Popular fish oil study deeply flawed, new research says
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cbc.ca
Fish oil has been tied to multiple benefits, not just heart disease. Claiming a blanket lack of efficacy for fish oil supplementation presumes that 1) there is no heart disease benefit (all we know is that there are methodological errors in the Inuit study) and that there are no other health reasons for supplementing with fish oil. From the Wikipedia article, identified (all specifically tied to studies).
• Cancer
• Cardiovascular
• Hypertension
• Mental health
• Alzheimer's disease
• Lupus
• Psoriasis
• Pregnancy
What this addresses is TFA's claim that fish oil has no benefits based on an analysis of one study concerning one claimed benefit. That claim is just as unsubstantiated as it claims the Inuit study benefits are.
Unfortunately it isn't apparent that that is the the focus until you look at where the article is hosted. So I'll vehemently agree with your initial observation that the original title is link-bait at best.
There are many studied and documented benefits of fish oil. This hardly "puts a nail in the coffin" for the supplement but hopefully it gets people thinking and some more studies funded so we can get a better picture.
Of course if our food just had a better omega-3 :omega-6 ratio we'd be in a situation where the supplement wouldn't be the necessary...
An observational study from the 1970s and a critique of an observational study from the 1970s will carry little merit compared to a 20k RCT.
Knowing that we'll have better data in 5 years, the comment by the researcher is nauseating: "They simply don't do anything for you. The people should know that it doesn't help to prevent heart disease." Since we haven't quite reached an apex in research in fish oil, the comment is short-sighted and is overstating what we know about fish oil to date.
The NEJM article in this thread is much better evidence -- a 13k RCT that found no statistically significant benefit in 1g/day of omega 3s. On the other hand, there was a large 11k trial in the 90s that did find benefit 1g/day of omega 3s: http://www.ncbi.nlm.nih.gov/pubmed/10465168
The VITAL study underway will be interesting. It's the largest trial to date on fish oil and is looking at a healthy normal population, as opposed to those with CVD or high-risk of CVD.
http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-ac...
Makes me think about people, science and the church. There is large decline in the church and it's as though a "faith" in everything "science" has replaced it.
It's not true that there's such a thing as "faith" in true science, since science is the opposite of faith.
But I would agree that there's faith in "science" with quotes, ie science-sounding pseudo-facts.
Food supplements can't be good; we should just eat real food that we cook ourselves; everything else is going to do us harm.
I find this behaviour weird, but it seems to be quite common.
About parapsychology as mentioned in your link: Personally, that stuff scears the crap out of me. I just like to think there is more between heaven and earth than we know...
The first is more of a metaphysical question. But there are huge doubts about the second in every discipline, maybe except physics. There are publishing biases, observational studies everywhere, replication problems, sample biases (19 year old college students), even straight up fraud that goes uncorrected for years. And that's just the cases we know about.
This struck me. For example examine.com has[0] quite good coverage when it comes to supplements like fish oil, and not surprisingly their round-up shows multitude of benefits from fish oil.
Okay, perhaps the phrasing was altered to provoke and mislead the reader, but still.
http://raypeat.com/articles/articles/fishoil.shtml
N-3 fatty acids interfere with oxidative metabolism and promote cancer. In the short term N-3 oils can appear to help various problems like inflammation because they suppress the immune system. In the long term that's obviously bad.
Also, I think more people need to look at what the prestigious Mayo clinic has to say about the positive benefits of fish oil as well:
http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-ac...
http://slatestarcodex.com/2014/04/28/the-control-group-is-ou...
Of course, vaccine studies are probably way more rigorous and easier to control than figuring out the complexities of nutrition, but it is a little unsettling how easily doubt can metastasize. There's really no solution here other than trying to spread scientific literacy and helping people understand the rigorous testing of modern medicine, while also encouraging them to think twice about the sensationalized studies they read.
There could hypothetically have been a basis like the one you're talking about, but it seems evident from the movement itself that this didn't happen in our version of reality.
