Troubled Waters: The Rising Fish Oil Debate

The New York Times – and the long-running PBS Frontline news program – have thrown in the towel when it comes to veracity in journalism.

One case in point is a Frontline episode segment that appeared as an insert in the January 21, 2016 online edition of The New York Times. The five and a half minute segment is troubling for several reasons.

First of all, the reporting on which the Frontline episode is based was not produced by New York Times reporters but rather by Frontline correspondents, so this story is second-hand news.

More importantly, despite the appearance of objectivity, the Frontline piece in question is actually an infomercial for Lovaza, a prescription drug from GlaxoSmithKline that is really nothing more than highly refined fish oils that have been run through two additional, patented processes.

Even worse, the Frontline segment goes on to present assertions by Dr. Andrew Grey, an associate professor of medicine at the University of Auckland in New Zealand who has a strong background in the treatment of osteoporosis,  that there is no compelling evidence to support the belief that the Omega 3 content of fish oils has any beneficial effects in terms of heart health. Dr. Grey’s contention is widely supported by health information resources but Grey, and other critics of fish oil, fail to take into account is that fish oils have a demonstrable effect upon the production of triglycerides, and decreasing high triglyceride levels is an essential step in reducing the incidence of heart disease.

So, then, if fish oils have an acknowledged observable effect in terms of reducing triglycerides, then why is there no statistical evidence documenting that fish oils actually reduce heart disease.

The answer to that question depends upon an understanding of the scientific process, which measures outcomes from multiple effects. Reducing excessive triglycerides may or may not result in an improvement in a patient’s cardiovascular health, depending upon several other factors, including diet, exercise, exposure to tobacco smoke, and previous damage to the cardiovascular system. The list of potential antagonists to heart health go on and on, but the core issue remains whether the Omega 3 in fish oil reduces the production of triglycerides. If it does, and there is plenty of evidence to support that contention, then it is irresponsible to warn consumers away from the consumption of fish oil.

The popular WebMD website warns consumers not to take fish oils to prevent a first or second heart attack because there is no documentary evidence to support that claim, but confirms the beneficial effect of Omega 3 fish oils with respect to the reduction of triglycerides. If fish oils are confirmed to reduce triglycerides and triglycerides are implicated as a culprit in the increasing rates of heart disease, then how can fish oils not have a beneficial effect in efforts to reduce heart disease?

In the Frontline segment, consumers are also told that there is a significant difference between prescription fish oil and the fish oil supplements you can purchase without a prescription. The highly respected Consumerlab.com website lists 30 different “acceptable” pharmaceutical quality brands of over-the-counter fish oils. (Consumerlab was listed as a resource for consumers in an online article published in conjunction with the Frontline segment, so their veracity appears to be legitimate.)

Here’s the problem: there is only one prescription fish oil product on the market: Lovaza.

The GoodRx website reports that prices for Lovaza range from $81.44 per 120 capsules at Wal-Mart up to $270 for the same product at HealthWarehouse, proving that Caveat Emptor is still the best policy for consumers. For comparison, Barleen’s pharmaceutical quality fish oil goes for just $10.80 for 120 capsules on the Lucky Vitamin website. (The actual price was $22.50 for 250 capsules, which we have adjusted for a fair comparison.)

The Lovaza capsules provide 900 mg of Omega 3. The Barleen capsules provide just 375 mg, slightly more than a third as much as the Lovaza. Adjusting for this discrepancy, you would need to take three Barleen capsules to equal the Omega 3 content of a Lovaza capsule, which means that an equivalent serving of the Barleen capsules would actually cost 27 cents as opposed to 67.8 cents for Lovaza. Under the best case scenario, Lovaza costs approximately three times more than Barleen. (The worst case would have resulted from using the highest price for Lovaza.)

If, as reported by ConsumerLab.com, Barleen is really a pharmaceutical quality fish oil product, then this Frontline segment, by implication, is suggesting that consumers spend three times more for the same benefit, but also suggests that there might not be any benefits at all.

Like many medical scientists, the scientists quoted in this article always suggest that it is better to get your Omega 3 from fresh fish by eating fish at least twice a week. That advice, however, does not take into account three factors in making the decision to eat fresh rather than taking supplements.

The best fish for Omega 3 consumption are either rather unpalatable (unless you happen to really like anchovies) or excessively expensive for daily consumption. (Have you seen the prices on fresh caught wild Salmon recently?) Secondly, suggesting that eating fresh fish twice a week is better than taking supplements on a daily basis contradicts basic logic. It’s a matter of well-settled science that regularized doses of any drug or supplement are better than occasional doses. The third issue is that much of the fish sold in the United States isn’t really fresh and, even when it is, cooking the fish has the effect of oxidizing the Omega 3 content of the fish. Frying is out, along with grilling, the two most popular methods of preparing fatty fish, which leaves poaching as the cooking method of choice. So, unless you like your fish raw or poached, it isn’t easy or cost efficient to meet your Omega 3 requirements with fresh fish.

If you want to see an perfect example of manipulative methodology in this report, check out the method by which the scientist makes his point that over-the-counter fish oils are often rancid because they smell fishy. He cuts open a fish oil capsule and offers it to the reporter for a sniff. One capsule. That isn’t science. It is manipulation, pure and simple. As it happens some perfectly good fish oil smells, well, like fish oil, while others are perfumed so that they don’t smell like fish oil, while still others may smell good but be worthless because of their low Omega 3 content.

The bottom line here is that Caveat Emptor is still the best advice, whether you are purchasing and consuming fish oils, or deciding where and how to get your information about fish oil.

Click Here to see the Times/Frontline Video Clip:

http://www.nytimes.com/video/health/100000004148407/is-fish-oil-helpful-or-harmful.html

(Editor’s note: a version of this article was also posted on the author’s Facebook page.)