Business

Fish oil pills: A $1.2 billion industry built, so far, on

empty promises
By Peter Whoriskey July 8

Foranyonewonderingaboutwhethertotakeafishoilpilltoimproveyourhealth,theWebsiteoftheNational
InstitutesofHealthhassomeadvice.
Yes.Andno.
OnepageontheWebsiteendorsestakingfishoilsupplements,sayingtheyarelikelyeffectiveforheartdisease,
becausetheycontainthebeneficialfattyacidsknownasomega3s.
Butanotherpagesuggeststhat,infact,thefishoilpillsseemuseless:Omega3sinsupplementformhavenotbeen
showntoprotectagainstheartdisease.
Icanseehowyoumightthinkthatthereissomeinconsistency,PaulR.Thomas,ascientificconsultantinNIHs
OfficeofDietarySupplementswroteinresponsetoquestionsabouttheNIHpages.
FewissuesbetterreflecttheAmericanconfusionoverdiet.
PeopleintheUnitedStatesspendabout$1.2billionannuallyforfishoilpillsandrelatedsupplementseventhough
thevastmajorityofresearchpublishedrecentlyinmajorjournalsprovidesnoevidenceofahealthbenefit.
Theaccrualofhighlevelevidence,accordingtoareviewofstudiespublishedlastyearinanAmericanMedical
Associationjournal,showsthatthesupplementslackefficacyacrossarangeofhealthoutcomes.
Whilethepersistentpopularityoffishoilmayreflectthehumanweaknessforanythingtoutedasalifeextending
elixir,italsoreflectsthat,evenamongscientists,dietnotionscanpersistevenwhenstrongerevidenceemerges
contradictingthem.Scientists,sometimes,arereluctanttoletgoofideas.
Unfortunately,itsacommonsituation,saidJohnP.A.Ioannidis,aprofessoratStanfordUniversitywhohas
critiquedthemethodsandfindingsinnutritionalresearch.

Toooften,intheviewofIoannidisandcolleagues,claimsthatonefoodoranotherhasaparticularhealtheffect
persistlongaftertheyhavebeencontradictedbymoreexactingresearch.
Forexample,hisresearchshowedthatvariousclaimsregardingvitaminE,estrogenandbetacarotenecontinuedto
findanaudienceamongscientistsasreflectedinscientificpapersevenwheninitialclaimsaboutthemappearto
havebeentrounced.
Whatwehavefoundisthattheoriginalpaperscontinuetobecitedwellaftertheyhavebeenrefuted,hesaid.
Theseclaimsdonoteasilydieaway.

Sorting through warnings

Americanconsumershavelonghadtosortthroughconfusingcontradictionsoverwhatfoodishealthfultoeat.And
thetroubleliespartlyintherealmofscience,whereresearcherssometimeshavedevelopeddietadvicethat,despite
weaknessinthesupportingevidence,hasbeenurgedonthepublic.
Thisyear,forexample,afederaladvisorypanelrecommendedwithdrawingthegovernmentslongstandingwarning
aboutconsumingfoodsrichincholesterol,decadesafterscientistsbegantoarguethatthewarningwas
wrongheaded.
Likewise,thelonglivedadmonitionthatAmericansareusingtoomuchsaltisfacingastrongchallengefrom
researchpublishedinprominentmedicaljournals.
Thedisputeoverfishoilanditsfattyacidsknownasomega3s,meanwhile,ispartofalongandconfusingdebate
abouttheroleoffatsintheAmericandiet.Asfarbackas1977,theU.S.DietaryGoals,aforerunnerofthefederal
governmentsinfluentialU.S.DietaryGuidelines,calledforAmericanstoeatmorecarbohydratesandeatlessfat.
Thatpositionisnowwidelyregardedasmisguided.
Acloserlookatthefishoilrecommendationshowshowhealthauthoritiesfirstrecommendedfishoildespitemixed
evidence,thenlettherecommendationstandevenasstudiessuggestingtheirworthlessnessmounted.
Theresultcanbeconfusion.
TheAmericanHeartAssociation,forexample,recommendsthatsomepeoplewithheartdiseasemaywanttotalkto
theirdoctorabout[omega3]supplements.Butwhentheassociationwasaskedforanexperttoexplainthe
recommendation,thatexpert,formerAHApresidentRobertEckel,saidthattherecommendationneedstobe
revised.

