Monthly Archives: August 2019
Featured Articles in Internal Medicine In the News
Do you know all the health benefits of fish oil?
Melissa Sammy, MDLinx | June 27, 2019
US adults are not meeting the recommended levels for omega-3 fatty acid intake—and it’s killing them. In fact, omega-3 fatty acid deficiency was ranked as the sixth highest killer of Americans, causing an average of 84,000 deaths annually, according to a study conducted by Harvard University researchers and colleagues.
Researchers have shown that fish oil may benefit more than just heart disease. In several studies, fish oil demonstrated protective effects against vision and memory loss, and promoted brain damage recovery and fat loss.
These deaths were considered preventable, given that adequate dietary amounts of omega-3 fatty acids have been shown to reduce the risks of some common causes of mortality. Because the body cannot produce omega-3 fatty acids on its own, it must be obtained from food—notably, seafood. Fatty fish, such as salmon and sardines, are perhaps the most potent dietary sources of these substances. The American Heart Association (AHA) recommends eating a 3-oz serving of oily fish at least twice weekly to get the full heart-healthy benefits from omega-3 fatty acids.
This level of intake, however, can quickly cut into a budget.
Incorporating fish-oil supplements into your diet can be a great way to get all of the heart-health benefits of omega-3 fatty acids at a low cost. Fish-oil supplements may also be good alternatives for vegetarians as well as those who are concerned about the mercury levels often found in seafood. When choosing a fish-oil supplement, make sure it contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—two essential omega-3 fatty acids that have been linked to positive effects on cardiovascular health problems.
With this in mind, let’s take a look at some of the powerful, scientifically documented health benefits of fish oil.
About one-third of epileptic patients are unable to achieve seizure control with available drugs; among those who do, many experience adverse drug effects. Numerous experts have demonstrated the safety, efficiency, and cost-effectiveness of fish oil for the treatment of refractory epilepsy.
In one small but notable study, low-dose fish oil significantly reduced seizure frequency in patients with drug-resistant epilepsy. Participants received a daily regimen of either placebo, high-dose fish oil (2,160 mg), or low-dose fish oil (1,080 mg) over 42 weeks (three 10-week treatment periods, two 6-week washout periods). Low-dose fish oil reduced the incidence of seizures in participants by nearly 34% vs placebo.
Interestingly, participants who received high-dose fish oil did not demonstrate any significant reduction in seizure frequency. Furthermore, in the low-dose fish-oil group, two patients achieved seizure freedom during their 10-week treatments compared with no patients in either the high-dose fish-oil or placebo groups. In addition, participants in the low-dose fish-oil group exhibited a decrease in blood pressure levels vs those in the high-dose fish-oil group—who actually showed a small increase.
“We don’t completely understand why low dose works and higher doses do not, but there is evidence from animal studies that high doses are counterproductive. The response to fish oil at low dose for both seizures and depression has substantial implications for use, given the common propensity for individuals to self-dose with an ‘a little helps, a lot should help much more’ thought process,” remarked lead study author and principal investigator Christopher M. DeGiorgio, MD, professor, Departments of Neurology, Cardiology and Neurobiology, UCLA School of Medicine, Los Angeles, CA.
- See Also: Omega-3 fatty acids: Hype or healthy?
Neurocognitive injury and impairment
Because DHA comprises about 30% of all brain matter, it has been broadly studied in the literature for its role in neurocognitive health.
In a study published in PLOS One, researchers found that omega-3 fish oil—specifically the component DHA—may help to protect against chronic alcohol-related brain damage and the subsequent risk of dementia. DHA exhibited protective effects against neuroinflammation and neuronal cell death in rat brain cells exposed to high levels of alcohol. In all, there was up to 90% less neuroinflammation and neuronal death in brain cells exposed to alcohol plus DHA than in cells exposed to alcohol alone.
“Fish oil has the potential of helping preserve brain integrity in chronic alcohol abusers,” concluded principal investigator and coauthor Michael A. Collins, professor, Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, IL. However, he noted that further studies are warranted to confirm the neuroprotective effects of fish oil against alcohol-related brain damage.
In another study involving an experimental model of acute ischemic stroke, investigators found that DHA may protect brain tissue and facilitate recovery—even when treatment is delayed by 5 hours. DHA reduced neurological deficits and swelling, and promoted neurobehavioral recovery. In all, DHA treatment not only salvaged brain tissue that would have died, but actually rendered some areas indistinguishable from normal tissue by 7 days via its mechanisms of repair.
