low-dose supplementation (<1 g/day), whereas higher doses (3 to 4 g/day) appreciably lower triglyceride levels. Fish oil supplementation also modestly raises concentrations of HDL-C (good cholesterol) and, particularly in patients with hypertriglyceridemia, raises concentrations LDL-C (bad cholesterol) and lowers the proportion of small dense LDL-C particles. This increase in LDL particle size may in part account for the higher LDL-C concentrations; that is, LDL-C concentration may slightly increase but without appreciable change in the number of circulating LDL particles. Given the frequently coexisting relationship of high triglycerides, low HDL-C, and small dense LDL particles in many individuals, the effects of fish oil to lower triglycerides, raise HDL-C, and decrease the proportions of small dense LDL particles appear concordant. Bottom line: at high doses fish oil reduces triglycerides by 20-30%, may elevate HDL by about 3% and slightly reduce LDL.

A generic can of tuna fish. Via Wikimedia.

But there are some purported concerns, problems, and side effects to fish oil supplements. Not all of them stand up to scrutiny, but they include the following:
Mercury—Despite common, persistent belief, fish oil contains little mercury. Only a few large predator fish species (e.g., sharks, swordfish, albacore tuna) contain appreciable amounts of mercury. Given cost considerations, such species would be used only very rarely to produce unusual “specialty” supplements. Furthermore, mercury is tightly bound to fish proteins, rather than present in the lipid fraction. Bottom line: similar to most fish species, commercially available fish oil capsules contain little to no mercury.

PCB and Dioxins—Fish oil capsules contain vanishingly small amounts of polychlorinated biphenyls and dioxins, with concentrations proportional to those in the fish species from which the fish oil is derived. Notably, given the small absolute quantities of fish oil that would be consumed (1 to 4 g/day), the absolute amounts of PCBs or dioxins that can be consumed from fish oil supplementation is extremely low. Bottom line: the concentrations of these substances are similar to dietary consumption of the great majority of fish and seafood species. Significant exposure to contaminants from fish oil is not a clinical concern, but should still be avoided by pregnant or lactating women.

Carcinogens—A post hoc subgroup analysis from a randomized trial of 2,501 adults with known cardiovascular disease found an association between supplementation with 600 mg of EPA and DHA and a higher risk of cancer in women, but not in the group as a whole. These findings should be interpreted with caution since, in addition to being a subgroup analysis, they were based on a total of only 29 cancer events. Additionally, other larger randomized trials of fish oil have not reported finding increased cancer risk, and a wide range of animal models demonstrate benefits of fish oil for the incidence and severity of many cancers. Systematic reviews and meta-analyses of numerous large prospective observational studies have generally found no significant effects of fish consumption on the risk of any type of cancer, although one such review suggested a possible lower risk of breast cancer with increased fish oil consumption. Some studies, though not all, have suggested an association between higher levels of long-chain n-3 PUFA and increased risk of prostate cancer; a meta-analysis of these mixed studies found no statistically-significant association between levels of n-3 PUFA and total prostate cancer risk. Bottom line: there may be a risk of prostate cancer but the research is not structured well enough to eliminate variable noise, and there is no evidence for any other cancer risk.

So does a failed dietary theory automatically mean that the benefit from fish oil is false? The short answer is no. After an extensive review of the available research I find that fish oil does appear to have some medical indications. Bringing it all together, as you can see, is very complicated. It is safe to say that 4g of fish oil per day does measurably reduce triglycerides and slightly help cholesterol levels. However, the fish oil doses required to lower triglycerides are several-fold higher than the doses that may reduce coronary mortality. Additionally, the clinical benefits of lowering elevated triglyceride levels, by any pharmacologic means, have not yet been convincingly demonstrated. There is no good evidence that it lowers the frequency or severity of cardiovascular events. It does not seem to reduce atherosclerosis (hardening of the arteries), and does not seem to prevent the formation of thrombi (clots) that cause a heart attack or stroke. It does not seem to have any anti-cancer benefit. Given the conflicting information about anti-oxidant benefits there is little chance that it provides any protective effect at all.

