Long-Awaited Study Results on Vitamin D and Fish Oil Supplements | Hacker News Reader

Long-Awaited Study Results on Vitamin D and Fish Oil Supplements

npr.org

264 pointsnradov235 comments

"Fine and Manson stressed that vitamin D and the omega-3 fatty acids found in fish oil are important nutrients, but the best way to get them is as part of a well-balanced diet. That includes eating fatty fish like sardines, tuna and salmon, and vitamin-D fortified cereals, milk, and orange juice."

Ah, okay. So instead of taking supplemental Vitamin D, you should get it from natural sources, such as..... foods that have been artificially fortified with supplemental Vitamin D.

I get your joke but the concern he expresses is only relevant to the Omega-3. In the case of vitamin D, outside of sunlight exposure, supplements are basically your only practical option. Furthermore, the foods mentioned often have it added (milk nearly always does) and so one would want to be aware of that before adding it further from another supplement.

At worst, the paragraph is just a poorly constructed catch all warning.

Bottom line is, get your Omega-3 from fish. Get your Vit D from the sun as much as you safely can and then from common sources before jumping to a separate supplement.

Here are my concerns with their statement:

First, I recall warnings about too much fish consumption due to mercury levels in the fish. So how much fish consumption is necessary to get the required omega 3 and does the benefits balance out over the harm caused by the mercury? And are there any particular kinds of fish to consume to limit mercury exposure while getting the benefits of omega 3?

Second, as far as I know juices are not too great for your health, all the sugars of a large amount of fruit in a quickly absorbable form without the fiber to slow it down. Consuming large amounts of juice might have been the trigger for diabetic conditions in a family member. Also, if I remember correctly, cereal had also been deemed not particularly healthy, although I don't recall the details.

> mercury levels in the fish

Better not to eat fish at all, as one small bit of tuna (for instance) per week already increases the mercury build up in the body.

https://nutritionfacts.org/topics/fish/

Also, you can get high DHA omega 3 supplements made from algae.

https://nutritionfacts.org/video/should-we-take-epa-and-dha-...

Tuna is nice and fancy (and expensive). Few eat it every day. Tilapia is cheap, sustainable, and has low mercury.

I’m no nutritionist, but what’s the big deal with eating tuna every now and again, but mostly sticking to smaller fish?

>Tuna is nice and fancy (and expensive). Few eat it every day.

In which country? Tuna cans and tuna sandwiches and salads are some of the most popular foods in lots of countries.

Nothing fancy (tuna is no lobster or caviar) or especially expensive about it. It's available as a Subway sandwich for dog's sake!

you're talking about different things... fresh tuna is pretty expensive. its just the cans that are dirt cheap

I see. But you can get your precious oils (or mercury) from either, right?

Not sure about the oils/omega-3, but the fish used to make the canned tuna is generally regarded as a much lower source of mercury compared to, say, the tuna used for sushi, and thus safer to eat.

Real tuna is delicious. Canned tuna is worse than pet food. (perhaps this explains the slip in your last sentence?) We probably shouldn't be eating tuna at all, for environmental reasons. GP's point that there are lots of non-apex-predator fish in both fresh and salt water still holds.

>Real tuna is delicious. Canned tuna is worse than pet food.

Don't know, I like both for their own tastes. Some canned tuna is worse than pet food (especially the one made into a mush), but some canned tuna is great.

>perhaps this explains the slip in your last sentence?

No, I wanted to give it a lighter slant than "god's sake" for our American friends, sort of like "heck".

If you really care about canned tuna, you can buy high quality stuff for $6/can that starts to approach the fresh stuff. No one does though. They buy the $1/can stuff that’s mostly junk.

What's wrong with pet food?

Depends on the price range and quality but in general it's highly processed, designed to addict, pumped with grains as filler/fiber.

Dry feed is linked to kidney failure in cars and small dogs.

Veterinarian food is marginally better but it still isn't comparable to a close-to-natural diet. Pretty much the same business model used by toothpaste brands sold by dentists (piggy-backing on profession trust).

There are higher quality cans and options like BARF which cost a bit more but are far better (and tastier) for pets. It can also be done at home at a lower cost but it's pretty messy. Time-wise takes around 8 man-hours per month for us (recepie calculation, getting supplements, grinding and cutting meat, getting it all together and packaging).

We've been feeding our cats with it for over 2y now. Their blood tests are far better and there's a visible increase in fur quality. Partner is a vet tech and has easy access to the clinic to checkup on our pets. She also daily sees effects of cheap dry stuff on patients.

Dogs have been genetically selected to process human food scraps. They have succeeded as a species because they eat what humans throw away. It’s not reasonable to think humans could extract proper nutrition from animal food (but if you’re starving, you’d probably deal).

> what’s the big deal with eating tuna every now and again

Once a week builds up merc in the body. Merc is toxic. That's the big deal. Smaller fish have less of this problem, but still add to it. Better avoid most fish at this point, we've destroyed the oceans to much, sadly.

https://nutritionfacts.org/video/which-brand-of-tuna-has-the...

'cies is repeatedly linking a vegan advocacy website. Infer from that what you will.

Those doctors recommend a WFPB diet. Veganism is an ethical stance, not promoted professionally that I know by any of them (Greger, Campbell, Furman, Eisselstyn, McDoughal, Klaper, etc.).

Is there a chance that a diet that is similar to chimps, bonobos and utangs is most healthy for us as well?

No refined food, mostly fruits+leaves and some seeds and bugs. It "maybe" that simple. These doctors are aware of this, and promote --to my best knowledge-- based on science what can logically be derived from our evolutionary ancestery.

Calling it "vegan advocacy" is besides the point. It's WFPB advocacy, because it's showing to work in studies/practices.

High meat cultures never produced the longest living people. High fruit+leaves have, repeatedly.

> High meat cultures never produced the longest living people.

This is a lie.

Spain has the fourth longest living country in the world according to the WHO, and ranks 11th in the world in meat consumption at 97 kg per person according to the FAO.

Australia, tied at 4th with Spain in life expectancy, consumes a whooping 111 kg per person, 3rd in the world.

Japan and Iceland, first and fifth in life expectancy, consume metric shittons of fish.

How would you bend this crushing evidence to support the argument that "high meat cultures don't produce the longest living people"?

That, as you said, of the developed nations Japan is the first (they eat fish rather than meat).

Also in Japan you can find the longest living people, Okinawa, and they barely eat meat (traditionally). A food culture is not defined by national borders: we have to look inside the countries to see what culture work for longevity. See the bluezones book.

Then I must say that I said something wrong: "longest living" alone is not enough, we want to be healthy too. Being sick for the last 30 years of my life, kept on my feet by a medical system (as what happens a lot in developed nations), it not a good prospect for me.

> they [Japan] eat fish rather than meat

You were specifically arguing against eating tuna. So a plant AND fish based diet might be best after all? Regardless, Spain and Australia trail very closely to Japan, and they are huge meat eaters.

> "longest living" alone is not enough, we want to be healthy too

You seem to be subtly implying now that these long-living countries might have serious public health issues. Again incorrect - according to Bloomberg, Australia, Italy or Spain are in the top-10 healthiest countries in the world, which includes measures other than longevity.

> Being sick for the last 30 years of my life

Well, I am sorry you had to endure that, but I hope you understand that your health and that of the public might not be related at all.

I argue against tuna for the mercury (not for the Omega 3; but I suggest to get that from algae extract).

I argue against beef for fat/ cholesterol/ animal protein (not for the iron, but get that from e.g. pommegranades)

> according to Bloomberg

I prefer the method of the BlueZones book (until I can read teh details of the Bloomberg study methods)

> Well, I am sorry you had to endure that

I expect not to endure that. As I do not consume the high-processed, high animal product diet so common in the west.

Evidence based nutrition :) That's my game. Meat causes colon cancer. The ideal consumed cholesterol amount is zero (yes a lot of short term studies like to show otherwise).

Canned tuna is quite cheap, isn't it?

> Consuming large amounts of juice might have been the trigger for diabetic conditions in a family member.

I believe this is only possible when on a diet that's >10cal% fat. When your fat intake is very low (like the fruit binging chimps/utangs/bonobos), and your cells are (thus) properly sensitive to insulin, you will not suffer from lots of sugar in fruit juice. Fibers help making it digest slower, and will reduce the blood sugar spike further, but the main thing is that your cells quickly absorb the blood sugar, for which proper insulin sensitivity is needed.

https://www.youtube.com/watch?v=uRbj3n-1CUM

But why drink juice when you can have the full fruit/vegetable? There is way more fiber, you fill up faster, and often it tastes better.

