Just a [heavily edited] note on today’s Daily Mail coverage of fish oil pills. The Mail have looked at label claims for magic beans snake oil Omega 3 fish oil and have rated the best products. The weird thing is, while they’ve rated them by cost per month per “optimal dose”, they have actually given the highest marks to the most expensive, worst-value pills. Omax 3 at £27.99 for 30 pills is rated at 9/10 and, while this product contains three times as much of the Omega 3 Fatty Acids Eicosapentaenoic Acid and Docosahexaenoic Acid as the cheapest product, it also costs ten times as much. Make sense to you? Not to me it doesn’t. The two products with the highest ratings, entirely coincidentally, are the two that include a web address and an 0800 number in order that readers may easily purchase them. Third place went to our old friends at Biocare. EDIT: Speaking of Biocare, there is a blog (that you almost certainly already know of) that looks at some of the claims made by their Head of Science and Education, the media nutritionist Patrick Holford, and they have now picked up on this Daily Fail story too.
Not only are the ratings dodgy, but so are the claims made for these pills. The article claims that 1000mg per day is needed to support optimal brain functioning. It doesn’t clearly state what this 1000mg relates to (Eicosapentaenoic Acid and Docosahexaenoic Acid? Total Omega 3 Fatty Acids?). Alex Richardson also claims that, while it is well-known that Omega 3s are important for staving off heart attacks etc [uh, Hooper et al aren’t so sure: Cochrane], “it is less well-known that EPA and DHA are crucial for brain function and mental well-being”. Well, after all the uncritical coverage of the Durham trial initiative I’m not so sure it is less well-known. I’m not sure it’s even true, though – if they are talking about daily intake of these fatty acids then vegetarians should be absolutely screwed brain-wise and I’m not sure they are. I’m interested in where that claim of 1000mg for optimal brain functioning comes from – as far as I am aware, the only decent trials in this area have been in children with learning disorders and have had mixed results. So how did we get to 1000mg for the general population? Did someone pluck this figure out of the air or did I not get that memo about the solid research showing we need a gram a day of Eicosapentaenoic Acid and Docosahexaenoic Acid? EDIT2: See bottom of page for more links relating to the brain claims made for EPA/DHA.**
The expert opinion for this piece was provided by Dr Alex Richardson. Having advertised Omax 3 and Barlean’s Omega Swirl, the article ends with a link to Dr Alex’s Fab Research website. Nice bit of free publicity there, perhaps it will bring the website some new readers. [Actually, do you reckon I could get the mail to give a shout out to www.jdc325.wordpress.com sometime?] The journalist was Caroline Ballinger. Dr Richardson has previously provided expert opinion for the Mail on additives in – in a piece written by Caroline Ballinger* (that ended with an advertisement for Dr Alex’s book). Here: dangerous junk. See, there’s something for everyone. Alex gets to promote her book and her research, the journalist gets to ride their favourite hobby horse, the Daily Mail gets a piece that will no doubt interest their readers (it’s a health piece in what is informally known as “The People’s Medical Journal” – of course they’ll love it), and the pill companies get free publicity (very good free publicity if you are Biocare, Barlean’s, or Omax). The whole article is bullshit and the point is to sell stuff. I’m starting to think that this is the point of newspapers. It really, really shouldn’t be though.
*The reason I know this is that I Googled Caroline Ballinger and found a site called www.journalisted.com, which lists journos and has a handy category cloud (like the ones you get on WordPress). Finding two articles featuring the same journalist, the same expert, and a very similar topic is hardly surprising to be honest. Hacks have their hobby horses and rating pills is presumably Caroline Ballinger’s particular thing. It could be interesting, fun and/or useful in future though – for a laugh, I looked up “Peter Hitchens” and found that his category cloud includes Britain, British, Cameron and Tories. I also found that the average article length was 715 words, while the average Hitchens article runs to 1321 words. I bet he likes the sound of his own voice too [I know, I know – another case of the pot calling the kettle black]. I checked Ben Goldacre’s page and found that the top two hits were “MMR” and “please”. Please is a keyword for Ben Goldacre? Well, he must be a nice, polite young man then. The MMR pieces aren’t bad either.
**This National Library for Health page shows one example of the phenomena – a study into fish oils given to four overweight children for three months. Note the comment that “[c]onsidering the research was conducted in only four overweight children, the results of the study can not be deemed to be substantial or reliable, and can not be generalised to other young people, overweight or not.” The Bad Science blog has a category for fish oil stories. I looked for RCTs and Meta Analyses on Pubmed for Fish Oil and Brain Performance and came up with a single hit. This paper reports a study that showed no significant differences in: neurodevelopmental indexes of the infants at 12 mo of age, the visual function at 4 or 8 mo of age, or in the Mental Development Index between two groups of infants. The only significant difference was in the Bayley Psychomotor Development Index. This study used either a high-DHA oil or a vegetable oil placebo (200mg per day) in pregnant women. I tried Fish Oil and Brain and got a few more hits (29). This study looked at the effect of supplementing pregnant and lactating mothers and “suggests that maternal concentration of n-3 very-long-chain polyunsaturated fatty acids during pregnancy might be of importance for later cognitive function, such as sequential processing, although we observed no significant effect of n-3 fatty acid intervention on global IQs.” Meanwhile, another study showed “[s]upplementation with docosahexaenoic acid and arachidonic acid for very preterm infants fed human milk in the early neonatal period was associated with better recognition memory and higher problem-solving scores at 6 months”. I need a Cochrane review or a decent meta-analysis – a bunch of single RCTs with mixed results is no good to me, as I don’t have the skills to work out if there is anything going on (if there was a pattern, I wouldn’t spot it). Apart from the odd study into fish oil for Alzheimers or Schizophrenia, the studies listed for “Fish Oil and Brain” are mostly looking at supplementing DHA in infants or pregnant/lactating mothers and the effects on development. None show that fish oils can improve brain performance in the general population and none show that 1000mg is an optimal intake of fatty acids. One issue people had with the Durham trial initiative scandal was that here was an opportunity for the first time to see whether fish oils containing Omega 3 Fatty Acids had a beneficial effect in “normal, healthy children”. That opportunity was utterly wasted by Durham County Council and so we still don’t have a good idea whether fish oil pills work in terms of improving mental ability. The only studies that have been properly conducted into fish oils in children have been done by researchers such as Dr Alex Richardson (credit where it’s due) and have looked at fish oil supplements in children with DCD, childhood developmental and psychiatric disorders, or in ADHD and related neurodevelopmental disorders. And those are the best studies we have for fish oil supplementation in children to improve brain function or positively affect academic achievement – I haven’t seen any that deal with supplementation of fish oil to improve brain performance in adults. And I definitely haven’t seen any mention of 1000mg of EPA/DHA/Fish Oil (or whatever the 1000mg was intended to refer to) as being an optimum dose.