Fried Herrings – Are They Really Good For The Heart?

March 15, 2005

An American study says that you can avoid heart flutter (atrial fibrillation) by eating fatty fish. Danish researchers have come to the exact opposite conclusion. Is that because the Danes like fried fish?

An American study concludes that you can avoid atrial fibrillation by eating fatty fish. Danish researchers have come to the exact opposite conclusion.

In the summer of 2004, researchers at Harvard University in Boston published an article stating that if you eat lots of fatty fish, your risk of atrial fibrillation will be reduced.

Atrial fibrillation is the most common cause of irregular heartbeat that will occur in a large number of elderly people and will require lifelong anticoagulant treatment.

To be precise, the American researchers had found that the risk of atrial fibrillation was reduced by 35% in people who consumed fatty fish at least five times a week and by 24% in the ones who consumed fatty fish 1 – 3 times a month – compared to people who only ate fish very rarely.

However, the matter is more complex than that: In January 2005, two Danish doctors published an article stating that a large consumption of fatty fish increases the risk of atrial fibrillation. They found the risk to be increased by 44% in the 20% who consumed the most fatty fish compared to the 20% who consumed the least.

Were do we go from that, then? If we take a rough average of the two studies, it will indicate that it does not matter whether or not you eat fatty fish.

But why are the results so conflicting? If we move below the surface, it turns out that the two studies are very different.

The American study included 5000 trial subjects with an average age of 73 years. The Danish study included 50,000 trial subjects with an average age that was 18 years less than the American study, i.e. 55 years.

Almost every fifth of the old Americans suffered atrial fibrillation during the 12-year duration of the American study. In comparison, the same was true for less than 2% of the Danes during the 6-year duration of the Danish study.

In total, the Americans observed more than twice as many trial subjects with atrial fibrillation compared to the Danes (980 and 456, respectively).

Frying distorts the fish oil
How were the person with atrial fibrillation indentified? The American trial subjects went through a cardiac examination every year in which all cases of atrial fibrillation were discovered. Contrary to this, information about the health state of the Danes was solely obtained from the hospitals – it was obviously assumed that all the trial subjects who had suffered atrial fibrillation had been hospitalized.

This discrepancy involves some uncertainty: Even though most trial subjects with atrial fibrillation were hospitalized, it is far from certain that this applied to everyone. Atrial fibrillation can very well be treated by a GP.

It was particularly important that the Americans observed that there is difference in the effect of fried fish and other kinds of fish. Fried fatty fish slightly increased the risk while non-fried (fatty) fish decreased the risk. Fried fatty fish neither increased the blood levels of fish oil (N-3 fatty acids) as non-fried fish does.

The Danish study does not explain how the fish were prepared. There was no distinguishing.

None of the studies explained how many and who took fish oil supplements: In the Danish study the trial subjects had not been given this question and in the American study, the information apparently did not alter the overall result.

To conclude: A detailed and precise American study has established that fatty fish reduces the risk of atrial fibrillation by approximately 33%.
A less detailed Danish study has established the opposite.

However, the size of the study is hardly decisive. It is probably more essential to pay some attention to how the fish was prepared. Fish oil is destroyed by high temperatures which, more or less, transforms the N-3 fatty acids into N-6 fatty acids, transfatty acids, and harmful oxidation products.

The American group has recently published some more news: Fatty fish – that has not been fried – reduces the risk of cerebral haemorrhage to approximately the same degree as is the case with atrial fibrillation. Fatty fish, on the other hand, increases this risk!

By: Vitality Council

1. Dariush Mozaffarian et al. Fish intake and risk of incident atrial fibrillation. Circulation 2004;116:368-73.
2. n-3 Fatty acids consumed from fish and risk of atrial fibrillation or flutter : The Danish Diet, Cancer and Health Study. Am J Clin Nutr 2005;81:50-4
3. Mozaffarian D et al. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study. Arch Intern Med 2005 Jan 24;165(2):200-6.

