This is post #112 on the site, about a biased study on fish oil by Brian Peskin. The review attacks the use of fish oil as a supplement and claims that fish oil is worse than trans-fats for health. Ridiculous? More details below.
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I encounter poorly done anti-vitamin research often, covered breathlessly by mass media, TV and online. I have debunked many of those studies before, exposing the bias and poor methodology behind them (see my previous posts on anti-vitamin studies).
This post is about another seriously flawed study, although it didn’t sweep mass media as many other anti-supplement studies have done. This so-called study is having an unfortunate impact on many gullible people in online health and social-media sites, including Linkedin.
Peskin’s fish oil review is built on other poorly done, junk studies that I have already debunked. Because of my experience with those key studies in the review abstract, I knew the review was another work of pseudo-science in a matter of minutes (there were other clues which I address in detail below).
Shortly after seeing the review link posted on Linkedin, I expressed my concerns to Hindawi, the publisher of the study (on September 14, 2014), with some information about its author, Brian Peskin (ironically listed as B.S. Peskin in the review), including his questionable background and legal troubles.
Hindawi is a pay-to-play journal that published this junk study. I also sent Hindawi an additional 5-page rebuttal that undercut many of Peskin’s review claims a few days after my first e-mail. When I followed up, Hindawi stopped responding. I wasn’t sure if they were investigating or not. I hoped they would take the issues seriously but I’m not sure if they are doing anything about the issue. After all, they were probably paid a thousand dollars or more to publish the bogus review. Would they really retract a work of pseudo-science they published? I’m not holding my breath.
Interestingly, Hindawi claims that manuscripts go through a peer review, but as you will soon see, whatever “peer review” they did was rather cursory and lacking in scientific competence. If you get through all the content and links I have compiled below, you will understand how troubling the issues are in this matter. The bottom line is that this review study should never have been published! It’s that unscientific.
Overall, the review is filled with exaggerated claims and non-scientific language (another indication of bias to me), loosely strung together in a wandering style, pumped up with hype and theatrics! It often reads like a piece of political propaganda. Hindawi published the study earlier this year, in 2014, and it undercuts their credibility (more on this later).
Brief Peskin history/bio
I initially found some unsavory history for Brian Peskin. In his recent past, he has been involved in several supplement companies (including one that sells an EFA oil, a competitor to fish oil). Peskin was charged with misrepresenting his credentials and making unproven medical claims for supplements he was involved in by the state of Texas. Peskin signed an injunction and paid a fine of $100,000! The Injunction tells a story of professional misrepresentation, illegal medical claims and other violations (see links below).
A partial history of Peskin’s education and background
Peskin got a degree in Electrical Engineering in 1979 and was appointed as an Adjunct Professor (a part-time/non-salaried, non-tenured position) at Texas Southern University in Houston, Texas. It was for the Department of Pharmacy and Health Sciences for the single academic year of 1998-1999 (which is now 15 years ago). You might wonder how someone with a degree in Electrical Engineering would end up claiming they were some kind of nutritional expert. It’s quite a leap to be sure, even if you include the supplements he worked on.
These links offer some perspective on Peskin’s background and previous work (this rebuttal will demonstrate that little has improved from the negative observations made below):
http://skeptics.stackexchange.com/questions/20455/does-fish-oil-fail
http://www.westonaprice.org/health-topics/brian-peskin-and-essential-fatty-acids/
http://www.westonaprice.org/book-reviews/the-hidden-story-of-cancer-by-brian-s-peskin-and-amid-habib/
http://www.quackwatch.com/11Ind/Peskin/injunction.html
Here are some quick debunks of Peskin’s fish oil claims:
http://fishoilguru.com/benefits-fish-oil/fish-oil-safe/
http://knowledgeofhealth.com/fish-oil-mongers-claim-rebutted-that-pcbs-fish-oil-pills-pose-potential-problems/
I’m including this link early because it does seem to apply to Peskin’s work:
http://www.codex.uu.se/en/etik6.shtml
Debunking Peskin’s biased flimflam review
Let’s start by taking Peskin’s abstract (the study summary) in sections, with each of his exaggerated and biased claims numbered as 1, 2, 3, etc. I need to be more detailed then Peskin’s shallow review is so there is little doubt about its poor quality.
