Hi you guys, my dad's primary care Dr recommended he take Omega 3 supplements, 3 of the 1000mg capsules a day. (To lower his triglycerides)
I have been reading old posts that say Omega 3 supplements are bad for PC.
What does everyone think? Could this affect his psa reading too?
Thanks
Ellie
Some observational studies raised a red flag:
academic.oup.com/jnci/artic...
ncbi.nlm.nih.gov/pmc/articl...
A large randomized trial found no link to incidence or deaths from any kind of cancer, but the 5-year follow-up was too short to detect deaths from prostate cancer that might have occured due to omega-3 intake:
nejm.org/doi/full/10.1056/N...
I'm not aware of any effect on PSA tests.
Will diet, exercise and low dose statins achieve what his doctor wants?
Hey Tall_Allen!
I know that you place much belief in the discredited Brasky Study. Please take a look at the info not only in his article but also the studies that Dr. Sperling lists that he used as the basis to refute the findings of the Brasky Study.
Decide if Dr. Sperling and the references he lists have credibility. There are quite a few.
sperlingprostatecenter.com/...
Currumpaw
Hey Currumpaw!
I know that you place much belief in the discredited Sperling Analysis. If Sperling had any credibility at all, he would publish in a peer-reviewed medical journal instead of a dubious website. Most of his references are not from peer-reviewed studies. He actually cites second-hand reports of what someone claims she heard on a radio talk show as a reference! He concludes "prostate cancer patients who either consume quality fresh fish high in omega-3s or fish oil supplement stand to benefit on many levels, including reduced risk of prostate cancer spread. " But if you check his references, some actually say the opposite of what he concludes. For example, one of his references (v) says:
"no other types of fish consumption or n-3 PUFA intake were associated with PSA levels. Our findings provide little evidence for a role of fish or n-3 PUFA consumption in influencing PSA levels."
plefa.com/article/S0952-327...
Most of his citations are from much smaller observational studies or lab studies, none of which carry any weight in comparison to the Brasky studies. The SELECT trial used by Brasky randomized 35,533 men from 427 study sites and followed them for 7-12 years. It was one of the largest trials ever done.
Brasky actually found the same results in two separate prospective case-cohort studies (links above), which adds to the credibility, but is not definitive. As I pointed out, both are observational, and are not randomized controlled trials (which would be definitive). In the only randomized controlled trial on the subject (link above), there was no proof of benefit or risk of incidence or death. Maybe it takes a long time to have a benefit or increase risk? The SELECT trial
Be careful about where you get your information from. The internet is full of claptrap. Sources matter.
Hey Tall_Allen!
Do you consider Professor Anthony D'Amico a vendor of 'claptrap'? He is a Professor of Radiation Oncology at Harvard Medical School, Chief of Genitourinary Radiation Oncology at Brigham and Women's Hospital and the Dana Farber Cancer Institute. Dr. D'Amico has written 140 plus publications reviewed by his peers. That isn't the totality of his career achievements.
Dr. D'Amico didn't give the Brasky Study much cred. He is one of the sources Dr. Sperling listed.
This was also in the sources that Dr. Sperling listed. Nice of the doctor to put these together!
ncbi.nlm.nih.gov/pubmed/313...
Has fish oil been pulled off the shelves like baby powder? Has the FDA required and warnings to be listed on the bottles? Are people warned that they should only consume so much fish?
A Dr. of Naturopathy I've spoken with doesn't agree with the Brasky Study.
I think this will be similar to the abortion debate.
The study above was published in July 2019.
Do you know of any recent studies supporting the Brasky Study?
Have a good evening,
Currumpaw
Hey Currumpaw-
He did not cite a D'Amico study. He cited some radio talk show that purportedly interviewed him (the link does not work). When D'Amico has a legitimate critique, he publishes in a peer-reviewed journal. He even edits one. He has no problem getting published when he has something worth saying.
Do you actually think a single observational study on 157 men on Active Surveillance followed for six months comes up to the level of evidence of the two Brasky studies covering tens of thousands of men for a dozen years? Even that study only found that level of omega-3 intake from eating fish (not taking supplements) was associated with upgrading on a 6-month confirmatory biopsy for men who initially qualified for AS. What they actually observed was a slight negative association with 6-month upgrading with diets higher in EPA (one of the ω3 fatty acids), and ω3/ω6 ratio in prostate tissue, but not blood. This indicates that G6 prostate tissue concentrates ω3 fatty acids more than G7-10 does. I don't think any sane person would conclude that the lack of fish caused the Gleason score to progress in just 6 months. Even though this study tells us little, I do believe that having fish in one's diet is a good thing.
