Omega-3 fatty acids and the guts: New proof, extra questions – Harvard Well being Weblog

My sufferers generally ask me whether or not they need to attempt one complement or one other. Typically my reply is equivocal, as a result of for many dietary supplements we simply don’t have sufficient proof to present a particular reply. This doesn’t imply {that a} specific affected person couldn’t profit from a particular complement; it simply means I don’t have standardized analysis to information my suggestions. Sadly, this stays true of omega-3 fatty acid dietary supplements. The outcomes of research omega-3 dietary supplements have been inconsistent, and have left each physicians and sufferers questioning what to do.

Omega-3 fatty acids present profit in REDUCE-IT trial and win FDA approval

Two principal omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are discovered primarily in fish and fish oil. Omega-3s from fish and fish oil have been really helpful by the American Coronary heart Affiliation (AHA) for the previous 20 years to scale back cardiovascular occasions, like coronary heart assault or stroke, in individuals who have already got heart problems (CVD). I’ve written about and been a robust advocate of getting omega-3s by way of food plan, and typically by way of the usage of dietary supplements.

Over the previous 12 months I’ve prescribed an omega-3, bought below the model identify Vascepa, to my sufferers who’re at excessive threat for CVD, primarily based on proof of cardiovascular advantages. Vascepa accommodates purified EPA, and its use relies on good medical knowledge from the REDUCE-IT trial. This examine enrolled over 8,000 sufferers with elevated cardiovascular threat and excessive blood triglyceride ranges. They assigned half of the examine individuals to obtain 2 grams of Vascepa twice a day, and assigned the opposite individuals a placebo (a capsule crammed with mineral oil). The outcomes confirmed a major good thing about Vascepa over the placebo. Vascepa diminished blood triglyceride ranges, however extra importantly, it diminished the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and loss of life.

A subsequent meta-analysis, which included knowledge from over 10 research, discovered fish oil omega‐3 dietary supplements lowered threat for coronary heart assault and loss of life from coronary coronary heart illness.

In December 2020, the FDA authorised the usage of Vascepa to scale back the chance of cardiovascular occasions in sure sufferers with, or at excessive threat for, CVD.

STRENGTH trial casts some doubt on omega-3 advantages

However a current examine has raised some questions. The STRENGTH trial, printed in JAMA, checked out a special formulation of omega-3 fish oil — a mix of EPA and DHA — to see if it might additionally scale back cardiovascular threat. This examine enrolled over 13,000 sufferers who had been randomized to obtain both the EPA/DHA mixture capsule or the placebo (a capsule crammed with corn oil). The trial was terminated early resulting from an interim evaluation revealing no distinction between the 2 therapy teams.

We don’t know for sure why the REDUCE-IT trial confirmed a profit from omega-3s whereas the STRENGTH trial didn’t. One risk is that the completely different outcomes are because of the completely different medication studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in increased EPA ranges. This was much like the outcomes of one other trial, which additionally discovered that pure EPA diminished the chance of cardiac occasions. The STRENGTH trial examined a mix of EPA and DHA. No giant examine has ever evaluated the results on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA would possibly counteract the advantages of EPA.

The place will we stand?

Again to my sufferers who wish to know if they need to be taking an omega-3 complement. With the provision of at present’s knowledge, I’d advocate a pure EPA complement, or one which accommodates extra EPA than DHA. However don’t cease there. Eat a heart-healthy food plan, get common train, and pursue different way of life adjustments which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I look forward to extra definitive knowledge on the utility of omega-3 fish oil, and who would possibly profit probably the most.

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