Fish oil: Difference between revisions

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A 2005 randomized double-blind placebo-controlled study conducted under the auspices of the New Zealand Institute for Crop & Food Research found "no evidence that fish oil improved mood when compared to placebo, despite an increase in circulating ω-3 polyunsaturated fatty acids."<ref>{{cite journal |doi=10.1016/j.plefa.2004.11.004 |title=Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression |year=2005 |last1=Silvers |first1=K |last2=Woolley |first2=C |last3=Hamilton |first3=F |last4=Watts |first4=P |last5=Watson |first5=R |journal=Prostaglandins, Leukotrienes and Essential Fatty Acids |volume=72 |issue=3 |pages=211–218}}</ref> Another study published in October 2007 found that fish oil supplements conferred no additional benefits beyond those conferred by standard treatment.<ref>{{cite journal |pages=1393–6 |doi=10.1016/j.pnpbp.2007.06.004 |title=Fish oil supplementation in the treatment of major depression: A randomised double-blind placebo-controlled trial |year=2007 |last1=Grenyer |first1=B |last2=Crowe |first2=T |last3=Meyer |first3=B |last4=Owen |first4=A |last5=Grigonisdeane |first5=E |last6=Caputi |first6=P |last7=Howe |first7=P |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=31 |issue=7 |pmid=17659823}}</ref> However, both of these studies used omega-3 primary consisting of DHA, not EPA.
A 2005 randomized double-blind placebo-controlled study conducted under the auspices of the New Zealand Institute for Crop & Food Research found "no evidence that fish oil improved mood when compared to placebo, despite an increase in circulating ω-3 polyunsaturated fatty acids."<ref>{{cite journal |doi=10.1016/j.plefa.2004.11.004 |title=Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression |year=2005 |last1=Silvers |first1=K |last2=Woolley |first2=C |last3=Hamilton |first3=F |last4=Watts |first4=P |last5=Watson |first5=R |journal=Prostaglandins, Leukotrienes and Essential Fatty Acids |volume=72 |issue=3 |pages=211–218}}</ref> Another study published in October 2007 found that fish oil supplements conferred no additional benefits beyond those conferred by standard treatment.<ref>{{cite journal |pages=1393–6 |doi=10.1016/j.pnpbp.2007.06.004 |title=Fish oil supplementation in the treatment of major depression: A randomised double-blind placebo-controlled trial |year=2007 |last1=Grenyer |first1=B |last2=Crowe |first2=T |last3=Meyer |first3=B |last4=Owen |first4=A |last5=Grigonisdeane |first5=E |last6=Caputi |first6=P |last7=Howe |first7=P |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=31 |issue=7 |pmid=17659823}}</ref> However, both of these studies used omega-3 primary consisting of DHA, not EPA.

A 2008 [[Cochrane Library|Cochrane]] [[systematic review]] found that limited data is available. In the one eligible study, omega-3s were an effective adjunctive therapy for depressed but not manic symptoms in [[bipolar disorder]]. The authors found an "acute need" for more randomised controlled trials.<ref>{{cite journal|author=Montgomery P, Richardson AJ|title=Omega-3 fatty acids for bipolar disorder (Art. No. CD005169)|publisher=Cochrane Database of Systematic Reviews|year=2008|issue=2|doi=10.1002/14651858.CD005169.pub2}}</ref>


A 2009 [[metastudy]] found that patients taking omega-3 supplements with a higher EPA:DHA ratio experienced less depressive symptoms. The studies provided evidence that EPA may be more efficacious than DHA in treating depression. However, this metastudy concluded that due to the identified limitations of the included studies, larger, randomized trials are needed to confirm these findings.<ref>http://www.jacn.org/content/28/5/525.full</ref>
A 2009 [[metastudy]] found that patients taking omega-3 supplements with a higher EPA:DHA ratio experienced less depressive symptoms. The studies provided evidence that EPA may be more efficacious than DHA in treating depression. However, this metastudy concluded that due to the identified limitations of the included studies, larger, randomized trials are needed to confirm these findings.<ref>http://www.jacn.org/content/28/5/525.full</ref>

Revision as of 23:57, 4 May 2012

A typical fish oil softgel

Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors of certain eicosanoids that are known to reduce inflammation throughout the body,[1][2][3] and are thought to have many health benefits.

