Marco Studer and his colleagues, at the University of Basel in Switzerland, while praising statin therapy in the April 11th issue of the Archives of Internal Medicine, missed an important point. The press picked up the "magic drug story of statin" but missed the power of natural supplements.

According to the study, fish oil supplements containing omega-3 polyunsaturated fatty acids also reduce the risk of death due to heart diseases.

Most importantly, it has the lowest overall mortality risk ratio -- 0.77 versus that of 0.87 for statins. Yet, this was overlooked.

This new information combined with the fact that fish oil supplements are cheaper and have no side-effects makes them ideal for preventing heart disease.

In fact, merely eating fish regularly should help.
Simply put, you do not have to fall sick to take fish oil. Instead, taking fish oil frequently might actually prevent you from falling sick.

But first, let us look at this study.

Meta-Analysis
A meta-analysis is a statistical practice of combining the results of a number of studies that address a set of related research hypotheses. It is merely a review of past studies.

Meta-analysts translates results from different studies to a common metric and statistically explore relations between study characteristics and findings. Meta-analysis is widely used in evidence-based medicine today.

To analyse the existing data as part of their meta-analysis, Swiss researchers included all studies that compared any lipid (or cholesterol) lowering method with a placebo or usual care. The trials had also to meet two other criteria in order to be included. They are:

- at least a six month follow up
- reported mortality data

This resulted in the inclusion of 97 randomised studies. These compromised six interventions -- statins, fibrates, resins, niacin, omega 3 fatty acids and diet.

These studies involved 137,140 individual who took any of these interventions. There were 138,976 patients in the control group.

Cardiac Death
The risk of deaths due to heart disease was significantly reduced by statins (22 per cent), resins (30 per cent) and omega-3 fatty acids (32 per cent). The overall mortality ratio was lowest for the fish oil intervention (0.77) compared to statins (0.87).

In the discussion sections of the paper, Studer and colleagues pointed out that if used in appropriate doses, omega 3 fatty acids are as effective as fibrates but are associated with a better reduction in overall death.

Irregular Rhythm
This meta-analysis merely confirms what many of us in nutritional medicine have known. Fish oil is very protective of the heart.

While Swiss researchers grappled with the "cholesterol is the culprit of heart disease" theory, it is being increasingly questioned as:

- cholesterol may have been the wrong target of the heart disease movement. It may play a role but it is not the only enemy of the heart

- heart disease is increasingly being seen as a disease of inflammation and fish oil plays a counter role as an anti-inflammatory

- fish oil plays a role in the heart tissue as agents that stabilise heart tissues and prevent fatal arrythimia (irregular heart rhythm) after an heart attack and hence prevents death

The Italian researchers in what is better known as the GISSI Trial found taking one gramme daily of omega-3 fatty acids significantly reduced the risk of death in people who had heart attacks.

They reported a 42 per cent drop in sudden cardiac death among those taking the fish oil supplements within three months after a heart attack.

Researchers say the lifesaving benefits of the supplements are due to reducing the likelihood of a potentially fatal type of irregular heartbeat known as arrhythmias.

"This study is important because there is no really effective therapy for arrhythmias," says Alexander Leaf, MD, professor of clinical medicine at Harvard Medical School.

Another fact is that fatty fish can't be marketed like a drug. The supply is limited and there is no great publicity machine behind it. As it cannot be patented like other health foods, there is no guarantee of sinful profits.

Toxins
The big issue is toxins. Fish have become mini reflections of the increasingly contaminated oceans that they live in. Oceans are probably flooded with organochlorine pesticides, DDT, lindane, poly cholorobenzenes and toxic metals like mercury and arsenic.

Fish oil supplements should be safe. In 1995, a Greenpeace independent study revealed that 21 of the 22 brands of fish oil in the United States failed in terms of heavy metal toxicity.

Fish oil supplements in the United States now undergo molecular distillation -- a process that removes toxins while preserving the fish oil's highly sensitive omega 3 fatty acids.

Choosing Supplements
So you want to discover "nature's miracle" and do not know how to start or what dose to take. Here is a quick guide:

- Toxin free

Ask your pharmacist for molecularly distilled fish oil. This is especially so if you are pregnant, nursing or on "high dose omega therapy". Always go for the cleanest fish oil as you do not want to accumulate toxins.

- High strength

Molecular distilled versions tend to be of double strength which gives you 600mg of omega 3 in each capsule. You should take one capsule for every 40 pounds of body weight, preferably in two divided doses. So if you weigh 160 pounds you would take two capsules twice a day. You should go for double strength versions that pack more essential fatty acids and less oil in each capsule.

- Anti-oxidants

Fatty acids in fish oil are extremely sensitive. Clever manufacturers normally add a small amount of vitamin E to prevent oxidation and rancidity. Check for a small amount of vitamin E.

- Packing

As fish oils are high sensitive, they should be packed in amber coloured glass bottles. This keeps out heat and light.

Be wary of fish oil supplements that come in plastic bottles. They may cost less but you would be paying for rancid fish oils that could be of more harm than good.

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Datuk Dr Rajen M. is a pharmacist with a doctorate in holistic medicine