NEW YORK (Reuters Health) - Recent research into the potential benefits of fish oil has been largely disappointing. But sales of the supplements have continued to rise, according to a new report. 
 
 "About 10 percent of U.S. adults use fish oils, most in the belief that they help heart health," study author Dr. Andrew Grey, from the University of Auckland in New Zealand, said. 
 
 He and colleague Dr. Mark Bolland looked at the results of 18 randomized controlled trials - the gold standard in medical research - and six analyses of past trials on fish oil published between 2005 and 2012. 
 
 The studies compared the risk of heart disease, cancer, thinking and memory problems and immune, digestive and respiratory conditions among people who were randomly assigned to take fish oil or not. 
 
 The researchers also searched for news reports generated by the studies within two weeks of publication. They ranked how favorably the media covered each study on a scale from 1 (very negative toward fish oil) to 5 (very positive). 
 
 Only two studies identified a benefit from fish oil. But most media coverage of the studies was very positive, Grey and Bolland wrote Monday in JAMA Internal Medicine. 
 
 For example, the researchers rated media coverage as 4 for two 2012 studies that found no benefits for heart disease or stroke and were each heavily covered. 
 
 "It's clear fish oils don't improve heart health," Grey told Reuters Health. "People can safely discontinue fish oil supplements, and focus on pursuing health behaviors with proven efficacy." 
 
 Sales of fish oil supplements in the U.S. rose from $425 million in 2007 to over $1 billion in 2012, according to data from Euromonitor International, a market intelligence firm. The supplements can be bought over the counter for a couple dollars per month. 
 
 Omega-3 fatty acids, found in fish and fish oil supplements, are considered to be important for a healthy diet. But they don't appear to help prevent major health problems for most people. 
 
 The World Health Organization recommends pregnant and nursing women consume at least 300 milligrams of omega-3s daily to help boost their baby's brain development, and no studies included in the report refute that recommendation. 
 
 Most people don't take the supplements based on a doctor's recommendation, Grey said. So other factors, like commercial efforts, may influence sales. 
 
 "Under certain circumstances, the pattern of use of some medicines or food additives tends to have a poor relation with the evidence provided by clinical trials," Andrea Messori told Reuters Health. 
 
 Messori, of Regional Health System in Prato, Italy, authored a paper this year on fish oil and heart disease, which found no benefit. He was not involved in the new report. 
 
 It's tough to figure out why evidence and practice don't always align, he said. 
 
 Grey agreed that fish oil is not unique among supplements. 
 
 "Vitamin D is another supplement for which clinical trial evidence of lack of efficacy has been accruing for some time, yet it remains very widely used and very profitable for those who sell it," Grey said. 
 
 SOURCE: bit.ly/IZGqPC JAMA Internal Medicine, online December 16, 2013. 

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 Fish oil is now the third most widely used dietary supplement in the United States, after vitamins and minerals, according to a recent report from the National Institutes of Health. At least 10 percent of Americans take fish oil regularly, most believing that the omega-3 fatty acids in the supplements will protect their cardiovascular health. 
 
 But there is one big problem: The vast majority of clinical trials involving fish oil have found no evidence that it lowers the risk of heart attack and stroke. 
 
 From 2005 to 2012, at least two dozen rigorous studies of fish oil were published in leading medical journals, most of which looked at whether fish oil could prevent cardiovascular events in high-risk populations. These were people who had a history of heart disease or strong risk factors for it, like high cholesterol, hypertension or Type 2 diabetes. 
 
 All but two of these studies found that compared with a placebo, fish oil showed no benefit. 
 
 And yet during this time, sales of fish oil more than doubled, not just in the United States but worldwide, said Andrew Grey, an associate professor of medicine at the University of Auckland in New Zealand and the author of a 2014 study on fish oil in JAMA Internal Medicine. 
 
 “There’s a major disconnect,” Dr. Grey said. “The sales are going up despite the progressive accumulation of trials that show no effect.” 
 
 In theory at least, there are good reasons that fish oil should improve cardiovascular health. Most fish oil supplements are rich in two omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — that can have a blood-thinning effect, much like aspirin, that may reduce the likelihood of clots. Omega-3s can also reduce inflammation, which plays a role in atherosclerosis. And the Food and Drug Administration has approved at least three prescription types of fish oil — Vascepa, Lovaza and a generic form — for the treatment of very high triglycerides, a risk factor for heart disease. 
 
 But these properties of omega-3 fatty acids have not translated into notable benefits in most large clinical trials. 
 
