Fish Oil for Depression, Anxiety and Heart Health
How Helpful are Omega-3 Supplements?
For more than 20 years, supplement companies have been promoting fish oil (omega-3) supplements to help with various conditions. They're supposed to reduce depression, lessen anxiety and lower cardiovascular risk for anyone who took them.
People taking fish oil for anxiety and depression got bad news in 2019. Small studies seemed to show benefit, but the data was limited. So researchers did a study of studies, also known as a meta-analysis. The requirements were simple. The trials had to be done on adults, they had to be randomized to increased omega-3, omega-6 or total polyunsaturated fat, and they had to run for at least 24 weeks.
The final result included 31 trials and more than 41,470 participants. The results were surprising. The researchers concluded, “Long-chain omega-3 supplementation probably has little or no effect in preventing depression or anxiety symptoms.” Eating oily fish can be part of a balanced diet. But taking fish oil supplements for depression or anxiety was a waste of money.
Omega-3 and polyunsaturated fat for prevention of depression and anxiety symptoms: systematic review and meta-analysis of randomised trials
Katherine H O Deane, Oluseyi F Jimoh, Priti Biswas, Alex O'Brien, Sarah Hanson, Asmaa S Abdelhamid, Chris Fox, Lee Hooper
The British Journal of Psychiatry, Published 2021 Mar
Click Here for the Study: https://doi.org/10.1192/bjp.2019.234
Just a year earlier, in 2018, researchers had started to poke holes in the idea that omega-3 supplements could help the heart. 15,480 patients with diabetes were randomly assigned an omega-3 supplement or a placebo. They were followed up for an average of 7.4 years.
Researchers found “no significant difference in the risk of serious vascular events” between people who got the omega-3 supplement and those that were given a placebo.
Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus
ASCEND Study Collaborative Group; Louise Bowman, Marion Mafham, Karl Wallendszus, Will Stevens, Georgina Buck, Jill Barton, Kevin Murphy, Theingi Aung, Richard Haynes, Jolyon Cox, Aleksandra Murawska, Allen Young, Michael Lay, Fang Chen, Emily Sammons, Emma Waters, Amanda Adler, Jonathan Bodansky, Andrew Farmer, Roger McPherson, Andrew Neil, David Simpson, Richard Peto, Colin Baigent, Rory Collins, Sarah Parish, Jane Armitage
The New England Journal of Medicine, Published August 26, 2018
Click Here for the Study: https://doi.org/10.1056/nejmoa1804989
More bad news came out in November of 2020. A study published in the Journal of the American Medical Association followed 13,078 patients for over 2.5 years. The focus was on patients treated with statins that had high cardiovascular risk, high triglycerides, and low HDL cholesterol levels. (Those at-risk people are the ones who should benefit most from a heart helping supplement.)
The results were bad. Researchers found that a high dose of omega-3 fatty acids resulted in “no significant difference in a composite outcome of major adverse cardiovascular events.” In other words, omega-3 supplements didn't appear to help the heart.
It gets worse. There was a 67 percent increase in risk of atrial fibrillation for the participants taking fish oil supplements. Rather than helping, supplements with both EPA and DHA fatty acids may be harmful to at-risk people. The researchers concluded that high-risk patients should NOT use omega-3 supplements to reduce cardiovascular events.
Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk - The STRENGTH Randomized Clinical Trial
Stephen J. Nicholls, A. Michael Lincoff, Michelle Garcia, Dianna Bash, Christie M. Ballantyne, Philip J. Barter, Michael H. Davidson, John J. P. Kastelein, Wolfgang Koenig, Darren K. McGuire, Dariush Mozaffarian, Paul M Ridker, Kausik K. Ray, Brian G. Katona, Anders Himmelmann, Larrye E. Loss, Martin Rensfeldt, Torbjörn Lundström, Rahul Agrawal, Venu Menon, Kathy Wolski, Steven E. Nissen
JAMA Network, Published Online: November 15, 2020
Click Here for the Study: https://doi.org/10.1001/jama.2020.22258
November of 2020 had even more bad news. Researchers wanted to see if vitamin D, omega-3 or a strength-training exercise program could help with six different health outcomes for people who were 70 years or older. They were looking at improvements in “systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rate, or cognition.”
The 3-year program tracked 2,157 adults. They found that none of the treatments, vitamin D, omega-3 or strength training, helped improve the six different health conditions.
Keep in mind; cardio exercises are designed and proven to help with blood pressure and cognition. So it's not surprising that strength training didn't help improve those conditions.
Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults - The DO-HEALTH Randomized Clinical Trial
Heike A. Bischoff-Ferrari, Bruno Vellas, René Rizzoli, Reto W. Kressig, José A. P. da Silva, Michael Blauth, David T. Felson, Eugene V. McCloskey, Bernhard Watzl, Lorenz C. Hofbauer, Dieter Felsenberg, Walter C. Willett, Bess Dawson-Hughes, JoAnn E. Manson, Uwe Siebert, Robert Theiler, Hannes B. Staehelin, Caroline de Godoi Rezende Costa Molino, Patricia O. Chocano-Bedoya, Lauren A. Abderhalden, Andreas Egli, John A. Kanis, Endel J. Orav, for the DO-HEALTH Research Group
JAMA Network, Published November 10, 2020
Click Here for the Study: https://doi.org/10.1001/jama.2020.16909
That leaves us with four studies involving more than 480,000 participants across multiple trials, all giving us the same answers. Taking fish oil supplements isn't a shortcut to health or happiness; it could be just the opposite. According to the Mayo Clinic, taking too much omega-3 can increase your bleeding risk and might suppress your immune response.
Dr. Katherine Deane, from UEA's School of Health Sciences, said: “Considering the environmental concerns about industrial fishing and the impact it is having on fish stocks and plastic pollution in the oceans, it seems unhelpful to continue to swallow fish oil tablets that give no benefit.”
If you're looking to improve your health and your mood, there are three things to do. Eat a variety of fruits, vegetables and lean meats. Do cardio exercises to help your heart and strength-training exercises to build muscle and bone. Avoid taking supplements unless your doctor has given you a specific prescription because of a medical diagnosis.
UPDATE 1/27/2022 - Problems With Fish Oil Sources
There was a great article in The Guardian about "the hidden cost of our obsession with fish oil pills."
The first problem is sustainability. Most fish used in fish oil comes from Peruvian anchovetas, a type of anchovy. Big companies are hauling out 4 million TONS of anchoveta a year. There are supposed to be regulations to verify that it's all done sustainably, but several companies have been documented openly ignoring the rules.
The second problem is freshness. Independent tests have found that at least 10% of fish oil supplements are rancid. Several national brands received the lowest rating of F when tested by Labdoor, including Nordic Naturals, Puritan's Pride, MET-Rx, Spring Valley, Kirkland Signature, Pure Alaska, Nature's Answer and Optimum Nutrition. (The scale went from A+ to F.)
We know from the studies that fish oil is not the heart-healthy supplement it's marketed to be. Now you know the environmental toll it's taking and the problem with freshness. Why are people still taking it?
A link to the original article is below.
Richa Syal - Seascape: the state of our oceans- Fish oil
‘It’s mind-boggling’: the hidden cost of our obsession with fish oil pills
Published Online January 18, 2022
Click Here for the article: https://www.theguardian.com/environment/2022/jan/18/mind-boggling-hidden-cost-ecosystems-obsession-with-fish-oil-pills
UPDATE 6/10/2024 - Increased Risk of Atrial Fibrillation
A large-scale prospective study, "Regular Use of Fish Oil Supplements and Course of Cardiovascular Diseases," followed 415,737 participants aged 40-69 over a median period of 11.9 years to assess the impact of fish oil supplementation on cardiovascular health. One-third of the participants were regular users of fish oil supplements. The study found that regular fish oil use was associated with a 13% higher risk of developing atrial fibrillation (AF), a concerning type of irregular heartbeat linked to sudden cardiac arrest, and a 5% increased risk of stroke among healthy individuals.
Reference Links:
Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study
Ge Chen, Zhengmin (Min) Qian, Junguo Zhang, Shiyu Zhang, Zilong Zhang, Michael G Vaughn, Hannah E Aaron, Chuangshi Wang, Gregory YH Lip, Hualiang Lin
bmjmedicine, Published May 21, 2024 - Online issue publication May 21, 2024
Effect of omega-3 fatty acid diet on prostate cancer progression and cholesterol efflux in tumor-associated macrophages—dependence on GPR120
Pei Liang, Susanne M. Henning, Tristan Grogan, David Elashoff, Jonathan Said, Pinchas Cohen & William J. Aronson
NATURE Prostate Cancer and Prostatic Diseases , Published 23 October 2023
Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies
Keum Hwa Lee, Hyo Jin Seong, Gaeun Kim, Gwang Hun Jeong, Jong Yeob Kim, Hyunbong Park, Eunyoung Jung, Andreas Kronbichler, Michael Eisenhut, Brendon Stubbs, Marco Solmi, Ai Koyanagi, Sung Hwi Hong, Elena Dragioti, Leandro Fórnias Machado de Rezende, Louis Jacob, NaNa Keum, Hans J van der Vliet, Eunyoung Cho, Nicola Veronese, Giuseppe Grosso, Shuji Ogino, Mingyang Song, Joaquim Radua, Sun Jae Jung, Trevor Thompson, Sarah E Jackson, Lee Smith, Lin Yang, Hans Oh, Eun Kyoung Choi, Jae Il Shin, Edward L Giovannucci, and Gabriele Gamerith
Advances in Nutrition, Published online 2020 Jun 3. doi: 10.1093/advances/nmaa055
Prostate Cancer Risk And Omega-3 Fatty Acid Intake From Fish Oil - A Closer Look at Media Messages Versus Research Findings
Walter Alexander
Pharmacy and Therapeutics (P&T), Published 2013 Sep; 38(9): 561–564.
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