That's the point: that we have trained people to distrust science because most of the "results" people are exposed to are bad popular articles reporting on sketchy studies from Psychology and Medicine that tend to be "overthrown" every few years: it is difficult to go to people and say "no, seriously: vaccines work" when they can retort "that's what you said about red wine, and just today I read an article about how that was all bunk... in another few years everyone is going to be sorry they listened to you guys about these vaccine things you all love so much". :(
I am not sure science is an article of faith to be trusted or not. Science is a continuous process of reviewing evidence and making hypothesis based on that evidence. It is not a mathematical proof.
Sure, there are "bad popular articles" that describe causal relations enthusiastically. However, the pipeline of bullshit flows backwards too. There are enough research papers out there where results may not be fudged but over enthusiastic language may be used that can to the layman's eye look like magic.
The result is that when Geophysics says something important the general populace doesn't believe them (hence why "trust" is the right word to be using here) because their mental model of Science is built out of "scientists" making lots of firm contradictory statements, and especially many situations they remember where what was said just a few years ago was entirely "overthrown" by the new research of the week. If you actually listen to the people who refuse to believe in things like vaccines or climate change, they seem to just think scientists are silly people who think they know more than they actually do :(.
I spent a few years in a heavy math PhD program before dropping out. The only two things I learnt.
1. Be skeptical of all statistics out there that you cannot personally replicate.
2. See 1.
The pressure to publish is real. The pressure to do something for the sake of novelty is real. The process becomes shakier and shakier as we go down the chain from Pure Math to Engineering and so on.
If there are Numerical Analysis papers with over 100 citations with basic linear algebra errors (that was a fun fucking two weeks of head scratching), why on earth would I trust the process somewhere downstream written by people who took a few grad courses in statistics?
Note that I am not taking sides here. I have no interest in one or the other part of the vaccine lobby. I just find it weird when people use terms best left to religion like 'faith' when it comes to scientific research.
> If you actually listen to the people who refuse to believe in things like vaccines or climate change, they seem to just think scientists are silly people who think they know more than they actually do
I think the problem comes from misconceptions in the fundamental nature of science. Scientists are not Gods who are bringing you truth from some mystical truth well. It is a continuous process prone with errors that eventually evolves into getting us closer to understanding processes. If people take that as a sign that everything is junk instead of having a healthy skepticism and reasoning for themselves, they have themselves to blame. Can't argue with stupid.
A couple points:
1) The average person probably lacks the necessary background (knowledge of statistics, methodological concerns, etc.) to independently evaluate scientific research. So blaming them for not going and evaluating the research themselves is a bit unreasonable.
2) You also have to realize that this is not an abstract question for new mothers. When you're injecting something into the precious bundle of joy they carried in their bodies for 9 months, asking them to trust the current conclusions of a "continuous process prone with errors" is not going to be the easiest thing. Accepting the scientific consensus, one which you yourself admit is no magical source of truth, is a leap of faith for these parents; they're committing their child to a medical procedure based on that consensus.
And they should take that leap of faith, in my opinion. But let's not pretend like faith doesn't enter into the equation just because it's science.
It's like a Chinese finger trap: if you want to convince an anti-vaxer, you can't treat them like they're crazy, even if you have an impulse to judge. You have to be able to meet them halfway, and from that point get them to understand the safety profile of vaccines. You don't have to throw numbers in their face, but there has to be some way of speaking to them as a fellow human being: "I know you're scared and you don't know if this is safe, but we don't want your child being hurt either. We've done an incredible amount of testing to make sure vaccines are safe, and we firmly believe they will keep your child as healthy as possible, as well as improving the overall health of the community."
Of course, this is just my opinion. But I really think that empathy will make it much easier to mend these kinds of fissures in our beliefs.
> You run the risk of creating a serious blowback effect, where your condescension drives them further away from accepting what you're trying to tell them.