 Some of the earliest enthusiasm for fish oil goes back to research carried out in the 1970s by the Danish scientists Dr. Hans Olaf Bang and Dr. Jorn Dyerberg, who determined that Inuits living in northern Greenland had remarkably low rates of cardiovascular disease, which they attributed to an omega-3-rich diet consisting mainly of fish, seal and whale blubber. Dr. George Fodor, a cardiologist at the University of Ottawa, outlined flaws in much of this early research, and he concluded that the rate of heart disease among the Inuit was vastly underestimated. But the halo effect around fish oils persists. 
 
 The case for fish oil was bolstered by several studies from the 1990s, including an Italian study that found that heart attack survivors who were treated with a gram of fish oil daily had a drop in mortality, compared with patients taking vitamin E. These findings prompted groups like the American Heart Association to endorse fish oil about a decade ago as a way for heart patients to get more omega-3s in their diets. 
 
 “But since then, there has been a spate of studies showing no benefit,” said Dr. James Stein, the director of preventive cardiology at University of Wisconsin Hospital and Clinics. Among them was a clinical trial of 12,000 people, published in The New England Journal of Medicine in 2013, that found that a gram of fish oil daily did not reduce the rate of death from heart attacks and strokes in people with evidence of atherosclerosis. 
 
 “I think that the era of fish oil as medication could be considered over now,” said the study’s lead author, Dr. Gianni Tognoni of the Institute for Pharmacological Research in Milan. 
 
 Dr. Stein said the early fish oil studies took place in an era when cardiovascular disease was treated very differently than it is today, with far less use of statins, beta blockers, blood thinners and other intensive therapies. So the effect of fish oil, even if it were minor, he said, would have been more noticeable. 
 
 “The standard of care is so good today that adding something as small as a fish oil capsule doesn’t move the needle of difference,” he said. “It’s hard to improve it with an intervention that’s not very strong.” 
 
 Dr. Stein also cautions that fish oil can be hazardous when combined with aspirin or other blood thinners. “Very frequently we find people taking aspirin or a ‘super aspirin’ and they’re taking fish oil, too, and they’re bruising very easily and having nosebleeds,” he said. “And then when we stop the fish oil, it gets better.” 
 
 Like many cardiologists, Dr. Stein encourages his patients to avoid fish oil supplements and focus instead on eating fatty fish at least twice a week, in line with federal guidelines on safe fish intake, because fish contains a variety of healthful nutrients other than just EPA and DHA. “We don’t recommend fish oil unless someone gets absolutely no fish in their diets,” Dr. Stein said. 
 
 But some experts say the case for fish oil remains open. Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital in Boston, said the large clinical trials of fish oil focused only on people who already had heart disease or were at very high risk. Fish oil has also been promoted for the prevention of a variety of other conditions, including cancer, Alzheimer’s and depression. 
 
 Dr. Manson is leading a five-year clinical trial, called the Vital study, of 26,000 people who are more representative of the general population. Set to be completed next year, it will determine whether fish oil and vitamin D, separately or combined, have any effect on the long-term prevention of heart disease, Type 2 diabetes, and other diseases in people who do not have many strong risk factors. 
 
 Dr. Manson says that although she recommends eating fatty fish first, she usually does not stop people from taking fish oil, in part because it does not seem to have major side effects in generally healthy people. 
 
 “But I do think people should realize that the jury is still out,” she said, “and that they may be spending a lot of money on these supplements without getting any benefit.” 
 
 
 
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– The "accrual of high-level evidence" indicates "that the supplements lack efficacy across a range of health outcomes for which their use is advocated." That pronouncement, a conclusion that comes from an analysis of 24 studies based on randomized clinical trials and published in JAMA Internal Medicine in 2014, is hardly a ringing endorsement. But as the Washington Post reports, we buy those supplements anyway, and lots of them: Americans spend roughly $1.2 billion each year on fish oil pills and associated products; one of the authors of that JAMA research told Reuters in 2013 that about 10% of Americans take them. They're touted for the good fatty acids—omega-3s—they contain. But while they're generally considered safe to take, it's pretty unclear whether they're beneficial for heart health. Writing for the Post, Peter Whoriskey astutely points out that even the National Institutes of Health and American Heart Association can't really make up their minds. The former endorses the supplements, then states "omega-3s in supplement form have not been shown to protect against heart disease" on its website; a scientific consultant with the NIH says the endorsement was supplied by a third-party contributor. As for the AHA, it advises people battling heart disease to ask their doctor about the supplements, but a former AHA president tells Whoriskey, "It would be a good time for that to be updated." As for those 24 aforementioned studies, all but two showed no benefit. But Whoriskey notes it's possible there is some, and our experiments on heart disease patients just can't pick up on it because heart medications cloud things. A 5-year study of 26,000 people—who the New York Times terms "more representative of the general population"—is due to be completed in 2016. (Another vitamin supplement could cause acne.)