Not to people used to adding tons of sugar and syrups in their "juices"

That's not a juice anymore. Then I'd call it lemonade. :)

Fructose does not raise blood sugar (!) but can lead to NAFLD. Bananas have a relatively low GI. Fat is not the enemy!

> Fructose does not raise blood sugar (!)

It does, but in the absence of fat (>10cal%) in the diet it does not raise it in a significant way.

> but can lead to NAFLD

Do you have a source for that? Here a pretty comprehensive breakdown of the ways NAFLD can come about. https://nutritionfacts.org/video/prevent-non-alcoholic-fatty...

FYI: nutritionfacts.org is a quack site run by a quack (Michael Greger).[0][1] It may on occasion present the truth (by accident if for no other reason), but it should not be trusted as a source.

[0]: https://sciencebasedmedicine.org/death-as-a-foodborne-illnes...

[1]: https://www.healthline.com/nutrition/how-not-to-die-review

[0]: Rubbish. Greger (and a long list of other docs) promote a WFPB diet. They are not professionally promoting "veganism" (which is not a diet, but an ethical stance; and wrt to diet is more broad than the WFPB diet), and this article makes claims against veganism. Off point. Let's move on...

[1]: HNTD (the book) is on the topic of treating disease with whole plant food. Is that a problem? Is he denying that sometimes another approach is needed? (nope) Is he claiming prevention is better than curing? (yups) Now the article does little more that claiming "cherry picking"... 1/4th of the book is refs to scientific publications. Whether you think this was cherry picked or carefully selected is up to you... It more a matter of taste than anything else.

You bring a lot of concerns with very little facts or data to back it up. You should do the research on all of these things because every single one is a case of nuances.

First, fish consumption mercury concerns are mainly relevant with large fish. So stick to smaller fish like salmon, or, if you want the biggest bang for your mercury buck, the healthiest fish to eat is actually anchovies. And frankly if you learn to prepare them right, they are delicious.

Regarding juice, you don't need to drink much juice to get a vitamin D boost. First of all, at least around here, the only juice you typically see with it is orange juice. A glass of OJ a day with an otherwise recommended diet isn't going to give you any problems unless you have an allergy or something. Actually a glass of OJ without supplements is not a bad idea as many popular "healthy" diets lack citrus which is important for numerous reasons. But the key here is quantity. It's true, lots of juice is associated with bad health outcomes. Just stick to a max of 1 cup (~230ml) a day, and be sure to get sufficient fiber. I'd always eat something with 5+ grams of fiber along with my OJ. That said, if you prefer you could always just drink milk or take a supplement. Or go outside. I get my Vit D by going outside. I drink OJ daily because there's very little citrus in my diet otherwise. Plus I like it. It balances my black coffee nicely.

Cereal, again, depends entirely on what you're eating as well as culturally what you even consider cereal to be. There is a near infinite range of foods called cereal with highly varying degrees of nutrition. I personally wouldn't rely on cereal for nutrition. The nutrient rich cereals on the shelf at the store are basically typical low nutrition grains with a ton of added vitamins. You may as well take a multivitamin. The importance of mentioning cereal is that they already have many added nutrients so you should be paying attention to what you are ALREADY getting before choosing to add a supplement.

Honestly, all of these things are VALID concerns, but, your whole post is an exercise in modern blanket nutritional and health guidance. In short, blanket health guidance is crap. For any blanket guidance you encounter, even scientifically support guidance, you are going to have a plethora of nuances that undermine it. Just take the "avoid carbs" advice so popular today. Turns out the healthiest people get about 50% of their daily caloric intake from carbs. But it's the KIND of carbs, and the combination of other factors that matter the most. https://www.medpagetoday.com/primarycare/dietnutrition/74608 In another recent study it was found the Japan's oldest and most healthy elderly people lived on 80% calories from sweet potatoes, ate hardly any rice, and small amounts of meat/fish. Sweet potatoes are extremely nutritious so I'm not surprised. The carbs are mostly complex as well. That's pretty important.

Point is, be sure to understand the details or you'll end up blanket statement-ing yourself out of every good thing this life has to offer.

to that effect, Tony Robbins was exclusively eating fish and ended up with advanced neurodegenration (due to heavy metal poisoning) had to go on chelation etc.

> And are there any particular kinds of fish to consume to limit mercury exposure while getting the benefits of omega 3?

Mercury bioaccumulates in the ecosystem. That means higher levels in fish that eat fish, and highest levels in fish that eat fish that eat fish. It also accumulates over a lifetime, so longer lived fish have higher levels.

Farmed fish (in this US mostly tilapia and salmon) have other issues, but mercury isn't a generally concern. For wild fish, the small ones--anchovies, herring, sardines--are low in mercury, along with catfish, pollock, shad, and haddock.

The worst for mercury that are widely eaten are tuna (sushi or steak grade, the species they used for canned tuna aren't as bad), certain types of mackerel, and grouper.

> Farmed fish (in this US mostly tilapia and salmon) have other issues, but mercury isn't a generally concern.

I'm an amateur Bay Area fisherman, so as someone eating fish out of the Bay, am often studying up on mercury and PCB levels in species. My understanding is this is not true- farmed salmon are often fed baitfish meal (sardine/anchovy etc). They eat orders of magnitude higher quantities of these fish than they would in the wild, so they bioaccumulate more toxins than they would outside the farm. Let me see if I can find a source.

Some quick googling returns sources supporting both sides, so I'd take either position with a grain of salt.

Most Omega-3 comes from fish already, though there is a point in preferring the fish to the supplements, it's not as if it was something completely synthetic (like other supplements)

Also eating fish has other problems

All O3 comes from algae, fish merely accumulate. One could also get algae based supplement. It's animal friendly and possibly less contaminated (fish are much polluted nowadays).

https://en.wikipedia.org/wiki/Fish_oil

I read there:

"""The fish used as sources do not actually produce omega-3 fatty acids, but instead accumulate them by consuming either microalgae or prey fish that have accumulated omega-3 fatty acids."""

Thanks for the info, it's interesting that Algae produce (fish) Omega-3, whereas land-based plants produce only ALA and not EPA/DHA

And your brain consists of a lot of DHA. ALA->EPA->DHA conversion is minimal, and depends on many factors (which are basically showing that we need to be healthy).

It's espacially weird given that D vitamins can be produced easily in the human body as long as you expose the skin to the sun. It's in no way required to be provided from external sources.

A daily 15 minutes of exposure for the face and forarms is enough, and it contributes to recalibrate the mood and circadian rythm as well. It's free, healthy, and simple. Why would anyone recommand a supplement to people that have access to the sun is beyong me.

Omega 3 is harder, but still.

It’s not free or simple if the sun doesn’t shine where you live.

And even when it does shine the critical UVB spectrum may not pierce the athmosphere at a strong enough intensity for the body to produce vitamin D.

That's not the majority of the world, population wise. You can offer alternative for the exceptional case, but you should label it as such.

Darker skin types do not produce adequate vitamin D.

> "Fine and Manson stressed that vitamin D and the omega-3 fatty acids found in fish oil are important nutrients, but the best way to get them is as part of a well-balanced diet. That includes eating fatty fish like sardines, tuna and salmon, and vitamin-D fortified cereals, milk, and orange juice."

That doesn't make any sense in the case of Vitamin D. The amount of fish necessary to get a reasonably high amount of Vitamin D from a diet is so high, you may well get heavy metal poisoning. Fish is pretty much the only viable dietary source of Vitamin D.

There is only two way to get "enough" Vitamin D: Sunlight and supplements. Obtaining enough sunlight in the winter with an office job isn't possible in the northern hemisphere.

> That doesn't make any sense in the case of Vitamin D. The amount of fish necessary to get a reasonably high amount of Vitamin D from a diet is so high, you may well get heavy metal poisoning. Fish is pretty much the only viable dietary source of Vitamin D.

I believe the portion of the sentence advising readers on vitamin D sources is this part: "vitamin-D fortified cereals, milk, and orange juice." It is confusing because the order is reversed from the first clause of the sentence.

I do think it's a bit odd that the article criticizes vitamin D supplements and instead advises ... vitamin D supplemented foodstuffs.

Study linked was not the biggest cardiovascular health news of today--

This was: https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

A single purified component of fish oil - EPA, did lead to a 25% relative risk reduction on top of statin treatment. This is a huge result with off the charts p values.

Importantly the results were only positive for those:

> Among patients with elevated triglyceride levels

Much like low dose aspirin its possible this is a bad idea for the average person unless you are already showing signs of heart disease.

https://examine.com/supplements/fish-oil/#hem-triglycerides

The effect is stronger in individuals with elevated triglyceride levels, but it seems to lower triglycerides in those with more normal levels as well.