This is exactly what I am coming from too. In my few years in the programming community, one thing I have noticed is a large population of people who pursue science as a religion. (I mentally tag them the r/atheism crowd.) When you treat something as canon and go up on people's faces as to why they are stupid and wrong, you are not creating a productive discussion.
IOW, our educational system has failed to train people to distrust -- or even to simply critically evaluate -- popular articles on science, leaving them vulnerable to sloppy misrepresentations of science by outlets that usually have neither the skill nor the interest to properly report on it.
Example: I used to be really into reading large meta-analysis dietary supplement efficacy, but lately I've stopped taking all supps. They changed consensus on plenty of them in front my very eyes, and I kinda lost faith in the field.
https://www.fhcrc.org/en/news/releases/2013/07/omega-three-f...
It's looking more and more like the prudent choice for men is to avoid fish oil supplements.
That is because it is vague, imprecise and can be defined whichever way you want.
For example, how much protein should a person intake? 56 gms per day as per the CDC. Other variant figures in the body building community include like 0.68 gms per kg to 2.5 gms per kg. So which figure does one use to establish the definition of moderation? Genetic and cultural differences also come into play. I have lived in cultures (Africa/Asia) where protein is expensive, eaten less. If I went with that sociological perspective of moderation, I could very easily eat less than the 56 gms of the CDC requirement. If I went with the American concept of protein, which sub population do I go with? Do I go with the traditional American eat a Burger + Mashed Potatoes erry day deal or go all Keto and eat Bacon every day?
Personally, I believe that one should gradually evolve towards a lifestyle that is suited to one's own needs.
Learning to live your own life really is a lot of work. Everyone's body is different and has its own set of quirks. I wonder when in the future medicine will be tailored to each individual. I would not be surprised if a diet/lifestyle that is healthy for one person is terrible for another. This is obviously the case for some people with well known disorders, but it might be true across the entire population.
For example, if I follow a diet where most of my calories come from carbohydrates, I tend to get very hungry in between meals. And even worse, if I miss a meal I feel very faint. However, if I get most of my calories from fat and protein, I do not get hungry between meals and if I miss a meal I don't feel like I'm going to die.
The two rules that you really can bank on are that calorie intake is directly linked to weight loss/gain, and you need a certain amount of protein and fat to maintain or build muscle. That being said, protein needed for survival is minimal. Other dietary parameters will affect long-term health, but laypersons are so inundated with misinformation that it's better to eat a variety of foods in moderation than to adopt extreme diets or novel nutritional theories.
Why are those "one weird trick" ads so profitable?
I have a hypothesis that people focus on magic pills (like fish oil) and conspiracy theories (like sugar toxicity) because it is a welcome distraction from an ugly truth: that in order to achieve their ideal body composition, they just need to be extremely disciplined and hardworking in their dietary and exercise habits, and for the sake of long-term health, they should lay off the junk food. There's no "trick". People already generally know what they have to do, but they pretend to themselves that they don't, because if they know what they have to do and fail to do it, that's indicative of personal weakness. It's cognitive dissonance.
http://jama.jamanetwork.com/article.aspx?articleid=1357266 http://archinte.jamanetwork.com/article.aspx?articleid=11514...
While not ground-breaking, it's something. And if you gather enough meta-studies showing "Supplementation of x in y circumstance had no significant effect", then it starts to become reasonable to claim supplementing x in general is not worthwhile. (I'm not saying they have done that, but I'm pointing out that this is part of the corpus of data we need to test a supplement in general.)
Woah, that's a horrible way to approach things.
As far as I know vitamin C only prevents exactly one ailment, scurvy. By that token, you could test against a hundred other random conditions and claim you'd proved it was worthless. Of course, you test substances for ailments you have a reason to think they will prove effective against and any other tests are beside the point.
Also, whatever the merit of the study mentioned, for its purse, the GP citing here is kind of misleading or irrelevant. People don't take fish oil to cure their existing heart disease, they take supplements to prevent heart disease (which it may or may not do regardless of whether or not it does other things).