NOTE: Medical and drug researchers often isolate nutrients like vitamins or minerals and place them in the role of drugs, ignoring the fundamentals of nutrition and the need for nutrients to work together as co-factors, along with food and lifestyle. This is one of the main reasons anti-supplement studies appear to have negative outcomes: the starting premise is grossly unscientific.
Anti-supplement studies also fail because researchers use too low or too high dosages, they often choose older subjects who already have established health conditions/diseases, they fail to track critical confounders, and they often use poorly formulated supplements, including using synthetic or less bioavailable supplements. Then they add statistical manipulation and package the biased, sometimes fraudulent work with a spiced-up press release, all to generate exaggerated headlines and to maximize media coverage/buzz.
Only gullible people fall for these poorly-done studies, and that includes many doctors, the public, or anyone else without much nutrition education. The foundation of Peskin’s review is 4 studies he cherry picks because of their apparent negative findings for fish oil. But each study is filled with glaring methodological problems like those I just outlined, problems he seems to utterly miss. Because these 4 studies are the foundation of his review, I will debunk each of them individually and in order.
Peskin review claim #1 (from his abstract)
Claims that fish oil’s EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy) released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention—both primary and secondary.
Right away, you can see that Peskin’s abstract includes unscientific language and exaggeration (words like “crushed” or “conclusive” are not used in this context for research), and in addition, the claim misstates the study’s intent and outcomes. The study was to see if fish oil would reduce the risk of heart disease (HD), which is very different from stopping the progression of existing HD, as measured by multiple endpoints and events in high risk HD/CVD patients. New endpoints were added a year after the study began because fewer subjects died then expected, a classic sign of study bias and manipulation.
Although Peskin’s review also claims this study is “conclusive” the study authors don’t say that, and that’s not how research actually works. Scientific research is a process; it’s ongoing. No single study or review is ever conclusive by itself! The results must be replicated multiple times with large human studies, done by independent researchers over long periods of time (hopefully, several years).
Main study problems: The subjects already had evidence of atherosclerosis and multiple heart disease (HD) risk factors, including high BP, diabetes, obesity, chest pain, stroke/TIA, smokers, age, mostly males, etc. HD, like most chronic disease takes decades to materialize (and this was a pretty sick group, one that no single drug could ever treat, a detail that everyone seems to ignore, including Peskin), subjects were already taking numerous prescription drugs (which often disrupt normal physiology), subjects took olive oil as a placebo (also proven to have anti-inflammatory and anti-oxidant benefits so it wasn’t a true, inactive placebo), the fish oil was a very low dose at 1 gm/day (equal to 1,000 mg) for just a year, typical for what younger, healthy people might take, the fish oil was the less bioavailable “ethyl ester” form (see links below for more detailed analysis), the endpoints were changed after the study began in order to include more conditions because fewer subjects died then the authors expected (because both fish oil and olive oil offer health benefits). The study started in 2004, which was 10 years ago (supplements and health knowledge is much better now so how relevant is this study now?).
Additional study problems: The study was funded by Pfizer and other drug companies (a probable source of bias and influence), and HD like many chronic diseases is multifactorial in origin taking decades of time to materialize. Expecting a low dose of fish oil to treat or reverse 20-30 years of HD/CVD development in a year is not only unscientific, it’s nonsensical.
The study also had several positive outcomes, even at the low doses of fish oil they used, and Peskin’s review ignores those positive outcomes, never mentioning them, in yet another indication of research bias. The study did find that fish oil lowered triglycerides significantly in many subjects and those taking fish oil were about 30% less likely to be hospitalized for heart failure. Women also benefitted significantly from the fish oils in both primary and secondary end points and there was a slight increase in HDL (often called good cholesterol).