“We are just now beginning to understand the significant impact of omega-3 essential fatty acids on stroke,” noted senior author Nicolas G. Bazan, MD, PhD, professor, Departments of Ophthalmology, Biochemistry and Molecular Biology, and Neurology, Louisiana State University Health Sciences Center, New Orleans, LA. “There is no simple solution just yet, but each new discovery brings us closer to defeating stroke and other debilitating neurodegenerative diseases.”
Fish-oil consumption has also been touted as an effective way to improve memory, particularly in older adults. In one systematic review and meta-analysis, adults with mild memory complaints who took DHA supplementation, either alone or in combination with EPA, demonstrated significant improvements in memory function outcomes, particularly episodic memory. Furthermore, investigators who conducted a trial across 19 US clinical sites with 485 participants, published in Alzheimer’s & Dementia, found that 24-week treatment with DHA supplementation (900 mg/d) improved learning and memory function in adults with age-related cognitive decline.
As with the brain, omega-3 fatty acids are an integral component of eye health. While fish oil may not necessarily benefit those with dry eye diseases—according to a large trial funded by the National Eye Institute—it may be an effective therapeutic option for those with more problematic eye conditions, such as age-related macular degeneration (AMD), which has been extensively covered in the literature.
For instance, in a pilot study of the efficacy of fish oil for the treatment of AMD, regular high doses of omega-3 fatty acids (3.4 g EPA, 1.6 g DHA) for 6 months resulted in significant improvements in vision acuity in 100% of patients within about 19 weeks. Moreover, in a recent review of the impact of diet and food consumption on AMD, researchers identified five studies in which high omega-3 fatty acid consumption was strongly associated with decreased development of intermediate and late AMD.
Body weight and fat reduction
In several high fat diet-fed obese animal models, fish oil was associated with reductions in body weight and fat, leading researchers in recent years to study the potential anti-obesity effect of fish oil in humans. In some studies, fish-oil supplements helped to reduce waist circumference and abdominal fat, and contributed to weight loss in combination with diet and exercise.
Researchers of a study published in the American Journal of Clinical Nutrition found that fish-oil supplements in combination with regular exercise reduced both body fat and improved cardiovascular and metabolic health in a cohort of overweight individuals with high blood pressure, cholesterol, and triglyceride levels.
In another randomized clinical trial that included young overweight men, fish oil intake as part of an energy-restricted diet resulted in ~2-lb greater weight loss after 4 weeks than a similar diet that did not include seafood or marine supplements. Furthermore, via a meta-analysis of 21 randomized, controlled trials, researchers concluded that overweight or obese individuals may benefit from taking fish-oil supplements—especially when combined with life modification intervention, including exercise—for abdominal fat reduction.
The benefits of fish oil on heart health have been widely studied and validated in clinical use.
According to experts at the Mayo Clinic, fish-oil consumption may help to reduce the risk of heart attack and stroke, and regulate triglyceride and blood pressure levels. Researchers have shown that taking fish-oil supplements for ≥ 6 months may reduce the risk of myocardial infarction and mortality in people at high risk for heart disease. Moreover, people who have experienced a heart attack or heart failure may benefit from fish-oil supplements. In a study conducted by the AHA, researchers found that omega-3 fish-oil supplements may help to prevent heart disease in patients who have had a recent heart attack and may even prevent death and hospitalization in patients with heart failure.
“Scientific findings from the past two decades that focused on the prevention of cardiovascular diseases continue to show that among people who are at risk of dying from heart disease, the potential benefit of omega-3 fish oil supplements is still useful for people who have had a recent heart attack, which is consistent with the 2002 statement,” said lead study author David S. Siscovick, MD, MPH, chair of the AHA Council on Epidemiology and Prevention. “What is new is that people with heart failure also may benefit from omega-3 fish oil supplements.”
Although fish oil is generally safe, excess consumption can increase the risk of bleeding events and may suppress immune response. Therefore, supplements should only be taken under physician supervision. Furthermore, people with shellfish allergies should avoid taking fish-oil supplements unless otherwise directed by their physicians, since it is unclear whether these supplements may trigger allergic reactions.
The following drug interactions should also be considered, according to Mayo Clinic experts:
- Anticoagulant and antiplatelet drugs, herbs, and supplements. These drug types, herbs, and supplements reduce blood clotting—thus taking fish-oil supplements in combination with them may increase the risk of bleeding.
