Something fishy

Omega 3 supplements are said to help everything from your heart to your brain, but new research casts doubt on some of their claimed benefits

The Sunday Times Published 7 October 2012 Lois Rogers

LIKE lots of small boys, Charlie Watson was a handful. Although clearly bright, he would not sit still at school, he disrupted lessons, and when told to pipe down, would take it as an invitation to bait the teacher.

Swimming lessons were a particular treat, providing an opportunity for lots of splashing and not too much stroke practice. While everyone else was listening to the instructor, five-year-old Charlie would hold his breath underwater and lurk around everyone’s feet, pretending to be a fish.

So far, so normal, you might think, but Charlie was taking things to extremes and other children did not like it. He was assessed by a psychologist, who diagnosed autism spectrum disorder. His worried parents were recommended to investigate a range of strategies to help him.

They alighted on fish-oil supplements containing omega 3 fatty acids, and within a few months Charlie, who has since turned six, was transformed by the treatment.

“The effect on his behaviour was really significant,” says his mother, Sam Watson, 36, an English teacher from Peterborough, who has taken a career break to look after Charlie and his four-year-old sister Lucy.

“He stopped messing about at school, and by June he was able to complete three 20-minute maths tests, one after the other. He has completely stopped flapping his arms when excited, which is considered one of the traits of autism.

“He is now in year two, he has been at school for 4 weeks this term, and it’s been completely incident-free. We are convinced the massive imp-rovement we have seen in him is down to omega 3.”

Fish-oil supplements have long been linked with improvements in behaviour and brain function, as well as protection from a host of diseases including Alzheimer’s and depression, arthritis, heart disease and stroke.

Cod liver oil, which contains high quantities of omega 3, used to be handed out free for children. Introduced in 1942 to compensate for the effects of wartime food shortages, it continued to be available on the NHS until 1975, when it was replaced by vitamin drops, free only to mothers on benefits who asked for them.

Enthusiasm for it was further boosted in the 1970s, when evidence emerged that a fish-based diet appeared to protect Eskimos from heart disease. According to last year’s National Diet and Nutrition Survey, up to one in five of us continue to take fish-oil supplements, while other studies have suggested one in three professional-class adults are users.

Yet faith in omega 3 supplementation has been dealt a blow following publication of new research involving almost 70,000 people that suggests the nutrient may not be as beneficial as previously believed. The new study, which re-analyses data from 20 different trials, shows it does not prevent heart attacks, strokes or deaths from heart disease, and raises questions about its claimed benefits for other conditions.

The food-supplement market in Britain, of which omega 3 is a substantial part, is worth upwards of £400m a year. Could we be wasting our money?

Omega 3 is needed for virtually all bodily mechanisms, but as the human body cannot man-ufacture it, we have to obtain it from our diet.

It comes in three sub-groups: eicosapentaenoic acid, known as EPA; docosahexaenoic acid, known as DHA; and alpha-linolenic acid, known as ALA. The most beneficial ratios of these three subtypes is a further source of scientific argument.

The study that has provoked a reassessment of the value of fish oil was carried out at the University Hospital of Ioannina in Greece, published by the respected Journal of the American Medical Association, and included 20 studies involving 68,680 omega 3 users.

It does not suggest the familiar yellow-gold capsules have a detrimental effect — merely that they are not doing our hearts any good.

“Overall, omega 3 supplementation was not associated with lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction [heart attack],” it said.

This followed another high-profile study from South Korea, involving more than 20,000 people, which was published in May and drew similar conclusions, and yet another report in 2010 in The New England Journal of Medicine.

The latter concerned a trial involving 4,837 men aged 60-80 with heart disease. Half were given omega 3, half were not, and all were followed up for more than three years. The two groups suffered comparable numbers of heart attacks.

Despite the recent findings, the British Heart Foundation says it has not changed its advice. It continues to recommend eating oily fish as a means of arriving at the recommended daily omega 3 intake of at least 400 milligrams. This is not as hard as it sounds — an average serving of salmon contains 3,000mg.

The biggest problem is people thinking that if they take a supplement, they can do everything else wrong in terms of diet and lifestyleBut do we need to take the capsules? Victoria Taylor, a senior dietician with the foundation, says we “should be be able to get all the omega 3 we need from our diet”. Yet she does not reject supplements in some cases: the National Institute for Health and Clinical Excellence advice recommends “prescribed supplements should be considered for the first three months after a heart attack for those who are not achieving sufficient dietary intake”, she says.

