A recent article in The New York Times once again raised the specter that fish oil omega-3 supplements are ineffective. Some experts maintain this is an exaggerated view of what recent studies say — a view that fits the anti-supplement bias of certain publications. 

The article, titled Should I Take Fish Oil?, was written by contributing writer Crystal Martin. 

Article makes blanket statement about fish oil ineffectiveness 

The New York Times article makes the case against fish oil supplementation. Martin sums up the evidence for and against fish oil supplements, but she begins her examination of what the research says with this statement: “For healthy individuals, fish oil supplements are unnecessary. It’s better to eat a few servings of fish a week, instead.” 

Among the most damning pieces of evidence that she brings to the table: the perceived failure of the VITAL (VITamin D and OmegA-3 TriaL) study, conducted at Brigham and Women’s Hospital, an affiliate of Harvard Medical School.  

Martin said the trial showed omega-3s were ineffective at reducing the risk of major cardiac events for most people. Yet, even with the blanket statement that omega-3 supplements are ineffective, she goes on to write that the lowest fish consumption group saw a 19% reduced risk for heart attack, and African Americans followed in the study saw a 77% reduced risk. 

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Martin also quotes prominent industry critic Dr. Pieter Cohen, M.D. Cohen’s assertion is that weak regulation of dietary supplements means consumers can’t be sure of what’s in the bottle when they purchase an omega-3 product. 

Industry experts familiar with omega-3s research said Martin is repeating tired criticisms leveled at supplements in general. In the case of omega-3s, the outcomes that critics point to, and on which supplement interventions are deemed ineffective, are often in the realm of curing diseases, which are the kind of claims no supplement can legally make. 

Supplements trials shouldn’t be judged on drug endpoints 

I contacted two omega-3s experts to get their take on why articles like the one in the Times continue to appear, repeating the arguments over and over. William S. Harris, Ph.D., of the Fatty Acid Research Institute and Harry Rice, Ph.D., vice president of regulatory and scientific affairs of the Global Organization for EPA and DHA Omega-3s (GOED) responded. 

“Since dietary supplements are not intended to treat, diagnose, mitigate, prevent or cure diseases, it's ridiculous that omega-3s, or any dietary ingredient for that matter, are held to pharmaceutical clinical trial standards, particularly given the challenges associated with designing nutrition research,” Rice said. 

Harris added that nutritional research has some unique challenges that makes trying to equate its outcomes with those of drug trials intellectually lazy at best and disingenuous at worst. 

“For nutrients which cannot be studied like you study a drug (i.e., even in the placebo groups there are omega-3s in the diet – that does not happen in drug trials) the wider evidence base needs to be considered when asking if omega-3s are good for you or not,” Harris said. 

Few Americans get enough omega-3s in diet, despite urging of health authorities 

Rice said Martin downplayed a significant aspect of the VITAL results, namely that omega-3s are beneficial to people who have the lowest levels of these nutrients in their diets. This is highly significant, since most Americans are moderately to severely deficient in omega-3s. While many dietitians consistently advocate for people to get their omega-3s via two or more servings of fatty fish per week, dietary survey research has consistently shown that most Americans fall short of that recommendation. 

“The nutrient status of an individual or a population can affect the response to nutrient supplementation,” Rice said. “Specific to omega-3s, for a number of outcomes, we have learned that many benefits seem to be best demonstrated in those with the lowest omega-3 levels. Given that 95% of Americans don’t get enough omega-3s, the potential benefits of omega-3 supplementation are immense.” 

When stepping back from specific results for subgroups in a particular study, the overall picture of positive benefits of omega-3s supplementation becomes clear, according to Harris. 

“In the larger picture, there have been 18 papers in in the UK Biobank dataset using reported regular use of fish oil supplements (FOS) as the ‘exposure’ and reporting the associations with a wide variety of disease outcomes. Of the 25 statistically significant associations seen in these papers, 24 were favorable for fish oil supplement use (i.e., the risk for disease X was lower in FOS users),” he said. 

Methodological flaws still plague some research 

Rice said another confounding factor in recent research on fish oil supplementation is that it is still not common practice to test baseline omega-3s levels in subjects. This is only one of several methodological flaws that plague some of these studies. 

“That a poorly designed omega-3 trial didn’t show a benefit for whatever outcome doesn’t mean that omega-3s don’t work,” Rice concluded. The devil’s in the details, and when we read about a failed omega-3 cardiovascular study, a deeper dive into the methodology will undoubtedly reveal the reason(s). Many times, it’s just a matter of too few subjects to demonstrate the benefit(s). Other times, the omega-3 dosage is too low, or the trial duration is too short.”