How is low dose aspirin bad for the average person? It is an anti-inflammatory, and inflammation is a leading theory of potential disease causation for a number of diseases. Daily low dose aspirin is associated with a significantly lower all-cause mortality in average people.

> How is low dose aspirin bad for the average person?

There's a small dollar cost, and there's this whole section: https://en.wikipedia.org/wiki/Aspirin#Adverse_effects

Nothing there suggests it is bad for the average person. The average person will lower their chances of dying by taking daily low dose aspirin. The average person does not have a sensitivity to aspirin, and the side effects of high dose aspirin don't apply.

Aspirin has detrimental effects on stomach, thats how. Ibuprofen was created because of that.

Think 1 teaspoon of blood per day that you bleed from stomach.

Vitamin C can prevent some of that but it still exists.

It has such effects only in a small portion of people, and only in high doses. That is not a reason for average people to avoid a daily low dose, which has a direct reduction in all cause mortality.

Yes, the fraud product from a one-product-wonder public company Amarin (NASDAQ: AMRN).

(see my comment below).

"fraud product" - Do you mean the product that has been FDA approved for 6 years? Is the FDA "in" on the fraud? Is the New England Journal of Medicine in too?

Does having one product (that sold $xxx mil last year) make a bad company? Or one that put all of it's chips into this long term outcomes study? (which has now paid off)

Why do you care so strongly about this?

>"fraud product" - Do you mean the product that has been FDA approved for 6 years? Is the FDA "in" on the fraud?

No, but something can be both FDA approved and fraud, e.g. snake oil. It just can't be particularly dangerous.

>Why do you care so strongly about this?

Wasn't you who devoted 4-5 arguments to a single comment the parent made? Why add this pop-psychology facile dismissal? What does "care so strongly" even means as an argument?

Trying to understand the commenter's motivations. This product has reduced cardiovascular death - if his fraud conspiracy theory convinces appropriate patients not to take it, it could literally kill people.

First time hearing about the product, but looking at the facts, the parent seems to be right. It's more snakeoil than product. Your argument was that FDA approved it, but here's the actual story:

"On 10/16/2013 after FDA's ADCOM panel had voted 9-2 against recommending to expand Vascepa's label for treatment of cardiovascular disease, shares dropped over 60%"

"In March 2016, after losing a court case, the FDA agreed to allow some off-label marketing"

So, it's not like FDA approved it as a drug for cardiovascular disease. They overwhelmingly rejected it as so, and then were forced to allow it to market it self off-label as such (for "free speech" purposes, as opposed for medical reality).

No better than regular fish oil but costs hundreds of dollars a month.

A way to scam money out of Medicare.

Using mineral oil in the study to make their product look superior.

I'm not the only one to share those concerns: https://www.forbes.com/sites/matthewherper/2018/11/10/fish-o...

The biomarkers of patients in the PLACEBO group decreased significantly (up to 30%). Why?

"But what seriously bothered five of the six cardiologists I spoke to was that the mineral oil had not behaved as a placebo at all. In other studies of cardiovascular drugs, blood test results on placebo do not budge. That’s not what happened here. Patients who received mineral oil saw their levels of low-density lipoprotein, the bad cholesterol, increase 10% to 84 milligrams per deciliter, 6% more than in the Vascepa group, according to the New England Journal of Medicine paper. What’s more, other blood test results used by cardiologists also went in the wrong direction. These changes were included in a supplement to the scientific paper, but not in the study itself. Levels of c-reactive protein, a measure of inflammation that is used to help calculate heart risk by some doctors, increased from 2.1 milligrams per liter to 2.8 milligrams per liter, a 30% increase. Could the placebo be causing some heart problems or strokes, making Vascepa look better than it really is?"

Shame on NPR for the sloppy reporting.

But since statins increase deaths from cardiovascular disease, it is very possible that EPA is only protective against the damage of statins, rather than being beneficial in general.

Dark-skinned office-working New Yorker here. Neglected blood tests for years. Took a significant other to realise that, every winter, I’d start eating tinned sardines by the caseload. Once I began supplementing, on doctor’s orders after a blood test, the cravings stopped. Guess what’s super-rich in Vitamin D?

Yeah I came here to say this. I'm sure people do take vitamin D to stave off heart disease and cancer but that was never my intention.

I live in scandinavia so every autumn I start taking one vitamin D pill a day to keep my spirits up during the long darkness.

I believe it helps and I have no illusions of preventing any diseases with it, except winter depression.

Came to say this. I’ve lived in London for 3.5 years and first winter got really depressed - originally from NZ and we have more light. Tried meditation and exercise and it kind of worked, but still not great. Next one and all since just took vit D everyday and the change in mood through winter has been remarkable.

What dosage did you take?

I take for example a 5000mg poll every two days. But in winter I take it every day.

You probably mean 5000 IU, which is equivalent to 125 micrograms (of vitamin D).

I don’t remember where I read this but I heard 2000 IU is the minimum to be effective.

This is common knowledge to everyone who lives in PNW. It rains most of the time so people take vitamin D.

https://www.nejm.org/doi/full/10.1056/NEJMoa1809944

Abstract: 'It is unclear whether supplementation with vitamin D reduces the risk of cancer or cardiovascular disease, and data from randomized trials are limited. Methods

We conducted a nationwide, randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (cholecalciferol) at a dose of 2000 IU per day and marine n−3 (also called omega-3) fatty acids at a dose of 1 g per day for the prevention of cancer and cardiovascular disease among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were invasive cancer of any type and major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes). Secondary end points included site-specific cancers, death from cancer, and additional cardiovascular events. This article reports the results of the comparison of vitamin D with placebo. Results

A total of 25,871 participants, including 5106 black participants, underwent randomization. Supplementation with vitamin D was not associated with a lower risk of either of the primary end points. During a median follow-up of 5.3 years, cancer was diagnosed in 1617 participants (793 in the vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95% confidence interval [CI], 0.88 to 1.06; P=0.47). A major cardiovascular event occurred in 805 participants (396 in the vitamin D group and 409 in the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P=0.69). In the analyses of secondary end points, the hazard ratios were as follows: for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95% CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for the expanded composite end point of major cardiovascular events plus coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to 1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to 1.40). In the analysis of death from any cause (978 deaths), the hazard ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or other adverse events were identified. Conclusions

Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo. (Funded by the National Institutes of Health and others; VITAL ClinicalTrials.gov number, NCT01169259.)'

What they tried: 2000 IU (1 tablet) of Vit D3 and 1g of Omega 3 per day.

Who they tried it on: older adults in USA.

What they found: no difference in risk of cancer, heart attack, stroke, or death.

I'm curious as to whether 2000 IU per day is considered a large dose by the HN community. I've a bottle of 5,000 IU.

This was in otherwise generally healthy people, so the dosage is going to be less than you'd give to a person with a deficiency.

A person with a moderate deficiency would probably get 5,000 IU. Doses up to 10,000 IU are fairly well tolerated.

So, no it's not a large dose. It's a modest dose.

Serum is more relevant. 40-60 ng/mL 25(OH)D, a commonly preferred range, is usually achieved with 50-100 IU/kg vitamin D3.

10 IU D3 : 2 mcg+ MK-4. And chelated/TRAACS magnesium.

In my opinion, the best benefit of fish oil and Omega threes and vitamin D are in combating depression. This article did not touch on that. There is pretty good evidence that fish oil is one of the best supplements for combating depression because it is used directly in construction of neurotransmitter pathways.

I highly recommend reading Dr Mark Hyman's book the Ultramind Solution. It's loaded with great info regarding nutrition and how it affects your brain. It is truly life changing information. He also had a podcast called Broken Brain that is worth checking out.

Julia Ross' the Mood Cure is good too, the not as detailed (tho that can be good if you are feeling overwhelmed).

Fairly recent Cochrane review concludes:

> ... we do not have sufficient high quality evidence to determine the effects of [omega-3] as a treatment for [major depression]. Our primary analyses suggest a small-to-modest, non-clinically beneficial effect ... compared to placebo; however the estimate is imprecise, and we judged the quality of the evidence on which this result is based to be low/very low.

https://www.cochrane.org/CD004692/DEPRESSN_omega-3-fatty-aci...

Also, I'd be careful with Mark Hyman. He's controversial at best and associated with some fairly quacky organisations. I'm also automatically wary because his bibliography is wonder-fix followed by magic-cure - and medicine is never that simple.

I'm a student doctor. If the answer was easy we'd have found it, and we'd tell you about it.

Can you recommend any books similar to Ultramind Solution but with more helpful info, in your opinion?

