AMSEL: Dear Prof. Buttmann, what is this warning about?
Buttmann: On November 16, 2023, the 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 recently recognized risks of taking medicines containing omega-3 fatty acids. This was preceded by a finding by the European Health Authority (EMA) that people with cardiovascular disease or Risk factors The risk of the so-called atrial fibrillation occurring increases with its intake. Such 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?
Buttman: The basis for the official warning are in particular three large meta-analyses published in 2021 and 2022, in each of which a series of controlled studies on this topic were summarized and scientifically analyzed. The three articles found that taking omega-3 fatty acid supplements compared to a placebo, e.g Dummy drug without the active ingredient the risk of atrial fibrillation can increase overall by 32 to 49%, i.e. up to one and a half times. However, an increased risk of stroke could not be demonstrated.
AMSEL: Does this increased risk affect everyone equally?
Buttmann: NO. On the one hand, it was noted that the risk of taking dose Depends. The risk was greatest when taking 4,000 mg per day. In the studies cited, a total of 80,000 people were involved, the majority of whom had cardiovascular diseases or risk factors for them, in particular a high level of lipids in the blood. Other similar risk factors include: hypertension, diabetes, high cholesterol or smoking. It is not known whether the risk of atrial fibrillation is increased by omega-3 fatty acid supplements without such 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 provide for multiple sclerosis?
Buttmann: Opinions differ there. I personally base my recommendations on what I consider to be reliable scientific evidence. To date, several randomized controlled trials have been conducted on the therapy SM conducted, which however were of very different size and study quality, and different dosages were also tested. If interpreted comprehensively, one can sometimes see a positive trend in favor of taking these preparations, but certainly no noticeable effect. With a more rigorous interpretation, it must be said that there is currently no reliable evidence from clinical studies demonstrating a benefit.
AMSEL: What advice do you give to people with MS during your counseling?
Buttmann: I continue to recommend a healthy and balanced diet first and foremost. I would like to clarify that to date no dietary supplement has proven beyond doubt to be beneficial for multiple sclerosis. This also applies to vitamin D3, of which up to 4,000 IU per day in the winter months can probably be taken safely and with possible benefits, 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 basic assessment is based on published case reports of sometimes dangerous side effects, while I have yet to see any scientific evidence of a benefit. I will now tend to advise against omega-3 preparations, on which I was previously neutral, at least at higher doses and if the risk factors mentioned above are present. According to current studies it is probably possible to take up to 1,000 mg per day even with such risk factors without problems, but I also think the benefit is questionable.
AMSEL: What does this mean for nutrition? Some types of fish such as tuna and oils such as linseed oil contain a relatively high amount of Omega 3. Do you have to be careful with the dosage or is there no danger if you consume the usual amount?
Buttmann: There is certainly no danger if you consume the usual quantities. Nutritional recommendations for MS do not change. The only thing to consider are high-dose omega-3 dietary supplements, which do not appear to be entirely uncritical, at least in the conditions mentioned above.
AMSEL: We would like to thank you very much and send you our regards to the Caritas Hospital Bad Mergentheim!