Despite its novel status as a supplement that became a drug there is little to support fish oil as a cardiovascular prevention agent. It does have uses as part of a total lipid-lowering regime for cardiovascular patients. I would not recommend that people take it regularly; although it’s probably not harmful it could have a negative cognitive behavioral effect: people may falsely believe that they can negate the terrible effects of inactivity, obesity, poor diet, and smoking by popping a fish oil capsule. Not true. For the average person, the only thing fish oil is likely to do is give you is fishy burps.


About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner specializing in spine and sports medicine. He is a member of the Society for Science Based Medicine.
This entry was posted in Alternative Medicine, Health, Pseudoscience and tagged , , , , , . Bookmark the permalink.

43 Responses to Something Fishy About Omega-3 Supplements

  1. Wordwizard says:

    What about Omega-6? One hears similar things, that THAT’S what really helps. I’d appreciate your giving us the skinny on Omega-6 too.

    Are there any vegetarian sources of either?

    • Eric Hall says:

      There are algae based ones that are much more expensive and are sold as a way to “avoid toxins” – though you have to watch for some as they still contain gelatin.

      Flax seed oil contains mostly ALA which your body can turn into DHA and EPA, but obviously not at anywhere near 100%. I believe olive oil and canola oil are also high in ALA, so given enough you should be able to obtain the omega 3 you desire.

      • The ALA effective conversion to the more beneficial DHA and EPA is something like 5% (although differs highly individually). In other words; to get relevant levels of EPA and DHA fatty lipids, ALA is simply not a viable source… almost to the point of pointless. ALA is in its own right relevant, but not as a source to EPA and DHA (the lipids found in animal fats, like fish).

        The Algae is indeed an expensive alternative to fish, but its effective ratio of the DHA/EPA lipids is also but a fraction when compared to the ordinary fish oil. In other words, a second mortgage is required to really compete with the active ingredients found in the typical OTC fish oil. Also logically, I am sceptical to how it is at all physically possible to derive DHA and EPA from a plant source… I fear it is not true DHA and EPA lipids found in the end algae product, but I am likely wrong.

        Regarding the Omega 6: Is indeed considered an important part of a well balanced diet – however, the Omega 6 is not really the challenge as this fine fatty acid comes in ready supply from many or our already popular eats. The problem is perhaps rather that the average consumer gets too much of the Omega 6. ( as opposed to Omega 3). And too much of anything is… well too much, so perhaps this is what you have heard. Anyways, generally a well balanced diet considers both acids – preferable in a 1:1 ratio (actual ratio is debated, and founded more on opinions than sound evidence – and in my opinion it is 1:1). Anyways, if you are anything like the average Joe, I can with confidence say that your diet is far far from this balance.

        And again Omega 6 (just as Omega 3) is not one thing. The rarer GLA Omega 6 is praised for many benefits too, especially in conjunction with the EPA Omega 3. And on top of that we can add the Omega 9 to the discussion (especially with a nice bottle of Chianti).

        Key word is healthy diet. And with proper attention and care to detail Omega supplements can assist.

        • Benedict X says:

          Yes, females are able to convert the shorter chained omega-3 fatty acids better than males (sorry guys) . This goes back to the (challenged) idea that the shorter chained omega 3’s are slightly feminising.

          • I would like to see that research if you can send me a title if not a link.

          • Benedict X says:

            A quick look, I had to dust off my old Lippincott (… I don’t have a copy of the 5th Ed. Ill get back to you in a few weeks.

          • Benedict X says:

   found from a 109 second google search

          • interesting but rodent studies are representative of human biochemistry, I am assuming since that was 6 years ago it has been duplicated and done in humans? Did you pick the best one out 109. My research led me to this that rats fed standard show females have higher levels of DHA. So that is what i mean by diffuse and contradictory evidence. You can assume that dha is better utilized by female rats or that the just have higher levels. You cannot extrapolate benefit or that rats chemistry=human chemistry.
            There is so much research that has been all over the place the meta analysis is the better tools. Thus far if you remove the multitudes of supposed plausible mechanism and ask what does it do the short answer is very little except reduce triglyceride levels. Assuming anything beyond that would require extensive research replicated and reproducible to overcome the mountains of current research done on this supplement. Thanks for taking the time to find that for me.