From the amazon page about ultramind: "Three-time New York Timesbestselling author Dr. Mark Hyman unveils his groundbreaking program that shows how we can fix our broken brains by healing our bodies first. Based on the emerging field of Functional Medicine, Dr. Hyman presents a simple six-week plan to restore health and gain an UltraMind, one that's highly focused, able to pay attention at will, has a strong memory, and leaves us feeling calm, confident, in control, and in good spirits."

That sounds like a bookful of BS and pseudo science.

without knowing anything about the book, i believe it is possible based on many videos by dr. gregor of NutritionFacts.org. Many nutritional changes, such as eating berries and other antioxidants and cutting saturated fat and cholesterol, and adding whole grains and beans have measurable improvements om the hourly and day scale increasing serotonin and decreasing anxiety. Add a few forms of exercise, fasting and supplements and your mind can be very clear and powerful.

If you're looking for general advice on living a healthy lifestyle, try this resource from the NIH:

https://www.nih.gov/health-information/your-healthiest-self-...

It's nothing groundbreaking, but that's a good sign in my book when it comes for credibility.

Or is it something more specific you're looking for?

I'm a vegetarian since birth who rarely ever gets sunlight exposure, and omega 3 (from algae pills) and vitamin D3 + K2 seem to have improved my mood within a few weeks of taking them daily. I still take them every day, and the mood improvement seems to have stuck around.

2000 iu per day is well under the recommended dose per this 2014 study published in the journal Nutrients:

http://dx.doi.org/10.3390/nu6104472

Indeed. If supplementing D3, at least respect the threshold value.

Except as fish oil supplements relate to heart attacks (headline is misleading IMHO):

> While the overall results were disappointing, there appeared to be a beneficial effect when it came to one aspect of heart disease and fish oil: heart attacks.

> Taking fish oil lowered the risk of heart attack by about 28 percent, which is a "statistically significant" finding, says Dr. JoAnn Manson, who is chief of the division of preventive medicine at the Brigham and Women's Hospital in Boston. She led the research.

> Those who appeared to benefit the most were people who didn't ordinarily eat much fish in their day-to-day diet, as well as African Americans, Manson says.

> African-Americans in the study experienced a 77 percent lower risk of heart attack when compared to placebo, which is a "dramatic reduction," Manson says. Further research is needed to confirm these findings, she adds, but, "in the meantime it would be reasonable for African Americans to talk with their health care providers about whether they may be candidates for taking fish oil supplements."

Likewise a Vitamin-D deficiency can make your tongue swell a bit. Is it a long term health issue? No. But, is it annoying af to bite your tongue and mess words up, yes it is.

Edit: LOL downvotes for a straight up medical fact :D

https://en.wikipedia.org/wiki/Vitamin_D_deficiency

Osteoporosis among other symptoms. Swelling tongue is not on the list.

Because Wikipedia is a medical reference.

Because Wikipedia is more reliable than a random guy from the internet.

So wait, what is disappointing about this:

"Taking fish oil lowered the risk of heart attack by about 28 percent, which is a "statistically significant" finding, says Dr. JoAnn Manson, who is chief of the division of preventive medicine at the Brigham and Women's Hospital in Boston. She led the research."

and

"African-Americans in the study experienced a 77 percent lower risk of heart attack when compared to placebo, which is a "dramatic reduction,"

The fact fish oil and vitamin d have been touted for couple decades as helping prevent cancer?

I remember both my parents taking both regularly growing up in the 90s and they both separately mentioned cancer prevention as the big reasons.

Even until recently I still see studies consistent with this idea (o-3 & cancer)

https://medicalxpress.com/news/2018-01-omega-3s-fish-flax-ca...

Isn't a risk reduction the same as helping prevent?

I’m a big believer in fish oil. In my late 30s I experienced a consistent feeling of unwell ness and what I describe as “brain fog” so badly and consistently I went to the dr about it. Turned I had high blood pressure and high cholesterol. Dr wanted me to modify my diet and if it didn’t improve he wanted to put me on statins(!)

Fish has never been part of my diet. Started using fish oil, eating Cheerios, vitamins and some excercise. Started makeung a point to include seafood 2 times a week. Long story short, 6 months later all my numbers were in line.

The most striking thing I recalled from this was the fish oil, brain fog went away, I felt a great deal more mental acuity.

Fast forward to today; that was all 8 years ago, in the interim I stopped all that and the brain fog and unwell ness are back. I started fish oil again, and the effect was immediate. I even remarked to my wife how much better I felt.

That’s all anecdotal, and probably placebo effect anyway, ymmv.

As for the statins... Doc said we had to treat my high cholesterol and triglycerides. I was very reluctant to take statins so she said "OK try red yeast rice for 3 months but if it doesn't improve you're gonna have to take statins". OK. My cholesterol 320->220. My triglycerides 300+ -> 115. It turns out that lovastatin was identified as one of the key molecules in the ancient Chinese remedy.

So that's my one data point, and the only one relevant to me regarding statins.

It's not at all surprising that red yeast rice would be as effective as a prescription drug in lowering triglycerides. In fact, "Some red yeast rice products contain large amounts of monacolin K, which is chemically identical to the active ingredient in the cholesterol-lowering drug lovastatin." (from https://nccih.nih.gov/health/redyeastrice)

It seems statins have serious side effects such as nerve damage, so perhaps you should go with the exact dosage prescribed by a doctor instead of taking an unknown quantity of the same drug from natural sources.

I got the muscle aches that can come from statins. Lowered my dose and they went away. Thing is, the doc never saw anyone achieve the results I did with the prescription stuff. No need to support a broken patent system and get a doctor and pharma company involved.

What part do you think Cheerios played in this?

Cheerios are advertise to reduce cholestol, there are studies to support the claim, whatever that’s worth.

The most striking thing I recalled from this was the fish oil, brain fog went away, I felt a great deal more mental acuity.

How much fish oil do you take?

Krill oil 300 mg once a day.

I have honestly never heard fish oil mentioned as a way to reduce cancer. I guess a lot of people have been taking/hyping it for that, but I've always only heard of it as a means of lowering your risk of heart problems. (And it sounds like the results of this study are that it dramatically lowers the risk of heart attack, as much or more as any prescription medication, so I agree with other commenters who say it's weird to describe this study as showing "disappointing" results for fish oil and heart disease.)

Wasn't fish oil recently linked to advanced prostate cancer? (people with prostate cancer had elevated DHA in a big study -- whether that's caused by fish oil consumption is unknown, but still something to consider.)

"Touted" based on what? There isn't much good evidence linking fish oil to cancer.

https://examine.com/supplements/fish-oil/

But there's very good evidence that shows fish oil has benefits for triglycerides and cholesterol, which is consistent with the results of this study re: heart attacks.

"The study, which was also a randomized clinical trial, tracked participants for an average of five years. The volunteers took icosapent ethyl, which is sold under the brand name Vascepa and was developed by the Amarin Corporation, which funded Bhatt's research."

Because if they spun the study as a success, the funders of this study, a pharmaceutical company, wouldn't be able to promote their drug.

Exactly. A private company selling a supplement paid for a study that shows said supplement is beneficial and should be consumed... This study cannot be taken seriously.

Yes, I don't understand why this is disappointing. The article also says there are no side effects. Even if there is 10% decrease, isn't it good?

If you read the editorial, the reason is that those were secondary endpoints (not what the trial set out to measure). The literature is filled with exciting secondary endpoint "discoveries" that turn out to be nonsignificant when they become primary endpoints in a study. Also, the data suggest that these secondary endpoints aren't to be trusted because findings don't match other studies.

Was going to post that first quote along with:

"Overall, they showed that neither fish oil nor vitamin D actually lowered the incidence of heart disease or cancer," Fine says.

So apparently heart disease and heart attacks are two different things. If so, why should we care about heart disease at all?

Sooooooo... I did a little bit of digging here.

3 studies:

-------------------

1st study about Vitamin D https://clinicaltrials.gov/ct2/show/NCT01169259

2nd study about fish oil with a low dose, 1 gram https://clinicaltrials.gov/ct2/show/NCT01169259

3rd study about a PROPRIETARY PRESCRIPTION variation of fish oil with a HIGH DOSE https://clinicaltrials.gov/ct2/show/record/NCT01492361

Results:

---------------------

1st study - no effect.

2nd study - no effect.

3rd study - "REMARKABLE degree of risk reduction".

The researchers are different but the HOSPITAL that conducted them is the same.

The HOSPITAL posted about BOTH studies at the same time (today): https://www.brighamandwomens.org/about-bwh/newsroom/press-re... https://www.brighamandwomens.org/about-bwh/newsroom/press-re...