The study authors wrote, in part (I excluded some of the content to shorten):
. . .The plasma triglyceride level fell significantly more in patients given n 3 fatty acids [omega-3 fats] than in those who received placebo ( 28.2±1.3 mg per deciliter vs. 20.1±1.3 mg per deciliter, P<0.001). There was a slight increase in the HDL level in patients who received n 3 fatty acids. . .
. . .but there were significantly fewer admissions for heart failure among patients who received n 3 fatty acids than among those who received placebo (96 patients [1.5%] vs. 142 patients [2.3%]. . .and:
In the prespecified subgroup analyses, there was a significant interaction between the efficacy of n 3 fatty acids and sex (P=0.04 for interaction). The event rate for the primary end point was lower among women than among men, with a significantly lower rate of events among those who received n 3 fatty acids than among those who received placebo. . .
Peskin’s review excludes all of these important fish-oil benefits, an unscientific approach as he should have included them. Here is a link to the study abstract (click “Article” for full details):
http://www.nejm.org/doi/full/10.1056/NEJMoa1205409#t=article
Several sites and articles that debunk Peskin’s highly exaggerated claim #1
http://www.greenmedinfo.com/blog/pfizer-funded-study-falsely-claims-fish-oil-useless
http://drhoffman.com/article/the-truth-about-fish-oil-2/
http://drgeo.com/fish-oil-history-does-not-taint-its-benefits
http://www.postindependent.com/news/grandjunction/6899661-113/fish-oil-disease-dha
http://www.steadyhealth.com/articles/really-fish-oil-doesn-t-help-prevent-heart-attacks-a2944.html?show_all=1
A few sites that debunk other negative fish oil and heart disease studies:
http://www.lef.org/magazine/mag2013/apr2013_Science-by-Ambush_01.htm?source=search&key=science%20by%20ambush
http://www.nutraingredients-usa.com/Research/Flawed-omega-3-meta-analysis-harms-public-health-GOED
http://www.ericcressey.com/omega-3-madness-recent-fish-oil-research
New fish oil and vitamin study info showing billions in savings for patients with CHD (added 10/1/14):
http://medicalxpress.com/news/2014-10-daily-supplements-decrease-health-care-expenditures.html
If you read the debunking articles, go back and read the language in the Peskin review about this first study. Do you see the bias and exaggeration? Does his first claim still ring true after you read the broader evidence?
Peskin review claim #2 (from his abstract)
Another major 2013 setback occurred when fish oil’s DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) analysis by Brasky et al.
Peskin’s review again misstates the actual study and findings, showing continuing bias and a failure to understand the actual study.
Main study problems: This is a highly misleading study based on a recycled, retrospective study (looking back at a different study). It’s an associative, non-causative study (no cause-and-effect was shown), so it’s ridiculous that Peskin used it. This was not an interventional trial with fish oil because it had nothing to do with fish oil or fish intake! There was only a single blood test taken initially for the previous SELECT study done many years ago (a blood test that measures only a few hours of recent fat intake that can be from a many dietary sources, including nuts and seeds). Most importantly, no fish oil or fish consumption was given or tracked for a single participant because it was not an interventional trial!
Additional study problems: Cancer, like HD takes decades to materialize, the omega-3 levels were actually quite low in all the study participants, while the omega-fat differences between the groups was less than 1% before the numbers were rehashed (exaggerated to ridiculous levels of over 71% using Relative Risk to manipulate media coverage and the public), critical confounders were not tracked effectively (such as diet, exercise, smoking, alcohol use, prescription drug use, weight, etc,), and the strongest associations for cancer subjects were those obese participants who were also smokers and drinkers (all common risk factors for cancer), and cancer, like many chronic diseases is multifactorial in origin.
