Omega-3 Overview 2020: COVID and Contradictions (in Science)

As is true for much of the supplement industry, the EPA and DHA omega-3 industry did well in 2020, perhaps due to the high level of awareness and ‘health halo’ omega-3s enjoy among consumers. When supplement stockpiling began back in March, omega-3s were part of the cart – indeed, many GOED members reported double or even triple digit growth in the March-April timeframe. Not surprisingly, much of this was online and this trend has continued throughout the year. Sales then reportedly decreased significantly over the late spring/early summer in the US, but GOED members report that for the most part, sales have stabilized in the last few months, and as we look to the end of 2020, most are reporting an overall increase for the year and an optimistic outlook for 2021.

EPA and DHA omega-3s are in a unique position in the industry. While not specifically associated with immunity in the same way that echinacea, elderberry or vitamin C are, the reality is that EPA and DHA are found in every cell of the body and there is plenty of evidence that adequate omega-3 intake helps your body function better. Add to that the link to inflammation and the fact that COVID-19 is an inflammatory disease and the argument for upping your EPA and DHA intake is a good one. Right now, there are more than a dozen studies in process that examine the effect of EPA and/or DHA on the prevention of or lessening of symptoms of COVID-19 and, while the trials are logistically challenging in a world where doctors are scrambling to save lives and multiple interventions can be the norm, the argument for testing an omega-3 hypothesis is strong.

Omega-3 Science: A Year of Mixed Outcomes​

Outside of the COVID realm, scientific publications around omega-3s continued in 2020 and a seminal paper on EPA and DHA omega-3s and cardiovascular outcomes was published in September in Mayo Clinic Proceedings​​. The study, Effect of Omega-3 Dosage on Cardiovascular Outcomes​, was a meta-analysis commissioned by GOED, and looked at 40 clinical trials and 135,000+ subjects. The research examined the connection between omega-3s and a variety of cardiovascular outcomes, finding that EPA and DHA supplementation is associated with a statistically significant reduced risk of:

• myocardial infarction (13%)
• fatal myocardial infarction (35%)
• CHD events (10%)
• CHD mortality (9%)

Importantly, the paper showed benefits appear to increase with dosage. The researchers, including first author Aldo Bernasconi, PhD, GOED’s VP of Data Science, found that adding an extra 1000 mg of EPA and DHA per day decreased the risk of cardiovascular disease and heart attack even more: risk of cardiovascular disease events decreased by 5.8% and risk for heart attack decreased by 9.0% (the study looked at dosages of up to 5500 mg/day).

On the science front, however, all was not rosy, as two studies published in November called into question omega-3’s heart health benefits. The first study, STRENGTH, was discontinued earlier this year by pharmaceutical company AstraZeneca because of the low likelihood of finding a benefit. The November publication confirmed that the researchers found no significant difference in the primary endpoint (composite outcome of major adverse cardiovascular events) between subjects receiving 4 grams/day of Epanova, an EPA/DHA carboxylic acid formulation, versus those receiving a corn oil placebo. There was a statistically significant 15% risk reduction in a secondary endpoint of coronary events in patients with established cardiovascular disease, but the reason for the lack of effect in the primary endpoint is unclear, particularly given the success of REDUCE-IT, which also used a high dose omega-3 intervention.

The other trial, OMEMI, tested the hypothesis that 1.8 grams of omega-3s per day given to 1027 elderly patients who had survived a heart attack would reduce the risk of subsequent cardiovascular events during a two year follow-up. There was no significant difference between subjects receiving omega-3s versus placebo. It’s worth pointing out, though, that the population studied – Norwegians – consumes fish regularly, as well as cod liver oil (20% of subjects across both groups took cod liver oil throughout the study). The baseline omega-3 levels of all subjects were high and while levels increased even further during treatment, the baseline levels were likely high enough in the placebo group that the additional omega-3s provided no discernible benefit. Had the study been conducted in a population with a low omega-3 baseline, the results could have been very different. 

Lastly on the science front, GOED wrote a rebuttal letter to Advances in Therapy​ in response to an Amarin-funded review article​ misrepresenting the quality of fish oil dietary supplements. The letter​ was published online in July.