Something’s Fishy About Macular Degeneration Fish Oil Studies

 Just seven months ago National Eye Institute researchers claimed fish oil “doesn’t seem to help macular degeneration,” (1) a sight-robbing eye disease that plagues adults in their senior years.

So how could another newly published study produce exactly opposite results? In fact, fish oil didn’t just slow down the insidious progression of this eye disease, it restored vision to every patient placed on high-dose fish oil. It was therapeutic and curative, not just preventive.

The study I’m referring to is likely to be dismissed. The study group was small - only 25 patients. There was no inactive placebo pill given to another group of patients for comparison, a requirement for scientific validity. And it’s also possible (but not plausible) that all the patients in the study were abjectly deficient in omega-3 fish oils, producing an atypical effect. But the study group was based in the Mediterranean where fish consumption is high. And it’s not likely any placebo effect was involved.

The study is so convincing, especially when combined with all of the positive fish oil studies conducted over the last decade (see chart below), eye physicians would now be derelict in their duty not to recommend every long-living senior adult to consume more fish, or better yet - take concentrated fish oil capsules, if they want to maintain their sight throughout their retirement years.

Growing evidence

The study I’m referring to was just published in the PharmNutrition journal. (2) It raises many questions, particularly why has it taken so long to discover high-dose fish oil can restore lost sight to many Americans. The data pointing to fish oil as a dietary agent that can stave off vision loss with advancing age has been growing for over a decade.

Except for one “fishy” study, all other human clinical fish oil studies published over the past 13 years indicate fish oil slows down or prevents macular degeneration, a sight-robbing condition that affects central vision used for reading, driving and face recognition.

The latest published study was more momentous than prior studies as it didn’t just show fish oil slows down the progression of the disease; it actually began to restore vision to patients within days of starting a daily regimen of high-dose fish oil capsules.

Slowing macular degeneration down is one thing, but reversing it is another. There is no cure for the common form of the disease, called dry macular degeneration. Antioxidant dietary supplements recommended for this disease slow down its progression by maybe 10 percent at best.

Macular degeneration patients began experiencing improvement in visual acuity from the get-go. After six months a third of the patients could see letters that were three lines smaller on the eye chart. Another third saw two lines better and the remaining third a single line of improvement.

100% of patients with macular degeneration experienced improved vision when the normal course of the disease is insidiously progressive loss of central vision.

High dose

The dose of fish oil was the highest used in any study so far — 5000 milligrams (3400 mg EPA, 1600 mg DHA), or a bit less than two tablespoons a day. That much fish oil is likely to be costly for retirees on fixed incomes, around two dollars a day. A six-month six-month course would certainly be worth the investment, especially when some seniors might be able to renew their driver’s license or resume activities that help them stay independent.

The one “fishy” negative study was reported in the Journal of the American Medical Association in May of this year. (3) National Eye Institute researchers said fish oil "doesn't seem to help age-related macular degeneration."

That study compared a low dose of omega-3 fish oil with an antioxidant formula providing lutein, zeaxanthin, zinc and copper (no true placebo group or inactive pill was used). The dose of fish oils in the treatment group was much lower than prior studies.

Some skeptical researchers I have consulted express concerns over the fact this study was conducted largely among well-nourished subjects who likely eat a lot of fish in their diet. I’m informed that the comparison group consumed up to 720 milligrams of fish oil from their daily diet. Also some study subjects in the comparison group may have been supplementing with folic acid which raises blood levels of omega-3 oils. (4) Researchers concede that “study results may not be generalizable, because the study population is a highly selected group of highly educated and well-nourished people.” Was the study rigged to fail?

(Bill Sardi is a well-known nutritional medicine writer and is the founder of Knowledge of Health, Inc. http://knowledgeofhealth.com/ Copyright (C) 2013 Bill Sardi and reprinted with his permission.)

