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Study claims to show no benefit from supplementation with omega 3s: should we believe it?

A new Norwegian study claims to show that fish oil is of no benefit to people with MS, but should we believe it?

Supplementing with polyunsaturated fatty acids (PUFAs) has been shown to slow the progression of MS. The current OMS recommendation is to supplement with at least 20g of fish or flaxseed oil daily in addition to the dietary change of minimising saturated and altered fat intake.

This is because omega 3 PUFAs have been shown to provide additional immune benefits in Multiple Sclerosis over and above the known beneficial cell membrane effects of omega 6 PUFAs. The authors of a recent blinded randomised controlled trial of fish oil supplementation in Norway claim their trial proves that supplementing with omega 3s has no beneficial effect on disease activity in MS.

The paper can be downloaded above right. The study was meticulously carried out, with 92 PwMS from several centres in Norway randomised to two groups. PwMS in the active treatment group received 7g of fish oil daily and people in the other group a placebo capsule containing corn oil, which contains a large proportion of linoleic acid (a PUFA previously shown to reduce the progression of disability when used at a higher dose of around 17-23g/day). Both groups also used interferon–beta therapy, and were followed up for two years. No difference between the groups was found in: appearance of new lesions on MRI, disability, disease progression, fatigue and quality of life scales. Should this result affect our decision to recommend omega 3 supplementation? We note the following:

  • Previous studies in a variety of diseases have emphasised the need to reduce saturated fat (SFA) intake in addition to omega 3 supplementation for optimal benefit
  • The dose of PUFA supplementation is around two-thirds lower than that recommended by OMS (7g vs 20g), based on the work of Gallai and colleagues who demonstrated dramatic anti-inflammatory effects of high dose fish oil in PwMS
  • The control group was taking a “placebo” which has previously been shown to reduce disease progression; it is quite likely that at the doses used, the omega 3s in the treated group and the omega 6s in the placebo group were having similar structural cell-membrane benefits in both groups, but that the dose of omega 3s was not high enough to produce the additional immune benefit

Rather than take this as confirmation that omega 3s are ineffective in MS, we can conclude that at low doses, omega 3s appear to have no additional benefit over the known beneficial effects of omega 6 supplementation in MS.

The OMS view is that supplementation with omega 3s should be at higher doses; importantly this should occur with a change in diet to minimise saturated fat consumption, and preferably in addition to using other lifestyle modifications such as adequate sun exposure, exercise and meditation to allow a synergistic shift in balance of the immune system towards an anti-inflammatory response.

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