For many, many years, there has been great hope that a dietary supplement would prevent some of the greatest causes of death in modern humanity, including the #1 cause of death in America, heart disease, and the #2 cause of death in America, cancer.

The concept that something normally found in our diet, taken in large doses, would keep us from dying from the main reasons we die has great appeal.  Why not?  After all, what could be more wonderful than finding something we normally eat as part of a healthy diet, boost the dose, and avoid the major diseases of our day?

The idea has its modern roots with Dr. Linus Pauling, a genius of towering intellect and achievement, rated as one of the top 20 most influential scientists of all time, and a winner of two separate Nobel prizes.  It was Pauling who stated that eating great amounts of Vitamin C would prevent one from getting cancer or heart disease.  He took large amounts of Vitamin C and ultimately died of cancer.  A very, very large number of studies later found you can take as much Vitamin C as you like, it won’t reduce your chance of getting, or dying, of heart disease or cancer.

But despite the failure of Pauling’s proposal for Vitamin C, the hope was launched, and since that moment, a seemingly endless stream of chemicals found in our food or our bodies, have been put forward as the one chemical to fulfill Pauling’s dream.   Over time various vitamins including many B vitamins, and Vitamin E have been proposed as the chemical to protect us from heart disease and cancer.  All have failed to do so.

Two chemicals of nutrition, omega-3 fatty acids (also known as n-3 fatty acids) and Vitamin D, have been under current investigation, do they deliver the promise Dr. Pauling thought Vitamin C would, will they protect us from death by heart disease and/or cancer?

Three studies published in the January 3, 2019 issue of The New England Journal of Medicine shed new light on this promise, and on the nature of the business of selling medications.

Study #1- Does Icosapent Ethyl prevent heart disease?

The first study looks at a very specific chemical called icosapent ethyl, derived from fish oil, and related to the famous omega-3 fatty acids fish oils.  https://www.nejm.org/doi/full/10.1056/NEJMoa1812792?query=featured_home

This study shows that in people who had established risk factors for heart disease events, already being treated with statins, about 22% of them went on to die from heart disease, have a non-fatal heart attack, or non-fatal stroke.  If they were also treated with icosapent ethyl, 17% suffered these same fates.

One could say that both groups suffered a bad heart disease outcome about 20% of the time, and that would be an accurate statement.   The authors of the article, led by the lead author, Dr. Deepak Bhatt, put the numbers this way.   A 17% chance of a bad outcome is 25% lower number than the 22% chance without icosapent ethyl, also a true statement.

In the accompanying editorial in the same journal, the commentators observe that recent studies on the impact of fish oil derived omega-3 fatty acids on heart disease have shown no impact, and that the effect of this omega-3 fatty acid on heart disease went beyond its impact on the expected variable, namely, the triglyceride level.

I noted in reading the paper that this study was paid for by a company called Amarin Pharma, which owns the drug called icosapent ethyl.  Amarin applied to the FDA to market icosapent ethyl to a group of people with elevated triglyceride levels, but the FDA denied permission to do so.  Amarin sued the FDA and the court granted it permission to sell this drug on the basis that the FDA was denying its right to free speech, and the drug was allowed to be marketed as Amarin wished.

At the end of the article, Dr. Bhatt discloses that he receives grant monies from Amarin and 20 other drug companies.  The disclosure goes on at great length to describe other fees from other companies Dr. Bhatt and some of the other authors of the paper have received.

Study #2- Do n-3 Fatty acids from fish oil prevent heart disease and/or cancer

This study was supported solely be the National Institutes of Health of the US government.

https://www.nejm.org/doi/full/10.1056/NEJMoa1811403?query=featured_home

This study found that people who took doses of n-3 omega fatty acids from fish oil had the same chance of developing a serious heart problem or cancer as people who did not.

Study #3- Does Vitamin D prevent heart disease and/or cancer

This study was supported solely be the National Institutes of Health of the US government.

https://www.nejm.org/doi/full/10.1056/NEJMoa1809944?query=featured_home

This study found that people who took doses of Vitamin D had the same chance of developing a serious heart problem or cancer as people who did not.

BOTTOM LINES

1. Oh, how we hope that something we eat or found naturally in our bodies will keep us from deadly illness.  But so far, no such chemical has been found.  Vitamin C and many other vitamins have been tested and found to fail to actually protect.
2. A major article on Vitamin D finds it fails to protect from heart disease and from cancer.
3. A major article on n-3, or omega-3, fatty acids from fish oil finds they fail to protect from heart disease and cancer.
4. Both these studies had funding from no company, only the US NIH.
5. One other study published in the same issue of the New England Journal of Medicine found that the risk of heart disease dropped from 22% to 17% if a particular chemical derived from fish oil, icosapent ethyl, was given.  Curiously, this finding is in contrast to finding little help from fish oil fatty acids in many other studies, including a major one in the same Journal’s issue.  And most curiously, this study was paid for by the same company, Amarin Pharma, that makes and sells this drug, and its authors have a long list of grants and fees from various drug companies, including the lead author’s receiving grant support from Amarin Pharma.

The evidence weighs towards Vitamin D and fish oil fatty acids failing to seriously impact the massive numbers of us who will likely die from heart disease and cancer.  Eating fish, however, does offer some protection.  These results are consistent with the repeated failure of chemicals in our food being able to prevent serious disease from happening.  In fact, to date, only one vitamin has been found to offer any medical benefit to otherwise healthy people when taken in large doses, that being folic acid in preventing spina bifida, and perhaps, folate in preventing autism.

The path to preventing heart disease and cancer will more likely be found in healthy lifestyles rather than in pills.  Of course, any breakthrough will be most welcome to help us all avoid these terrible fates.

To your health,
Dr. Arthur Lavin