Omega-3, a Prescription?

Column #170

On November 10, 2018 it was BREAKING NEWS. Headlines on NBC, NY Times, Washington Post, and on and on called it a miracle heart drug. Guess what, it’s purified fish oil (a highly concentrated form of Omega-3) in a prescription pill that costs “only” $278 a month per person. Does it work? Yes, it lowers heart attack risks by 25% and death by 20%. Wow, what a discovery!

Or is it a wow? Is it even a discovery? To answer that question I read the report. Then I dusted off additional research from over the years. Then I reviewed my own experiences. The following is my analysis of the “Breaking News.”

The report was sponsored by Amarin Pharma. They manufacture and sell the “drug.” That doesn’t automatically taint the report’s results since it passed peer review. The conclusions are most certainly correct. But the analysis and reporting were structured so that it left out alternatives other than their prescription pill. Are they correct to assume consumers are so ignorant they can’t see that? The media certainly fell for their marketing tactic. My guess millions of people will also fall for it. So what’s the actual story?

The people selected for the test were patients with established cardiovascular disease, or diabetes, and other risk factors. They were receiving statin therapy for elevated triglyceride levels and were at increased risk for ischemic events (restriction in blood supply to tissues). They were divided into two groups. One received a mineral oil placebo and the other four grams per day of Icosapent ethyl (4,000mg of Omega-3).

It’s a well established fact that Icosapent ethyl, pure EPA Omega-3, will lower triglyceride levels. But the test was to determine the pill’s affect on ischemic events. The results of the test confirmed what Amarin Pharma hoped because heart attack risks were 25% lower and death was 20% lower. That’s good.

Interestingly the report contained this warning. “Metabolic data provide evidence that icosapent ethyl–based formulations do not raise LDL cholesterol levels, whereas DHA-based formulations do. The results of the current trial should not be generalized to other n-3 fatty acid preparations--in particular, dietary-supplement preparations of n-3 fatty acid mixtures, which are variable and unregulated and which have not been shown to have clinical benefit.”

In other words, according to them, Omega-3 supplements sold by health food stores won’t work. I’ve written about those failed studies. They fail because low doses of Omega-3 without a corresponding and significant drop in Omega-6 consumption cannot meaningfully reduce the Omega-6 to Omega-3 Essential Fatty Acid (EFA) ratio. The report also disappointed me when a search of the text failed to turn up even one mention of “Omega-6" or “EFA ratio.”

In her 1999 report, “Essential Fatty Acids in Health and Chronic Disease,” Artemis P. Simopoulos M.D. stated that “Another important consideration is the finding that during chronic fish-oil feeding postprandial triacylglycerol concentrations decrease. Furthermore, Nestel reported that consumption of high amounts of fish oil blunted the expected rise in plasma cholesterol concentrations in humans.”

James J DiNicolantonio, PharmD has written extensively about these same issues. He states that “Dietary guidelines should shift focus away from reducing saturated fat, and from replacing saturated fat with carbohydrates, specifically when these carbohydrates are refined. To reduce the burden of chronic heart disease (CHD), guidelines should focus particularly on reducing intake of concentrated sugars, specifically the fructose-containing sugars like sucrose and high-fructose corn syrup in the form of ultra-processed foods and beverages.”

In my own experience I know that after a few years of eating more grass-fed meat and focusing on balancing my EFAs, my cholesterol was around 260. But my HDL was over 100 and my LDLs were 120 or so. My triglycerides were about 40. Some years later the research regarding the many myths surrounding concerns for higher cholesterol numbers started coming out and I stopped worrying about cholesterol, HDL, LDL, and triglycerides. Now I focus on balancing the EFAs as close to 1:1 as possible because it tends to put all the checks in the box for optimal heart heath without needing a doctor visit for a prescription that costs $278 per month.

The report proves that what you eat impacts your health. It also underscores the power of Omega-3 in preventing or subduing CHD. Unfortunately it did not disclose what has been known for over two decades about the importance of eating foods that balance the EFAs 1:1. It ignored the data that associates EFA ratios over 4:1 with higher incidences of chronic diseases of all kinds. It ignored the fact that ratios below 2.5:1 subdued most chronic diseases.

By learning about the EFA profiles of the foods we eat, we can select foods that lower our EFA ratios and avoid the foods that raise our EFA ratios. We don’t need to visit a doctor to do it.

To your health.

Ted Slanker

Ted Slanker has been reporting on the fundamentals of nutritional research in publications, television and radio appearances, and at conferences since 1999. He condenses complex studies into the basics required for health and well-being. His eBook, The Real Diet of Man, is available online.

Don't miss these links for additional reading:

Prescription Drug with Fish Oil Reduces Risk of Heart Attack or Stroke, Study Finds NBC News

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia by Deepak L. Bhatt, M.D., et al.

Fish, Fish Oil May Lower Your Heart Attack Risk by Dennis Thompson at WebMD

Fish-Oil Heart Medicine Is Rarest of Drug Breakthroughs by Max Nisen, Bloomberg Opinion in The Washington Post

Essential Fatty Acids in Health and Chronic Disease by Artemis P. Simopoulos M.D.

Effects of Dietary Fats on Blood Lipids: a Review of Direct Comparison Trials by James J DiNicolantonio, PharmD, et al.

The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease by James J. DiNicolantonio, PharmD, et al.

Worried About Cholesterol? by Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T. at the HeartMD Institute

Why You Should No Longer Worry About Cholesterol in Food from Cleveland Clinic

Ethyl Eicosapentaenoic Acid from Wikipedia

Pure EPA Omega-3 Prescription VASCEPA® | Very High Trigylceride ...