Go Fish! Do Omega-3 Supplements Deserve a Spot in Your Medicine Cabinet?

A new report making waves this month says the jury’s still out on whether those big, fish-oil soft gels offer much benefit for persons already living with heart disease.

The latest analysis, which reviewed just over a dozen smaller studies, found that taking the supplements – or not – made little difference in whether 20,000 chronic heart disease patients suffered heart attacks or strokes.

But don’t toss your fish pills just yet, says URMC cardiologist Dr. Robert Block. There’s more to consider. Below, he helps make sense of the latest science – and its short-comings.

Scripts: Historically, have cardiologists advised cardiac patients (say, those with high cholesterol) to take fish-oil capsules – and if so, based on what research?

Block: It’s important to note that a fair number of older studies – many of which were conducted before the mainstream adoption of today’s aggressive medicines, like statins and beta-blockers – were quite conclusive. They suggested fish oil supplements indeed played an important role of protecting patients with heart failure.

Take the GISSI (Gruppo Italiano per lo Studio dells Sopravvivenza nell’Infarto Miocardico) trial, for instance, which found that these pills lowered the risk of fatal cardiovascular events by 10 percent for cardiac patients. So, conceivably, it could be that more recent trials (in which the bulk of patients were already taking powerful medications) might not accurately appreciate the role that fish oil actually plays – especially for people never diagnosed with heart disease to begin with.

To that end, many cardiologists do recommend fish oil supplements – or better yet, eating more real fish – since the known side-effects (other than the occasional potential for a fishy burp!) are negligible. What’s more, fish oil does not interact with other medications – a big problem we see with many prescription drugs.

Scripts: Some people assume that “supplements,” in general, are just as good of a substitute for consuming the real food. But does this study possibly suggest that the part of the benefit of fish oil, in its most natural form (that is, in actual fish!), comes because fish are eaten in place of other less-healthy meats?

Block: Certainly, fish are a wonderful dietary staple. The health benefits are well-documented, and the most current, 2010 Dietary Guidelines for Americans advise all of us (even pregnant women) to eat more servings of fish. And, even while the data supporting fish oil supplements is less cut -and-dried, the American Heart Association nevertheless maintains an official recommendation that patients with the metabolic syndrome (pre-diabetes) should eat more fish – or take fish-oil supplements.

But certainly, you raise a fair point – consuming nutrient-rich foods in their natural form is important, because theoretically, because it represents a smart trade-off: Chances are good that your fish-based meals are replacing other less-good-for-you protein sources, like pork or red meats.

Scripts: Many of the studies wrapped into this latest analysis didn’t follow patients for the long-term. Isn’t it possible that, especially for patients who have not developed heart disease, there still is some longitudinal benefit from supplements?

Block: Absolutely! This is a major limitation of the study, and a point that’s getting a good deal of press attention. When it comes to preventive cardiology, we’re keenly focused on long-term health risks – looking ahead 30 to 50 years, rather than shorter periods like these trials are studying.

What’s more, sample size really matters – and is often overlooked by the public. Frankly, many of the studies wrapped into this most recent meta-analysis (a “study of studies”) were probably too small to detect the modest but important risk-reduction role supplements likely play.

Scripts: So bigger, longer-term studies are warranted – that makes sense. But, are all fish-oil supplements created equal?

Block: Supplements definitely vary in quality – and of course, cost. Take Lovaza, for instance; it’s an FDA-approved prescription drug composed of about 85 percent EPA and DHA, the most important fatty acids in fish, and is commonly prescribed for diabetics and obese folks with high triglycerides (a major cause of pancreatitis—a very serious health issue).

On the other hand, cheaper, over-the-counter options generally pack only 30 to 60 percent EPA and DHA. Many people at high-risk for cardiovascular disease take them (including me) because they feel better doing so, and are banking on their potential for longer-term health benefits.

Of course, it’s important to note that improving heart health isn’t the only thing omega-3 fatty acids have been lauded for.  Other studies have found fish-oil supplements to reduce joint pain and stiffness, boost the effects of anti-depressants, and play an important, brain-building role in the womb (aiding babies’ neurological and visual development). So, it’s important that we take new studies in stride, looking closely at their design and asking how each fits into the bigger picture of all the science that’s gone before – as well as the science that’s currently underway.

Dr. Block specializes in the care of patients with high blood cholesterol levels. If you’ve been diagnosed with unhealthy cholesterol levels, and are you looking for help getting them under control, call URMC’s Lipid Clinic at URMC at (585) 341-7700.

The Latest Claim: Some ‘Fried Foods’ OK for the Heart

No, it’s not carte blanche to toss aside the carrot sticks and gleefully chow down on drive-thru fare.

