A heart specialist solutions 10 questions from readers about fish oil and coronary heart illness l Skilled Opinion


I’ve written several articles on fish oil supplements, but none have generated the response I got after my last article published in the Inquirer in late May. I evaluated a study that challenged the evidence of using fish oil for heart disease prevention and concluded that I would no longer recommend it to my patients. I’ve clearly hit a nerve, especially in the pro-supplement scene.

One reader said the column was “a scientific travesty and medically irresponsible considering that high potency icosapentethyl (Vascepa) reduces cardiac risk. Sometimes Dr. Becker negligently mixing high-dose prescription icosapentethyl (EPA) with all the fish oil supplements that are available off the shelf, which can be pretty worthless. “

Another reader sent me a statement from Deepak Bhatt (the lead author of the Vascepa study) showing a 25% reduction in heart attack risk and said, “I was a little surprised to see that you got through the attack on Amarin’s Vascepa Short sellers have hooked up on the stock market and others trying to derail the outcome of a $ 600 million study of 8,000 people conducted over seven years under the supervision of the FDA, which approved the use of mineral oil as a placebo. “

It is difficult to say whether these answers are motivated by an understanding of science or of financial markets. Vascepa is big business, and its success largely depends on the differentiation between it and other fish oils. There seem to be conflicts of interest everywhere. The STRENGTH study, which showed no cardiovascular benefits from fish oil, was conducted by cardiologist Steven Nissan. He often speaks about the dangers of conflict, but has received grants from multiple industry sources, including the maker of Vascepa’s main competitor. Bhatt, the principal investigator of the REDUCE-IT study, has received grants from Amarin, the principal sponsor.

The article I wrote (I have no financial support to disclose) raised many other questions for readers, not all of which were negative. Among them:

  1. “I was wondering if any of the studies took into account the gross burp taste” of fish oil. The answer is yes, especially the cleaned prescription versions. If you have this symptom, you can try refrigerating your fish oil as this will help prevent the “burp” taste.

  2. “Wouldn’t seeds and nuts be the more optimal choice?” Yes, nuts, seeds and olive oil have been shown to reduce the heart risk with moderate consumption. Fish, especially the more fatty fish like salmon, have also been shown to promote heart health. Eating fish high in omega-3 fatty acids two to three times a week is good for you.

  3. “Absolutely nice analysis of the fish oil riddle with clear eyes. Great contribution to calm the confusion “

  4. “I take a teaspoon of cod liver oil a day and wonder if it’s chemically the same as fish oil.” It is not. Cod liver oil contains large amounts of vitamins A and D, which in high concentrations can be toxic.

  5. “I still wonder if consuming omega 3 from algae and not fish oil produces the same results?” The positive effects (which are controversial) likely come from EPA and DHA, which are primarily derived from fish sources rather than algae.

  6. “A degree and it’s over for you? … What if the study showed errors? ”I share this frustration. It may seem like medicine is upset with each new study. In this case, it is the increased risk of developing atrial fibrillation with high doses of omega-3 fatty acids that led to my conclusion that most people shouldn’t be taking fish oil supplements.

  7. “How can fish oil, especially from cold water (Alaska, Canada) be harmful or unproductive to your health?” High-dose fish oil (2 grams twice a day) can cause a higher risk of atrial fibrillation. There is no way to eat that much fish at once.

  8. “I often have chest pain, palpitations, and fatigue and am afraid it might be a heart problem.” I wrote back to this man immediately, suggesting that he see a doctor as soon as possible. The time to make a lifestyle change or consider supplementation isn’t when you have symptoms suggestive of heart disease.

  9. “Fish oil can still be useful in obstetrics. Please avoid media sensation and black and white thinking when considering this study. ”The studies I have discussed relate only to the lack of cardiac benefit and should not be generalized to other possible benefits / harms of fish oil.

  10. “What do you recommend?” I am concerned about the cardiac risk from taking high doses of fish oil (4 grams per day). I think it’s interesting that I’ve received very few comments about this risk. Unless you have high triglycerides and heart disease, the data suggest that the dose should be reduced to reduce the risk of atrial fibrillation. There is no evidence that 1 gram per day causes atrial fibrillation, and this is what I have suggested to my patients, if they want to continue taking fish oil, the approach can be a diet high in omega-3 fatty acids, daily exercise, decreased intake sugar and junk carbohydrates, quitting smoking, weight loss, and practicing relaxation techniques.

David Becker is a certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown. He has been in the practice for more than 30 years.


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