Decisive Agreement About Fish Oil Has Now Been Reached

January 10, 2005

For the first time, there is agreement about chronic lack of fish oil increasing the risk of coronary heart disease. An official American report sets a recommended intake for all adults.

It looks like there is now decisive agreement among experts that there is a connection between coronary heart disease and a chronic lack of the fatty acids in fish oil. This is the conclusion of a report published in Current Atherosclerosis Reports which was prepared at the request of the federal health authorities of the USA.

According to the report, the indications for a connection between a lack of fatty acids and death caused by coronary heart disease have become stronger year by year. It is the two N-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that are significant. According to the report, DHA and EPA have “clear heart-protective effects.”

It also states that both national American and international experts now recommend larger intakes of N-3 fatty acids. The recommended daily intake is 450 mg. a day (EPA + DHA), but for persons with recognized coronary heart disease, the recommendation is 1000 mg. a day. This equals 1.5 g. of ordinary fish oil for healthy persons and 3 g. in case of heart disease, respectively; this is half the contents of a concentrated fish oil capsule.

The report underlines that according to both cellular- and animal tests, the N-3 fatty acids are capable of preventing irregular heartbeat and that this has now also been confirmed in tests on humans; this fact is also mentioned elsewhere on this site. In particular, the fatty acids can counteract the extremely common and often uncomfortable atrial fibrillation. All in all, the risk of death as a result of coronary heart disease is reduced by 25% when taking sufficient amounts of fish oil, as mentioned.

The strength of this evidence is now so comprehensive that the report encourages measuring people’s blood content of fatty acids just as measuring the blood pressure, checking the cholesterol, etc. is being done at present to estimate the risk of coronary heart disease. Likewise, it is now appreciated that it must become a national priority to see to it that everyone gets a sufficient intake of fish oil.

By: Vitality Council

Harris WS. Are omega-3 fatty acids the most important nutritional modulators of coronary heart disease risk? Curr atheroscler Rep. 2004;6:447-52.

Dangerous to Stop Taking Fish Oil!

September 8, 2004

Recent media reports have been saying that, according to a Danish study, fish oil does not prevent cardial arrythmia. Many have gotten the impression that fish oil does not at all benefit the heart. This is very wrong! Considering the many who take fish oil for the health of their heart, it is of utmost importance that this mistake be corrected, as it may be dangerous to stop supplementing with fish oil!

By: Vitality Council

1) Albert C. Fish oil – an appetising alternative to anti-arrhytmic drugs? Lancet 2004;363:1412-3.
2) Schrepf, R et al. Immediate effects of n-3 fatty acid infusion on the induction of sustained ventricular tachycardia. Lancet 2004;363:1441-2.

Fish Oil is Effective Against Cardiac Arrest (Heart Failure)

July 7. 2004

With an interesting study doctors from the University Hospital of München have shown that fish oil may very likely prevent incidents of heart failure considerably.

According to the medical journal The Lancet, a German study can lead the way to using fish oil as a harmless and more savoury alternative to traditional heart medicine.

If cardiac atherosclerosis is the cause of death, then, in every other case, death occurs as unpremeditated cardiac arrest and the person affected will simply fall to the ground. In approximately every other one of these cases, the cardiac arrest is both the first and last symptom of the disease, and a blood clot is often the triggering factor.

In an interesting study, doctors of the Munich University Hospital have demonstrated that fish oil is supposedly to a very lage extent capable of preventing these cases of cardiac arrest. This took place in an experiment with ten patients suffering from heart problems who all had a high risk of dying of their disease and for that reason had had a defibrillator surgically implanted; this device is capable of re-vitalizing the heart if it stops.

The experiment was supposed to examine whether fish oil can protect against the rhythm disturbances that can lead to cardiac arrest and death. All ten patients were predisposed to attacks in which the heart beats with up to 200 beats per minute. This is very often a premonitory symptom of so-called ventricular fibrillation which is the cause of almost all cases of cardiac arrest. In ventricular fibrillation, the cardiac action is transformed into a very fast but weak tremble.

