Do you take a fish oil supplement? If so, you’re not alone. It’s one of the most common supplements that I see on my patient’s medication list. The question is, are you wasting your money? 

 

New research suggests that if you’re taking fish oil for heart health or cancer prevention, you are likely wasting your money. But like most controversies in medicine, there’s more to the story.

If you take fish oil supplements, I understand because there was a time as a cardiologist that I took fish oil supplements and recommended them to my patients. In fact, the American Heart Association in the past gave a strong recommendation for taking fish oil supplements if you didn’t eat two or more fatty fish meals per week.

I don’t take fish oil or recommend it to my patients anymore because newer research has not shown a benefit to fish oil supplements.

Except for one type.

 

The REDUCE-IT Trial Findings

The REDUCE-IT trial was a surprise. With most recent fish oil trials not showing a benefit, REDUCE-IT showed a remarkable benefit – a 20% reduction in cardiovascular death and a 25% reduction in death from heart disease, heart attack, and stroke.

There were three unique things about REDUCE-IT.

  1. Use of a pure EPA version of omega-3 called icosapent ethyl
  2. Use of mineral oil in the placebo
  3. The large dose, 4 grams, with most prior studies using 1 gram

 

Therefore, some had questions. Was it the pure EPA, the dose, or was it not that EPA was better, but mineral oil is worse? Two newer studies shed some light on these questions.

New research suggests if you’re taking fish oil for heart health or cancer prevention, you are likely wasting your money. Newer studies shed some light on these questions.

The EVAPORATE trial

The EVAPORATE trial did CT angiograms – an x-ray of the heart arteries – on 80 subjects who took either icosapent ethyl or mineral oil.

They found that the group that took icosapent ethyl or the pure EPA agent had a reduction in their plaque in their arteries by 17%. However, the mineral oil group increased plaque by 109%.

How do we interpret these results? Those who believe in icosapent ethyl say this shows why it works. It decreases plaque volume. Those who don’t believe say look at the mineral oil group. They more than doubled their plaque volume.

The debate will continue.

Three other fish oil trials showed no benefit:

The VITAL trial, the OMEMI trial, and the STRENGTH trial.

The STRENGTH trial is different from most other fish oil trials because they used four grams of fish oil and they compared it to corn oil, which is a more neutral oil than mineral oil on the LDL cholesterol and C-reactive protein.

So how do we put this all together? Here’s what I tell my patients based on what we know so far:

The bulk of the evidence strongly suggests there are no heart or cancer prevention benefits to taking over-the-counter fish oil supplements at any dose.

There may be some risk to over-the-counter fish oil with a higher incidence of upset stomach, atrial fibrillation, and bleeding in some studies.

For high-risk people with high triglycerides, icosapent ethyl is likely the preferred treatment. However, that depends also on insurance, and financial means as the medication can be expensive.

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