This study is an ironic choice as it mirrors much of Peskin’s review, with its obvious bias, poor methodology and exaggeration. Remember, no fish oil was given or measured in this study! For anyone who has research savvy, as the following links will demonstrate, this was a work of junk science (yet Peskin was apparently taken in and found it credible)?
Sites and articles (many by MDs) that debunk this bogus fish oil and cancer study:
http://www.naturalnews.com/041344_fish_oil_omega_3_junk_science.html
http://www.cureality.com/blog/post/2013/07/18/omega-3-fatty-acids-likely-not-associated-with-prostate-cancer.html
http://www.lef.org/featured-articles/2013-08_Fish-and-Prostate-Cancer-Risk-Fact-or-Fiction.htm
http://drhyman.com/blog/2013/07/26/can-fish-oil-cause-prostate-cancer/?utm_source=WhatCounts+Publicaster+Edition&utm_medium=email&utm_campaign=drhyman+newsletter+issue+%23135&utm_content=Get+the+story+…#close
http://doctormurray.com/how-a-selected-bad-study-became-big-news/ (click on Read more)
http://drhoffman.com/article/something-fishy-this-way-comes/
http://www.nutraingredients-usa.com/Research/Experts-slam-omega-3-link-to-prostate-cancer-as-overblown-scaremongering
http://www.anh-usa.org/flawed-study-fish-oil-cancer/
http://www.integrativecanceranswers.com/do-fish-oils-really-cause-prostate-cancer/
http://www.wellnessresources.com/health/articles/fish_oil_prostate_cancer/
http://www.crnusa.org/CRNPR13-Omega3071113.html
Now go back and read the language in the Peskin review abstract for fish oil and cancer. Does it still ring true, given that no fish oil was ever given or its use documented because this was not an interventional trial with fish oil or fish? Do you think Peskin read the whole study carefully to understand the obvious bias and glaring flaws outlined? Do you begin to see how research fraud carries forward to expand the fraud, as poorly done research is cited by other biased research authors like Peskin? It’s a reminder that much of modern research is more political in nature.
Peskin’s review claim #3 (from his abstract)
Another monumental failure occurred in 2013 whereby fish oil’s EPA/DHA failed to improve macular degeneration.
Once again, Peskin’s review distorts and misstates the study’s objectives, goals and outcomes. The study was to see if a complex formula (not just fish oil) could help to decrease in the risk of developing advanced AMD (Age-Related Macular Degeneration), not to improve existing AMD as Peskin claims (see author comments below).
This study was the second version of the AREDS 1 study, called the AREDS 2. Like AREDS 1, this was a study to test different supplements combining the carotenoids lutein and zeaxanthin, plus EPA or DHA, or both, divided into 4 groups (the “placebo” group was actually those subjects taking AREDS 1 which is not a real placebo); placebos are supposed to contain inactive ingredients. This was not just a fish oil study as the Peskin abstract claims nor was it a “monumental failure” (another example of his exaggerated, unscientific language as the below information will again deomnstrate).
Main study Problems: The study participants were up to 85 years old (mean age was 77), again with existing eye disease and at a high risk for progression to advanced AMD, with about 50% of subjects being former smokers (a significant risk factor/common cause of AMD). Many subjects had also taken the AREDS 1 supplement with vitamin C, E, zinc, copper and beta carotene, researchers mentioned various effects from the dosages and complex combinations and analysis, fish oils were the ethyl ester form again, not the triglyceride form which is thought to be more bioavailable (see links below). Other studies have shown risk reduction for AMD from fish oil, plus many subjects already had higher levels of DHA/EPA.
Once again, these were largely elderly subjects with decades of lifestyle contributions and problems with their eyes and AMD, especially with the high level of smokers, putting many subjects at higher risk for progression (again showing a multifactorial aspect behind those who get AMD). Interestingly, no adverse effects were found for fish oil, which conflicts with Peskin’s central claims of harms from fish oil oxidation and increased ROS). Again, he apparently missed that important point. That’s more bias!