In the German study, the hazardous rhythm disturbances to which the patients were predisposed were stimulated with electrical impulses. As expected, provoking the attacks were an easy task. In three out of the seven, however, they did not succeed, and it turned out that – contrary to the other seven – they were used to eating fish 2 – 3 times a week. The other seven people had triggered attacks which were interrupted by the defibrillator.

The sensational thing about this was that after having been given fish oil as intravenous transfusions, it was impossible to provoke attacks in now five out of the seven patients! Left were only two patients who apparently were not protected by fish oil. Despite the infusion (equalling 12 g. of ordinary fish oil), one of them had a very low blood level of fish oil.

In total, eight out of the ten patients were so effectively protected by fatty fish or fish oil that provoking the deadly attacks in them was impossible. However, this German study is only a pilot study. Larger and more thorough studies must succeed in order for the effect to be considered reliable.

The result matches other findings from very large studies. The most famous one is the Italian GISSI study from 1999; a randomized trial with 10,000 men who had recently survived a cardiac thrombosis. It stated with great certainty that taking fish oil supplements resulted in a total reduction in mortality of 20% and a reduction in the risk of sudden cardiac death of more than 50%.

According to the editorial commentary of the magazine, the German study that was published in The Lancet can lead the way to using fish oil as a safe and more appetizing alternative to traditional heart medicine. First and foremost, fish oil can substantially reduce the danger of having a cardiac thrombosis!

By: Vitality Council


1. Albert C. Fish oil – an appetising alternative to anti-arrhytmic drugs? Lancet 2004;363:1412-3.
2. Schrepf R et al. Immediate effects of n-3 fatty acid infusion on the induction of sustained ventricular tachycardia. Lancet 2004;363:1441-2.

Fish Oil for the Heart

March 7, 2003

Essential oils in fish oil can prevent heart disease in elderly people. Quite many consumers and doctors have good experiences with this, but now it has also been confirmed by a study, recently published in the American Journal of Clinical Nutrition.

The trial included 360 persons at the age of 65, and the researchers found that a high concentration of the fatty acids DHA and EPA is associated with a lower risk of dying of blood clots in the heart.

– “Again, this is a good example of a preventive measure with natural substances such as fish oil, pays off” says Claus Hancke, chairman of the Vitality Council.

–  Fish oil reduces the risk of both blood clots and atherosclerosis, so there is common sense in taking fish oil, especially if you do not eat as much fish.

– Research results of this type unfortunately receive far too little attention in Denmark, on the contrary, we have often been told that dietary supplements are not useful at all. As a consumer, therefore, it can be difficult to know what to believe.

– Therefore, I believe that a sober-minded information about dietary supplements such as fish oil should be one of the obvious tasks for a future Council for Exercise and Nutrition, says Hancke, who is a specialist in general medicine and General Manager of the Department of Orthomolecular Medicine in Lyngby.

Science today knows very little about the link between heart disease in the elderly and the body’s content of these fatty acids, and therefore studies like this are welcomed by the doctors who work with orthomolecular medicine on a daily basis, popularly speaking: Biological medicine.

By Vitality Council

American Journal of Clinical Nutrition, Vol. 77, No. 2, 319-325, February 2003.