IMHO, something smells a little bit ... FISHY in here LOL.

Amarin is a one-product medical "startup" trying to show that their fish oil variation works. Oh, they are also publicly traded. Their stock went up after this announcement. It has also 10x-ed this year. They are also trying to convince the FDA that it "works".

My opinion? Total fraudsters.

It is unclear what your suspicions are. You capitalized a bunch of words and concluded with "Total fraudsters". Can you tell us your specific issues with the studies?

See my other comments in the thread, the Forbes article quoting a few other cardiologists from other major universities.

Google around about the company and their drug Vascepa. Many people are skeptical about it and IMHO they have a point. Vascepa an extract from fish oil but is... prescription? Why? So they can extract hundreds of dollars from programs like Medicare when your doctor writes you a prescription about it. Vascepa does not seem to be any better than regular over-the-counter fish oil.

Good catch and a good reason to be suspicious.

The D-Health study in Austrialia will be done in a couple of years and is a similar size just looking at vitamin D, so we can see then if the results match. That is a large monthly dose so not exactly the same thing. Also, vitamin D studies seem to very often get contradictory results and I don't know if the reasons for that have been figured out.

Not directly related to this study, but one oddity with vitamin D for anyone who had done testing is that the most common tests undercount D2 and fortified products and many supplements use D2.

Establishing an Accuracy Basis for the Vitamin D External Quality Assessment Scheme (DEQAS). Burdette et al. 2017.

[pdf] http://www.ingentaconnect.com/contentone/aoac/jaoac/2017/000...

It always surprises me the amount of woo commenters here are willing to swallow.

Why came up with this title?

""We are reporting a remarkable degree of risk reduction," says Dr. Deepak Bhatt, who headed the study and is a cardiologist at Brigham and Women's Hospital."

"Taking fish oil lowered the risk of heart attack by about 28 percent, which is a "statistically significant" finding".

"African-Americans in the study experienced a 77 percent lower risk of heart attack when compared to placebo, which is a "dramatic reduction," Manson says".

"Overall, that study found there was a 25 percent risk reduction for patients taking the extract. These patients were less likely to die from heart disease, have a heart attack or stroke, be hospitalized for chest pain or need procedures such as angioplasty, stenting or bypass surgery, researchers reported."

Yeah, it's very stupid. "Fish oil slashes heart attack risk by a huge percentage--but it's not a Wonder Drug that cures all ailments. Disappointing!"

I can't say I noticed a change in mood when taking D3.

However fish oil undeniably reduces dryness in the EYES, with and without contact lenses.

They do sell in pharmacy supplements for eye health, I think targeted at older people, and the dosage of EPA /DHA is very low. I didn't try those so I can't say how much is needed.

I took eg. Life Extension 700/500 epa/dha and for me the effect was 100% reproducible. On a day I took it, my eyes supported the contacts much better in the evening. Without supplements I could feel the difference.

I wish I could say as much about D3. I keep hearing how it's good for winter etc, but even though I am healing TRAUMA and have suffered anxiety for 20+ years before starting therapy.. i never noticed any obvious changes in mood when supplementing with D3 (which was averaging 3000-ish IU per day). I wish! (edit: and, I spend a ton of time indoors, and working on a PC.. so if they did anything I should have noticed?)

Hello,

I didn't noticed a lot of changes with 2000 IU but at 5000 IU the effect on mood is dramatic and quite noticeable. Being liposoluble the effect has quite a latency over several days.

It's basically the "summer vacation" feeling.

(Be carefult to take pure D3 not something mixed with calcium though: effective dosage of vit D. would bring into calcium overdosage.)

Thank you. Could you mention a brand that I could look into and compare to what I was taking? And what are they sourced from (those that you took?).

It's winter soon so I guess I could give it another go.

I've noticed my mood improves at higher Vitamin D dosages as well. I've currently been taking Solaray brand Vitamin D3+K2, which is 5000IU D-3, 50mcg K-2, 110mg Calcium, 84mg Phosphorus.

Since this contains calcium, is it harmful to take everyday? Should I try to find a different supplement?

No comment was about supplements that are 500IU + 110mg Calcium. If you 10x this does you will have too much calcium.

Vitamin D supplements can sometimes be underdosed.

Man I am so confused. How is 28% reduction in heart attacks and 77% for african american men "negative" for both cancer and heart disease??? Am I missing something? Those results seem HUGE. Right?

"At this point, if one is thinking about supplementation, either omega-3s or vitamin D, talking to your physician or healthcare provider is the next step" Does anyone actually talk to their doctor before taking a vitamin? What information could they possibly provide

They could inform you how much 30 minutes of their time and the facility fees truly cost. ;-)

If you're quite serious about it you could maybe draw blood and see if you're deficient in any particular vitamins.

Just ask them at your annual checkup for ghod's sake. it's free then.

Yeah, that's true. My previous comment was very tongue-in-cheek, sorry. (And: in this country you're reasonably lucky if you get a free annual checkup.)

I have a terrific new naturopathic doctor who actually cares about my health and will run blood panels frequently and let me know what lifestyle changes and supplements would help me. I never knew before that I was deficient in zinc. Before her though, most of my doctors were of the bland "if you aren't in extreme pain then it's not a problem" camp.

I would much rather have a "if you aren't in extreme pain then it's not a problem" doctor, than one who would over diagnose every minor issue.

I'd rather have a competent doctor than either of those.

And them listening to their patient is a necessary condition! A doctor who doesn’t listen to his/her patient is a red flag.

And one who doesn't just happen to sell the thing she just told you you need.

I've recently discovered that naturopaths actually go to med school and that a naturopaths has a license to practice medicine, which blows my mind. I always thought they were snake oil salesmen.

My doctor's excellent on the topic. She pays a lot of attention to studies on supplements and has made recommendations and answered questions for me. The key information she provides is: Given my health history, is this likely to be useful to me? With a side of: Are there unexpected risks for me?

And what has she suggested?

You are seriously asking me to reveal my medical history?

Short answer: none of your business.

I'm glad to say, though, that I spot-checked what she said against the medical research literature myself and it seemed right to me.

We should also note that the studies were only done on people over 50 years old:

"... among men 50 years of age or older and women 55 years of age or older in the United States"

Maybe by then it's too late?

I admit to some confusion: my wife and I take omega-3 supplements, eat fatty fish, and take vitamins D supplements because of the purported increase in brain health.

Still, a 25% decrease in heart decease for African Americans and people who don’t eat fatty fish is a good result.

Also, re: “That includes eating fatty fish like sardines, tuna and salmon, and vitamin-D fortified cereals, milk, and orange juice.” I don’t like breakfast cereals, to many carbs, I prefer my morning carbs from steamed cauliflower, broccoli, etc. I decided to cut out dairy partly for health reasons and partly because of animal cruelty. I hate drinking commercially packaged orange juice, tastes like sugar. A fresh orange is tasty but does does not have artificially added vitamin D - so take vitamin D pills.

I am in my mid 60s and felt tired and low energy earlier this year. My doctor tested vitamin D levels, put me on vitamin D pills, and I literally felt good again within a week.

In my opinion the biggest issue with meds, supplements, and health studies in general is that it's an n+1 issue. All humans are unique individual cases.

What works great for one person might not work for the majority. This doesn't mean a particular remedy or supplement should be cast aside.

Here is an example of where I wish the "health industry" would move:

https://leapsmag.com/how-bacteria-killing-viruses-may-save-u...

https://phagesdb.org/

https://en.wikipedia.org/wiki/Phage_therapy

Isn’t fish oil also good for your joints?

EDIT: here’s some information - https://arthritisaustralia.com.au/managing-arthritis/living-... - and without doing much research I’ve been taking it to prevent joint strains from running - not sure if that’s worthwhile or not

Been taking 10k IU of D3 for a few months now, managed to get my measurement from the teens or 20s into the 90s of whatever unit that's in. I believe 100 is the max of the healthy range. Can't tell the difference, but allegedly you're going to feel "worse" if you're low on this stuff.

It would be amusing to find out that it actually makes no difference at all and it's all placebo.

I find it helps a little in the winter when it’s dark and rainy all the time. It’s cheap so I don’t see a downside if it is acting as a placebo.

Long-term health risks associated with low D include cancer and heart disease. I tested very low a few years ago and get tested every 6 months now. 10k for me as well. Who figured 12-14 hours a day at a computer would be unhealthy.

Are you taking it to prevent musculoskeletal disorders or cancer/heart disease? Works for the former

Immune system support.

