Kitchen Sink "Multi" W/ 55+ Ingredients Doubles Red Blood Cell Accumulation of Fish Oil: Taken With MV 3g of Fish Oil Increase Red Blood Cell DHA + EPA Just as Much as 6g!

If is debatable how beneficial high tissue levels of omega-3s are, but if you are between 50-70 years old and insist on loading your red blood cells and tissue with DHA + EPA, a certain kitchen sink multi may help.
Supplement interactions are either great or dangerous. If they are the former you often call them synergisms. If they are the latter, you will usually call them interference. Whether the latest paper from the Swinburne University of Technology in Australia is about the former, or the latter form of interaction probably depends on your stance with respect to the beneficial effects of high red blood cell and tissue omega-3 levels.

In view of the fact that few people share my skepticism with respect to the possibility that all the "good" fish oil supplements could tip the scale which is currently unbalanced in favor of omega-6 fatty acids into the other direction, I simply assume that calling what Andrew Pipingas et al. observed in a recently conducted human trial a "synergism" has a better chance of majority appeal.
You can learn more about omega-3 & co at the SuppVersity

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Now that I have made sure that you remember articles like "Too Much of a Good Thing: When Fish Oil Starts to Clog Your Arteries (re-read it) or "High Omega-3 Diet Sucks: Intra-Muscular Lipid Ratios Determine Exercise Performance" (re-read this one), it's about time to take a closer look at the actual "news". News that have been published in the peer-reviewed open source journal nutrients; and news that would confirm what most "health" fanatics do already: believe in the power of multivitamin tablets.

In the said study, Pipingas et al. fed their 160 subjects who had been randomized to one of the following four treatment arms (see Figure 1), either 3g (240 mg EPA and 240 mg DHA) or 6g of fish oil (480 mg EPA and 480 mg DHA) and a regular multivitamin supplement, 6g of fish oil alone or placebo supplement.
Figure 1: Graphical overview of the randomization process (Pipingas. 2014)
In accordance with the subjects age, i.e. 50-70 years, the multivitamin products that were selected were the Men's & Women's editions of Swisse Ultivite 50+ a kitchen-sink "multi" with 55+ ingredients (see Figure 4 for the complete ingredient profiles)!
"The sample consisted of 160 healthy male and female volunteers aged 50 to 70 years. Participants were recruited from the general community and were non-smoking volunteers, not currently taking any medication or vitamin/herbal supplements. Exclusion criteria were; diagnosis of dementia, diabetes, neurologic (i.e., Epilepsy, Parkinson’s disease, head trauma) or psychiatric disorders (i.e., depression, schizophrenia), cardiovascular disease (including stroke) or past or present drug or alcohol abuse. Individuals taking anti-coagulant, anti-cholinergic, anti-depressants or acetyl-cholinesterase inhibitors were also excluded. Further exclusion criteria included those currently taking cognitive enhancing supplements regularly and current or long-term multivitamin or fis hoil supplementation." (Pipingas. 2014)
The placebo "fish oil" contained 1000 mg of Sunola Oil and 50 IU of vitamin E administered in a soft gelatin capsule. Sunola oil is a mono-unsaturated, high oleic (n-9) sunflower oil and was chosen as a control given that it is virtually trans-fat free and has a similar profile to olive oil. Small sachets with a few drops of fish oil were included in containers to assist with blinding by providing a fish odour when opened. The placebo multivitamin contained carrot powder with a small amount of riboflavin to produce colouration of the urine similar to the active multivitamin. The placebos were identical to the active tablets in shape, size and colour.
Figure 2:Change for red blood cell fatty acid status over the course of supplementation (Pipinga. 2014). Please mind that the values are shown as percentages of the fatty acid indices, which in turn are percentages - absolute changes are small!
And the results? Well, as you can see in Figure 2 it's hard to ascribe the different effects placebo and active treatment hat on the red blood cell omega-3 levels, above all the levels of EPA and DHA, where the addition of the "cheap" multi made the 3g dosage as potent as the 6g dosage of fish oil, to the "placebo effects".

Aside from the "Kitchen Sink"-sring, I am about to discuss in the bottom line, there is yet another string attached to theses impressive results - a gender-catch, if you will (see Figure 3):
Figure 3: Variability in red blood cell incorporation stratified by treatment allocation for measures of DHA (A), EPA (B), AA/EPA ratio (C) and total n-3 fatty acid (D). EP: eicosapentaenoic acid, DHA: docosahexaenoic acid, AA: Arachidonic acid, FO: fish oil, MV: multivitamin. Circles and stars represent outliers less than 2 and greater than 2 standard deviations from the mean respectively (Pipinga. 2014).
The inter-individual variability you easily see if you take a look at the confidence intervals (boxes) and standard deviations (lines) in Figure 3, is enormous and gender-dependent - a variability that does not remain without consequences:
  • the increase in DHA failed to reach statistical significance,
  • at study endpoint, the total LC n-3 PUFA index was statistically significantly elevated only for those receiving this multivitamin in addition to 6 g of daily fish oil
  • the general observation that women seem to incorporate DHA + EPA more efficiently is thwarted by the extreme inter-individual differences among the female participants
Even if it was not questionable what it is that increases the accumulation of DHA + EPA (see bottom line for more detailed elaborations on this question), it's eventually even questionable to which extent you're going to benefit.
Figure 4: Ingredient profile of the "multivitamin products" that were used in the study at hand (ingredients according to manufacturer website)
Bottom line - Let's take a parting look at these "multivitamins": Based on the experimental evidence from the study at hand, it's quite obvious that this multivitamin will double the effects the use of a regular fish oil supplement will have on the DHA + EPA enrichment of red blood cells, but the use of the word "this" is of paramount importance, here. It's the "on the other hand" that tells you that it's well possible that your multivitamin will not have the same effects, because it does not contain extra 20 mg Actaea racemosa, 1.25 mg Bacopa monnieri, 50 mg Crataegus monogyna, 50mg Curcuma longa, 25 mg Cynara scolymus, 500mg of Gingko biloba, 5 mg phosphatidylserine-enriched soy, as well as vitamin C as ascorbate dihydrate with added citrus bioflavenoids, calcium as orotate, vitamin E as succinate, iron as ferrous fumarate, magnesium as aspartate dihydrate and amino acid chelate mixture and so on and so forth (see Figure 4 for the complete ingredient profiles).

As I have hinted at in the headline of today's SuppVersity article this was thus no ordinary multivitamin suppplement and the effect could be due to any of the 55 herbals, polyphenols, vitamins, minerals and what not. Unfortunately, it's not very likely that Swisse Wellness Pty Ltd., who sponsored the study at hand, will be inclined to sponsor the necessary follow up studies as well.

I mean, it would not be good for business, if it was only one of the common ingredients to elicit this effect... And let's be honest, the statement that the results were "suggesting that some vitamins/minerals aid the incorporation of LC n-3 PUFA into red blood cells" (Pipinga. 2014) is, if anything, testimony to the fact that the scientists did not read the labels of the "multivitamin" supplements they were administering.
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