Last Tuesday, PBS-TV’s "Frontline” took aim at the supplement industry.
Sadly, the report was deeply misleading … especially with regard to fish oil and herbal supplements.
The hour-long report
was a co-production of "Frontline”, The New York Times
, and the Canadian Broadcasting Corporation (CBC).
Their reckless, sloppy report undermined the reputations of the journalists, much more than the credibility of fish oil as a heart-health aid.
The charges leveled by "Frontline” repeat equally bogus ones published last March in The New York Times.
The "Frontline” episode focused on two topics affecting our customers – herbal supplements and fish oil – and we'll start with the second.
Critique of fish oil lacks credibility
"Frontline” made four assertions concerning fish oils:
- The evidence does not show cardiovascular benefits
- There is little clinical evidence for other health benefits
- Fish oils have overly high levels of omega-3s, with unknown risks
- Fish oil supplements are overly oxidized, making them unhealthful
Frankly, these assertions don’t square with the facts, and we’ll address them one by one.
#1 - The evidence on cardiovascular benefits
Public health authorities agree that fish oil does at least three good things for heart health:
- Reduces the risk of having a second heart attack.
- Reduces two major heart-risk factors: high blood pressure and high triglyceride levels
- Reduces the risk of "sudden cardiac death" (SCD) – which accounts for half of all heart-related deaths.
The evidence for these benefits is quite consistent:
- Every meta-analysis of randomized controlled trials (RCTs) – 13 in total – has found a statistically significant 9 to 30 percent reduction in risk of cardiac death.
- Every meta-analysis of RCTs (22 in total) has shown that fish oil reduces triglycerides by to 40 percent.
- One of the largest meta-analyses of RCTs showed blood pressure reductions (full disclosure: the fish oil trade association GOED funded this study).
And a rigorous evidence review performed for the U.S. Agency for Healthcare Research and Quality by Tufts University came to positive conclusions:
"According to both primary and secondary prevention studies, consumption of omega-3 fatty acids, fish, and fish oil reduces all-cause mortality and various CVD outcomes such as sudden death, cardiac death, and myocardial infarction. The evidence is strongest for fish and fish oil supplements." (Wang C et al. 2004)
But many negative trials suffered either from limitations that could prevent or reduce any heart benefits, and/or from "confounding factors" that muddied the waters:
- Trial was small and/or short.
- The omega-3 doses were low.
- Participants already had heart disease.
- Analysis of results failed to account for participants’ omega-6 intakes*.
- Participants were taking cardiac drugs (e.g., statins) proven to reduce heart risks.
Many clinical trials with negative outcomes involved heart patients taking drugs such as statins, ACE inhibitors, beta blockers, and aspirin.
So those negative trials were actually testing whether fish oils could add benefits on top of those delivered by drugs … not whether fish oil is beneficial all by itself.
Irresponsibly, the "Frontline" report cited only one evidence review, led by Dr. Alexander Gray at New Zealand's Auckland University.
Dr. Gray's review only included clinical trials and evidence reviews published between 2005 and 2012 ... a minority of the available evidence.
And "Frontline" implied that Gray's conclusions were definitive .... a claim that lacks credibility, given the positive findings of other trials and evidence reviews.
Finally, "Frontline” failed to mention three facts that severely undermine their negative case:
- The FDA has approved prescription fish oils for heart disease.
- The FDA approved this claim on fish oil labels: "Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
- Fish oil is recommended to people who've had a heart attack by (among others) the World Health Organization, the American Heart Association, Australia's National Health and Medical Research Council, and the National Heart Foundation of Australia.
#2 - Clinical evidence of other health benefits
A review of the medical evidence commissioned by the fish oil trade association (GOED) found 1,166 clinical trials that detected health benefits from fish oil and 257 that found no benefits.
In other words, 82 percent of the trials published in the past six years detected health benefits from supplemental omega-3 fish oil.
3# - Is fish oil too potent?
This was the silliest part of the segment on fish oil.
"Frontline” asserted that the amounts of omega-3s in fish oil could be dangerous.
Most fish oil supplements contain 300-500mg of omega-3s (EPA and DHA) per serving.
But a single 3.5 ounce serving of fatty fish will typically provide 1,000 to 1,800mg of EPA and DHA.
So if fish oil supplements are risky, then eating salmon, tuna, and sardines must be more dangerous … yet it’s clearly beneficial.
#4 – Are fish oil supplements dangerously oxidized?
"Frontline” claimed that a very high percentage of fish oils exceed acceptable oxidation levels.