Worthless opinions from bad sources do not lend credibility. Sources matter.
Hey Tall_Allen!
Thanks for your reply.
The conclusions from the Brasky Study were derived from reviewing the data gathered from the 2011 Select Study which wasn't compiling and reviewing data about fish oil but about how selenium and vitamin E affected prostate cancer.
The data from that study may be irrelevant to found the Brasky Study on. This was likely a glaring red flag to Professor D-Amico.
Points-
Blood plasma rather than red blood cells in just one single draw.
For 14+ years I worked in manufacturing specialty chemicals and 14+, again, in pharmaceuticals. The manufacturing process begins with completely sanitized equipment which is work in itself, between vessels, reactors, piping, condensers and pumps to name a few. During the manufacturing process it is essential to remove atmosphere containing oxygen from the equipment in which the product is being manufactured to prevent oxidation. Vacuum and nitrogen are used to keep thee head space of the reactors and vessels free from oxygen. cGMP manufacturing rules are tightly followed and stability tests are conducted. One way that a manufacturer ensures that a product that is susceptible to oxidation is to purge the top of the container for the consumer with nitrogen before it is capped preventing oxidation. Inferior products or even the very best products stored improperly by the consumer can cause a supplement to degrade.
There were other issues with the study but I m not into that.
I am going to concede that you are correct. Omega 3's from fish oil does indeed promote prostate cancer! A problem with the Brasky Study is it had no idea where the omega 3's came from, the source! Or quality, type and frequency of fish and fish oil consumption.
Here is a link to a study that concludes that fish oil causes prostate cancer.
Consumption of fish products across the lifespan and prostate cancer risk.
Torfadottir JE1, Valdimarsdottir UA, Mucci LA, Kasperzyk JL, Fall K, Tryggvadottir L, Aspelund T, Olafsson O, Harris TB, Jonsson E, Tulinius H, Gudnason V, Adami HO, Stampfer M, Steingrimsdottir L.
An excerpt from the study.
"Conclusions
Salted or smoked fish may increase risk of advanced prostate cancer, whereas fish oil consumption may be protective against progression of prostate cancer in elderly men. In a setting with very high fish consumption, no association was found between overall fish consumption in early or midlife and prostate cancer risk."
How about these smoked sardines on crackers and a can of kipper snacks--the smoked herring? Do those of us who enjoy smoked caviar and salmon still get to occasionally indulge?
Another excerpt from the study.
"Results
Among the 2268 men, we ascertained 214 prevalent and 133 incident prostate cancer cases, of which 63 had advanced disease. High fish consumption in early- and midlife was not associated with overall or advanced prostate cancer. High intake of salted or smoked fish was associated with a 2-fold increased risk of advanced prostate cancer both in early life (95% CI: 1.08, 3.62) and in later life (95% CI: 1.04, 5.00). Men consuming fish oil in later life had a lower risk of advanced prostate cancer [HR (95%CI): 0.43 (0.19, 0.95)], no association was found for early life or midlife consumption."
This study took detailed information from these men, table after table and all dedicated to research focused only on the effect that fish oils have in prostate cancer incidence, not whether selenium or vitamin E had a relationship to prostate cancer in men.
Stay away from smoked fish products and only supplement with high quality fish oils.
If Brasky is so certain of the findings of his 2013 study why hasn't he done another study focusing on the causative rather than using another study's data associatively. Perhaps funding? Perhaps other more pressing interests? Or?
I must say that I enjoy reading your posts and almost always find them informative and on point.
Thanks for your contributions to HU.
Currumpaw
I don't understand the relevance of the point you are making about manufacturing processes. The two Blasky studies looked at plasma levels of long-chain ω-3 fatty acids, no matter how they got there. They used plasma because that is where fatty acids are carried.
It is common practice to use data collected on well-done clinical trials like SELECT or PCPT for other purposes. When samples are large enough,it is possible to find enough matched cases to do a trial-within-a-trial. This is a well-estabished method, and is not a red flag for D'Amico or anyone else. It is not the same level of evidence as an RCT (like the VITAL trial), but is the next best thing.
