"Fish oil is stupid"

"Fish oil is a waste of time and money. It's stupid. Just stop it."

So a patient of mine was advised by another physician when he complained that he occasionally experienced a fishy aftertaste.

This attitude perplexes me. After all the confirmatory data that support the enormous health benefits of omega-3 fatty acid supplementation, including the 11,000 participant GISSI-Prevenzione Trial, you'd think this attitude would be history. What's a little fish aftertaste when heart attack risk is slashed 28%?

Perhaps the tendency to pooh-pooh fish oil is because it's available as a nutritional supplement. This shouldn't make fish oil appear inconsequential. Far from it.

If you witness the extraordinary power for fish oil to reduce triglycerides, you will be immediately convinced of its effectiveness. The ability of omega-3 fatty acids from fish to eliminate intermediate-density lipoprotein (IDL), the persistent abnormal lipoprotein which signals an inability to clear dietary fats from the blood, can also convince you. More than 90% of people with excessive IDL have it completely eliminated by 4000-6000 mg of fish oil (providing 1200-1800 mg EPA + DHA) per day.

The fact that fish oil is available as a prescription "medication," as well as an over-the-counter supplement, causes some physicians to dismiss the power of the supplemental form. This is nonsense. The over-the-counter form is every bit as effective as the prescription form.

The makers of prescription Omacor also make the claim that their preparation is safer and purer. That may be true, but I'd like to see independent verification from the FDA, USDA, or an unbiased organization like Consumer Reports before I accept their marketing as fact--particularly at $120 to $240 per month! If Omacor proves to contain substantially less mercury and pesticide residues, then that will need to be factored in. (Please note that both Consumer Reports and Consumer Labs measured no substantial mercury or pesticide residues in their analyses of 16 and 41 brands, respectively.)

I try to persuade my colleagues that the idea of taking supplements is a wonderful trend that allows people to express ownership of their own health. What people need is guidance, not salesmanship for a more expensive version, nor dismissal of nutritional preparations that actually possess considerable benefits.

Comments (13) -

  • Cindy

    4/3/2007 1:24:00 AM |

    I've heard that fishy burps means the fish oil is rancid and should be thrown out!? I've also been advised to cut open and taste a capsule every once in a while (I do it weekly) and to throw it out if it tastes or smells fishy.

  • Dr. Davis

    4/3/2007 1:49:00 AM |

    You're brave. My experience is that virtually all fish oil is fishy to one degree or another. The Consumer Lab analysis is probably the most enlightening on this question: they found that only 2 of 41 preparations had any rancidity breakdown products present. That's pretty good. Neither of the two preparations that flunked their analysis were popular brands.

  • JJ

    4/3/2007 7:15:00 PM |

    Can you help interpret EBT scan results.  50 y/o male with 3rd EBT scan now indicates a decrease:  
    '05 152;
    '06 417;
    '07 350.  
    Is this common?  An error? Please advise.  Thanks you.

  • Dr. Davis

    4/3/2007 7:35:00 PM |

    I'd advise you to see the website, www.trackyourplaque.com. We discuss these issues extensively here. Or go to my book, Track Your Plaque, available on Amazon. From what little you've told me, it could be true or it could be an error, i.e., scanner inaccuracy, depending on the type of scanner used. However, the entire Track Your Plaque concept is built on the idea of trying to gain control over your heart scan score.

  • Anonymous

    5/22/2007 5:03:00 PM |

    Your last paragraph makes perfect sense and is logical. I think that this is exactly what the pharma companies dont want is for the patient to express ownership of their health or realize that otc supplements have any merit. I applaud you for sticking to the facts that you find not just the data and marketing that the pharma companies and reps feed the doctors.

  • Fr. Gregory

    8/17/2007 1:28:00 PM |

    Fish oil is immensely beneficial for many reasons.  The challenge is that most manufacturers of fish oil are not held to any standards, so as Cindy says above, if you are having problems with "fishy heartburn" or the like, chances are it is rancid.  Norway is one country that has strict standards for the production of fish oil.  Hence, Nordic Naturals is a good brand, because it is produced there.  My two cents worth: use Norwegian Fish oil products.  Be wary of product in America.  The "taste test" is a good way to note if the fish oil is of quality.  Rancid fish oil, I've been told, can be worse for you than no fish oil at all.

  • mill

    9/23/2007 6:53:00 PM |

    I know of so many people who have lowered their cholestral but after 6 months of taking 6 caps of 1250 mg daily mine actually went up a few points. I called the company (Res-Q) and they said that happens to some people. What is your opinion?

  • Dr. Davis

    9/23/2007 11:39:00 PM |

    I have never seen anyone reduce LDL cholesterol with fish oil, but that is not its purpose.

    Fish oil 1) reduced triglycerides, 2) reduces lipoprotein patterns like VLDL and IDL, and 3) reduces heart attack and other heart events.

    The only way fish oil can reduce LDL cholesterol is by reducing triglycerides and thereby providing the appearance of a drop in LDL, since LDL is calculated with values that include triglycerides.

  • Mark

    3/18/2008 11:44:00 PM |

    I think it is quite ignorant of you to claim that a dietary supplement is the same as a prescription medication.

    There is a reason that manufacturers need to place a disclaimer on their products "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."  Simply put, manufacturers can put whatever they like in a supplement, as long as they put their precious disclaimer on the bottle.

    By the way, there is no such thing as an "over the counter" fish oil.  OTC implies that a product, at one time, was available with a prescription (i.e. Claritin), and is now available without a prescription.

    Lastly, your idea about Consumer Reports doing a comparison of dietary supplements versus Lovaza/Omacor is a valid one.  However, it seems to me it would be easier to simply compare the EPA and DHA contents of the product to get an idea of their efficacy.  In my experience, there are no products in the market that can match the potency of the prescription product.

  • mill

    6/27/2008 12:36:00 PM |

    Dr Davis
    I've been on 2 naicin tabs daily and my cholestral is done from 240 to 164!!!!it's amazing. Can i go back to taking just one daily  now?
    Thanks so much!

  • mill

    7/9/2008 9:39:00 PM |

    How much naicin is bad for the liver?

  • lizzi

    8/25/2008 3:05:00 PM |

    I worry about omnacor (Lovaza) because they chemically altered fish oil, (made it an ester, I think) in order to increase stability.  I just hope this doesn't ruin its good effects.  The process reminds me of the creation of transfat to enhance the stability of margarine in the 1950's.  It took us 40 plus years to figure out that was a big mistake.  Anyone else worried about this?

  • Mary P

    4/27/2009 2:03:00 PM |

    I have concerns about the amount of fish that it takes to produce supplements.

    If you don't want to take a fish oil supplement and are not in one of the demographics that should limit the consumption of oily fish - is there a daily consumption of dietary fish that would meet nutritional needs? E.g., 80g of sardines or mackerel?