Yeah, I've tried the same (my theory was it would help mitigate the effects of SAD through the long, dark winter).

I've noticed no difference (though to be fair, it was hardly an empirical approach). I have a pretty well-rounded diet, so I assume I'm not deficient.

I do think that fish oil makes a difference, at least in terms of exercise.

Do you also take magnesium? Have you verified serum levels via blood work?

As I said, I have to admit it wasn't empirical, so no blood work.

I wasn't aware of magnesium supplements - what's the science behind it?

If anyone is wondering why the study results are being framed as "disappointing" to major media outlets, take a look at the disclosed financial conflicts of interest document. Lots of mysterious "consultant" fees paid out by major pharmaceutical companies who have an obvious incentive to bash any natural alternative to their drugs.

Also, the "placebo" used here was mineral oil, which has many known health benefits. Why not use some type of sugar pill? Talk about tipping the scale in favor of big pharma's desired results from the beginning. Past similar studies on fish oil (funded by big pharma) have even used an olive oil "placebo", which skews p-values even further. Imagine a weight loss study that told the placebo group to start running a mile everyday and eating healthier food....

Exposing the scrotum/testicles to direct sunlight for 20 minutes/day increases testosterone significantly. I wonder if a sun/S.A.D. lamp would have a similar effect?

Citation needed

Fellow Europeans under the GDPR, FTFY: https://text.npr.org/s.php?sId=666545527

That's a forced consent design if I ever saw one.

Interesting. In the UK, the NHS suggests most people should routinely take vitaminD between November and March, but I wasn’t aware that heart attacks were the main issue with vitamin D deficiency.

Also, though the studies are dubbed ‘disappointing’ in the second paragraph

> African-Americans in the study experienced a 77 percent lower risk of heart attack when compared to placebo,

Isn’t exactly chicken feed.

Given these studies. I will stop taking fish oil. However, in light of further evidence by gwern as presented below, I will continue to take Vitamin D, even though my confidence in it is lessened.

https://www.gwern.net/Longevity

It's one study, and it was only done on people over 50. But yeah more science needs to be done.

I have my doubts on omega-3 supplementation as the amounts typically are not enough to change the omega-3:omega-6 ratios, which has been shown to have a big effect on hazard ratios for CVD. It looks like this study was for 1g of fish oil and there were no controls on dietary intake, so IMO the results aren't surprising.

I'd recommend that anyone interested in the health benefits of eating healthier... look into eating healthier. I really dig Marty Kendall's work on https://nutrientoptimiser.com/

Algae and Fish oil bypass the preferential omega-6 metabolism - EPA & DHA are downstream metabolites, so there is no barrier.

Flax seed oil is still healthy but only for the lignans - only marine oils can effectively provide DHA and EPA. Though most commercially available products are DHA heavy, which no longer seems to be the beneficial conjugate.

I'm a little surprised by the combination of a study on low dose (1 g) of fish oil coupled with the recommendation to get fish oil from diet. When I eat a tin of sardines, I'm certainly getting more than a gram of fish oil. Am I missing something?

Well, first, the study looked at cancers and heart disease. The conclusion is:

> there appeared to be a beneficial effect when it came to one aspect of heart disease and fish oil: heart attacks.

> Taking fish oil lowered the risk of heart attack by about 28 percent,

This reminds me of the study showing that a component of coconut oil can delay alzheimer's onset by years. There need to be more studies done with traditional remedies.

It’s been known for a while that supplemental omega 3s are probably best avoided until there’s more data out there.

https://www.health.harvard.edu/blog/fish-oil-friend-or-foe-2...

Vitamin C, E, and many other supplements have similarly questionable benefits with possible harsh side effects.

I wouldn’t reach for almost any supplement unless a doctor + blood tests + my own research suggested I should. And even then I believe diet and lifestyle modifications could be attempted beforehand.

Just to highlight one of the points in the linked page: There was a recent study that correlated high levels of serum DHA with aggressive prostate cancer. It is not known whether the elevation in DHA from the subjects was due to fish oil supplementation or some other biochemical process.

Everything has side effects.

> "statistically significant"

Why the quotes?! If the author doesn't understand what that means why report on science at all?

Because those two words were a quote.

Glad to see this thread about scientific research didn't immediately devolve into speculation about nutritionology.

It always seemed unlikely to me that any single substance that can be ingested as a supplement would have any significant effect on general malignancies. There are probably thousands of paths by which these can occur, one magic pill that would address them all is improbable to say the least.

text.npr.org https://text.npr.org/s.php?sId=666545527&rid=1001

TLDR; Overall, they showed that neither fish oil nor vitamin D actually lowered the incidence of heart disease or cancer. However aspect of heard disease that benefits is heart attack. Taking fish oil lowered the risk of heart attack by about 28 percent.

It is important to remember though D3 has other proven benefits.

I hadn’t even heard of it being potentially beneficial to prevent heart disease and cancer.

I take vitamin D because it makes a massive difference to my mood during the gloomy months in Seattle.

The broader significance is that fish oil was considered one of the most well supported supplements out there. Others like turmeric are less evidenced but maybe promising, and there's stuff like colloidal silver which is homeopathy nonsense. If fish oil does nothing for large swaths of the population, what do we really know about the efficacy of any supplements?

Quite a large population in the the world lives at place where fishes aren't available.

So is it possible some people don't really need fish oil for well-being? Evolution might have rendered eating fish useless for these people.

Yes, absolutely. Fish oil is not needed at all. The EPA and DHA in fish was initially produced by algae anyway.

https://en.wikipedia.org/wiki/Essential_fatty_acid

The 2 essential fatty acids are:

- alpha-linolenic acid (ALA, an omega-3 fatty acid). https://en.wikipedia.org/wiki/Alpha-Linolenic_acid

- linoleic acid (LA, an omega-6 fatty acid). https://en.wikipedia.org/wiki/Linoleic_acid

Linseed oil (flaxseed oil) is a good provider of essential fatty acids. https://en.wikipedia.org/wiki/Linseed_oil

EPA (eicosapentaenoic acid) or DHA (docosahexaenoic acid) are conditionally essential fatty acids.

https://en.wikipedia.org/wiki/Essential_fatty_acid#Condition...

https://en.wikipedia.org/wiki/Eicosapentaenoic_acid

https://en.wikipedia.org/wiki/Docosahexaenoic_acid

Experts recommend a vegan diet against heart disease and cancer.

E.g.

http://www.who.int/features/qa/cancer-red-meat/en/

https://www.ncbi.nlm.nih.gov/m/pubmed/19562864/?i=2&from=/27...

https://www.eatright.org/food/nutrition/vegetarian-and-speci...

https://lustysociety.org/diet.html

>Fish oil is not needed at all. The EPA and DHA in fish was initially produced by algae anyway

People who lived in areas without fish also lived in areas without algae.

>The 2 essential fatty acids are

It is worth noting that there is basically no evidence that those 2 fatty acids are actually essential. A single study done in the 1930s is the basis for that belief. A study in which rats fed no fat got symptoms we now would consider indicative of vitamin B6 deficiency. This study was done prior to the discovery of vitamin B6. Although adding "essential" omega 6 fatty acids alleviated the rat's symptoms, later studies were able to alleviate the symptoms using vitamin B6 while the rats continued to receive absolutely no fats.

>Linseed oil (flaxseed oil) is a good provider of essential fatty acids

And linseed oil consumption is correlated with an increase in all cause mortality.

>Experts recommend a vegan diet against heart disease and cancer.

Experts recommend all sorts of things that contradict evidence. Like taking statins even though they increase mortality. Or switching from perfectly safe saturated fats to "heart healthy" trans fats even though it increases mortality. Or once trans fats were too obviously bad they simply changed their recommendation to "polyunsaturated fats" which are also correlated with increased mortality.

> People who lived in areas without fish also lived in areas without algae.

The point is that EPA and DHA is not made by fish. EPA and DHA can be bought in vegan form. EPA and DHA are not even considered as essential fatty acids. Unlike ALA and LA.

I have not seen any study what shows that ALA and LA are not essential. If you have one, please link it. I would like to know.

> And linseed oil consumption is correlated with an increase in all cause mortality.

Link please.

> Or switching from perfectly safe saturated fats to "heart healthy" trans fats even though it increases mortality.

What are you talking about ? Are yout talking about margerine and butter ?

But I agree that many so called experts are not experts.

Many organizations and in particular government organizations (e.g. EPA and FDA in the USA) affected by politicians are very prone to corruption and pleasing corrupting lobby groups like the food industry and the military industry and the fossil fuel industry.