As to why he hasn't done more - well, he confirmed his findings in two of the largest prospective trials ever done. Outside of an RCT, there is nothing more to be done. Perhaps there will be more useful PC-specific data emerging from the VITAL trial in 10 years. (It will take that long to have enough deaths from PC in their sample)
Meanwhile, there is good enough reason to stay away from ω-3 supplements if one has prostate cancer. Why would anyone risk it?
Hey Tall_Allen!
The relevance about manufacturing processes is simply that unless all SOPs are adhered to a poor quality or even dangerous product may reach the consumer. A bad quality oil, a badly packaged fish oil or one that has been mishandled and gone rancid shouldn't be taken and fish oil goes rancid quickly. There was no control over quality. Control of quality is important.
Had Brasky used the Select study's data as supporting data rather than as the principal data it is unlikely that there would have been much criticism.
The media seized upon the sensational aspect of the report. They were quick to realize that large numbers of men take fish oil. They increased copy, viewership and had nice numbers to present to their sponsors by sensationalizing the study! It was big news and caused much concern keeping it on our newsfeeds and hard copy for quite a time.
As for his take on fish oil the link to the study I posted, that study focused entirely on and was designed to find if fish oil caused a higher incidence of prostate cancer. Well, I wasn't surprised to read that --salted and smoked fish consumption increased the incidence of prostate cancers and didn't it say higher Gleason grade cancers? Frequent consumption of cured and smoked meats, bacon, ham, cold cuts, corned beef all those tasty dead animal products that we humans originally processed to retard spoilage--increase the incidence of prostate cancer. We as a species can't leave well enough alone can we? A taste developed of necessity, preservation of food supplies, passed down through the generations. What is a little of the by products of burning wood or some nitrates
An excerpt:
"Furthermore, processed meats can also contain other carcinogenic compounds such as PAHs which can be formed during smoking of meat (e.g. salami)."
Here is the link--
hsph.harvard.edu/nutritions......
Anyway, that is what smoking food can do to it. As the study stated, only smoked or salted fish elevated the incidence of prostate cancers.
Risking taking fish oil? I would agree wit you that there is a risk. Until people are educated the importance of buying the top of the line fish oil and understand how fragile the quality of a fish oil is and how it should be stored, they probably shouldn't take it. Somebody buys the big bottle because it is a "smart" consumer move. It has an expiration date a year in the future. It is stored on a kitchen counter. Really! I would suggest the smallest bottle of liquid as it will be used in a shorter time reducing the chances of degradation. Once opened to be refrigerated.
Dosage--the "if this much is good than twice as much is better". I disagree.
As an example. A product I once was involved in manufacturing went through a lengthy, weeks long process, through quite a chain of equipment. There was extensive testing by quality control on every step. At the end there was only a small amount of product to which an extremely pure sesame oil was added. The oil cost about $7,000 a drum. Before adding any oil to the product the oil was tested for peroxides to determine the amount of oxidation. Of course the head space of the drum was purged with nitrogen every time it was opened before being resealed.
The company that manufactures the fish oil one chooses should be as careful with their product and the consumer should care for it when it is opened.
As the study showed, those who consumed smoked or salted fish rather than fresh had twice the incidence of prostate cancers.
Perhaps there should be a study on the initial quality of fish oil products and the storage of them. Why not educate the public?
I have long known the importance of both these factors. Overlooked it seems!
A the computer folks say, " garbage in, garbage out". Shall I say, "Bad or contaminated fish oil in, could result in a prostate cancer diagnosis". Smoked or salted fish, bad quality fish oil, improperly stored fish oil. We humans can screw up a good thing can't we?
Something to remember, the prostate is a gland, a very sensitive gland. It appears like it doesn't take much to upset the prostate cart. Diet and the quality of one's diet is a large factor.
Thanks for the back and forth--stimulating!
Currumpaw
My point was the manufacturing process was irrelevant - they looked at blood levels, not intake. Our body's aren't designed to take nutrients that way.
I agree with you that it's sad that the media sensationalize and misinterpret results of excellent studies like Brasky's. My recommendation is usually to ignore mainstream media on medical issues.
Ellie,
You don't say what his triglyceride level is. The American Heart Association (AHA) recommends up to 4 grams (4,000 mg)/day omega-3 for individuals with elevated triglycerides (I think above 150 mg/dL.)
Does he like fish? Small fatty fish are best but difficult to find. Canned sardines & Alaskan salmon are usually good sources of omega-3.
