eat fish, not fish oil

Omega-3 fatty acids, found in oily fish such as sardines and salmon and once touted as a way of staving off heart disease and stroke, don't help after all, according to a Greek study.

Based on a review and analysis of previous clinical trials including more than 68,000 participants, Greek researchers whose report appeared in the Journal of the American Medical Association said the fatty acids have no impact on overall death rates, deaths from heart disease, or strokes and heart attacks.

This was true whether they were obtained from supplements such as pills, or from fish in the diet, said the researchers, led by Mosef Elisef at the University Hospital of Ioannina.

A decade ago, medical evidence suggested that boosting omega-3s, including the acids known as EPA and DHA, with food or supplements had a strong protective effect even though the mechanism wasn't understood.

Scientists cited improvements in levels of triglycerides - a type of fat in the blood - as well as blood pressure levels and heart rhythm disturbances.

But since then, the picture has grown clouded. Earlier this year, a group of Korean researchers found that omega-3 supplements had no effect on heart disease or death based on 20,000 participants in previous trials.

Because people who eat a lot of fish have been found to have less heart disease, researchers figured that perhaps putting the supposed "active ingredients" in a pill could provide similar benefits, said Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University in Boston.

 "What we have learned over the years is you can't think about individual nutrients in isolation," she added.
People who eat fish often may be replacing things like steak, hamburgers or quiche, making for a healthier diet.

Instead of supplements, Lichtenstein recommended eating fish at least twice a week, having a diet rich in whole grains and vegetables, getting lots of physical activity, and not smoking.

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The medical world long ago noted that societies in which diets were high in fatty fish such as salmon, sardines, mackerel and others had lower rates of heart disease. A large 1989 study found that men who had already had a heart attack and changed their diets to include more fatty fish rich in omega-3 polyunsaturated fatty acid were 29% less likely to die in the next two years. Because of these and other findings, many medical groups suggest that people at risk for heart disease either increase their fatty fish intake or take omega-3 supplements.

However, subsequent studies that looked at omega-3 fatty acid supplements derived from fish were less clear. Some supported and some refuted the findings, though overall the connection between supplements and lowered heart disease has been elusive. The study released today attempts to pull together all the current research.

The message Americans may not want to hear is that eating healthy foods, not taking pills, is what helps heart health, says Richard Karas, director of the preventive cardiology center at Tufts Medical Center in Boston.
Time and time again research shows that a diet rich in a certain vitamin or nutrient is beneficial. But then people think "if you take a pill containing that ingredient, you'll be healthier," Karas says. It doesn't work that way.

He now tells his cardiac patients to eat fatty fish in at least two meals a week.