Essential fatty acids, Research references

January 1999

1. Adler AJ, Holub BJ: Effect of garlic and fish-oil supplementation on serum lipid and lipoprotein concentrations in hypercholesterolemic men. Am J Clin Nutr 65:445-450, 1997.
2. Albert CM, Hennekens CH, Willett WC, Manson JE, et al.: Fish consumption and risk of sudden cardiac death. JAMA 279:23-28, 1998.
3. Amusquivar E, Ruperez FJ, Barbas C, Herrera E: Low arachidonic acid rather than alpha-tocopherol is responsible for the delayed postnatal development in off… J Nutr 130:11:2855-65, 2000.
4. Annuzzi G, Rivellese A, Capaldo B, Di Marino L, et al.: A controlled study on the effects of n-3 fatty acids on lipid and glucose metabolism in non-insulin-dependent diabet. Atherosclerosis 87:1:65-73, 1991.
5. Appel LJ: The effect of omega-3 polyunsaturated fatty acids on blood pressure. Omega-3 News:1:1-4 , 1994.
6. Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH: Omega-3 fatty acids in rheumatoid arthritis: an overview. Semin Arthritis Rheum 27:6:366-370, 1998.
7. Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, et al.: Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med 332:15:977-982, 1995.
8. Bagga D, Capone S, Wang HJ, Glaspy JA, et al.: Dietary modulation of omega-3/omega-6 polyunsaturated fatty acid ratios in patients with breast cancer. J Natl Cancer Inst 89:15:1123-31, 1997.
9. Barham JB, Edens MB, Fonteh AN, Johnson MM, et al.: Addition of eicosapentaenoic acid to gamma-linolenic acid-supplemented diets prevents serum arachidonic acid… J Nutr 130:8:1925-1931, 2000.
10. Bartels M, Nagel E, Pichlmayr R What is the role of nutrition in ulcerative colitis? A contribution to the current status of diet therapy in treatm. Langenbecks Archiv fur Chirurgie 380:1:4-11, 1995.
11. Begin ME, Das UN, Ells G, Horrobin DF: Selective killing of human cancer cells by polyunsaturated fatty acids. Prostaglandins Leukotrienes and Medicine 19:177-186, 1985.
12. Begin ME, Das UN: A deficiency in dietary gamma-linolenic and/or eicosapenta- enoic acids may determine individual susceptibility to AIDS. Medical Hypotheses 20 20:1-8, 1986.
13. Belluzzi A, Brignola C, Campieri M, Pera A, et al.: Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease. New England Journal of Medicine 334:24:1557-60, 1996.
14. Berth-Jones J, Graham-Brown RA: Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis published erratum appea. Lancet 341:8860:1557-1560, 1993.
15. Bittiner SB, Tucker WF, Cartwright I, Bleehen SS: A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet 1:8582:378-380, 1988.
16. Bjørneboe A, Søyland E, Bjørneboe GE, Rajka G, et al.: Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Br J Dermatol 117:4:463-469, 1987.
17. Bonefeld-Jørgensen EC, Møller SM, Hansen JC: Modulation of atherosclerotic risk factors by seal oil: a preliminary assessment. International. J. of Circumpolar Health 60:25-33, 2001.
18. Brown JE, Wahle KW: Effect of fish-oil and vitamin E supplementation on lipid peroxidation and whole-blood aggregation in man. Clin Chim Acta 193:3:147-56, 1990.
19. Brown M: Do vitamin E and fish oil protect against ischaemic heart disease? Lancet 354:441-442, 1999.
20. Burkow IC, Henderson RJ: Analysis of polymers from autoxidized marine oils by gel permeation HPLC using a light-scattering detector. Lipids 26:3:227-231, 1991.
21. Cathcart ES, Mortensen RF, Leslie CA, Conte JM, et al.: A fish oil diet inhibits amyloid P component (AP) acute phase responses in arthritis susceptible mice. J Immunol 139:1:89-91, 1987.
22. Cathcart ES, Gonnerman WA, Leslie CA, Hayes KC: Dietary n-3 fatty acids and arthritis. J Intern Med Suppl 225:731:217-23, 1989.
