BLOG: Why all the hate for fish oil?
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Seriously? Are we still doing this? Why are we still seeing poorly done studies using protocols that do not reflect real-world practice being used to make broad, sweeping denigration of omega-3 fatty acid provided by fish oil?
I mean, haters gonna hate and all, but the folks using this latest study to declare fish oil ineffective in treating dry eye disease (DED) don’t appear to have bothered to read the study; it only sought to determine if fish oil prevents the development of DED in people who were not diagnosed with it upon entering the study.
Why all the hate?
To be fair (quick: what TV show is that from?), the omega fatty acid community is fairly thin-skinned when it comes to this stuff. If not for a bit of social media piling on by the post-DREAM haters, this would have been a really good opportunity for the pro-omega-3 set to starve this little study of air by ignoring it. VITAL is a long-term study of the possible effect of marine omega-3 fatty acid, fish oil, in the prevention of cancer and cardiovascular disease. In the study, a trivial dose (1 g) of commercial-grade (not re-esterified) fish oil was given to subjects who were then studied for many years to see if they developed the diseases in question.
In the case of DED, the mean follow-up was roughly 5 years. A review of CPT codes was done to determine if DED had been newly diagnosed over those 5 years, and study subjects were compared with those who received a placebo. No treatment effect was noted, prompting the study conclusion that fish oil is not effective at preventing DED. This has been extrapolated by the haters to “fish oil doesn’t work to treat DED.”
Here’s the rub: You simply can’t make either conclusion from VITAL. Come on — 1 g of commercial fish oil? Think Nature’s Bounty here, not the re-esterified version that we all know is more effective. No measurement of the Omega-3 Index to determine whether a therapeutic level of omega-3 fatty acid (index value of 8 or greater) has been achieved. This was even less than a chart study; CPT codes were evaluated, and study subjects were not universally examined by an eye doctor. Topping off, VITAL never actually offers a conclusion regarding the treatment of DED. The most recent study to conclude that fish oil is indeed an effective DED treatment is Giannaccare’s meta-analysis from 2019, which quite convincingly makes the case once again for treating DED with oral fish oil.
Let’s ground this canard once and for all. Hate all you want, but re-esterified fish oil is an effective treatment of the signs and symptoms of DED.
References:
- Christen WG, et al. JAMA Ophthalmol. 2022;doi:10.1001/jamaophthalmol.2022.1818.
- Giannaccare G, et al. Cornea. 2019;doi:10.1097/ICO.0000000000001884.
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