COMPILATION OF STUDIES Fish Oil/ Age-Related Dry Macular Degeneration Studies Limited to human studies involving fish oil alone AMD= age-related macular degeneration
Study published	Type of study	Length of time	# of subjects	Location	Dose of fish oil	Result
PharmNutrition Dec 2013	Controlled THERAPY	6 mos	25 (40 eyes) 50-85 yrs of age	Cyprus	3400 mg EPA/1600 mg DHA	100% improved at least 1 line visual acuity; avg. 2 lines vision improvement (10 letters1)
Ophthalmology Aug 2013	Controlled PREVENTION	3 years	263 55-85 yrs of age	France	270 mg EPA/ 840 mg DHA	Highest EPA/DHA blood level = -68% risk reduction for new blood vessel formation. No visual acuity improvement. Note: placebo was olive oil2.
Ophthalmology May 2013	Dietary intake PREVENTION	5 & 10 yrs	2531	Boston, Mass	Dietary intake	8.1% and 16.9% of healthy eyes progressed (geographic atrophy) over 5 & 10 years; highest intake of DHA = -32% relative reduced risk
J American Med Assn May 2013	Controlled TREATMENT	4.3-5.1 yrs	4203 73.1 yrs mean age	Multi-center study USA	650 mg EPA/ 350 mg DHA	Omega-3 levels rose in blood but visual improvements were not significant
J. Nutrition April 2013	Dietary PREVENTION	32 mos avg	963 Age 73+ yrs	France	Dietary intake	Highest blood levels of omega-3 = -38% reduced risk for advance AMD
Investigative Ophthalmology July 2011	Dietary intake PREVENTION	3 yrs	666	France	Dietary intake	Fish oil intake decreased risk for early AMD (-17%) and advanced AMD (-74%)
Archives Ophthalmology July 2011	Dietary intake PREVENTION	–	38022 women- mean age 54.6 yrs	Boston, MA	Dietary intake	1 serving fish/week compared to 1 serving/week reduced relative risk for AMD -42%
Amer J Clinical Nutrition Dec 2009	Dietary intake PREVENTION	13 yrs	1837	Multi-center study USA	Dietary intake	High intake fish oil 30% less likely to advanced AMD
British J Ophthalmology Sept 2009	Dietary Intake PREVENTION	8 yrs	2934	Multi-Center Study USA	Dietary intake	Highest intake (=64.0 mg/d for DHA/ =42.3 mg/d EPA) had a significant ~25% decreased relative risk for disease
Archives Ophthalmology May 2009	Dietary Intake PREVENTION	4 yrs	6734 58-69 yrs of age	Australia	Dietary intake	Highest intake fish oil reduced relative risk for advanced AMD by 15%
Euro J Ophthalmology Jan 2009	Controlled THERAPY	6 mos	22	France	720 mg EPA/ 480 mg DHA	Improved circulation (“blood enrichment”) observed
Archives Ophthalmology Jan 2009	Dietary Intake PREVENTION	12-yrs	1837	Multi-Center Study USA	Dietary intake	Highest intake fish oil 30% less likely to develop advanced AMD
Archives Ophthalmology Sept 2008	Dietary intake PREVENTION	6.3 yrs	2132 71+ yrs	Multi-Center Study USA	Dietary intake	Participants w/highest levels of DHA intake half as likely to experience progression (geographic atrophy)as lowest intake
Archives Ophthalmology May 2007	Dietary PREVENTION	–	4519 60-80 yrs of age	Multi-Center Study USA	Dietary intake	-46% relative risk reduction for advanced AMD with highest DHA intake
Archives Ophthalmology July 2006	Dietary PREVENTION	5 yrs	2335 49+ years	Australia	Dietary intake	Highest intake of fish oil reduced relative risk for early AMD 59%
Archives Ophthalmology Aug 2001	Dietary PREVENTION	–	349 55-80 yrs of age	Boston, MA	Dietary intake	Greater fish consumption reduced risk for AMD
Am J Clinical Nutrition Feb 2001	Dietary PREVENTION	–	72489 50+ yrs of age	Boston, MA	Dietary intake	Highest DHA intake reduced relative risk for AMD 30%; more than 4 servings of fish/week reduced AMD risk 35%
Archives Ophthalmology March 2000	Dietary PREVENTION	–	3654 49+ years of age	Australia	Dietary intake	Fish consumption associated with reduced risk for advanced AMD
1 One line of letters on the visual acuity chart = 5 letters 2 Olive oil shown to halve risk to develop advanced AMD in another study (Archives Ophthalmology 127: 674, May 2009), so not wise choice of placebo. Would have narrowed differences between fish oil and olive oil supplemented subjects.

References:

1. http://www.sciencedaily.com/releases/2013/05/130513152403.htm

2. Georgiou T, Neokleous A, Nicolaou D, Sears B. Pilot study for treating dry age-related macular degeneration (AMD) with high-dose omega-3 fatty acids. PharmaNutrition, Available online 18 October 2013. http://dx.doi.org/10.1016/j.phanu.2013.10.001

3. The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA. 2013;309(19):2005-2015. doi:10.1001/jama.2013.4997. http://jama.jamanetwork.com/article.aspx?articleid=1684847

4. Das UN. Folic acid and polyunsaturated fatty acids improve cognitive function and prevent depression, dementia, and Alzheimer's disease--but how and why? Prostaglandins Leukot Essent Fatty Acids. 2008 Jan;78(1):11-9. Epub 2007 Nov 28.http://www.ncbi.nlm.nih.gov/pubmed/18054217

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you:http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (USA)
Damien Downing, M.D. (United Kingdom)
Dean Elledge, D.D.S., M.S. (USA)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Peter H. Lauda, M.D. (Austria)
Thomas Levy, M.D., J.D. (USA)
Stuart Lindsey, Pharm.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)
Atsuo Yanagisawa, M.D., Ph.D. (Japan)

Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email:omns@orthomolecular.org This is a comments-only address; OMNS is unable to respond to individual reader emails. However, readers are encouraged to write in with their viewpoints. Reader comments become the property of OMNS and may or may not be used for publication.

http://orthomolecular.org/resources/omns/v09n28.shtml