AMSEL: Dear Professor Buttmann, what is the reason for this warning?
Buttman: 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 finding by the European Health Authority (EMA) that people with cardiovascular or Risk factor’s By taking it, the risk of the appearance of so-called atrial fibrillation increases. A cardiac arrhythmia that often goes unnoticed can be dangerous because, among other things, it can increase the risk of suffering a stroke.
AMSEL: How did health authorities arrive at this risk assessment?
Buttman: The basis for the official warning was, 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. All three articles found that taking omega-3 fatty acid supplements versus a placebo, i.e. Fake medicines Without the active substance, the risk of atrial fibrillation can increase by a total of 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?
Buttman: No. On the one hand, it was observed that the risk of taking dose depends. The risk was highest when 4000 mg per day was taken. On the other hand, a total of 80,000 people participated in the aforementioned studies, most of whom suffered from cardiovascular diseases or risk factors, 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 think probably at least not to the same extent.
AMSEL: Based on the current state of science, what benefit do omega-3 fatty acid preparations have for multiple sclerosis?
Buttman: Opinions differ there. Personally, I base my recommendations on what I consider reliable scientific evidence. To date, several randomized controlled therapy studies have been conducted. EM Studies were carried out, however, they were of very different size and study quality, and different doses were also tested. If interpreted with understanding, you can sometimes see a positive trend in favor of taking these preparations, but certainly no clear effect. In a more strict 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 consultation?
Buttman: I continue to recommend, above all, a healthy and balanced diet. I would like to clarify that to date no nutritional supplement has been proven beyond a doubt to be beneficial for multiple sclerosis. The same applies to vitamin D3, of which up to 4,000 IU per day can probably be taken safely and with possible benefits 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 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. Based on current studies, it is probably possible to take up to 1000 mg a day without any problems, 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, contain a relatively high amount of Omega 3. Should we be careful with the dosage or is there no danger if we consume the usual amount?
Buttman: There is certainly no danger if the usual quantities are consumed. Nutritional recommendations for MS do not change. The only thing to take into account are food supplements with high doses of omega 3, which do not seem to be completely unimportant, at least in the conditions mentioned above.
AMSEL: Thank you very much and greetings to the Caritas hospital in Bad Mergentheim!