- Blood pressure drugs, herbs, and supplements. Taking fish-oil supplements may decrease blood pressure levels, and taking these supplements with blood pressure drugs may amplify the effects on blood pressure.
- Contraceptive drugs. Some contraceptives may interfere with the effect fish oil typically has on triglyceride levels.
- Orlistat. Taking fish oil with this weight-loss drug may reduce absorption of fish-oil fatty acids. Consider taking the supplement and drug 2 hours apart.
- Vitamin E. Taking fish oil can reduce vitamin E levels.
Explainer: what is fibromyalgia, the condition Lady Gaga lives with?
June 18, 2019 5.53am AEST
- Michael Musker Senior Research Fellow, South Australian Health & Medical Research Institute
- Tiffany Gill Senior Research Fellow, University of Adelaide
Tiffany Gill is affiliated with Arthritis SA.
Michael Musker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Republish our articles for free, online or in print, under Creative Commons licence.
- At least one in ten of us suffer some sort of troublesome, long-term (chronic) pain. But not all have fibromyalgia.
People with fibromyalgia have chronic widespread pain — including musculoskeletal aches, pain and stiffness, and soft tissue tenderness — in many areas across the body.
This affects other systems like the brain, impacting a person’s ability to concentrate and remember things. People who have fibromyalgia often refer to this as the “fibro fog”. It can affect sleep patterns, emotions, and many other aspects of everyday living.
So what causes fibromyalgia? How does it differ from other types of chronic pain? How is it diagnosed and treated?
What causes fibromyalgia?
When investigations can find no other cause for widespread chronic pain, it’s generally diagnosed as fibromyalgia.
We don’t know exactly what causes fibromyalgia, but genetics, environment, hormonal and neural (brain and central nervous system) factors are all believed to play a role. Research indicates genes may be responsible for up to 50% of susceptibility to the condition. The latest research indicates the body’s immune system is involved, too.
An online survey of 596 people with fibromyalgia found a few common causes reported by participants. Around two thirds of people could relate the start of their symptoms to a specific incident or event, such as a physical injury, a period of sickness that might have involved surgery, or a stressful life event.
Notably, many of those surveyed said they experienced negativity and stigma when trying to explain and authenticate their symptoms to professionals, their families, and their communities.
Who is affected?
Fibromyalgia affects around 2% of the world’s population. A recent literature review showed the frequency of fibromyalgia in the general population was between 0.2 and 6.6%. It’s often reported as higher in women, at a ratio of three to one.
The World Health Organisation recognised fibromyalgia as a disease in 1994. Since then, doctors have debated how fibromyalgia should be diagnosed and who should diagnose it, leading to the so-called “fibro wars”. It continues to be controversial.
The latest version of the International Classification of Diseases says for someone to be diagnosed with fibromyalgia, there needs to be pain in “at least 4 of 5 body regions and is associated with significant emotional distress”.
The American College of Rheumatology devised a widely accepted test which looks for 11 points from 18 potential tender points of pain from areas across the body using what’s called the widespread pain index.
How is it treated?
The drugs pregabalin and duloxetine work by altering the neurotransmitters in the brain (gamma amino butyric acid and serotonin), and are effective for many people.
There are many other options including medication specifically for pain (analgesics), muscle relaxants (benzodiazepines), or treatments to address nerve or spinal pain (neuropathic treatments).
Many of these medications can have side effects, including constipation, or allergic reactions like digestive upset or inflammation. They can also be addictive. Always be honest with your GP about what painkillers you’re taking so they can help you safely manage your pain.
Another common treatment is using a TENS machine (transcutaneous electrical nerve stimulation). This involves applying pads around the area of pain, or the nerves that might be sending the pain message, and interfering with these using small electrical pulses.
It’s important to check with your doctor if TENS treatment is appropriate because it might affect pacemakers or people with epilepsy.
How about the future?
In time, we might be able to look for diagnostic immune markers for fibromyalgia in our genetic material to help find who might be at risk of developing the condition, and take preventative action.
Many of the symptoms of fibromyalgia can be found in people who have a condition known as myalgic encephalomyelitis, or chronic fatigue syndrome. Our research is currently looking at the blood of people with fibromyalgia and chronic fatigue syndrome to see if there are specific inflammatory markers that may help us understand how these illnesses develop.