23. Cathcart ES, Gonnerman WA: Fish oil fatty acids and experimental arthritis. Rheum Dis Clin North Am 17:2:235-242, 1991.
24. Christensen M S, Mortimer B, Høy C, Redgrave T G: Clearance of Chylomicrons following Fish Oil and seal Oil Feeding Nutr. Res. 15:3:359-368, 1995.
25. Cleland LG, Hill CL, James MJ: Diet and arthritis. Baillieres Clin Rheumatol 9:4:771-85, 1995.
26. Cleland LG, French JK, Betts WH, Murphy GA, et al.: Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol 15:10:1471-5, 1988.
27. Cleland LG, Gibson RA, Neumann M, French JK: The effect of dietary fish oil supplement upon the content of dihomo-gammalinolenic acid in human plasma phospholipids. Prostaglandins Leukot Essent Fatty Acids 40:1:9-12, 1990.
28. Cleland LG, James MJ: Rheumatoid arthritis and the balance of dietary N-6 and N-3 essential fatty acids :editorial. Br J Rheumatol 36:5:513-4, 1997.
29. Christensen JH, Aaroe J, Knudsen N, Dideriksen K, et al.: Heart rate variability and n-3 fatty acids in patients with chronic renal failure–a pilot study. Clinical Nephrology 49:2:102-106, 1998.
30. Christensen JH, Christensen MS, Dyerberg J, Schmidt EB: Heart rate variability and fatty acid content of blood cell membranes: a dose-response study with n-3 fatty acids. Am J Clin Nutr 70:3:331-7, 1999.
31. Christensen JH, Gustenhoff P, Korup E, Aarøe J, et al.: Effect of fish oil on heart rate variability in survivors of myocardial infarction. BMJ 312:677-78, 1996.
32. Christophe A: Effects of feeding a supplement of gamma-linolenic acid containing oils with fish oil on the fatty acid composition. In: Gamma-Linolenic Acid, ed. Yung-Sheng Huang, D.:168-174, 1996.
33. Connor SL, Connor WE: Are fish oils beneficial in the prevention and treatment of coronary artery disease?. Review[53 refs] American Journal of Clinical Nutrition 66:4 Suppl:1020S-1031, 1997.
34. Connor W: Fish oil prevents death from heart disease. PUFA Newsletter 3:3:1 (1999)
35. Connor WE: Importance of n-3 fatty acids in health and disease. Am J Clin Nutr 71:1 Suppl:171S-5S, 2000.
36. Darlington G, Jump A, Ramsey N: Dietary treatment of rheumatoid arthritis. Practitioner 234:1488:456-460, 1990.
37. Das G: Fish oil in heart disease. Int J Clin Pharmacol Ther Toxicol 27:12:569-77, 1989.
38. D’Aquino M, Benedetti PC, Di Felice M, Gentili V, et al.: Effect of fish oil and coconut oil on antioxidant defence system and lipid peroxidation in rat liver. Free Radic Res Commun 12-13 Pt 1:147-152, 1991.
39. de Deckere EA: Possible beneficial effect of fish and fish n-3 polyunsaturated fatty acids in breast and colorectal cancer. Eur J Cancer Prev 8:3:213-21, 1999.
40. de Deckere EA, Korver O, Verschuren PM, Katan MB: Health aspects of fish and n-3 polyunsaturated fatty acids from plant and marine origin. Eur J Clin Nutr 52:10:749-753 , 1998.
41. Dehmer GJ, Popma JJ, van den Berg EK, Eichhorn EJ, et al.: Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Engl J Med 319:12:733-40 (1988)
42. Deutch B, Bonefeld Jørgensen E, Hansen JC: Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (Fishoil or Sealoil)
43. Rome: Women’s Health in the Year 2000 (conf. paper:1 (1998)
44. Deutch B, Jørgensen EB, Hansen JC: N-3 PUFA from fish-oil or seal-oil reduce atherogenic risk indicators in Danish women. Nutrition Research 20:8:1065-1077 (2000)
45. Deutch B, Jørgensen EB, Hansen JC: Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA (fish-oil or seal-oil) and B12. Nutrition Research 20:5:621-631 (2000)
46. Deutch B: Menstrual pain in Danish women correlated with low n-3 polyunsaturated fatty acid intake. European Journal of Clinical Nutrition 49:7:508-16 (1995)
