3/3 TOP-Selling US Fish Oils Exceed Maximal Peroxide and Total Oxidation Levels - Levels Roughly 4000% Higher Than in Medical Grade N3 Supplements, Harvard Study Shows

The US' favorite fish oil supplements: Dirt cheap and still not worth the money. Better buy fish - fresh fish.

"I told you so!" That's how someone else in my position would probably start today's blogpost. In view of the fact that "smartassing" is not exactly an effective means of education, I will yet refuse from reminding you that I've been reporting about unwanted side effects of the gold-ish pills that claim to have "fish oil" in them on various occasions.

And guess what!? The publication of a recent study by scientists from the Cardiovascular Division, Brigham and Women's Hospital at the venerable Harvard Medical School, gives me yet another reason to rant against the evermore popular fish oil supplements.

You can learn more about omega-3 & co at the SuppVersity

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In their study, the scientists analyzed 3 commonly available fish oil dietary supplements and found that (a) their level of omega-3 fatty acids varied significantly, that (b) they contained tons of other fats that you would ask to be paid for to consume if you knew about them and, that (c) the caps were so full of oxidized fats that they exceeded international standards and may (d) may harm, rather than help with your health.

No, we're not talking about cheap Chinese internet purchases, bro!

The Harvard scientists bought the "three top-selling fish oil DS [dietary supplements] in the United States and to examine the extent of oxidative damage in the DS as compared with chemically characterized standards with respect to purity and ability to prevent human sdLDL oxidation in vitro" (Mason. 2016). The commonly heard excuse that this is "just a problem with the cheap Chinese stuff" is thus as useless as it is ridiculous in view of the data from the study at hand.

Figure 1: The TOP3 US fish oil products are rancid... well, mostly (right hand side) and they have almost no ability to prevent human LDL particles from oxidation, as the results of the MDA test on the left indicates (Mason. 2016).

Compared to the medical grade control, the US top-sellers look as if they had been tainted with motor oil from a fishing cutter. Speaking of which: I would not guarantee that the 34%, 21% and 24% of "other oils" in this so-called dietary supplements do not include at least tiny amounts of mineral oils.

Your fish oil contains 4000% more oxidized fats than prescription fish oil! That's a huge problem, because many of the studies you're so fond of, because they seem to prove how healthy fish oil is, have been done with medicinal grade fish oils. Accordingly, the results of these studies have ZERO predictive power with respect to what your "machine oil" fish oil will do to your health. Speaking of "your" - it is not impossible that the oxidative damage occured during storage, which reminds me to remind you NEVER to use fish oil in a bottle that's constantly exposed to pro-oxidative oxygen, whence you've opened the bottle. Note: If stored in the fridge (4°C) the shelf life of the fish oil in fresh fish is, as Boran et al. show in their 2006 paper in Food Chemistry ~ 90 days.

In fact, the scientists measured not just primary oxidation products, as the highly elevated peroxide levels, an indicator of high levels of primary oxidation and hydroperoxides, confirm, but also secondary products of the decomposition of the primary oxidation products during continued exposure to oxidative conditions, as they ar detected in the p-anisidine test.

Figure 2: Indeed, there was also some "fish oil" in the caps - emphasis on "also" and "some" (Mason. 2016)!

The total oxidation levels in Figure 1 were then derived from the peroxide and anisidine values indicate without fail that "[a]ll three DS exceeded the recommended maxima for peroxide and total oxidation values (5 meq/kg and 26, respectively) when normalized to 1 g OM3FA (based on the number of capsules needed to achieve 1 g of OM3FA)" (Mason. 2016). The latter is particularly shocking in view of the fact that the prescription product of pure OM3FA did not contain significant levels of these oxidation products under identical test conditions. Any studies on the health effects of fish oil - mostly conducted with medical grade capsules - is thus meaningless for the average consumer who shies away from the exorbitant costs of LOVAZA and co. - a bad mistake, as it turns out, now, that the Harvard scientists' study shows that EPA and DHA containing oxidized trash fats from the dietary fish oil supplements have a >77% reduced ability to protect your LDL oxidation from (>90% protection for pure products, a meager 21 ± 4% for the "fish oil" you have probably been buying for years).