Others point out that while fish eaters apparently have a lower risk of heart disease, we do not know that omega 3 fatty acids are the cause.

“I think fish oil is snake oil in a way,” says Tom Sanders, professor of nutrition and dietetics at King’s College school of medicine in London. “There’s a beneficial effect from fish and it may be [due to] fish oil or it may be something else. Heart disease rates have fallen a lot in the past 50 years anyway.

“The biggest problem is people thinking that if they take a supplement, they can do everything else wrong in terms of diet and lifestyle.”

Even if fish oil supplements do not improve the health of our heart, is there evidence that they have a positive impact on other body functions?

The European Food Standards Agency is engaged in a long-term project to quantify the research supporting the claimed benefits of thousands of dietary supplements. Although it does not allow advertisers to claim fish-oil products can reduce disease, they can say the products help to maintain health as far as a variety of aspects of heart and brain function are concerned.

It is not approved as a health claim, but there is some research evidence that omega 3 has anti-inflammatory properties that might translate into a clinical benefit. Arthritis sufferers have reported it reduces pain better than paracetamol and other painkillers — with fewer side effects. The jury is out pending further research.

Then there are omega 3’s anti-ageing effects, borne out by dozens of studies. The most recent one, published last week by researchers at Ohio State University, suggested fatty acids can reduce biological ageing in cell reproduction.

Research on the 14,500 young adults whose health has been tracked from birth in the Bristol University Children of the 90s study, has suggested improvements in brain function and protection against depression.

Nicholas Perricone, an American dermatologist and diet guru, has made a multi-million-dollar fortune from his salmon and fish-oil capsule-inspired diet. His books, The Perricone Prescription and The Wrinkle Cure, have sold millions of copies. The Hollywood stars Jennifer Lopez, Julia Roberts and Jennifer Aniston are among his disciples.

Perricone admits the anti-wrinkle message trivialises the content, but believes omega 3 has undoubted anti-ageing properties. “I’m standing on the shoulders of other scientists and translating for people,” he says. “I’ve gotten the message to millions that eating makes a huge difference in the way you feel. If you’re eating salmon now, or taking fish-oil capsules, I’ve helped you.”

Many people agree.

Alex Richardson, a research fellow at Oxford University’s department of physiology, anatomy and genetics, has published widely on the links between fatty acids and children’s behaviour for more than a decade, and is convinced of the benefits. “Anyone who suggests that omega 3s don’t do anything needs their brain examining,” she says. “No one has ever demonstrated exactly how smoking causes cancer, but we know it’s a fact.”

Why is medical scepticism about fatty-acid supplements resurfacing now? There are probably several factors. Most plausible is the likelihood that people are generally healthier than they were a generation or two ago, so studies investigating the effects of supplements may show less of a difference.

Doctors are instinctively drawn towards pharmaceutical drugs that ideally come with a large body of evidence demonstrating their mechanism and effect.

Despite public health guidance on fish-oil dating back to the second world war, many clinicians reject a belief in its benefits on the principle that such claims are old wives’ tales that must have been superseded by science.

The fish-oil lobbyists also claim there is a tendency for healthcare interventions to be enthusiastically promoted and then dismissed. For decades we have been told fish oil is good for us, but efforts to find out exactly what it does have been unsuccessful.

“The academic media love to set something up and knock it down,” says Richardson. “It is an irrefutable fact that brain tissue needs the fatty acids. I think we have to accept that absence of evidence for the precise effects does not equal evidence of their absence.”

Charlie Watson’s mother Sam, meanwhile, remains convinced the supplement is doing him good, and points to research showing children with behavioural problems tend to have lower natural omega 3 levels in their brain. So far, little sister Lucy has not shown any of Charlie’s behavioural traits; if she does, she will also be given golden capsules.

Watson is not the family’s real surname. 

Additional reporting: Peter Newlands


Fatty acid facts

Omega 3 fatty acids are found naturally in oily fish, such as salmon, herring, mackerel, anchovies, and sardines. They also occur naturally in plant oils such as echium and flaxseed.

The European Union, which is clamping down on the labelling of dietary supplements, rejects claims that fish oil supplements can prevent disease, on grounds of insufficient evidence.

It does, however, allow “general health claims” that, among other things, they help the maintenance of normal vision and heart and brain function and the normal growth and development of children.