47. DeLuca P, Rothman D, Zurier RB: Marine and botanical lipids as immunomodulatory and therapeutic agents in the treatment of rheumatoid arthritis. Rheum Dis Clin North Am 21:3:759-77 (1995)
48. Dolecek TA: An ongoing evaluation of dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. Omega 3 News 7:4:1-3 (1992)
49. Dyerberg J: Bioavailability of n-3 fatty acid formulations. Annual Meeting, Eur Soc for Clin Invest:1-2 (1995)
50. El Boustani S, Colette C, Monnier L, Descomps B, et al.: Enteral absorption in man of eicosapentaenoic acid in different chemical forms. Lipids 22:10:711-4 (1987)
51. Endres S, Ghorbani R, Kelley VE, Georgilis K, et al.: The effect of dietary supplementation with n-3 PUFA’s on the synthesis of interleukin-1 and TNF… N Engl J Med 320:5:265-71 (1989)
52. Espersen GT, Grunnet N, Lervang HH, Nielsen GL, et al.: Decreased interleukin-1 beta levels in plasma from rheumatoid arthritis patients after dietary supplementation. Clin Rheumatol 11:3:393-5 (1992)
53. Fahrer H, Hoeflin F, Lauterburg BH, Peheim E, et al.: Diet and fatty acids: can fish substitute for fish oil? Clin Exp Rheumatol 9:4:403-6 (1991)
54. Fernandez E, Chatenoud L, La Vecchia C, Negri E, et al.: Fish consumption and cancer risk. Am J Clin Nutr 70:1:85-90 (1999)
55. Fish oil: Lancet 1:8594:1081-3 (1988)
56. Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, et al.: Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acut … Crit Care Med 27:8:1409-20 (1999)
57. Geusens P, Wouters C, Nijs J, Jiang Y, et al.: Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. A 12-month, double-blind, contr … Arthritis Rheum 37:6:824-9 (1994)
58. Gibson RA: The effect of diets containing fish and fish oils on disease risk factors in humans. Aust N Z J Med 18:5:713-22 (1988)
59. Gogos CA, Ginopoulos P, Salsa B, Kalfarentzos F, et al.: Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely… Cancer 82:2:395-402 (1998)
60. Grimsgaard S, Bønaa KH, Hansen JB, Myhre ESP: Effects of highly purified eicosapentaenoic acid and docosahexaenoic acid on hemodynamics in humans. Am J Clin Nutr 68:52-59 (1998)
61. Grubb BP: Hypervitaminosis A following long-term use of high-dose fish oil supplements. Chest 97:5:1260 (1990)
62. Guallar E, Hennekens CH, Sacks FM, Willett WC, et al.: A prospective study of plasma fish oil levels and incidence of myocardial infarction in U.S. male physicians. J Am Coll Cardiol 25:2:387-94 (1995)
63. Haglund O, Wallin R, Luostarinen R, Saldeen T: Effects of a new fluid fish oil concentrate, ESKIMO-3, on triglycerides, cholesterol, fibrinogen and blood pressure. J Intern Med 227:5:347-53 (1990)
64. Haglund O, Luostarinen R, Wallin R, Wibell L, et al.: The effects of fish oil on triglycerides, cholesterol, fibrinogen and MDA in humans supplemented with vitamin E. J Nutr 121:2:165-9 (1991)
65. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL: Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents Am J Obstet Gynecol 174:1335-38 (1996).
66. Harris WS. n-3 Long-chain polyunsaturated fatty acids reduce risk of coronary heart disease death: extending the evidence to the elderly. Am J Clin Nutr 2003;77 279-280.
67. Hartmann G, Endres S: n-3 polyunsaturated fatty acids and human cytokine synthesis. In: Handbook of Essential Fatty Acid Biology (Yehu:Chapt. 5:103-113 (1997)
68. Heller A, Koch T, Schmeck J, van Ackern K: Lipid mediators in inflammatory disorders. Drugs 55:4:487-96 (1998)
69. Hibbeln JR: Fish consumption and major depression. Lancet 351:1213 (1998)