Fish do not actually produce omega-3 fatty acids, but instead accumulate them by consuming either microalgae or prey fish that have accumulated omega-3 fatty acids, together with a high quantity of antioxidants as iodide and selenium, from microalgae, where these antioxidants are able to protect the fragile polyunsaturated lipids from peroxidation [4] .[4][5][6] Fatty predatory fish like sharks, sword fish, tilefish, and albacore tuna may be high in omega-3 fatty acids, but due to their position at the top of the food chain, these species can also accumulate toxic substances (see biomagnification). For this reason, the U.S. Food and Drug Administration recommends limiting consumption of certain (predatory) fish species (e.g. albacore tuna, shark, king mackerel, tilefish and swordfish) due to high levels of toxic contaminants such as mercury, dioxin, PCBs and chlordane.[7] Fish oil is used as a component in aquaculture feed. More than 50 percent of the world's fish oil used in aquaculture feed is fed to farmed salmon.[8]

The omega-3 fatty acids in fish oil are thought to be beneficial in treating hypertriglyceridemia, and possibly beneficial in preventing heart disease.[9] Fish oil and omega-3 fatty acids have been studied in a wide variety of other conditions, such as clinical depression,[10][11] anxiety,[12][13][14] cancer, and macular degeneration, although benefit in these conditions remains to be proven.[9]

Production

In 2005, fish oil production declined in all main producing countries with the exception of Iceland. The 2005 production estimate is about 570,000 tonnes in the five main exporting countries (Peru, Denmark, Chile, Iceland and Norway), a 12% decline from the 650,000 tonnes produced in 2004.[citation needed]. Peru continues to be the main fish oil producer worldwide, with about one fourth of total fish oil production.

Grams of omega-3 fatty acids per 3oz (85g) serving of popular fish.[15]
Common name grams
Tuna 0.21–1.1
Tuna (canned, light) 0.17-0.24
Pollock 0.45
Salmon 1.1–1.9
Cod 0.15–0.24
Catfish 0.22–0.3
Flounder 0.48
Grouper 0.23
Halibut 0.60–1.12
Mahi mahi 0.13
Orange roughy 0.028
Red snapper 0.29
Shark 0.83
Swordfish 0.97
Tilefish 0.90
King mackerel 0.36

Health benefits

Cancer

Several studies report possible anti-cancer effects of n−3 fatty acids found in fish oil (particularly breast, colon and prostate cancer).[16][17][18] Omega-3 fatty acids reduced prostate cancer growth, slowed histopathological progression, and increased survival in genetically engineered mice.[19] Among n-3 fatty acids (omega-3), neither long-chain nor short-chain forms were consistently associated with reduced breast cancer risk. High levels of docosahexaenoic acid, however, the most abundant n-3 polyunsaturated fatty acid (omega-3) in erythrocyte membranes, were associated with a reduced risk of breast cancer.[20] A recent study of 35,000 middle-aged women found that the women who took fish oil supplements had a 32% lower risk of breast cancer, although the authors stress the result is preliminary and falls short of establishing a causal relationship.[21]

Cardiovascular

A 2008 meta-study by the Canadian Medical Association Journal found fish oil supplementation did not demonstrate any preventative benefit to cardiac patients with ventricular arrhythmias.[22]

The American Heart Association recommends the consumption of 1g of fish oil daily, preferably by eating fish, for patients with coronary heart disease although pregnant and nursing women are advised to avoiding eating fish with high potential for mercury contaminants including mackerel, shark, or swordfish.[23] Note that optimal dosage relates to body weight.

The US National Institutes of Health lists three conditions for which fish oil and other omega-3 sources are most highly recommended: hypertriglyceridemia, secondary cardiovascular disease prevention and high blood pressure. It then lists 27 other conditions for which there is less evidence. It also lists possible safety concerns: "Intake of 3 grams per day or greater of omega-3 fatty acids may increase the risk of bleeding, although there is little evidence of significant bleeding risk at lower doses. Very large intakes of fish oil/omega-3 fatty acids may increase the risk of hemorrhagic (bleeding) stroke."[9]

There is also some evidence that fish oil may have a beneficial effect on some forms of cardiac dysrhythmia.[24] [25]

Mental health

Studies published in 2004 and 2009 have suggested that the n-3 EPA may reduce the risk of depression and suicide. One study[26] compared blood samples of 100 suicide-attempt patients and to those of controls and found that levels of Eicosapentaenoic acid were significantly lower in the washed red blood cells of the suicide-attempt patients. A small American trial in 2009 suggested that E-EPA, as monotherapy, might treat major depressive disorder but failed to achieve statistical significance.[27]