Please note the difference between supplementation and deficiency. I am using "supplementation" in the same way that I understand the medical community uses it: for strictly when you are supplementing a normal diet, and you are not already deficient in that vitamin or compound. If you are deficient in vitamin C because you are forced to eat foods without it for a long period, then you should take vitamin C pills to prevent scurvy. But if you are not deficient in vitamin C, and you do get it from your normal diet, then no one has established any benefit to its supplementation.
In that context, I think that the meta-study is relevant. People supplemented their normal diet with omega-3s, and it didn't help. Yes, there are other circumstances we have to test. We have not "proved" that omega-3 supplementation is not beneficial. But we need to amass a large corpus of evidence to address the question, and that is part of it.
The largest study there (MARGARIN) showed pretty much no benifit for ordinary people with no history of MI. There are many mixed results in that summary as well...
Several randomized trials of fish oil were conducted over the past 10 years to test the hypothesis that omega-3 fatty acids could prevent restenosis after percutaneous transluminal coronary angioplasty. Although a meta-analysis of seven early trials concluded that supplementation was beneficial,49 more recent trials (with large study populations given 5 to 7 g/d of omega-3 fatty acids) have not supported this conclusion.50,51 Most investigators have concluded that further trials are not warranted.
The first study to explore the effects of omega-3 fatty acids on angiographic progression rates provided 59 patients either 6 g/d of omega-3 fatty acids or olive oil for 2 years.46 No benefit was observed.
In contrast to the growing body of evidence supporting a protective effect of omega-3 fatty acids in secondary prevention, a recent study reported no effect of 3.5 g/d of DHA+EPA versus corn oil on cardiac events in post-MI patients (n=300) after 1.5 years of intervention.
Far from conclusive.
Placebo? Maybe, but it works for me.
There was a study [0] about the placebo effect in heart failure patients: "In a 1999 Swedish Study, doctors implanted an active pacemaker into 40 heart failure patients. Another 40 patients underwent the same surgery, believing they were receiving active pacemakers. But their pacemakers were never turned on: they were, in essence, placebo pacemakers." - [1]
Now as a disclaimer, I did not complete read or understand this study nor do I know if there are counter studies, but it's my favorite bit of information about the placebo effect.
[0] http://www.ncbi.nlm.nih.gov/pubmed/10190407
[1] http://blog.placeboeffect.com/reverse-heart-disease/ (laymen conclusion)
Look for his postings on Omega3, Flaxseed oil etc.
Well, hucksters that sold patent or proprietary medicine caught wind of the miraculous muscle-soothing powers of snake oil. Naturally, they decided to sell their own versions of snake oil—but it was just much easier to forgo using actual snakes.
(From the Collectors Weekly reference below.)
https://en.wikipedia.org/wiki/Snake_oil
https://en.wikipedia.org/wiki/Chinese_Water_Snake
http://www.collectorsweekly.com/articles/how-snake-oil-got-a...
"Popular debunking study of popular fish oil study deeply flawed, new research says."
All this confusion is the natural result of the combination of profit seeking and the difficulty of medical research. Maybe someday they will find that magic pill just not yet.
NY Times had a bunch of good article on the subject at the end of last year such as this one:
http://mobile.nytimes.com/blogs/well/2013/12/16/a-challenge-...
You're absolutely right. Taking supplements is about attempting to minimize the probability that one is deficient in something that's needed, which, if not addressed, can eventually affect one's health.
In the same sense, it's impossible for one to prove to themselves that they are perfectly healthy.
In the future this may change. For example genetic tests may be able to identify hidden long-terms problems with clear biochemical mechanisms that can be corrected with a pill. Much harder to find something that will make most people healthier but it could happen. Just not yet.
A diversity of foods doesn't mean much.