But some truth is known in 2018.

https://livinontheveg.com/omnivore-or-herbivore/

https://www.youtube.com/watch?v=xl8zNztsoGg

https://www.youtube.com/watch?v=ZCMWctmCCqU&t=432

https://www.youtube.com/playlist?list=PLLrSGiXTX6Im72KTZRDln...

>The point is that EPA and DHA is not made by fish

But that point is not relevant to the post you replied to, which was wondering aloud about human adaptation to the availability of fish. The availability of algae is the same as the availability of fish.

>I have not seen any study what shows that ALA and LA are not essential.

Have you seen one that shows it is? Because there are none.

>Link please.

I can't find the original study, just people talking about it. They gave up on the original premise as the linseed oil was killing people instead of making them healthy, so they ended up reporting on smoking and blood pressure.

https://tidsskriftet.no/en/2012/01/life-expectancy-and-cause...

>But some truth is known in 2018.

But people with agendas lying on their blogs or youtube isn't truth. Pretending carnivores are omnivores and then saying "look we're not like omnivores" is just deliberate dishonesty. We are not like carnivores. We are, 100% without any question, omnivores. Read literally any text on mammology, there is no debate, no controversy, no ambiguity. Poor studies like the adventist study vegan advocates like to cite may show benefits when they don't control for anything else. But properly defined and conducted trials show veganism is not associated with lower mortality: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691673/

> But that point is not relevant to the post you replied to

Yes it is. Remember:

>>> So is it possible some people don't really need fish oil for well-being? Evolution might have rendered eating fish useless for these people.

> But people with agendas lying on their blogs or youtube isn't truth. Pretending carnivores are omnivores and then saying "look we're not like omnivores" is just deliberate dishonesty.

Yes we can it fresh meat and digest it. Even cows can digest milk and meat to some degree; remember the mad cow disease.

The human body works best with vegan food as main food or only vegan food in 2018 with modern vitamin supplements. This is a fact.

Regarding vitamin B12: https://www.youtube.com/watch?v=cavI_FnIrh4 and https://www.youtube.com/playlist?list=PL5TLzNi5fYd-Tyz9vI6Q2...

I am sure you have not watched the videos because otherwise your would reply differently.

Again, human physiology that you can not deny or call a lie:

https://livinontheveg.com/omnivore-or-herbivore/

https://www.youtube.com/watch?v=sXj76A9hI-o

By far most humans do not like and do not eat raw meat.

Most humans do not even like predigested meat in the form of cooked meat or grilled meat without further additions like salt and spices and other plant based food for the taste.

>Yes it is.

No it is not, read the context you intentionally cut out: "Quite a large population in the the world lives at place where fishes aren't available".

>The human body works best with vegan food as main food or only vegan food in 2018 with modern vitamin supplements

There is no evidence to support your assertion. The fact that vitamin supplements are required in order to avoid dying is incontrovertible evidence that humans are not herbivores. Our digestive tract, dentition, and enzyme production are those of an omnivore. We have absolutely no characteristics of herbivores.

>Even cows can digest milk and meat to some degree

All mammals can digest milk, that is why all mammals produce milk. That has nothing to do with your claim. Meat fed to cattle is pre-digested in order to allow them to get some energy value from it. They can not digest it normally.

>Again, human physiology that you can not deny or call a lie:

It is a bunch of lies and deliberate nonsense. Claws do not define diet, that is a completely irrelevant characteristic to focus on. Dogs are not omnivores they are carnivores. Our closest primate relatives are omnivores just like us, not herbivores. Notice how you keep referencing vegan activists spouting nonsense on blogs and videos? That is not evidence. There is a reason every biologist in the US has read this book rather than watch vegan youtube videos: https://www.amazon.ca/Mammalogy-Adaptation-Diversity-George-...

>Most humans do not even like predigested meat in the form of cooked meat or grilled meat without further additions like salt and spices and other plant based food for the taste.

And your basis for this claim is that the vast majority of the population of earth consumes meat all the time? If lots of people choose to add additional flavorings to something they eat, then that means it isn't part of their natural diet? By that definition, the natural diet of humans is absolutely nothing, not even water.

I will not further defend the points that I have made and still make. You just call it lies and link a book that I will not buy. Probably because you can not find valid information against my standpoint on the internet.

Wolves are presented as typical carnivores in the linked video.

The web page puts dogs in the category of omnivores like many experts do or did.

https://en.wikipedia.org/wiki/Dog

https://en.wikipedia.org/wiki/Dog_food

http://www.vetstreet.com/our-pet-experts/are-dogs-carnivores...

I link these "vegan activists" because they were active to create the good videos that I can link.

I live in West-Europe and from primary school to university, the recommendation for food has always been less meat and less cheese and less fat and less candy and more vegetables including fruits and more fiber.

The benefits of a plant based or vegan diet have become only more scientifically validated and more accepted in the population. Also because of a growing acceptance that actions against climate warming and pollution and unsustainable and horrible animal farming are needed.

https://xkcd.com/1338/

http://www.who.int/features/qa/cancer-red-meat/en/

https://www.ncbi.nlm.nih.gov/m/pubmed/19562864/

https://www.ncbi.nlm.nih.gov/m/pubmed/27886704/

https://www.ncbi.nlm.nih.gov/m/pubmed/21139125/

https://www.eatright.org/food/nutrition/vegetarian-and-speci...

>You just call it lies

You are literally linking to youtube videos by an infamous crank.

>link a book that I will not buy

You don't need to buy it. The point is, biology text books contradict your advocate fraud. Which is more credible?

>The web page puts dogs in the category of omnivores like many experts do or did.

Dogs are the same species as wolves.

>I live in West-Europe and from primary school to university, the recommendation for food has always been less meat and less cheese and less fat and less candy and more vegetables including fruits and more fiber.

And health problems have gotten worse. Funny how that works huh? Myocardial infarctions literally did not exist prior to the 1900s when "vegetable oil" was introduced to our diets. We consume far less animal fat than Victorians did, yet have far worse health. Hmmm.

>The benefits of a plant based or vegan diet have become only more scientifically validated and more accepted in the population.

There is no evidence to support that belief.

>Also because of a growing acceptance that actions against climate warming and pollution and unsustainable and horrible animal farming are needed.

That has nothing to do with veganism, it is a red herring vegans use to push their agenda on the back of environmentalism which people are more receptive to.

Evolution might just have found a way to get people to reproduce before the lack becomes a problem. Most certainly it didn't optimize for age 60 and beyond.

This headline is quite misleading (and arguably very biased toward white readers). It describes a marked improvement in outcomes for African American study participants.

So perhaps NPR views this as "disappointing" but the headline suggests broadly that everyone should stop taking those supplements, when in fact the results are far more nuanced.

HN's absurd title policy is using a clickbait (and misleading) title chosen by NPR and amplifying it.

>This headline is quite misleading (and arguably very biased toward white readers). It describes a marked improvement in outcomes for African American study participants.

Maybe NPR is just playing to their audience?

Without reading the article, if you're dark skinned you need to be really aware of your vitamin D levels when living away from a tropical sun.

Just like super white people need to be careful about sun screen when away from northern European climates.

The article only mentioned benefits for African Americans for fish oil not vitamin d, and related to heart health not (skin) cancer... and as the other commenter pointed out even the data on that was flimsy and not the main focus of the study.

Does not matter. The effects on African American populations were probably not part of the pre defined endpoints, so yes, it is perfectly acceptable to say the study is negative. Looking at subgroups a posteriori is essentially what leads to p hacking and this is the behavior that we want to discourage in sciences.

Shouldn't one consider what the p-value is in weighing whether it is a fluke or not?

In theory, you can do some more statistical tests to study if the subgroup analysis has statistically significant results.

In practice, those tests are probably going to be skipped or done improperly, and it's difficult to tease out if the subgroup analysis suffers from the statistical fraud of reanalyzing until you get a positive result. Redoing the test from the start with the subgroup as the primary endpoint would always get you more accurate data, and history has pretty clearly shown that most instances of "we looked at the subgroups and found something where it works!" tend to not actually work when done properly anyways.

The study is designed to evaluate precise and well-defined endpoints. Any additional observation not planned from the start does not have the same rigor (since the study does not control for all thousands of variables at once, obviously), so in practice you should never draw conclusions from what was not agreed to evaluate from the start.

I don’t know, the findings about African Americans seem to be a case of “outcome switching” [0] since it does not appear that this trial was specifically designed to test against that group.

[0] https://www.vox.com/2015/12/29/10654056/ben-goldacre-compare...

A more approachable description of why this is bad: "Green Jellybeans cause acne, p=0.05"

https://xkcd.com/882/

No, outcome switching is not exactly the same as P-hacking, but either could be blamed here.