70. Hodge L, Salome CM, Peat JK, Haby MM, et al: Consumption of oily fish and childhood asthma risk see comments. Med J Aust 164:3:137-40 (1996)
71. Hogg RJ: A randomized, placebo-controlled, multicenter trial evaluating alternate-day prednisone and fish oil supplements. Am J Kidney Dis 26:5:792-6 (1995)
72. Hogg RJ: A randomized, placebo-controlled, multicenter trial evaluating alternate-day prednisone and fish oil supplements. Am J Kidney Dis 26:5:792-6 (1995)
73. Holm T, Andreassen AK, Aukrust P, Andersen K, et al.: Omega-3 fatty acids improve blood pressure control and preserve renal function in hypertensive heart transplant… Eur Heart J 22:5:428-36. (2001)
74. Holub B, Hunter E: Health effects of fish, fish oils. JAOCS 65:11 (Nov):1722-1726 (1988)
75. James MJ, McClelland LG: Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum 27:2:85-97 (1997)
76. James MJ, Gibson RA, Cleland LG: Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr 71 (suppl):1 (s):343s-8s (2000)
77. Kaasgaard SG, Hølmer G, Høy CE, Behrens WA, et al.: Effects of dietary linseed oil and marine oil on lipid peroxidation in monkey liver in vivo and in vitro. Lipids 1992 27:10:740-5 (1992)
78. Kang JX, Leaf A: Prevention of fatal cardiac arrhythmias by polyunsaturated fatty acids. Am J Clin Nutr 71:1 S:202S-07S (2000)
79. Knapp HR, FitzGerald GA: The antihypertensive effects of fish oil. A controlled study of PUFA supplements in essential hypertension. N Engl J Med 320:16:1037-43 (1989)
80. Kromhout D: Fish consumption and sudden cardiac death (Editorial). JAMA 279:65-66 (1998)
81. Kremer JM, Jubiz W, Michalek A, Rynes RI, et al.: Fish-oil fatty acid supplementation in active rheumatoid arthritis. Ann Intern Med 106:4:497-503 (1987)
82. Kremer JM, Lawrence DA, Petrillo GF, Litts LL, et al.: Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthritis Rheum 38:8:1107-14 (1995)
83. Kremer JM: n-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr 71:1 Suppl:349S-51S (2000)
84. Kremer JM, Lawrence DA, Jubiz W, DiGiacomo R, et al.: Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum 33:6:810-20 (1990)
85. Kelley DS, Bendich A: Essential nutrients and immunologic functions. Am J Clin Nutr 63:6:994S-996S (1996)
86. Kramer TR, Schoene N, Douglass LW, Judd JT, et al.: Increased vitamin E intake restores fish-oil-induced suppressed blastogenesis of mitogen-stimulated T lymphocytes. Am J Clin Nutr 54:5:896-902 (1991)
87. Kremer JM, Bigauoette J, Michalek AV, Timchalk MA, et al.: Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet 1:8422:184-7 (1985)
88. Kremer JM: Effects of modulation of inflammatory and immune parameters in patients with rheumatic and inflammatory disease receivin. Lipids 31 Suppl:S243-7 (1996)
89. Kremer JM: Clinical studies of omega-3 fatty acid supplementation in patients who have rheumatoid arthritis. Rheum Dis Clin North Am 17:2:391-402 (1991)
90. Kinsella JE: Dietary n-3 polyunsaturated fatty acids of fish oils, autoxidation ex vivo and peroxidation in vivo: implications. Adv Exp Med Biol 289:255-68 (1991)
91. Kudo N, Kawashima Y: Fish oil-feeding prevents perfluorooctanoic acid-induced fatty liver in mice. Toxicology & Applied Pharmacology 145:2:285-93 (1997)
92. Laganiere S, Yu BP, Fernandes G: Studies on membrane lipid peroxidation in omega-3 fatty acid-fed autoimmune mice: effect of vitamin E supplementatio. Adv Exp Med Biol 262:95-102 (1990)
93. Landmark K, Abdelnoor M, Urdal P, Kilhovd B, et al.: Use of fish oils appears to reduce infarct size as estimated from peak creatine kinase and lactate dehydrogenase activiti… Cardiology 89:2:94-102 (1998)