Studies[28][29] were conducted on prisoners in England where the inmates were fed seafood which contains omega-3 fatty acids. The higher consumption of these fatty acids corresponded with a drop in the assault rates. Another Finnish study found that prisoners who were convicted of violence had lower levels of omega–3 fatty acids than prisoners convicted of nonviolent offenses. It was suggested that these kinds of fatty acids are responsible for the neuronal growth of the frontal cortex of the brain which, it is further alleged, is the seat of personal behavior.[citation needed]

A study from the Orygen Research Centre in Melbourne suggests that omega-3 fatty acids could also help delay or prevent the onset of schizophrenia. The researchers enlisted 81 'high risk' young people aged 13 to 24 who had previously suffered brief hallucinations or delusions and gave half of them capsules of fish oil while the other half received placebo. One year on, only three percent of those on fish oil had developed schizophrenia compared to 28 percent from those on placebo.[30] A study conducted at Sheffield University in England reported positive results with fish oil on patients suffering from schizophrenia. Participants of the study had previously taken anti-psychotic prescription drugs that were no longer effective. After taking fish oil supplements, participants in the study experienced progress compared to others who were given a placebo.[31][32]

The largest controlled study to date found no cognitive benefit after two years in the elderly.[33][34]

Alzheimer's disease

According to a study from Louisiana State University in September 2005, Docosahexaenoic acid, an omega-3 fatty acid often found in fish oil, may help protect the brain from cognitive problems associated with Alzheimer's disease.[35]

Lupus

In a Northern Ireland study, lupus disease activity, especially in the skin and joints, was significantly reduced in patients who received fish oil supplements at both 12-week and 24-week follow-up periods versus patients who received placebo. There were also changes in the blood platelets of the patients who took the fish oil supplements, with an increase in proteins that are considered anti-inflammatory and a decrease in proteins that promote inflammation; these changes were not evident in the group that took placebo. The fish oil group showed an increase in FMD, which the researchers took as a sign that the omega-3 oils were helping the cells in the blood vessel walls to remain healthy. [citation needed]

Parkinson's disease

A study[36] examining whether omega-3 exerts neuroprotective action in Parkinson's disease found that it did exhibit a protective effect in mice. The scientists exposed mice to either a control or a high omega-3 diet from two to twelve months of age and then treated them with a neurotoxin commonly used as an experimental model for Parkinson's. The scientists found that high doses of omega-3 given to the experimental group prevented the neurotoxin-induced decrease of dopamine that ordinarily occurs. Since Parkinson's is a disease caused by disruption of the dopamine system, this protective effect exhibited could show promise for future research in the prevention of Parkinson's disease.[36]

Depression

Evidence regarding the efficacy of fish oil supplements as a treatment for depression is inconclusive. Whereas several methodologically rigorous studies have reported statistically significant positive effects in the treatment of depressed patients, other studies have found effects to be insignificant.

In 1999 a team of researchers lead by the Harvard psychiatrist Andrew Stoll published a preliminary placebo-controlled double blind trial which found Omega 3 fatty acids "improved the short-term course of illness" of bipolar disorder.[37][38]

A 2003 double-blind placebo-controlled study published in the journal European Neuropsychopharmacology found that among 28 patients with major depressive disorder, "patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group."[10] Another study in the American Journal of Psychiatry reported that the addition of fish oil supplements to regular maintenance anti-depression therapy conferred "highly significant" benefits by the third week of the trial.[14]

A 2005 randomized double-blind placebo-controlled study conducted under the auspices of the New Zealand Institute for Crop & Food Research found "no evidence that fish oil improved mood when compared to placebo, despite an increase in circulating ω-3 polyunsaturated fatty acids."[39] Another study published in October 2007 found that fish oil supplements conferred no additional benefits beyond those conferred by standard treatment.[40] However, both of these studies used omega-3 primary consisting of DHA, not EPA.