The study authors stated this, regarding important study limitations and caution in interpreting the study outcomes:
The limitations of this study include a complicated study design involving a secondary randomization, which may have affected our ability to evaluate the role of adding lutein + zeaxanthin and DHA + EPA to the AREDS formulation. Not all participants were taking the original AREDS formulation, with some taking only certain components of the AREDS formulation. This formulation was given as a mixture of antioxidant vitamins and minerals. It is not known whether a single specific ingredient is important or if the combination is essential for its therapeutic effect.
Do you see how much more precise the language is for their limitation comment? And here is an insightful summary from Dr. Hoffman, MD as he debunks several areas this study (which ties into the subjects existing dietary intakes as mentioned above):
So AREDs 2 was undertaken, and the results are in: contrary to press reports, lutein, zeaxanthin and DHA worked!
Let me explain. The press reported that there were no benefits of the AREDS 2 supplements, but that was true only for study participants who already had adequate dietary intake of these nutrients.
AREDS 2 displayed significant finding for those with the lowest dietary intakes of lutein and zeaxanthin. Those subjects experienced a 26 percent decrease in advanced AMD progression, and a whopping 36 percent reduction in risk for severe cataracts, with 32 percent fewer patients requiring cataract surgery.
Moreover, the results demonstrate the study supplementation significantly improved the plasma antioxidant capacity and fortified the optical density of the macular pigment.
So again, Peskin’s review skips over important study limitations that impact the study’s possible meaning and interpretation (as stated by the authors themselves), along with other important outcomes that his review skipped. Again, his bias and misstatements are obvious, his omissions significant.
AREDS 2 study link:
http://jama.jamanetwork.com/article.aspx?articleid=1684847
Link to Dr. Hoffman’s info (scroll down for AREDS 2 comments):
http://drhoffman.com/article/the-truth-about-fish-oil-2/
Now go back and read the language in Peskin’s review abstract when he claimed: Another monumental failure occurred in 2013 whereby fish oil’s EPA/DHA failed to improve macular degeneration.
It’s another material misstatement of the study’s design and goals, which were to see if a combination of supplements: “. . .decreases the risk of developing advanced AMD.” There was no study done to see if those supplements or fish oil would improve or reverse existing eye disease or AMD as Peskin claims. It’s like he just makes things up.
Do you think Peskin read this study either? My guess is no. Can you see the repeated bias and exaggeration of Peskin’s review as he misstates the actual AREDS 2 objectives and outcomes? Do you find Peskin to be someone who has scientific credibility? (If you still believe his review is credible, there is more debunking evidence to come!)
Peskin claim #4 (from the abstract)
In 2010, fish oil’s EPA/DHA failed to help Alzheimer’s victims, even those with low DHA levels. These are by no means isolated failures.
This is yet another example (4 out of 4), showing how Peskin’s review misstates the #4 study’s goals, design and outcomes, which were to see if DHA alone (not DHA and EPA) could slow cognitive decline in subjects with existing Alzheimer’s. And guess what? The DHA given was NOT fish oil or sourced from fish. It came from algae.
That’s another huge blunder for Peskin and another hit to the credibility of everyone involved in his review (including Hindawi). No scientist or publisher can produce work that is this sloppy and crude and maintain their credibility.
Main study problems: The subjects were in their mid-70s, again with an existing disease: Alzheimer’s. Alzheimer’s disease (AD), like HD and cancer takes decades to materialize, not a few months or a year, the DHA used was an algae-based vegetarian form, so it wasn’t fish oil at all! Peskin’s review completely misidentifies the treatment and its origin in the rush to demonize fish oil). The study was relatively short at 18 months for elderly people with existing AD (again, AD is decades in the making so 18 months is a short period for just using DHA), the placebo was corn or soy oil so many questions there as well), the DHA was used as a treatment rather than a preventive or prophylactic, between 25-30% of subjects dropped out thereby skewing the results and cutting participation numbers significantly, and Alzheimer’s, like many chronic diseases is multifactorial in origin.