Fish oil is commonly recommended for good reasons. The amount of Omega 3 in the American diet is insanely low, mostly due to the lack of sea food in the average American diet (Seafood being one of the more plentiful sources of Omega 3).
In addition to that, the amount of Omega 6 in the average American's diet is sky high. There are potential problems when the Omega3/Omega6 ratio in a diet is too far in favor of Omega 6, these problems are what Fish Oil is theorized to help with.
On a more general note, many supplements can help with a variety of problems. While I'd say most supplements are worthless, there are quite a few that are not.
If you properly take melatonin, it will help with your sleep. (Don't take the huge doses most people do, 300mcg will suffice, overdosing will hurt your sleep after awhile!)
l-Theanine greatly reduces the side effects of caffeine and helps it work longer. Flat out, less anxiety, less jitters, and a large increase in focus.
Creatine flat out helps all around with physical performance, and may help out with some mental performance as well. There are dozens upon dozens of studies showing creatine's effectiveness.
Heck there are supplements out there that work as treatment for diabetes by controlling blood glucose levels, and by control, I mean "take this supplement, blood glucose levels drop".
The multi-vitamin sold at your local pharmacy? Yeah likely useless (or even worse), assuming it has any active ingredients in it at all.
But well researched supplements from reputable companies that have independent third party audits done on their production lines?
Pretty damn useful.
Cinnamon and Alpha-Lipoic Acid among others, are reputed to have this effect. Being diabetic, I was curious, and one time when I ran out of Metformin while traveling and not having a chance to get back to my doctor to get a new prescription, I decided to do a little (totally unscientific, not to be relied on) testing on myself.
I checked my blood sugar a couple of times, took 1 gram of ALA, and checked my blood sugar an hour later, and 90 minutes later.
I always saw a decrease. Now, this doesn't prove anything, as it could be that, by happenstance, the timing worked out that way, in terms of when I last ate and the natural upswings and downswings in the levels. But I made it a point to try and do this several hours I'd last had anything to eat to minimize that aspect, and I saw marked (50-60 point) drops after taking the ALA.
I never bothered testing Cinnamon or ALA+Cinnamon, but I tend to believe the suggestion that ALA supplementation may be of value for diabetics.
What you want is stabilized R-ALA, it is much more expensive but the unstabilized form of ALA tends to degrade quickly so you have less guarantees over what you are getting.
If you are type 2 you can do a good job of maintaining it by supplements and dietary maintenance. A Ketogenic diet is great, since it just removes carbs all together. :)
http://examine.com/supplements/Hibiscus+sabdariffa/#summary4...
Also cut all caffeine from your diet. :) (Also the #1 recommendation when people come over to /r/nootropics and ask for help with anxiety!)
If you just use it occasionally when it is really needed you will get a much bigger boost from it.
Define "bad diet". Define measuring method & desired degree of food diversity. Isn't that what we're all here trying to figure out? ;-)
I want to eat more fish but the whole mercury thing scares me away. Perhaps fish oil supplements grant me the benefits of eating fish without the mercury??? I have no idea, but that sounds like a reasonable conclusion I'd come to.... then a study like this comes out and then I'm like (╯°□°）╯︵ ┻━┻
But to claim that all supplements, and vitamins, are bullshit, without substantiation, is simply not justified. There are in fact clear cases where supplementation has proven beneficial where a deficiency exists (vitamins C, D, and B-complex vitamins in particular).
And it seems HN are calling you on that.
I do generally agree that eating a balanced and nutritious diet is your best insurance.
However if you are healthy (i.e. have no known condition requiring treatment with vitamins), then there is no solid evidence that vitamins or supplements improve health outcome. If you disagree the burden of proof is on you: Point to multiple double blind studies by reputable researchers showing consistent and significant (practically not statistically) positive results. This may happen but AFAIK has not happened to date.
[0] http://www.scientificamerican.com/article/vitamin-d-deficien...
http://mobile.nytimes.com/blogs/well/2013/12/11/limits-of-vi...