Speaking of "for years": Is it possible that you've done more harm than good in the past years of consuming copious amounts of fish oil to your health? Yes, it is, but in view of the fact that even the "motor oil" version of fish oil in the average US dietary fish oil supplement (the brand names are obviously undisclosed = not mentioned in the paper) was still anti- and not pro-oxidative, it's more likely that you have only wasted time and money.

Only three brands, but unfortunately in line with previous research: The scientists make no secret of the fact that a major limitation of their study "is that, although [they] evaluated the top-selling DS in the United States, [they] only assessed three products given the scope of this initial investigation" (Mason. 2016). Bad luck for fish oil fans: e results of this study are consistent with previously published analyses of DS with respect to content and oxidative damage" (ibid.) - studies that didn't just find oxidized fatty acids, but also heavymetals and cholesterol in the pills.

So what do we make of these results? Well, I guess it depends on how indoctrinated you've already been about fish oil being an essential supplement (the word "supplement" already implies that it cannot be essential). If you actually believe in the magic of fish oil (imho bogus for healthy individuals), you should go and buy pharma grade fish oil spending your whole monthly supplement budged on fish. If, on the other hand, you've any sanity left, you simply do what I've been recommending for years: eat your fatty fish once or twice per week (doesn't have to be wild-caught | Farmed Fish is Less Poluted and Has More Omega-3) | Comment!

References:

• Boran, Gökhan, Hikmet Karaçam, and Muhammet Boran. "Changes in the quality of fish oils due to storage temperature and time." Food chemistry 98.4 (2006): 693-698.
• Mason, PR and Sherrat SCR. "Omega-3 fatty acid fish oil dietary supplements contain saturated fats and oxidized lipids that may interfere with their intended biological benefits." Biochemical and Biophysical Research Communications - Available online 21 December 2016 | In Press, Corrected Proof

Will "Muscle Building Supplements" Give You Testicular Germ Cell Cancer? Creatine & Protein Stand in the Pillory

The study at hand makes protein and creatine look worse than prohormones - can that be right?

Maybe you've already seen a link to this study on Facebook, maybe not: "Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts" - that's the title of a study which claims to provide convincing evidence that "MBS use is a potentially modifiable risk factor that may be associated with TGCC" (Li. 2015), a study of which I don't have to tell you that it is of observational nature, a study based on interviews with 356 cases and 513 controls and thus a study that may and certainly is skewed by false recalls and deliberate lies - I mean, who would admit to have used illegal steroids if at Yale? Some may, but others certainly won't.

With dairy proteins being beststeller, the study is also an assault on whey & casein

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That being said, reason #1 to take the results of the study with the necessary skepticism is a combination of false recall and flat-out lies / not disclosing one's complete "supplement" regimen. Moreover, the fact that the subjects were asked about a finite set of 30 different types of MBS powders or pills which certainly didn't include powerful designer steroids made it even easier for the study subjects to conceal some o the "supplements" (haha) they actually took. Against that background it's a bold claim to say that

"Considering the magnitude of the association and the observed dose-response trends, muscle-building supplements use may be an important and modifiable exposure that could have important scientific and clinical importance for preventing testicular germ cell cancer development if this association is confirmed by future studies" (Li. 2015).

That's even more true in view of the fact that lies and recall errors are one thing that hampers the reliability of the results, while a statistically significant difference in the rate of (again) reported injuries to the groin which has long been shown to increase the risk of testicular cancer (Coldman. 1982; Oliver. 1994) is another one and reason #2 to take the results of this study with appropriate skepticism.

No, creatine does not give you cancer due to elevated DHT. As you know from a previous SuppVersity article, the increase in DHT that was observed in only one study may be statistically significant, but physiologically irrelevant (learn more).

The fact that the 95% confidence levels (95% CI: 1.11–2.46 total cancer risk, 95% CI: 1.34–3.63 cancer before 25, 95% CI: 1.39–4.74 long-term use) adds another question mark to the claim that using creatine once or regularly is going to give you germ cell cancer.

Figure 2: While both undescended testes and injuries to testes and groin can increase the risk of testicular cancer, only the latter shows a statistical significant inter-group difference between cases and controls (Li. 2015).

