Omega-3 & Acupuncture

A New Look at Controversial Therapies

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Journal Highlights

A pair of recently published studies has shed new light on two controversial therapies—omega-3 fatty acids to prevent heart disease[1] and acupuncture for pain relief.[2]

The first study is a large meta-analysis of nearly 70,000 patients who took omega-3 polyunsaturated fatty acids (PUFAs) as either supplements or from dietary sources (oily fishes such as salmon and sardines) to prevent secondary cardiovascular disease.   Various hypotheses have been put forth as to why omega-3s might improve cardiovascular outcomes, ranging from their ability to lower triglyceride levels, prevent serious arrhythmias, or even decrease platelet clumping and lower blood pressure.

Current guidelines issued by major societies recommend the use of omega 3s either as supplements or from dietary sources after a heart attack.  While FDA does not regulate dietary supplements, prescription-strength omega-3s are approved only to treat hypertriglyceridemia.  Some, but not all European national regulatory agencies have approved prescription-strength omega-3s for modifying cardiovascular risk.  The controversy stemming from the varying labeling indications causes ‘confusion in everyday clinical practice about whether to use these agents for cardiovascular protection,’ according to background information in the article.

Twenty studies were included in the meta-analysis, reflecting 68,630 patients.  All but two of the studies analyzed supplements as the source of omega-3s, and the average supplement dose was 1.51 grams per day taken for an average of two years. When all supplement studies were analyzed, there was no statistically significant association with all-cause mortality, cardiac death, sudden death, heart attack, and stroke.

According to the authors, these findings do not justify the use of omega-3s as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 PUFA administration.

What Can You Tell Patients?  No doubt many of your patients are among those Americans who spent $1.1 billion on omega-3 supplements in 2011—an increase of 5.4% from 2010, according to estimates from the Nutrition Business Journal.  This is a good opportunity to remind patients not to rely solely on supplements to prevent cardiovascular disease.   As the meta-analysis did not reveal any adverse effects from the consumption of omega-3s, they should be considered one component of a healthy lifestyle alongside smoking cessation, exercise, and eating lots of whole grains and vegetables.  And as we’ve learned from studies of antioxidant supplements, consumption of foods rich in vitamins and minerals—in this case, oily fishes, walnuts, and flax seed oil, may confer health benefits that supplements cannot.

Needle in a Haystack?

In the second study, a research team from the Memorial Sloan-Kettering Cancer Center sought to determine the effect size of acupuncture for chronic pain conditions when compared with sham acupuncture or controls (standard care).  Sham acupuncture involves the placement of needles inserted only superficially or placed in locations outside of key treatment points.

Published in the Archives of Internal Medicine, this very large and rigorous meta-analysis included 29 randomized control trials representing almost 18,000 patients from various parts of the world.

The researchers found that acupuncture outperformed sham treatments and standard care when used by people with osteoarthritis, migraines and chronic back, neck and shoulder pain.  The researchers were able to determine that 50% of true acupuncture patients experienced pain relief, compared with 42% of patients who underwent sham acupuncture and 30% of the controls.

What Can You Tell Patients?  According to background information in the article, more than 3 million Americans use acupuncture, but it is even more popular in other countries. In France, for example, one in five people has tried acupuncture. Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects.  And while acupuncture may not provide sustained pain relief, it may offer effective short-term relief when used alongside mainstream pain management.  Remind patients that Medicaid and Medicare often do not cover acupuncture, so they may end up having to pay out-of-pocket.

 

Jill Shuman, MS, ELS
Published on October 9, 2012

 

References

  1. Rizos EC, Nitzani EE, Bika E, Kostapanos MS, Elisaf MS, et al.  Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events.  JAMA. 2012;308(10):1024-1033.
  2. Vickers AJ, Cronin AM, Maschino AC, et al.  Acupuncture for chronic pain.  Individual patient data meta-analysis.  Arch Int Med. 2012; Sept 10 (online before print).