          • I apologize if you feel that my request was not sincere. I truly thought based upon your writing that you had this information. I am not being snarky. There is no reason to post a textbook link. Or are you claiming that general biochemistry dictates that women metabolize omega-3 differently than men?

          • Benedict X says:

            Im claiming its old knowledge, and it would seem I am going to have to go back to original sources just to prove a point. Unfortunately real life intervenes but when I get the chance I will attempt to explain. …. As for the ‘ya’ stuff, you referred to this in the second person, sorry if I misunderstood this to mean something I had said when I had assiduously avoided saying exactly that (that was apportioned to me).

        • Eric Hall says:

          The algae sources are not overly expensive – they are sold mostly as prenatal supplements.

          Not that I’m recommending them for the average person – just pointing out they are available.

          • If calculated on how much DHA and EPA they offer, they are not competitive to a good brand of fish oil… I arrogantly say, as I obviously don’t know all the brands, but those few I have seen, offers little in a comparative cost-benefit analysis. Some algae brands offer e.g. only EPA and no DHA. You would need to eat a considerable amount to get similar levels of the active ingredients. Same can be said about the overhyped Krill source products.

            But for sure, the algae sourced products offer an alternative to those who want to avoid animal products and still want to supplement on the DHA and EPA lipids. Although, I am sceptical if it is, in fact, possible to extract DHA and EPA from plant sources. I suspect the lipids are not of the entirely same bioavailable form found in animal lipids, and thus possibly less effective… as a side note and as for example, those lipids extracted from krill are too not exactly the equivalent extracted from fish either – though the difference in this case is not in a compromising way.

            It is not all oranges or apples

  2. Benedict X says:

    Omega-3 vegetarian sources are widely available, flax seed/linseed oil, evening primrose oil. Evidence is limited to mostly anecdotes, nonetheless, the shorter chain omega-3 in the vegetable oils may have a slight feminising effect.

    My suspicion of the science is asking the wrong questions, perhaps a lot of the effects could be the ratio of omega-3 to other oils (such as omega-6 and other PUFAs), analogous to the ratio of oestrogen to testosterone is important in homeostasis.

    • Most of the research tends to use olive oil as a control.
      I am curious, estrogen vs testosterone and homeostasis of what?
      That is actually assuming that there is a benefit and asking why? Your question about ratio and other oils presumes a benefit. Since flax and other oils are based upon the coldwater oily fish diet effect there is probably no real cardiovascular benefit to any oil fish or not. Most likely the triglyceride treatment is a happy accident. The prescription medicine, which has the best evidence, uses esters of omega-3 because that is the only way to properly control dosage. OTC fish oil has a wide variation in contents, percentage, and impurities. Although often woo marketers will promote “only fish oil from Fish x” is of benefit. That is marketing trying to convince people that their brand is better. In this case research has shown that diets high in cold-water oily fish actually does not reduce CV disease. Given that the CV benefit evidence is weak already that kind of puts the whole class of supplements in doubt. I think that kind of answers W.Wizard’s good question as well.

      • Benedict X says:

        homeostasis (noun) – the tendency towards a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.

        • Ya nice definition and still doesn’t answer my question homeostasis of what estrogen and testosterone? That is like saying medically what is the homeostasis of blood pressure and bowel movements. Except for being hormones they are not directly related and are not proportionally related. they have different functions. So let me be more clear, homeostasis of what?

          • Benedict X says:

            Homeostasis of the human being, where if you add a new ingredient into the mix (*or equally – subtract), the equilibrium may change (usually slightly) and may (in this case) change the ratio of gonadal hormones.

      • Benedict X says:

        Assuming benefit – yes. Benefit for cardiovascular outcome, depression, or inflammatory conditions – all I deliberately did not answer …. You stated benefit… please be scientifically precise, about benefit and please delineate between mental health (depression and anxiety), inflammatory disease (such as rheumatoid arthritis) and cardiovascular outcomes (have you compared the numbers for fish oil against the standards of AIIA, ACEi, Ca++ channel blockers, diuretics and b-blockers? ) . In summary, please keep an open mind, but not so open that your brains fall out (

        And you have evidence about the happy accident about lowering triglycerides? (there is evidence that lowering triglycerides improves cardiovascular outcomes ……… errrr I don’t think so?).