In conjunction with reason #3 which is the fact that there is absolutely no mechanism that would explain pro-carcinogenic effects of non-steroidal supplements in general and creatine and protein supplementation in particular (creatine has even been shown to inhibit breast cancer and general tumor growth | Miller. 1993; Juhn. 1998 and anti-tumor effects mostly in the colon, though, of whey protein have been reported among others by  Eason, 2004; Xiao, 2005 & 2006; Parodi, 2007; Attaallah, 2012; etc.), you may even call it "bad science" or "sensationalism" that that none of the several "reviews" of this study on the Internet mention the most important of all findings, which is the non-significance of the results of the TGCC subtype analysis and reason #4:

"Analyses by TGCC subtype suggested similar associations between use of MBS and the risk of seminoma and nonseminoma  (all the P-values for hierarchical coefficients tests were >0.05)."

Against that background I would be curious how the scientists were able to do an exploratory stratified analysis which found that "both creatine and proteins increased the risk of TGCC significantly (OR =2.55, 95% CI: 1.05–6.15)" (Li. 2015).

Table 1: Association Between MBS Use and the Risk of TGCC, Connecticut and Massachusetts, 2006–2010 (Li. 2015).

That sounds very odd considering the facts that (a) no associations were found for a complete analysis, that (b) there's no mention what exactly the data was stratified for and that (c) no previous epidemiological study provides the slightest hint that there may be a potentially causal association between supplement use and testicular cancer.

Speaking of causality, you are aware that the "odds ratios" from the case-control study like the one at hand provide extremely weak evidence? Evidence that cannot provide any information about cause and effect? If that's not your first visit to the SuppVersity you probably knew that already. If it's not, I believe it may be worth remembering that correlation and causation are two different pairs of shoes; or, like my friend Carl Lanore likes to explain it: Just because there are firefighters all over the place, whenever a house burns down (association), they're not the cause of the fire (causation).

Learn more about the old-wife's tale about creatine, DHT and hair loss.

Overall, it's probably rather the Yale and Harvard labels than the quality of the data that made this study pop up all over the Internet. With less than 1000 subjects, a possible reporting bias, error of recall, an interview that used a pre-compiled list of agents instead of just asking which product the subjects used and reconciling the data afterwards and the hushed up non-significance of the results of the full agent-specific analysis should be four good reasons not to freak out about possible increase of testicular cancer risk from 0.2% in the general population (Schottenfeld. 1980) to 0.6% which would be the corresponding 155% risk increase Li et al. report for creatine or protein supplements.

If anything, there may be a generally increased risk of prostate cancer due to high(er) protein intakes and correspondingly increased IGF-1 levels as it was observed among others by the scientists who conducted the European Prospective Investigation into Cancer (cf. Key. 2014). If you re-read my previous posts on dairy and cancer risk (article I, article II, article III, article IV), though, you will notice that even this association is a weak one that was observed in some, but by no means all studies on dairy intake and cancer risk. Corresponding evidence for creatine is - in spite of the existence of tons of long-term safety studies for what probably is the best researched ergogenic on the market, simply non-existent | Comment on Facebook!

References:

• Attaallah, Wafi, et al. "Whey protein versus whey protein hydrolyzate for the protection of azoxymethane and dextran sodium sulfate induced colonic tumors in rats." Pathology & Oncology Research 18.4 (2012): 817-822.
• Coldman, A. J., J. M. Elwood, and R. P. Gallagher. "Sports activities and risk of testicular cancer." British journal of cancer 46.5 (1982): 749.
• Eason, Renea R., et al. "Dietary exposure to whey proteins alters rat mammary gland proliferation, apoptosis, and gene expression during postnatal development." The Journal of nutrition 134.12 (2004): 3370-3377.
• Li, N., et al. "Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts." British journal of cancer 112.7 (2015): 1247-1250.
• Juhn, Mark S., and Mark Tarnopolsky. "Potential side effects of oral creatine supplementation: a critical review." Clinical Journal of Sport Medicine 8.4 (1998): 298-304.
• Key, Timothy J. "Nutrition, Hormones and Prostate Cancer Risk: Results from the European Prospective Investigation into Cancer and Nutrition." Prostate Cancer Prevention. Springer Berlin Heidelberg, 2014. 39-46.
• Miller, Elizabeth E., Audrey E. Evans, and Mildred Cohn. "Inhibition of rate of tumor growth by creatine and cyclocreatine." Proceedings of the National Academy of Sciences 90.8 (1993): 3304-3308.
• Oliver, M. C. "Social, behaviouraland medical factors in the aetiology of testicular cancer: results from the UK study." Br. J. Cancer 70 (1994): 513-520.
• Parodi, Peter W. "A role for milk proteins in cancer prevention." Australian journal of dairy technology 53.1 (1998): 37-47.
• Schottenfeld, Davit, et al. "The epidemiology of testicular cancer in young adults." American Journal of Epidemiology 112.2 (1980): 232-246.
• Xiao, Rijin, Thomas M. Badger, and Frank A. Simmen. "Dietary exposure to soy or whey proteins alters colonic global gene expression profiles during rat colon tumorigenesis." Molecular Cancer 4.1 (2005): 1.
• Xiao, Rijin, et al. "Dietary whey protein lowers serum C-peptide concentration and duodenal SREBP-1c mRNA abundance, and reduces occurrence of duodenal tumors and colon aberrant crypt foci in azoxymethane-treated male rats." The Journal of nutritional biochemistry 17.9 (2006): 626-634.