Itwouldbeagoodtimeforthattobeupdated,Eckelsaid.Almostallstudiesoffishoilsupplementsshowno
benefit.Ireallyfeelthisremainsunproven.
AnAHAspokesmanadded:AHAguidelinecommitteesarealwaysreviewingguidelinesandassessingwhether
updatesareneeded.AHAcannotdiscussanyguidelinesorstatementsthatarecurrentlyintheworks.
AsfortheconfusingadviceontheNIHWebsite,Thomassaidthepagethatendorsesfishoilwasprovidedtothe
NIHbyathirdpartythatassessesdietadvice.
Theirconclusionthatfishoilomega3sarelikelyeffectiveforheartdiseaseisgenerous,hesaid.Whetherfishoil
canhelphealthypeoplepreventorreducetheirrisksofcardiovasculardiseasewhentakenovermonthsandyearsis
stillanopenscientificquestion.

A fish oil story

Thefishoilstorybeginswiththeaccountofitsdiscovery.Inthe1970s,twoDanishscientists,HansOlafBangand
JornDyerberg,visitedremoteInuitvillagesinnorthwestGreenland.
Thepeopleinthosevillagesatemostlywhale,sealsandfish,accordingtothescientists.Whileorthodoxthinkingat
thetimesuggestedthatadietsorichinanimalfatwouldcauseheartdisease,reportsofheartattackstherewerevery
few.BangandDyerbergwereintrigued.
Duringtheirvisit,theydrewbloodsamplesof130Inuits.Thesamplesshowedlowlevelsofcholesteroland
triglycerides,whichareviewedasmarkersofheartdisease.
Eventually,thetwoformallywouldhypothesizethatthelowlevelsofheartdiseaseamongtheInuitwascausedby
theomega3sintheirfishydiets.
OneofthefirstmajortestsofthisideawaspublishedintheBritishmedicaljournaltheLancetin1989.Thetest,
oftenreferredtoastheDARTstudy,lookedatmorethan2,000Welshmenwhohadsufferedheartattacksome
weretoldtoeatmoreoilyfish.Thatgroup,itturnedout,was29percentlesslikelytodieoverthenexttwoyears.
Thedemandforfishoilwasabouttogrow.Pharmaciesandhealthfoodstoreswerestockinguponfishoil
supplementsinthe80s,andbythemid90s,theindustrycountedsalesinthetensofmillions.
Butitwasntuntiltheearly2000sthatthemarketbegantosoar.Inpart,theenthusiasmstemmedfromtheadvice
fromthebroadlyinfluentialAmericanHeartAssociation.