        Just ‘cos the omega-3 esters are EXACTLY a certain dose – the 100x less expensive fish oils don’t work?

        The original article suggest (as n example) BP lowering effect comparable to several classes of FDA registered antihypertensives (look at the trials the numbers for omega-3s is comparable to the fda approved meds).

        Again, and finally, it realy depends on what question(s) you ask.

        • No, what I am saying that I did a complete review of relevant research related to Fish Oil supplementation both prescription and OTC through brown university medical database. There is no way I can specifically delineate each individual disease in a blog post. I am not about to put 120 references in the Bib.

          So yes, there is no evidence that fish oil has any effect on any of those problems. Most have been looked at least once. Some have been meta-analysis as well. SO ya when you have conflicting results on all cause mortality you can say it is only possibly helpful. Comparing to other products is irrelevant.

          So ya, if you think a group of people have low rates of CV disease and they don’t. You create a supplement based on a wrong idea then you and a guess that it comes from the fish that they eat. Then despite being wrong twice you discover that it actually lowers triglycerides then yes I think that is evidence of a happy accident. 🙂

          • Benedict X says:

            I said nothing about the Inuit hypothesis, I said nothing about creating supplements based on a wrong idea, I said nothing about being wrong twice…. is this ad homenum?

          • “So ya, if you think a group of people have low rates of CV disease and they don’t. You create a supplement based on a wrong idea then you and a guess that it comes from the fish that they eat. Then despite being wrong twice you discover that it actually lowers triglycerides then yes I think that is evidence of a happy accident. :)”

            for clarity this was referring to the research and the pathway to the discovery of the triglyceride benefit.

          • Related to fish oil as a triglyceride treatment I make no claims that lowering triglycerides improves cardiac outcomes. There are direct non cardiac problems from hypertriglyceridemia, There are reasons to prescribe that medication beyond CV benefit.

  3. KW says:

    Dr Barnard on quackwatch –

    and science based medicine –

    With that said, agree with your conclusion. Fish tastes better but supplements could be a cost effective alternative.

  4. marianwhit says:

    Definitely look into the credibility of your sources. Barnard has close ties with PETA, a group that would have us all give up our pets (they see this as a form of slavery), and force us to be vegans.

    • I reviewed literally 120 abstracts related to this topic in the literature. My opinion is based upon that research not barnard’s article. In this case he is mostly correct and I agree for the most part with his interpretation based on a extensive analysis of the historical and current literature. He is not my source just an interesting starting point. I only included the most pertinent research in the ref section since most people don’t look through them.

    • Wordwizard says:

      PETA’s motto is “Animals are not ours to eat, wear, experiment on, use for entertainment, or abuse in any way.” PETA is not against having companion animals— PETA simply encourages people to get them from shelters, rather than breeders, and to treat them well. PETA also ENCOURAGES people to become vegans, but does not try to force anyone. Your OWN credibility as a source is lacking.

      Read more:

      • Christian says:

        PETA kills pets. PETA lies constantly. They are a fringe group of nut jobs. I’d avoid any one who had ties to them, although I would not assume it meant everything they said was wrong.

  5. Brian Seiler says:

    I suppose I should chime in to note that the “moderate” triglyceride effect is averaged and differs significantly for individuals. A couple of years ago, I went in to get my regular suite of blood tests for Type 1 diabetes (including a lipid panel) and my triglyceride number came back in excess of 1600 – fairly convincing evidence of genetic hypertriglyceridemia. I started therapy with Lovaza (and nothing else) and cut off more than 1000 points in three months. It didn’t do much of anything for my other lipid numbers, but unless the nurse who collected my blood in the first place got confused and instead delivered a sample of her salad dressing from lunch to the lab, I’m pretty well convinced that it’s doing something significant.

    • Triglycerides are directly linked to blood sugar and you may have had a uncontrolled blood suger episode within 72 hours of the blood test when you had your triglycerides measured. That said, there is no doubt that it helps lower triglycerides. There are other drugs more effective although not as safe as the lovaza. There is conflicting results in research related to cardiovascular outcomes and lowering triglycerides. Meaning were not really sure how much lowering triglycerides helps prevent or control cardiovascular disease.