A 2008 Cochrane systematic review found that limited data is available. In the one eligible study, omega-3s were an effective adjunctive therapy for depressed but not manic symptoms in bipolar disorder. The authors found an "acute need" for more randomised controlled trials.[41]

A 2009 metastudy found that patients taking omega-3 supplements with a higher EPA:DHA ratio experienced less depressive symptoms. The studies provided evidence that EPA may be more efficacious than DHA in treating depression. However, this metastudy concluded that due to the identified limitations of the included studies, larger, randomized trials are needed to confirm these findings.[42]

In a 2011 meta-analysis, researchers from Yale found that "nearly all of the treatment efficacy observed in the published literature may be attributable to publication bias."[43]

Psoriasis

Diets supplemented with cod liver oil have shown beneficial effects on psoriasis.[44]

Pregnancy

Omega-3 polyunsaturated fatty acids (commonly found in fish oil) protect against fetal brain injury and promotes fetal and infant brain health.[45] Some studies reported better psycho motor development at 30 months of age in infants whose mothers received fish oil supplements for the first four months of lactation.[46] In addition, five-year-old children whose mothers received modest algae based docosahexaenoic acid supplementation for the first 4 months of breastfeeding performed better on a test of sustained attention. This suggests that docosahexaenoic acid intake during early infancy confers long-term benefits on specific aspects of neurodevelopment.[46]

Docosahexaenoic acid supplementation has also been found to be essential for early visual development of the baby.[47] However, the standard western diet is severely deficient in these critical nutrients. This omega-3 dietary deficiency, a nutrient found in fish oil, is compounded by the fact that pregnant women become depleted in omega-3s, since the fetus uses omega-3s for its nervous system development. Omega-3s are also used after birth if they are provided in breast milk.[48]

In addition, provision of fish oil during pregnancy may reduce an infant’s sensitization to common food allergens and reduce the prevalence and severity of certain skin diseases in the first year of life. This effect may persist until adolescence with a reduction in prevalence and/or severity of eczema, hay fever and asthma.[49]

Omega-3 fatty acid supplementation is also beneficial to the mother.[45] It has been shown to prevent pre-term labor and delivery.[48] It is recommended that women who are breastfeeding consume fish oil at least twice a week, although the American Heart Association recommends pregnant and nursing women are to avoiding eating fish with high potential for mercury contaminants including mackerel, shark, or swordfish.[49]

Dangers

Maximum intake

The FDA says it is safe to take up to 3000 mg of omega-3 per day.[50] (This is not the same as 3000 mg of fish oil. A 1000 mg pill typically has only 300 mg of omega-3; 10 such pills would equal 3000 mg of omega-3.) Dyerberg studied healthy Greenland Eskimos and found an average intake of 5700 mg of omega-3 EPA per day.[51]

Vitamins

The liver and liver products (such as cod liver oil) of fish and many animals (such as seals and whales) contain omega-3, but also the active form of vitamin A. At high levels, this form of the vitamin can be dangerous (Hypervitaminosis A).[52]

Toxic pollutants

Fish oil supplements came under scrutiny in 2006, when the Food Standards Agency in the UK and the Food Safety Authority of Ireland reported PCB levels that exceeded the European maximum limits in several fish oil brands,[53][54] which required temporary withdrawal of these brands. To address the concern over contaminated fish oil supplements, the International Fish Oil Standards (IFOS) Program, a third-party testing and accreditation program for fish oil products, was created by Nutrasource Diagnostics Inc. in Guelph, Ontario, Canada.[55]

A March 2010 lawsuit filed by a California environmental group claimed that eight brands of fish oil supplements contained excessive levels of PCB's, including CVS/pharmacy, Nature Made, Rite Aid, GNC, Solgar, Twinlab, Now Health, Omega Protein and Pharmavite. The majority of these products were either cod liver or shark liver oils. Those participating in the lawsuit claim that because the liver is the major filtering and detoxifying organ, PCB content may be higher in liver-based oils than in fish oil produced from the processing of whole fish. [56][57]

An analysis based on data from the Norwegian Women and Cancer Study (NOWAC) with regards to the dangers of persistent organic pollutants (POPs) in cod liver came to the conclusion that "in Norwegian women, fish liver consumption was not associated with an increased cancer risk in breast, uterus, or colon. In contrast, a decreased risk for total cancer was found."[58]

However, a report by the Harvard Medical School studied five popular brands of fish oil, including Nordic Ultimate, Kirkland and CVS. They found that the brands had “negligible amounts of mercury, suggesting either that mercury is removed during the manufacturing of purified fish oil or that the fish sources used in these commercial preparations are relatively mercury-free.” [59]

Mania

There are isolated case reports of development of mania in persons with bipolar disorder who took fish oil. [60]