Rather, new research from Spain (which followed 40,000-some Spaniards for 12 years), suggests that not all “fried foods” deserve to be demonized. Researchers found that, so long as the cooking involves healthier fats, like olive and canola oils, the occasional indulgence might not significantly increase risk for heart disease. What’s more, it may even be a smart part of a balanced diet.

“Like so much nutrition advice, this all boils down to moderation,” said registered dietitian Tracy Cherry, a clinical nutrition specialist with URMC’s Cardiac Rehabilitation program. “Integrating a reasonable amount of heart-healthy oil into our cooking can go a long way toward keeping our diet interesting – and maintainable.”

In the interview below, Cherry talks about the rightful place for some “fried fare” on our daily plate.

Scripts: There seems to be a bit of a disconnect, here. In the U.S., the term “fried” is usually a dead giveaway that a food item is chocked full of fat, salt, and other unsavory ingredients – but this study is almost putting a halo on some fried foods. Can you expound?

Cherry: Here in the U.S., the notion of “frying” foods conjures up thoughts of battered fish fries and greasy, sugared donuts (which almost act like sponges to soak up fats!). But this study took place in Spain, where residents eat a more traditional Mediterranean diet; they’re rarely breading and deep-frying salty, sugary foods in Crisco-like fats – but rather, they’re stir-frying veggies or pan-frying undressed fish, using just a couple of teaspoons of olive oil. There’s a world of difference between these two concepts of what it means to “fry.”

Scripts: Tell us more about heart-healthy oils.

Cherry: Really, oils in general – especially olive and canola oils (though peanut, grape seed, and sunflower oils aren’t a bad second choice) – are more heart-healthy than solid, saturated fats, which tend to raise “bad” cholesterol levels in the blood, upping one’s risk for heart disease. 

But portion size matters, too. Oils and solid fats pack the same calorie content, tablespoon for tablespoon, so it’s smart to budget just a teaspoon of oil per serving when you’re cooking. That’s why stir-frying, sauteing and pan-frying are far better options; you can cook a really flavorful meal without having to douse it in a bath of bubbling fat. For an even leaner option, you can supplement the pan oil with a few splashes of water, or a cooking spray; it can help with the cost, too, and no one will be the wiser.

Scripts: You touched on this earlier, but does breading really make a big difference?

Cherry: You’d be surprised, but yes, it does. Again, it almost mops up oils – and the U.S. dietary guidelines recommend just one or two tablespoons of fats per person per day. (Remember, there are plenty of other sources that can supply fat – mayonnaise, peanut butter, olives, and walnuts – so there’s no need to “spend” all of your allowance in one place.)

Scripts: You talk about fats very matter-of-factly – as if they’re not necessarily bad. Why is that?

Cherry: It’s the truth! Back in the 80s and 90s, the party line was that all fats were evil; diet foods touted “no-fat” labels with pride, as Americans ruthlessly ridded the full-fat versions from their cupboards.

Now, we’re much savvier; we realize that small amounts of fat are beneficial, even essential, to our diet. Brain-building omega-3 fatty acids, found in foods like walnuts and fish, promote vigorous neurodevelopment in infants (even in-utero). Omega-3’s are also thought to help pull down triglycerides (bad fats in the bloodstream), help patients with arrhythmias (irregular heartbeats), and lower overall blood pressure.

Scripts: So, what’s the takeaway?

Cherry: I might sounds like a broken record, but it’s important: Moderation. Using modest amounts of healthy oils while cooking can go a long way toward creating a flavorful, heart-healthy meals that won’t derail your diet.

To learn more about heart care at URMC – including our cardiac rehabilitation programs – click here.

New U.S. Dietary Guidelines Decidedly ‘Fishy’

While the new 2010 U.S. Dietary Guidelines prod Americans – especially pregnant or breastfeeding moms – to eat more fish, many may be wondering exactly why seafood is so vital for a healthy diet.

To learn more about the powerful nutrients found in fish, we spoke with URMC neurologist Dr. Gary Myers.

For more than two decades, Dr. Myers and a team of URMC researchers have been conducting research in Seychelles, a tiny island nation in the Indian Ocean whose residents consume about 10 times as much fish as the average American.

Fish consumption, Myers explains in the video below, has been fraught with concerns related to whether or not the small amounts of mercury in seafood is harmful to people. By studying the Seychelles population, however, the team is witnessing firsthand that the good-for-you fatty acids found in fish (which are critical for building babies’ brains) seem to outweigh any potential ill effects related to mercury.

To make sense of the new dietary guidelines – and the science supporting them – just listen to Dr. Myer’s insights below.

Dr. Myers is a professor of Neurology, Environmental Medicine and Pediatrics at the University of Rochester Medical Center.