But on the other hand if you do the equivalent of 20 parallel trials and one of them has a naive p value of .001 then you still have a good result.

I don't know how what heart attack values normally look like, but those percentages are pretty huge. They sound like numbers that might stand even after you compensate for the subsetting.

> HN's absurd title policy is using a clickbait (and misleading) title chosen by NPR and amplifying it.

In general I think the HN title policy works great, and I don’t think it’s fair to call it “absurd”.

I think HN at its core always was a sort of social experiment revolving around online discussions. The title policy, along with the guidelines, is what makes HN be HN.

The absurd part isn't the convention of being true to the source's headline — which is good, generally — but the dogged persistence in keeping bad and misleading headlines, with extremely rare exception.

This is not a case of misleading headline. The study endpoints were not met. It is negative.

Agreed. This is turning out to bettet represent commenters preference for controversy and superiority over other comments/submissions than any expose of social media sites or HN's preference for negativity.

In the article, there are 6 paragraphs on the recent negative study results, followed by 15 paragraphs suggesting possible benefits either out of scope of the two recent studies, or potential future avenues of research.

NPR's title is certainly accurate for the portion on the two studies, but ~3/4 of the text is not about the negative study results. So, while it's not the most misleading headline ever to grace the orange site, it's not exactly representative of the text either.

Since the comment yesterday, the HN headline has changed to "Long-Awaited Study Results on Vitamin D and Fish Oil Supplements," dropping "disappointing."

Look, its pretty clear the study did not meet any of the expectations set before it started. Disapointing is totally appropriate. No need to be overly optimistic about every failure out there by cherry picking a few avenues for further research.

Exactly. Not sure this is an example of that, but what you describe is the major problem with the HN title policy in my opinion.

I don't know, the linked editorial in NEJM summarises it pretty well:

>However, these “positive” results need to be interpreted with caution. First, there was no correction for multiple comparisons, as would be required to attenuate the chance that these are spurious results, owing, in part, to the number of secondary end points. Second, these putative effects have not been consistently observed across other large, randomized trials of n−3 fatty acids.5,6 However, in one of the trials of vitamin D supplementation, post hoc analysis showed a lower incidence of cancer among women who received active supplements than among those who received placebo, excluding women who had withdrawn or in whom cancer had developed in the first year of the trial.13 Finally, the medical literature is replete with exciting secondary end points that have failed when they were subsequently formally tested as primary end points in adequately powered randomized trials. Thus, in the absence of additional compelling data, it is prudent to conclude that the strategy of dietary supplementation with either n−3 fatty acids or vitamin D as protection against cardiovascular events or cancer suffers from deteriorating VITAL signs.

https://www.nejm.org/doi/full/10.1056/NEJMe1814933

So HNs "click bait" is not the issue at all then... The article merely misrepresented the positives for cardiovascular health but was largely correct about cancer (which was the entire point of the study as well as the topic of the headline).

From https://news.ycombinator.com/newsguidelines.html

>Otherwise please use the original title, unless it is misleading or linkbait; don't editorialize.

HN's policy is just the opposite. It would be good to know what the guidelines are before calling them absurd!

"Please use the original title, unless it is misleading or linkbait."

https://news.ycombinator.com/newsguidelines.html

This is absolutely a clickbait title.

A better one would be something like "Landmark Study On Fish Oil and Vitamin D Shows Fish Oil Reduces Heart Attacks, But Few Other Benefits"

Orig title was: "Vitamin D And Fish Oil Supplements Disappoint In Long-Awaited Study Results"

Current title is: "Long-Awaited Study Results on Vitamin D and Fish Oil Supplements"

The current title doesn't contain the conclusion which is much more neutral and invites for more reading. The current title is not clickbait.

It was fixed after my comment.

Why do we keep looking for some magic pill and ignore diet and exercise, especially when we talk about cancer and cardiovascular disease? Expecting a pill to counteract a sedentary lifestyle and a diet high in sugar and carbs is lunacy.

Diet and exercise have considerably higher costs than pills. Seems like that should be apparent.

I don't see it as lunacy. Some chemicals we put into our bodies kill us, some cure our illnesses, some keep us awake or put us to sleep. It's lunacy to believe that some can benefit our health?

Regardless, this isn't zero-sum. I don't think people are advocating for a pill to replace diet and exercise, but it seems obviously worthwhile to pursue other avenues of living a healthy life.

If you want to lose weight, spending hours in the gym is a waste of time if you change nothing about a bad diet high in carbs and sugar. I think the same goes with vitamins or supplments...if you change nothing about your lifestyle and are at risk of developing a cardiovascular disease taking a vitamin probably won't do anything. If you make significant lifestyle changes that are already proven, or at least more proven, to reverse symptoms of cardiovascular disease and then take certain vitamins as part of that change then the vitamins might have the impact of slightly speeding up the recovery time and/or slightly reducing the chance you'll be diagnosed in the first place.

Post body

There's a cost to exercise? Walking, running, and jumping jacks are free.

It still costs time.

You make time.

There's a cost not just in time, but also in willpower. There is some disagreement as to whether willpower is a finite resource or not, but if there is even a partial limitation, then coming up with that willpower needs to be taken into consideration.

Also, saying "you make time" is true in such a way that is of little value, as there are a multitude of things you can make time for, such as connecting with your friends and family, learning new skills, educating your children, and any of those can take up as much time as you have. Life is a balance of things where you try to minimize your regret, since there is just not enough time to do everything you want to do.

Exercise is very important. I wouldn't recommend looking at it as something that is optional. It's funny you mention willpower, as there is a book called "The Willpower Instinct" and the author claims that willpower is indeed finite and exercise is one of the best things that can lead to a greater amount of willpower over time. So exercise may be a short term willpower cost but if this author is correct, exercise would lead to a net gain in willpower over the long term.

Exactly. We all have the same 24 hours, how we we choose to prioritize is up to us. But I’m not interested in excuses of “I don’t have the time.” You MAKE the time when it comes to your health.

Of course, a decade ago, the lunacy was expecting something to counteract a diet high in fat.

There's a lot of back on forth on this, and I think that while Ancel Keys was wrong, he now gets unfairly maligned a lot. Nutritional science is just hard. Here's an interesting writeup on how dietary fat became the bogeyman: https://deniseminger.com/2011/12/22/the-truth-about-ancel-ke...

(One interesting thing about the past associational studies is that many did not control for transfats, or even smoking).

I also like this Vox article from a few years ago that describes why nutritional research is so hard: https://www.vox.com/2016/1/14/10760622/nutrition-science-com...

It's absolutely hard. I just expect that a blanket "carbs are evil" is likely to be as incorrect as the blanket "fats are evil" advice. (e.g., the Twinkie diet http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/... )

Amount of food we eat, roughly eetimatable as calories, is important. I think gut biota is also an interesting field we are just learning about.

But yes, eat in moderation and exercise.

Why can't we take supplements AND have a healthy diet and exercise.

These pills are part of your diet.

Because magic pills don't require lifestyle changes, and lifestyle changes are quite difficult to do for many people.

The evidence suggests that "quite difficult" is actually closer to "practically impossible". It's not just willpower, it's social and economic also!

That's sort of like asking why we keep using antibiotics when you could just live in a bubble. Answer: Because not dieting and exercising is easier, cheaper, and more efficient.

Why do you think so? If you accept the body as a very complex biochemical machine, then you should also accept that there are some changes you can introduce that impact the overall state. Take for example Myostatin: its an active ingredient that promotes the build up of muscular mass, and this does not require to do any physical activity. There are thousands of substances that significantly impact how you feel, sleep, and operate, so I am not sure why the answer to every problem should always be diet and exercise.

I work indoors and there's not enough sunlight around to get enough vitamin D, especially this time of year.

Show me a randomized control study of healthy people with lower all cause mortality from either diet or exercise, and I'll gladly change my ways.

Nutrition studies are very difficult, which is exactly how we get to a place where governments are pushing food pyramids telling everyone to eat mostly carbs everyday. I won't show you anything, other than articulating that I genuinely believe sugar is toxic, we should be eating fewer carbs, intermittent fasting makes me feel better, and 3 meals a day is unnecessary.

This comes across like the people who say, show me incontrovertible proof God does not exist and I will happily become an atheist.

Knowing, of course, it cannot be proven.

If you are actually of open mind, there are some natural experiments that have been done, e.g. see Blue Zones.

One of the largest observational studies done, the PURE study (large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires) includes statistically significant all-cause mortality data and is the best controlled for study yet.

Here are the abstract results: Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. INTERPRETATION: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

doi: 10.1016/S0140-6736(17)32252-3