See also

Notes

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  3. ^ Cleland, Leslieg; James, Michaelj; Proudman, Susannam (2006). Arthritis Research & Therapy. 8: 679–81. doi:10.1186/ar1876. PMC 1526555. PMID 16542466 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526555. {{cite journal}}: Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
  4. ^ a b Venturi S, Donati FM, Venturi A, Venturi M (2000). "Environmental iodine deficiency: A challenge to the evolution of terrestrial life?". Thyroid. 10 (8): 727–9. doi:10.1089/10507250050137851. PMID 11014322.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ Venturi S, Venturi M (2007). "Evolution of Dietary Antioxidant Defences". European Epi-Marker. 11 (3): 1–12. http://www.icb-asbl.com/en/pdf/epimarker/epimarker_3_07.pdf.
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  7. ^ EPA (2007-01-31). "Fish Consumption Advisories". Retrieved 2007-02-08.
  8. ^ FAO: World Review of Fisheries and Aquaculture 2008: Highlights of Special Studies Rome.
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  11. ^ Naliwaiko, K.; Araújo, R.L.F.; Da Fonseca, R.V.; Castilho, J.C.; Andreatini, R.; Bellissimo, M.I.; Oliveira, B.H.; Martins, E.F.; Curi, R. (2004). "Effects of Fish Oil on the Central Nervous System: A New Potential Antidepressant?". Nutritional Neuroscience. 7 (2): 91–9. doi:10.1080/10284150410001704525. PMID 15279495.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
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  18. ^ Caygill, C P J; Hill, M J (1995). "Fish, n-3 fatty acids and human colorectal and breast cancer mortality". European Journal of Cancer Prevention. 4 (4): 329–32. doi:10.1097/00008469-199508000-00008. PMID 7549825.
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  22. ^ Nair, G. M.; Connolly, S. J. (2008). "Should patients with cardiovascular disease take fish oil?". Canadian Medical Association Journal. 178 (2): 181–2. doi:10.1503/cmaj.071654. PMC 2174997. PMID 18195293.
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  24. ^ Charnock, John S (1999) "The role of omega-3 polyunsaturated fatty acid-enriched diets in the prevention of ventricular fibrillation" Asia Pacific Journal of Clinical Nutrition, 8 (3): 226–230.
  25. ^ Li G-R, Sun H-Y, Zhang X-H, Cheng L-C, Chiu S-W, Tse H-F and Lau C-P (2009) "Omega-3 polyunsaturated fatty acids inhibit transient outward and ultra-rapid delayed rectifier K+currents and Na+current in human atrial myocytes" Cardiovasc Res, 81 (2): 286–293. doi:10.1093/cvr/cvn322
  26. ^ Huan, M; Hamazaki, K; Sun, Y; Itomura, M; Liu, H; Kang, W; Watanabe, S; Terasawa, K; Hamazaki, T (2004). "Suicide attempt and n-3 fatty acid levels in red blood cells: A case control study in china". Biological Psychiatry. 56 (7): 490–6. doi:10.1016/j.biopsych.2004.06.028. PMID 15450784.
  27. ^ Mischoulon, David; Papakostas, George I.; Dording, Christina M.; Farabaugh, Amy H.; Sonawalla, Shamsah B.; Agoston, A. Monica; Smith, Juliana; Beaumont, Erin C.; Dahan, Liat E. (2009). "A Double-Blind, Randomized Controlled Trial of Ethyl-Eicosapentaenoate for Major Depressive Disorder". The Journal of Clinical Psychiatry. 70 (12): 1636–44. doi:10.4088/JCP.08m04603. PMC 2918427. PMID 19709502.
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  30. ^ Amminger, G. P.; Schafer, M. R.; Papageorgiou, K.; Klier, C. M.; Cotton, S. M.; Harrigan, S. M.; MacKinnon, A.; McGorry, P. D.; Berger, G. E. (2010). "Long-Chain  -3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial". Archives of General Psychiatry. 67 (2): 146–54. doi:10.1001/archgenpsychiatry.2009.192. PMID 20124114. {{cite journal}}: no-break space character in |title= at position 12 (help)
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  40. ^ Grenyer, B; Crowe, T; Meyer, B; Owen, A; Grigonisdeane, E; Caputi, P; Howe, P (2007). "Fish oil supplementation in the treatment of major depression: A randomised double-blind placebo-controlled trial". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 31 (7): 1393–6. doi:10.1016/j.pnpbp.2007.06.004. PMID 17659823.
  41. ^ Montgomery P, Richardson AJ (2008). "Omega-3 fatty acids for bipolar disorder (Art. No. CD005169)" (2). Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005169.pub2. {{cite journal}}: Cite journal requires |journal= (help)
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References

External links