Acute L-Carnitine Tartrate Supplementation Boosts VO2-Max, Fat Oxidation & Endurance in Elite Wrestlers

The VO2-max boosting effects of l-carnitine tartrate can be beneficial for almost every athlete.

After being the hype supplement in the 1990s, carnitine eventually sank into obscurity; and while the revelation that l-carnitine tartrate may increase the androgen receptor density is the main reason it can still be found in various T-boosters and pre-workout supplements, people appear to have forgotten that the original idea of carnitine supplementation was to increase the effectivity of the carnitine shuttle and thus to increase the oxidation of fatty acids.

As a recent study from the Shahid Chamran University in Iran shows, this could be a mistake. After all, Mostafa Dehghani and his colleagues were able to show that "supplementation of L-carnitine improved effectively the performance by increasing in [sic!] lipid metabolism" (Dehgani. 2015).

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But how did the researchers come to this conclusion and are the results relevant for you and me? Well, the first good news is that we are talking about a randomized controlled clinical human study, in which the subjects were not training noobs, but elite wrestlers.

The twenty healthy elite male wrestlers with a mean age of 22.05 ± 2.6 years, mean weight of 77.10 ± 11.65 kg, mean height of 1.79 ± 0.06 m, and mean body mass index of 23.79 ± 2.45 kg/m2 who participated in this single-blind clinical trial were randomly divided into two groups including test and placebo.

• The test group received 3 g of L-carnitine tartrate in 200 ml water and 6 drops of lemon juice.
• The placebo group consumed only 200 ml water and 6 drops of lemon juice.

Both, the active and placebo treatments were administered 90 minutes before performing the so-called Conconi Test for anaerobic and aerobic threshold, a test of lactate threshold using only heart rate (learn more). Blood samples were collected from brachial veins 90 minutes before the activity, immediately after the activity, and 30 minutes after rest and their serum lipids were measured. The results were analyzed using SPSS-16.

Figure 1: The carnitine supplement led to significant increases in VO2 max (fatty acid oxidation) and the maximal distance the subjects were able to cover in the Concoi test (Dehgani. 2015).

Speaking of results: As the previously quoted conclusion already gave away, 3g of l-carnitine tartrate lead to significant improvements in distance run performance. An effect that was probably at least partly mediated by a significant elevations of the the lipid metabolism and VO2 max.

Immediately after the workout there were transient changes in blood lipids that are surprising, but probably not (health-)relevant (Dehgani. 2015).

Overall, the study at hand does therefore appear to confirm the usefulness of l-carnitine tartrate supplementation in athletes. In that, it's very important that the subjects were highly trained wrestlers and not regular couch potatoes, because the former exhibit training-related improvements in the efficacy of the carnitine shuttle, anyway.

What remains to be seen, though, is whether the effects will still be visible after weeks of supplementation. You, as a SuppVersity reader, should know that acute supplement studies can be deceiving. Therefore, it would be great if we had a 6-week study that compared the performance increases in response to standardized training regimens with and without carnitine supplementation | Comment on Facebook!

References:

• Dehghani, Mostafa, et al. "Effects of L-Carnitine L-Tartrate Acute Consumption on Lipid Metabolism, Maximum oxygen consumption (VO2 max), and distance run Following Aerobic Exhaustive Exercise on Treadmill in Elite Athletes wrestling." The AYER 2 (2015): 189-105.