A low-fat/high-carb meal may boost triglycerides.
I understand that the focus is on PCa, but very high triglycerides needs to be addressed IMO.
-Patrick
PJ,
Is that 4 grams of fish oil or 4 grams of Omega 3?
I think only a portion of fish oil is Omega 3.
Doug
Doug,
It is up to 4 grams of marine Omega 3 (DHA+EPA).
4 grams of a good fish oil will provide only 2.4 grams of DHA+EPA, as I recall. & that's about the max anyone should normally be contemplating. But for hypertriglyceridemia (above 200 mg/dL), a much higher dose might be needed.
-Patrick
There is a recent study suggesting that there is an increased risk of prostate cancer associated with omega 3 fatty acids plasma levels:
ncbi.nlm.nih.gov/pubmed/238...
People taking these acids as a supplement should probably stop.
Your Dad's situation is different. He needs to take them to control high triglycerides levels.
The FDA has approved prescription omega-3 fatty acid medications only for treating triglyceride levels above 500 mg/dL.
You should consider to discuss with your internal medicine doctor and with your oncologist the pros and cons of using these fatty acids in his situation.
They could use fibrates and/or niacin instead of omega 3 fatty acids to try to control triglycerides levels.
Omega 3 isn't bad for prostate cancer and is probably good.
Omega 3 is very good for prostate cancer but is not good for patients with prostate cancer
Dr. Myers had me on it for years.
He was using prescription grade Omega 3 off label.
The only reason was prostate cancer related.
So what exactly are you saying about it?
Hi Cesces,
For many years everyone believed that Omega 3 supplement is good for prostate cancer. Medicine, however, is developing all the time and new research shows that taking Omega 3 supplements is associated with a high risk of developing prostate cancer. Google has a lot of information on this subject, for example: From Harvard Health Medical School: "High intake of omega-3 fats linked to increased prostate cancer risk".
Another source: Fred Hutchinson Cancer Research in Seattle:
..".These anti-inflammatory omega-3s were associated with a 43 percent increased risk for prostate cancer overall, and a 71 percent increased risk in aggressive prostate cancer," said lead author Theodore Brasky, a research assistant professor at Ohio State University Comprehensive Cancer Center in Columbus, who was at Hutchinson at the time of the study.
In Google you can find many others researches on this subject.
It is also worth reading the links that Mr. Tall-Allen posted.
Hmmm well that's interesting.
Look a bit more at this, it seems that this research occurred in a blip about 7 or 8 years ago. Nothing prior or subsequent?
Hi Cesanon,
you are absolutely right, all these studies are from 7 to 8 years old. I don`t think any institution will start researching this topic again. Studies are long -lasting and very expensive. Probably the
result would be similar. Currently, many patients instead of omega-3 take others supplements like berberine, turmeric, powdered grape seeds, vitamin C, vitamin D together with vitamin K2 MK7 and other. These supplements may slightly
support the basic treatment and there is no risk of the disease
getting worse. Many patients also take "repurposed" drugs like
metformin, statins, antifungals, antiparasitics drugs and even cholera vaccines. There are many clinical trials with these drugs.
Why take unnecessary cancer risks with dietary supplements! The cause of elevated triglyceride levels is usually lifestyle factors related to a diet containing very fast carbohydrates, obesity, type-2 diabetes or high alcohol consumption. Because triglycerides are something we get through our diet, the triglycerides can be easily affected by changing diet and physical activity levels.
My husbands triccylerides went up to 1350 recently along with elevated liver enzymes after 2 treatments of keytruda for his msh2 mututation. Cardiologist recommended Vascepa for triccylerides stronger strength fish oil than over the counter. He sees Mskcc liver doctor Tues. He is off statins for awhile since they said could raise liver enzymes. When we got married he had 1350 and high cholesterol. Heavy drinker,ate all fatty foods. Got them way down in later life to around 200 never this high. Diet doesnt seem to be making dent now.
My dad has kidney damage and is having a hard time knowing what to eat on the renal diet (he has seen a dietitian and follows it as much as possible), he is a healthy eater but eats a lot of fruit and pasta in order to feel full..
We are trying to modify somehow, but don't know what outweighs..... We don't want to aggravate the pca just to keep the triglycerides in check ...
Best to double check with your Dad's oncologist....
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 10/27/2019 5:54 PM DST
Omega 3, PCa, Cardiac
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