  6. es says:

    As for the Inuit, the understanding of the value of their diet did not begin with a single study in the 1970s. They had been studied for years prior to that, beginning in the 19-teens. The other factor to consider is that while the native populations still continue to consume a high content of meat and fish oil, they have also been “enjoying” a western diet, with processed foods and high carb content, for over 50 years. As with any indigenous culture that is introduced to a western diet, their overall health declined. They are now experiencing rates of obesity, similar to other native Americans, where in their history obesity was quite rare. It’s not surprising their modern diet also leads to the same diseases that the non-native people suffer. To look at the modern (1960s and beyond) Inuit diet tells us nothing about the traditional Inuit diet, which was high fat, almost zero carbs, no processed foods, and lot’s of fish and marine mammals.

    • Although that sounds plausible. The researchers went back and looked at the raw data from that 1976 study. There is no other information about CV disease historically. So what you are saying is speculative the only answers we have from that time period say higher than average CV disease. That is all you can really say about it.

  7. Nelson says:

    I begin this post with the admission that it is obviously a anecdotal account and therefore of little “Scientific” use, however it does speak to the issue of Omega 3 and it’s effect on inflammation. I have had a annoying issue with excessive tearing in my eyes that have gone on for many years now. Having gone to 7 eye doctors now I have received the same diagnosis each time: Dry eye. Yes I have the wettest “dry eye” condition on planet earth. Nevertheless I was finally prescribed the drug Restasis which was supposed to reduce the inflammation that was the cause of my very very “dry” eyes. After 3 months of consistent use of this drug I found absolutely no change to my wet,, I mean my dry eyes. I started on 3,000 mg daily of Omega 3 fish oil and that very day my eyes were actually dry for the whole day until about 10 PM which was something Restasis never did, ever. I continue to take my 3 grams daily and if I forget to take it that day I start to tear up ( I mean my eyes get dry once again). So if the stats show that Omega 3 doesn’t have the ability to reduce inflammation but it does for my condition, that’s good enough for me.

    • Guest says:

      Hi Nelson, I’m glad to hear that you’ve found some relief with the fish oil. I was wondering if you have ever had any testing for autoimmune diseases. Certain autoimmune diseases can cause dry eyes, the autoimmune disease most well known for its relation to ocular, as well as oral, dryness is Sjögren’s syndrome, although other autoimmune diseases can cause dryness in eyes and elsewhere. Sjögren’s very often causes dry eyes and/or mouth, as well as joint pain and fatigue. While it’s frequently known mainly, or even only, for the dryness aspect, it is a systemic disease that can affect many different organs and tissues, and like all autoimmune diseases, it tends to overlap with other autoimmune diseases. Like other autoimmune diseases, there is a familial aspect, although often in one family there will be multiple autoimmune diseases in various individuals as opposed to just one disease among members. Despite studies showing Sjögren’s syndrome to be one of the most common autoimmune diseases, many in the medical profession still know comparatively little about the disease, even those professionals working with body parts and systems frequently affected by it, such as dentists and eye doctors. Due to this lack of knowledge of Sjögren’s in particular and autoimmune diseases more generally, many patients have symptoms for years before getting a proper diagnosis.

      Anecdotally I have heard about fish oil improving dryness of eyes, mouth and/or skin, mostly from Sjögren’s syndrome patients, but am not sure if there have been any studies to date regarding fish oil’s effects on dryness specifically. I have seen a few small studies recently indicating that fish oil helped reduce disease activity in patients with lupus (another autoimmune disease) and as such may hold some promise as a treatment in the future, but I can’t remember if the studies indicated an improvement in any symptoms in addition to the reduction in disease activity.

      Dry eyes may be idiopathic of course, but some medications can also cause watery or dry eyes, and there are the “usual suspects” of allergies, or dry/windy climate.

      • Eric Hall says:

        My eye doctor also suggested fish oil as a way to make contacts more comfortable when I wear them – though I have not had the time to research the literature on that particular treatment for dry eyes.