There is also the risk of overdose in any widely used supplement. Thankfully few of the 60,000 cases of vitamin toxicity in the US annually are Vitamin D (Iron is the riskyist).
A short walk in the sunlight is the best source of Vitamin D because your body naturally regulates it's production to near the optimum amount! I often wonder if the extreme avoidance of sunlight by some people is actually unhealthy...
Cancer: http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/3...
Heart Disease: http://www.ncbi.nlm.nih.gov/pubmed/21505219 http://www.news-medical.net/news/20111117/Vitamin-D-and-its-...
As a child I was made to feel that as a vegetarian, if I did not take these fish oil supplements, then I would probably die. No TV advert or doctor told me that, just ambient peer pressure from good, well-meaning friends and their mothers that indulged in these fish oil things. The fear of god is one thing, scientific evidence from the back of the packet is something else. Looking back it is a miracle that I did not give in to the peer pressure.
I am part of the self-selected control group of vegetarians. We exist so any normal people (i.e. in the meat-eating cult) can see if you really need fish, meat or some scientifically proven meat/fish dietary supplement thing. As it happens the vegetarian control group, even if some of them do wear leather shoes, tends to outlive those that are tied to their beliefs about things like eating their fish oils, getting tonnes of protein from beef, eating things because those vitamins can only be found in pigs not celery and so on.
Hence I can quietly keep my feelings of "told you so" to myself on this one, rather than go round my friend's mum's house and tell her how wrong she was to try and force feed me that fish oil stuff.
Just saying.
Yes, quietly post to an international forum of thousands of users how you're keeping those feelings to yourself.
As a vegetarian myself, I would suggest that you'll hold an audience longer by dialing the "smug" knob down a notch. People like their meat, and someone waiting since childhood to say "I told you so" isn't likely to change their mind.
On the other hand, calm and reasonable explanations aren't likely to change their minds, either. Because, damn, bacon sure tastes good.
I am sorry, but no such thing happens. There's a lot written on the subject why you can not directly compare "vegetarians" to "everyone else". For example, vegetarians not only do not eat meat, but also smoke and drink less, and exercise more than the general population and are in general more health conscious. So there are many confounding factors involved.
However, if you study people who are vegetarians not for health reasons, but, for example, religion - you suddenly find no health benefits, but rather quite a few increased risks.
Here's one of the articles on the topics, and plenty of scientific links inside for the curious.
http://rawfoodsos.com/2011/01/06/vegetarians-and-heart-disea...
Key quotes for those who like TL;DRs:
The good news for the vegetarians is that their Lp-PLA2—a marker specifically for vascular inflammation—was lower than in the control group. But that’s where the good news ends. The researchers seemed pretty surprised to report that the vegetarians had higher levels of CRP (borderline significant at p=0.05) than the omnivores, along with higher homocysteine and triglycerides.
The surprising results? The vegetarians had significantly thicker arterial walls (p<0.0001), reduced flow-mediated dilation (a predictor of cardiovascular events) (p<0.0001), higher blood pressure (p<0.05), and higher triglycerides (p<0.05) than the omnivores. (According to the paper, the raised blood pressure might be related to some popular high-sodium vegetarian foods such as processed protein food substitutes, fake oyster sauce, and tomato paste.)
In the researchers’ multivariate statistical models, vegetarianism had the strongest association with both artery thickness and diminished flow-mediated dilation out of all the variables documented—including age, gender, and triglyceride levels.
As might be expected, the vegetarians also had lower B12 levels and higher homocysteine than the control group—but even after adjusting for these, vegetarianism remained strongly linked with less-healthy hearts. The researchers concluded with this:
In summary, contrary to common belief, vegetarians, at least in the Chinese, might have accelerated atherosclerosis and abnormal arterial endothelial function, compared with omnivore control subjects. The increased risk could only be partially explained by their higher blood pressure, triglyceride, homocysteine, and lower vitamin B12 concentrations.