Science is change. There is nothing in science called the truth. Each time it is a truth which could change with newer data. This is the bane of our reductionist science. Drug companies make tons of money these days selling omega acids (fish oil) as the panacea for all kinds of vessel diseases, by playing upon the gullibility of the common man. Ordinary man is being frightened daily by the scientific community that almost anything that he enjoys is bad for his vessels. Fat has been one such culprit for quite sometime now. However, when it suits their convenience they fish out some data from some where, sometimes they even invent data, hereinafter called, data dredging, to sell their wares. One such story is the fishy story of omega acids. Years ago I had written an article on fishy meal wherein I had quoted a Canadian study that showed that there was no difference in the heart attack and stroke incidence between those that ate fish everyday compared to those that never ate fish or ate it once or twice a week. Much water has flowed under the Hoogly Bridge since then.



This week (January 3rd, 2004) the British Medical Journal has an exhaustive review of the whole literature on omega acids. Since this makes interesting reading, it might be misused by the pharmacy lobby for selling more fish oil, I thought I better write about it for the benefit of the common man as also those in the medical profession that do not have the time and patience to go deep into this jungle of medical literature. Whenever I write something some of my “scientific” friends demand cross references. Writing with references is knowledge based on others’ findings. Wisdom dwells in one’s head when one starts thinking and not just depends on information from others alone.



Reductionism never gets at the root of any problem in this dynamic universe. Diseases and death do not depend on any single factor but, it is the culmination of many interacting aspects of our very existence and chance. The first ever Diet-Heart Study, done in Framingham village in the USA, which ended in 1959, after five years of prospective observations, showed that what one eats, as long as one eats in moderation, had nothing to do with heart disease. The study started in 1954 when the fat hypothesis had just been propounded. During the next five years there was a billion dollar revolution in food and drug industry. Newer drugs to lower fat and innovative fat free and fat low diets were already in the market when this major scientific study came up with the negative finding. Money runs science in many places. Would you believe if I told you that the diet-heart study, which had spent $ 110 million American tax payer’s money, never saw the light of the day in print? Modern science, for a change, has realized now that what one eats does not kill but what eats one (our negative thoughts) does kill for certain. This has been the wisdom of Ayurveda for centuries.









This has an important bearing on the fish story, nay on all reductionist ideas in medicine. Whereas eating fish could be a very good supply of protein, especially for the poor in India who hardly get any good protein in their diet, to say that the fatty acids in the fish would protect against heart diseases is very far fetched indeed. In fact, many large observational studies did not support this theory. There have been no prospective studies, anyway. This brings to mind the story of Vitamin C. The world is grateful to Linus Pauling for discovering this chemical, ascorbic acid. If one has not eaten fresh fruits and vegetables for years, as happened in the long sea voyages in the past, vitamin C could be a good treatment for the deficiency, but to say that taking vitamin C daily would help keep one healthy has not been proved to be true. On the contrary, taking large doses of vitamin C daily might lead to increased incidence of certain cancers in the body. Eating a tomato daily, on the contrary, which contains 500 mg of vitamin C, for life decreases the incidence of cancers. Similarly there is a world of difference between eating fish and consuming omega fatty acids. While the former, as is shown above, is good supply of nourishment, the latter might do harm even. Tomato, like fish, contains many other ingredients that we do not know at the moment, which might prevent these individual chemicals from harming the system while helping with their good qualities-the difference between holistic knowledge and reductionism.



Be that as it may, let us now think about eating fish or omega acids for good health of the heart and blood vessels. The review of world literature in this area shows the following salient features.



* Eating fish, especially those that contain eicosapantanoic acid, like the macarel, is said to be good for vessel disease based on four epidemiologic studies published so far of 300, 306, 11324 and 2033 individuals. These studies showed benefit only for people who have had a heart attack already and did not show any benefit in others.

* Two studies, one very large study of 44,000 people from Harvard medical school and another from Finland of 3,480 individuals, did not show any benefit from Omega acids. The Harvard study did not show any difference in vascular diseases between those that ate fish daily and those that ate fish occasionally.

* The Finnish study did show that fish eaters have twice as much heart attacks as those that did not eat fish!

* The Finnish study is very elaborate and looked at various other parameters. The study found that most fish have, in addition to these fatty acids, a good dose of methyl mercury that damages the heart and blood vessels.

* There have been no controlled studies to date in humans, of omega fatty acids. But they are being sold regularly to patients and, worse still, to healthy individuals, under the garb of health protection. There is not even an iota of evidence to date in support.

* Even the epidemiological studies reported above, all the four in support put together, do not even have one quarter of the number of individuals studied in the very large Harvard research. As such, they, all four of them, lose their validity. Chance can never be ruled out in small, retrospective, questionnaire based epidemiologic studies.

* The present knowledge does not support administering these omega acids to healthy people. Patients who have already had a heart attack could, possibly, benefit. Even there the conflicting data is worrying. Eating fish, not fried fish, could be tried in people who have had a heart attack instead of the omega acids.

* Prescribing omega acids to healthy people could be dangerous based on the present knowledge.

* Omega acids have been shown to adversely affect blood sugar control in diabetics.

* Omega acids are also advised to lower triglycerides in blood. While they do so there is no proof that they are safe otherwise.

* To make matters worse, we do not know what dose of Omega acids is good for humans even now. The doses used in small studies have been found to be either too much or too little!

* The whole data, reviewed extensively, does not support the view that fish and/ or omega acids are health promotive in healthy individuals.



In conclusion, one could reasonably argue that the whole area is very hazy as of now. While a few small epidemiologic studies, that the industry is trying to sell to the medical profession as also to the lay public, do not tell the whole story, much larger studies, as also one prospective study from Finland, warn us about jumping to early conclusions. They have even shown the potential dangers of universally prescribing fish or fish oils to prevent chronic diseases which do not follow the epidemiologic rules and have multiple factors governing their natural history. As of now the patients who have had a myocardial infarct could be advised to have fish (not any fish) containing high amounts of omega acids, as a diet supplement. For the media and the drug industry fishing in troubled waters is good business, anyway. In addition, the same fish at different times and seasons, as also in different geographic areas, does not contain the same acid in similar doses. One example would suffice. Finnish cold water macarel contains large amounts of omega acids while the Indian warm costal water does not have that kind of macarel. “Science does not solve any problem; it adds more questions to the mystery.” wrote Bernard Shaw in his book Doctors’ Dilemma. This world is a wonderful wonder, where some men could easily take mankind for a ride to make money. Money is our God today and making money, by any means, our religion