An exchange between correspondent Gillian Findlay and Adam Ismail of the leading fish oil trade association – the Global Organization for EPA and DHA (GOED) – leaves the impression of a real problem.
The GOED test still found that one in five supplements exceeded their voluntary limits … but not by significant amounts.
And the results of oxidation tests cited by "Frontline” did not match the far better results obtained when GOED tested 47 different fish oils at multiple labs.
Ms. Findlay also interviewed Preston Mason, M.D., of Harvard University, who recently found higher levels of oxidation in six leading over-the-counter brands of supplemental fish oil, versus prescription fish oils from drug companies.
In contrast, GOED recently examined all of the publicly available testing data from the scientific literature and consumer watchdog groups, and found very high rates of compliance with the organization’s rigorous oxidation restrictions:
- Out of 2,187 test results for primary oxidation, only 3.7 percent exceeded GOED's limits.
- Out of 2,117 test results for secondary oxidation, only 2.1 percent exceeded the GOED limits.
It’s worth noting that GOED’s voluntary limits for fish oil oxidation levels are one-half of the limit the US government sets for vegetable oils, which are consumed in much greater quantities.
(Vital Choice is a member of GOED, and our fish and krill oils are tested for oxidation products, mercury, PCBs, and other impurities by NSF … one of the world’s most highly respected quality assurance organizations.)
Needless to say, it’s better to avoid oxidized fats, because they strain the liver and pancreas, and can trigger inflammation in the body.
However, that would only happen with fish oils that are highly oxidized, and Dr. Preston did not find unhealthful oxidation levels in any of the supplemental fish oils he tested ... only levels modestly in excess of desirable limits.
We should note that disputes over oxidation testing methods and results are common, and that Dr. Preston's results have not been verified by other labs.
Segment on herbs repeated bogus claims
The report also repeated bogus claims made last year by New York State Attorney General Eric Schneiderman.
Yet, Attorney General Schneiderman has ignored scientific experts in the field – including critics of the supplement industry – who agree DNA testing cannot identify the plants used to make herbal extracts.
Since enduring that near-universal scientific criticism, Schneiderman has stubbornly refused to release the test results for examination by independent experts.
To avoid the high legal costs of a protracted fight with the New York AG, the retail chains he attacked caved to his demands to pull the tested products.
The retailers gave in to the AG, despite the invalidity of DNA testing and the positive results of widely accepted, scientifically valid tests showing no herb-identity fraud.
In addition to Schneiderman, "Frontline" interviewed Dr. Pieter Cohen of Harvard Medical School, who has been a critic of the supplement-industry.
Ironically, Dr. Cohen was among those who've pointed out that DNA testing is an inappropriate, unreliable way to verify the identity of herbal extracts.
That's because the extraction processes used to make herbal supplements eliminate the DNA of the original plant material, leaving only isolated chemical compounds.
In an affront to journalistic integrity, the "Frontline" producers failed to mention the the invalidity of DNA testing of herbal extracts when they repeated Schneiderman's headline-making charges ... or when they interviewed the University of Guelph lab whose bogus DNA tests inspired his investigation.
Canadian co-producers retract supplement accusations
Coincidentally, the Canadian broadcasting Corporation (CBC) – which co-produced the "Frontline” report – just retracted the results of its own supplement expose.
A recent CBC report alleged ingredient fraud in supplements, but the network retracted the story after it became clear the test results were faulty.
Their report alleged that EmergenC and two protein powders – GNC Lean Shake 25 and Cytosport Muscle Milk – did not meet label claims.
Upon retesting, neither claim proved true.
Buyer – and viewer – beware
Of course, there is fraud in the supplement industry.
But fraud and cover-ups occur in every industry, from auto and drug firms to news and energy companies.
Recent examples include GM (deadly ignition switches), BP (biggest oil spill in history), Volkswagen (cheating on emissions controls), and more.
Now we can include three big media brands – The New York Times, the CBC, and "Frontline" – whose joint "expose" is rife with reckless, sloppy reporting.
- Pezzullo L. / Deloitte Access Economics Pty Ltd. Fish oils for the secondary prevention of Coronary Heart Disease, February 17, 2012. Prepared for the Complementary Healthcare Council of Australia
- Wang C, Chung M, Lichtenstein A, Balk E, Kupelnick B, DeVine D, Lawrence A, Lau J. Effects of Omega-3 Fatty Acids on Cardiovascular Disease. Evidence Report/Technology Assessment No. 94 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 04-E009-2. Rockville, MD: Agency for Healthcare Research and Quality. March 2004.