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Orthomolecular Medicine News Service, December 11, 2013

Something’s Fishy About Macular Degeneration Fish Oil Studies

by Bill Sardi

(OMNS Dec 11, 2013) 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. Copyright (C) 2013 Bill Sardi and reprinted with his permission.)


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
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)
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.
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 less than 1 serving/month 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.



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.

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.

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.

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