Fish oil: The promise and the proof

Laura Stewart, Member-at-Large and Board Member of SPAP, received her Bachelor of Arts degree in Biology from Baylor University and Masters of Science degree in Communication Sciences and Disorders. Following a 9 year career as a Speech Therapist, she then sought a Masters degree in Physician Assistant Studies at UT Southwestern which she completed in 2017.  Ms Stewart is now a Physician Assistant member of the Inpatient Pulmonary Team at Children's Medical Center of Dallas.

Certainly, these are interesting times in medicine as the integration of homeopathic remedies and over-the-counter supplements has become increasingly more common in the past few decades-from the use of elderberry to boost immunity or oscillococcinum to shorten the duration of influenza. 

However, with inconsistent medical research and a lack of US Food and Drug Administration regulation, it remains unclear what the most safe and efficacious role these substances will play in the future of medical care.  Fish oil is one such supplement that has now been well studied and demonstrated to have value in lowering cholesterol, limiting heart disease, improving cognitive function, and helping to foster brain and eye development.  The article in review in the latest issue of Contemporary Pediatrics, entitled “Fish oil supplements not a fix for obese patients with asthma” addresses this subject of fish oil, specifically for the treatment of patients with asthma.

The jury is still out

The primary focus of the article is a discussion of Jason E. Lang, MD, MPH’s study, published by the American Thoracic Society, which seems to debunk the premise that there is a viable role for fish oil in the treatment of asthma.  It becomes apparent throughout the article, by the comments on Lang’s study by multiple researchers, that the verdict, however, remains outstanding whether fish oil will have a beneficial role in the treatment of kiddos with asthma.  It seems to be agreed by all parties that there is still the need for additional research.  The article points out that Lang’s study was quite specific to a subset of the pediatric asthmatic population who were specifically obese and overweight. The mechanism of action for fish oil in treatment of asthma is generally to reduce immunoglobulin E and an allergic inflammatory response. The article notes that children with obesity or who are overweight will have more of a chronic inflammatory response independent of their diagnosis of asthma which could account for the lack of efficacy of fish oil in treating patients with asthma.

MOAs at cross purposes?

Many of the participants in Lang’s study did not reflect improvement in asthma control and lung function despite elevated blood levels of omega-3. Additional evidence has been previously discussed in the literature about whether chronic use of systemic steroids may block the end effect of the omega-3 fatty acids in the fish oil, thus providing additional information that may affect the ultimate outcomes of these studies.

John La Puma, MD, FACP, an internist, and New York Times best-selling author on nutrition from Santa Barbara, California, makes specific reference in the article to the physiologic effect of chronic inflammation that is present in the obesity setting.  An additional co-founding factor is presented by Augusto Litonjua, MD, MPH, division chief of Pediatric Pulmonary Medicine at the University of Rochester School of Medicine, Rochester, New York.  Dr.  Litonjua suggests that, in addition to the factor of obesity, genetic differences and variations may also contribute to the reason why some patients with asthma respond more favorably to fish oil supplements than others.  As more and more variables become apparent in this discussion, I would agree with both of these physicians that larger and more comprehensive studies need to be done before final conclusions are drawn with regard to the efficacy of fish oil supplementation in the treatment of asthma.

Promise may await

It is clear that the strength of evidence around the effectiveness of most homeopathic remedies leaves much to be desired. This article discusses one such example. However, in spite of the current absence of strong evidence, there remains mounting hope for those suffering with illnesses such as asthma for the potential use of homeopathic remedies and over-the-counter supplements.  Wouldn’t it be wonderful to be able to treat children with asthma with improved safety and, at least, equivalent efficacy without the harmful side effects of chronic steroid use? While the ultimate conclusions regarding the use of fish oil in treating asthma remain to be drawn, as noted by Lang et al, there are additional promising studies just on the horizon.