94. Lavine JB: Blood pressure and cholesterol in fish-eaters versus vegetarians (Letter) Lancet 348:1460 (1996)
95. Leaf A, Weber PC: Cardiovascular effects of n-3 fatty acids. New England Journal of Medicine 318:9:549-557 (1988)
96. Lee TH, Arm JP: Benefits from oily fish – may help in coronary artery disease and several inflammatory conditions. BMJ 297:1421-22 (1988)
97. Lund E, Bønaa KH: Reduced breast cancer mortality among fishermen’s wives in Norway. Cancer Causes Control 4:3:283-7 (1993)
98. Margolin G, Huster G, Glueck CJ, Speirs J, et al. Blood pressure lowering in elderly subjects: a double-blind crossover study of omega-3 and omega-6 fatty acids. Am J Clin Nutr 53:2:562-72 (1991)
99. Malasanos TH, Stacpoole PW Biological effects of omega-3 fatty acids in diabetes mellitus. Diabetes Care 14:12:1160-79 (1991)
100. Mayser P, Mrowietz U, Arenberger P, Bartak P, et al.: Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomi… Journal of the American Academy of Dermatology 38:4:539-47 (1998)
101. McCarty MF: Vascular heparan sulfates may limit the ability of leukocytes to penetrate the endothelial barrier–implication. Med Hypotheses 51:1:11-5 (1998)
102. Marchioli R, Tognoni G, GISSI Prevention Study, Valagussa F: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction. Lancet 354:447-455 (1999)
103. Maurice PD, Allen BR, Barkley AS, Cockbill SR, et al.: The effects of dietary supplementation with fish oil in patients with psoriasis. Br J Dermatol 117:5:599-606 (1987)
104. Mori TA, Burke V, Puddey IB, Watts GF, et al.: Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL.. Am J Clin Nutr 71:5:1085-94 (2000)
105. Miller CC, Tang W, Ziboh VA, Fletcher MP: Dietary supplementation with ethyl ester concentrates of fish oil (n-3) and borage oil (n-6) polyunsaturated fatty ac. J Invest Dermatol 96:1:98-103 (1991)
106. Meydani M, Natiello F, Goldin B, Free N, et al.: Effect of long-term fish oil supplementation on vitamin E status and lipid peroxidation in women. J Nutr 121:4:484-91 (1991)
107. Navarro E, Esteve M, Olive A, Klaassen J, et al.: Abnormal fatty acid pattern in rheumatoid arthritis. A rationale for treatment with marine and botanical lipids. J Rheumatol 27:2:298-303 (2000)
108. Nordvik I, Myhr KM, Nyland H, Bjerve KS: Effect of dietary advice and n-3 supplementation in newly diagnosed MS patients. Acta Neurol Scand 102:3:143-9 (2000)
109. Nøding R, Schønberg SA, Krokan HE, Bjerve KS: Effects of polyunsaturated fatty acids and their n-6 hydroperoxides on growth of five malignant cell lines and th… Lipids 33:3:285-93 (1998)
110. O’Connor TP, Roebuck BD, Peterson F, Campbell TC: Effect of dietary intake of fish oil and fish protein on the development of L-azaserine-induced preneoplastic lesions. J Natl Cancer Inst 75:5:959-62 (1985)
111. Oomen CM, Feskens EJ, Rasanen L, Fidanza F, et al.: Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands. Am J Epidemiol 151:10:999-1006 (2000)
112. Olsen SF, Sørensen JD, Secher NJ, Hedegaard M, et al.: Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration. Lancet 339:8800:1003-7 (1992)
113. Olsen SF, Secher NJ, Tabor A, Weber T, et al.: Randomised clinical trials of fish oil supplementation in high risk pregnancies. Fish Oil Trials In Pregnancy (FOTIP). BJOG 107:3:382-95 (2000)
114. Opstvedt J: Fish lipids: more than n-3 fatty acids? Med Hypotheses 48:6:481-3 (1997)
115. Rozenn N Lemaitre, Irena B King, Dariush Mozaffarian, Lewis H Kuller, Russell P Tracy, and David S Siscovick. n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Am J Clin Nutr 2003;77 319-325.

Joseph E. Pizzorno Jr., Michael T. Murrey & Melvyn R. Werbach.