AMSEL: Dear Prof. Buttmann, what is this warning about?
Butman: On November 16, 2023, manufacturers of medicines containing omega-3 fatty acids published the so-called Red Hand Letter in coordination with health authorities. This informs the medical community about the newly recognized risks of taking medications containing omega-3 fatty acids. This was preceded by a conclusion from the European Health Authority (EMA) that people with cardiovascular diseases or Risk factors The risk of so-called atrial fibrillation increases when taking it. An often unnoticed cardiac arrhythmia can be dangerous because, among other things, it can increase the risk of stroke.
AMSEL: How did health authorities arrive at this risk assessment?
Butman: The basis for the official warning were, in particular, three large meta-analyses published in 2021 and 2022, in each of which a series of controlled studies on this issue were summarized and scientifically analyzed. The three papers found that taking omega-3 fatty acid supplements versus a placebo, i.e. Simulated medication without active ingredient, the risk of atrial fibrillation can increase overall by 32 to 49%, that is, up to one and a half times. However, an increased risk of stroke could not be proven.
AMSEL: Does this increased risk affect everyone equally?
Butman: No. On the one hand, it was observed that the risk of taking dose It depends. The risk was greatest when taking 4,000 mg per day. On the other hand, a total of 80,000 people were included in the aforementioned studies, the majority of whom had cardiovascular diseases or risk factors for them, namely high levels of lipids in the blood. Other risk factors include: high pressure, diabetes, high cholesterol or smoking. It is not known whether the risk of atrial fibrillation is increased with omega-3 fatty acid supplements without these risk factors. I would think probably at least not to the same extent.
AMSEL: Based on the current state of science, what benefits do omega-3 fatty acid preparations have for multiple sclerosis?
Butman: Opinions differ there. Personally, I base my recommendations on what I consider to be reliable scientific evidence. To date, there have been several randomized, controlled therapy studies IN performed, which, however, were of very different study size and quality, and different dosages were also tested. If interpreted sympathetically, one can sometimes see a positive tendency in favor of taking these preparations, but certainly no clear effect. With a stricter interpretation, it must be said that there is currently no reliable evidence from clinical studies proving a benefit.
AMSEL: What advice do you give people with MS during your consultation?
Butman: I continue to recommend, first and foremost, a healthy and balanced diet. I would like to clarify that, to date, no nutritional supplement has been proven to be beneficial for multiple sclerosis. This also applies to vitamin D3, of which probably up to 4,000 IU per day can be taken safely and with possible benefit in the winter months, or alternatively 20,000 IU once a week. I actively and clearly recommend ultra-high doses of vitamin D3 because of the dangers associated with it. My underlying assessment is based on published case reports of sometimes dangerous side effects, although I have not yet seen any scientific evidence of benefit. I will now tend to advise against omega-3 preparations, about which I was previously neutral, at least at higher dosages and if the risk factors mentioned above are present. According to current studies, taking up to 1,000 mg per day is probably possible without any concerns, even with such risk factors, but I also think the benefit is questionable.
AMSEL: What does this mean for nutrition? Certain types of fish such as tuna and oils such as flaxseed oil contain a relatively high amount of Omega 3. Should you be careful with the dosage or is there no danger if you consume the usual amount?
Butman: There is certainly no danger here if the usual quantities are consumed. Nutritional recommendations for MS do not change. The only thing that needs to be considered is high dose omega-3 dietary supplements, which do not appear to be completely uncritical, at least in the conditions mentioned above.
AMSEL: We would like to thank you very much and send greetings to Caritas Hospital Bad Mergentheim!