In2002,theassociationissuedaScientificStatementconcludingthatomega3fattyacidshavebeenshownin
epidemiologicalandclinicaltrialstoreducetheincidenceofcardiovasculardisease.
Thestatement,however,wasbasedonmixedevidence.Someoftheobservationalstudiesatthetimeshowedthat
eatingfishprovidedabenefitothersdidnt.Tworandomizedtrialsshowedabenefit,whileathirddidnt.Atthe
sametime,consumingfishandfishoildidntshowharmfuleffects,either.
BillHarris,oneofthethreeauthorsoftheAHAstatement,saidthatcurrentlytheevidenceisunclearonthe
benefitsoffishoils.
Butitallmadealotofsenseatthetime,saidHarris,nowaprofessorattheUniversityofSouthDakota.Heisalso
presidentofOmegaQuant,acompanythatanalyzesthecontentoffoods.Thereseemedtobeabenefit,andthey
weresafe,sotherewasjustnodownside.Everythinglookedgood,sowhynotdoit?
TheAHAcontinuestoendorsetheuseoffishoil,suggestingthatpeoplewithheartdisease,particularlythosewho
donteatmuchfish,maywanttotalktotheirdoctoraboutsupplements.
In2003,someoftheresearcherswhoconductedtheearlyandinfluentialDARTstudypublishedtheresultsofa
followup.Of3,000Welshmenwithanginaachestpaincausedbycoronaryheartdiseasesomewereadvisedto
eatoilyfishortakefishoilsupplements.Thistime,thefishgrouppatientsweremorelikelytodie,andthe
researcherssaiditwasparticularlyworseforthosetakingthefishoilpills.
Theexcessrisk[ofcardiacdeath]waslargelylocatedamongthesubgroupgivenfishoilcapsules,theyreported.
Thatfindingdidntstopthegrowthinsalesoffishoilpills,however,eventhoughthepagesoftheacademicjournals
werefillingwithevidencethatfishoilhasnobenefits.
AndrewGreyandMarkBolland,researchersattheUniversityofAucklandinNewZealand,forexample,lastyear
reviewedfishoilresearchpublishedinmajorjournalsbetween2005and2012basedonrandomizedclinicaltrials.
Twentytwoofthe24studiesshowednobenefit,accordingtotheirworkpublishedinJAMAInternalMedicine.
Itispossiblethatfishoilhashealthbenefitsthatscientificexperimentsarenotsensitiveenoughtodetect.
Mosttrialshavefocusedontheeffectsoffishoilonpeoplewhohavehadahistoryofhearttrouble.Thetroublewith
thosestudiesisthatsuchpatientsaretypicallytakinganarrayofheartmedicines,suchasstatins,bloodthinnersand
betablockers.Itispossible,scientistssay,thattheeffectsofthefishoilcantbedetectedamongtheeffectsofthe
othermedicines.

Anongoingtrialof26,000people,however,willfocusontheeffectsoffishoilonabroadersetofpatients
includingthosewhodontalreadyhaveheartdiseaseorusemultipleheartmedicines.
JoAnnE.Manson,principalinvestigatorofthetrialandchiefofpreventivemedicineattheHarvardaffiliated
BrighamandWomensHospitalinBoston,saidthatitisbiologicallyplausiblethatomega3scouldprotectagainst
heartdisease,thoughtheresnotenoughevidencetorecommendfishoilsupplementsroutinely.
Itsamazinghowpopularthefishoilsupplementshavebecomewithoutconclusiveevidenceoftheirefficacy,she
said.
Intheabsenceofclearmessagesfromhealthauthorities,however,consumersarefacedwithabarrageofunproven
promises.
Theomega3s[EPAandDHA]infishoilhelpsupportahealthyheart,accordingtoNatureMade,onecompany
thatsellsthesupplements.
Theirbenefitsgofarbeyondtheheart,saysNordicNaturals,whichboastsofofferingthe#1sellingfishoilinthe
U.S.
AndDr.Tobias,anotherleadingfishoilcompany,suggeststhatthepillshelpdefendagainstaremarkablearrayof
ailments.ItsayssupportivebutnotconclusivestudiesindicatebenefitsofOmega3essentialfattyacidsforheart
disease,dementia,
Alzheimers,arthritis,symptomsofasthma,pneumonia,depression,suicide,wrinkles,acneand
psoriasis.
Attheendoftheday,omega3sarehealthyfats,saidAdamIsmail,executivedirectoroftheGlobalOrganization
forEPAandDHAOmega3s,anindustrygroup.Webelievetheypreventheartdisease.

Peter Whoriskey is a staff writer for The Washington Post handling investigations of financial and economic
topics. You can email him at peter.whoriskey@washpost.com.