      • Nelson says:

        I was in fact tested for Sjögren’s becasue at the time I went to my doctor I was also having a dry mouth spell as well but I was negative for it and the dry mouth as since dissapeared. The usual drug prescribed for this condition as I mentioned is Restasis but fish oil works and Restasis doesn’t have any remediation at all. I will stick with what works, thanks for the comment.

        • Guest says:

          I’m glad to hear that your dry mouth has improved. I have Sjogren’s and had a pretty dry mouth for years before diagnosis as well as several years into my diagnosis, however even without treatment, now it is not nearly as dry! I’m also glad your doctor thought to test you for it, many docs don’t and it gets overlooked for longer than it should.

          However just so you’re aware, as with other autoimmune diseases, having negative blood tests for it does not mean you don’t have it. Autoantibodies levels can fluctuate, some labs may use testing methods that aren’t as sensitive as others, or people might be quite early on in the disease. Additionally, there has been quite a lot of research indicating that in addition to the commonly tested autoantibodies in Sjögren’s , SS-A, SS-B (more specific for Sjögren’s) and ANA and RF (less specific for Sjögren’s) there are numerous other autoantibodies involved in the disease generally. It is likely that those with negative blood tests may currently have other autoantibodies that are not usually tested for in a clinical setting.

          If you doctor still suspects Sjögren’s syndrome based on your dry eyes and/or other symptoms, there are other tests that can be done. According to the most recent criteria used in the US, positive eye staining and positive salivary gland biopsy would be indicative in the case of negative blood tests. The current criteria for blood tests is a positive SS-A or SS-B, OR a positive ANA AND RF. According to this criteria, a person needs two positive out of the three -blood tests, eye staining, salivary biopsy-to be considered positive. I believe other countries still use the European American consensus criteria which the US used until a few years ago. That criteria also includes blood tests, salivary gland biopsy, and eye staining, but includes both ocular and oral symptoms, and a category each for ocular and oral signs, which in addition to eye staining included the eye strip test, and things like salivary scinctigraphy.

      • Nelson says:

        By the way, from what I have learned about this problem, the usual cause of the excessive tearing is the premature evaporation of the aqueous layer of the tear as the lipid layer which protects the tear from drying out is either not present or in too small amounts to stop the process. So any wind or breeze can aid in evaporation and exacerbate the symptoms. Inflammation of the Meibomian glands where the lipids are produced is the cause and Omega 3 has a inflammation reducing effect, the reason therefore that they help with the problem. Just thought anyone who has this problem would be interested.

        • Guest says:

          Thanks for the interesting info Nelson! I hope further research will be done in the future on the effects of omega-3’s, fish oil and other omega-3 containing substances for the symptom of dryness as well as its underlying causes.

  8. Larry says:

    Stephen I am very busy and haven’t had time to hunt down this pooled JAMA article that recently was published. Not pushing off work on you but you seem to be one that can get this stuff in a heartbeat. Something about Omega 3 and reduced ALS. I found the intro to be of interest. Thanks Larry

    A pooled analysis reported online on July 14, 2014 in JAMA Neurology unveils an association between higher omega-3 fatty acid intake and a reduction in the risk of developing amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), a devastating progressive disease of the central nervous system.

  9. Larry says:

    I just don’t have time to run this down. sorry I may get to it over the weekend and we can debate the findings.

    • That is ok this study was a dietary questionnaire analysis. Essentially interesting but not really evidence of anything. Out of 1 mil questionnaires they pulled a thousand cases of als. So what we are talking about is a tiny sample of disease with a small correlation in a huge sample set. There are likely to be many many small correlations with dietary factors with many diseases in that subset.. The stats are not very robust numbers. Frankly I am surprised it was published. More likely this is product of the large sample size the so called large sample false positive. Might be worthy of a subsequent research but als is a small number disease and susp pop is even smaller so how do you really even measure this as a preventative. There are buckets of this type of correlational research about this supplement. None of the follow ups pan out though. The medsacpe article you pointed me two was a seprate editorial actually the original research was in JAMA neuro online this month.

  10. Graham says:

    Interesting, the Dr I saw for a cold told me to start taking it to help get over the illness. Mind you she also told me to buy Vit C. I bought orange juice instead. But as with all things time is the best cure, thought this year has been pretty rough in that regards.

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