If we can understand the interaction of the immune system with pain and inflammation, then we can begin to target treatments more effectively for people living with fibromyalgia.
Countercurrents: Is now the right time to pull the plug on mammography?
My views on this are well known, and I have much more information on my web-site under Breast screening, mammography, overdiagnosis.
In their report of 10 December 2018, the Canadian Task Force on Preventive Health Care gave a lukewarm endorsement of screening mammography1. After a review and meta-analysis of the literature, the Task Force estimated a 0.85 relative risk of dying of breast cancer for women who attended mammography compared with those who never did, with no differences by age group.
That is to say, regular mammography attenders faced nearly the same risk of dying of breast cancer as women who did not attend (85% to be precise), and in no subgroup did the level of protection exceeded 15%. Further, the evidence in favour of any benefit was judged to be very low (ages 50–59 years) or low (ages 60–69 years). The downgrading of the evidence for mammography came largely from a re-analysis of the Swedish quasi-randomized trials. An updated analysis of the Canadian National Breast Cancer Study showed that, although cancers detected at screening had a better prognosis than cancers detected in the control arm, no benefit was associated with screening in terms of breast cancer mortality at 30 years post-randomization2.
A relative risk of 0.85 is derisory and in any other setting would be dismissed as nugatory. We would never think to adopt a new screening test that performed that badly. And it can hardly be claimed that such a small effect justifies early detection as the “key to survival,” as is often bruited about. The Task Force also had no appetite for either breast self-examination or clinical breast examination.
We have heard the meretricious arguments of the most vocal calumnists. They say that the Canadian National Breast Cancer Screening trial was biased—claiming widespread false randomization—but that was impossible3. Of greater interest are the several claims that mammography in “the real world” performs even better than reported in the Swedish trials.
An observation trial from Sweden pegged the benefit at a 60% reduction in deaths4, and a trial from Canada, at 40%5. The difference between the Task Force estimates and those estimates is not attributable to the “real world,” but to real bias. The Canadian and Swedish studies compared, at a population level, breast cancer mortality in women who attended mammography screening with those who did not attend. But women who attend mammography clinics are selected to have no cancer at study onset, whereas women in the comparison group might well have been diagnosed with breast cancer in the past6.
Consider a women who has breast cancer and who receives an invitation to attend screening in the mail. I am pretty sure she doesn’t go. But her death would be considered an event in the comparison group (non-attendees). Between 2004 and 2014, the U.S. Surveillance, Epidemiology, and End Results database captured 126,511 deaths from breast cancer. Of those 126,511 deaths, 88,322 (70%) were diagnosed before 2004.
If the Task Force believes the screening mammography benefit is 0.85, why bother to recommend it? Surely the reasonable thing is to abandon mammography and spend the money elsewhere. Instead, they offer the avuncular opinion that each woman should discuss the risks and benefits with her physician. That sounds like a compromise, but diligent physicians might be perplexed upon consulting the Canadian Medical Association Journal recommendations and finding the ball fired back into their court.
Part of the mission of the Task Force is to consider all the prevalent opinions and to separate those of disinterested parties from those of parties with something to gain. The fact that they are not practitioners of the art of mammography is what makes them credible. Unless a more forceful recommendation against mammography emerges, the taxpayer will continue to pay. I propose that, as is the case for other screening tests such as colonoscopy and prostate-specific antigen, it is reasonable that the woman who wishes to have a mammogram should pay for the test out-of-pocket. Neither of the former two screening tests for men are paid by ohip (the Ontario Health Insurance Program), but they are available at the patient’s choice (fecal occult blood testing is covered by the province).
The Task Force cites overdiagnosis and issues of sensitivity, specificity, and cost as harms and the reasons contributing to mammography failure. I don’t think that that case holds. If the screening paradigm were true, then finding some cancers early would surely do some good. I have come to a different conclusion about why mammography fails: that if a cancer is going to metastasize, it will do so before it is clinically (or radiologically) apparent, and that breast cancer does not metastasize in the interval between the mammogram and the mass7–9. I propose that the cancer will have metastasized by the time of diagnosis—whether by imaging or palpation—but will not metastasize thereafter. Under the parallel model, the size of the cancer is a marker of aggressivity, and the bigger the cancer, the more likely it is that metastases are present at diagnosis. But the latter model does not imply that the chance of metastases can be lessened by advancing the date of detection. This is an area that we hope to explore further.