The authors correctly stated the following outcome limitation:
Because part of the rationale for the trial was epidemiological evidence that DHA use before disease onset modifies the risk of Alzheimer disease, it remains possible that an intervention with DHA might be more effective if initiated earlier in the course of the disease in patients who do not have overt dementia.
Again, note the more responsible, precise language the authors used and their focus on a preventive approach that can lower AD risk. Another important point Peskin’s review fails to mention or address. Is he so focused on finding failure that he misses written limitations, caveats and other glaring problems? Remember, no fish oil was used in this study!
Here is a link to the actual study:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259852/
I wasn’t able to find many sites that debunked this study beyond my own observations but here are quite a few studies/sites that show benefits for fish oil and cognitive decline/AD:
http://www.ncbi.nlm.nih.gov/pubmed/20434961
https://www.drfuhrman.com/library/DHA_memory.aspx
http://www.blisstree.com/2012/06/13/food/supplements/fish-oil-study-omega-3-supplements-not-suddenly-useless-heres-why-you-should-still-take-it-920/
http://www.sciencedaily.com/releases/2010/11/101108151346.htm
http://www.sciencedaily.com/releases/2014/07/140715142845.htm
http://www.naturalnews.com/043755_omega-3_fatty_acids_Alzheimers_disease_prescription_drugs.html
http://misc.health.alternative.narkive.com/yapDr8lf/scientists-discover-how-fish-oil-protects-the-brain
http://www.ncbi.nlm.nih.gov/pubmed/16266772
http://www.ncbi.nlm.nih.gov/pubmed/17030655
Now go back and read the language used in Peskin’s review abstract when it claimed: In 2010, fish oil’s EPA/DHA failed to help Alzheimer’s victims, even those with low DHA levels. These are by no means isolated failures.
Do you think Peskin read this study at all? My guess is no (the description of the algae form of DHA and no EPA was included early on and repeated in the study details. Can you see the repeated bias and exaggeration in Peskin’s review as it again misstates the actual study objectives, outcomes and DHA source?
This is #2 of the 4 studies that form the basis of Peskin’s anti-fish oil review, but no fish oil was ever used in the study! Therefore, the study (like the fish oil/cancer study) has no relationship or baring on his fish-oil bogeyman of peroxidation! And the claim that fish oil “failed” is another complete falsehood because there was no fish oil in the study!
Is it ever more obvious how unscientific and sloppy Peskin’s review is? Can you believe that this junk science passed a peer review at Hindawi? There is much more to follow (bias reaches every corner of this flimflam review).
A few general articles and studies on fish oil benefits to provide more balance and perspective, something Peskin’s review again omits:
http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/
http://www.goedomega3.com/healthcare
http://www.dailymail.co.uk/health/article-2180298/Are-hooked-fish-oil-The-natural-wonder-drug-proven-treat-range-conditions.html
http://www.ncbi.nlm.nih.gov/pubmed/20088810
http://www.nutraingredients.com/Research/RCT-data-backs-EPA-omega-3-to-prevent-depression
Pubmed search for fish oil benefits in human trials has 13 pages, and over 250 citations (Peskin relies on 4 badly done studies for his abstract):
http://www.ncbi.nlm.nih.gov/pubmed/?term=fish+oil+benefits+human+trials
http://www.naturalnews.com/omega-3.html
http://ajcn.nutrition.org/content/83/6/S1505.full
http://www.vitalchoice.com/shop/pc/articlesView.asp?id=1075
Peskin’s abstract finishes with a flourish of more overblown claims:
The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology.
If you have read this article to this point, you already know how farcical this proclamation is. Remember 2 of 4 studies he cites did NOT use any fish oil! It’s also a gross overstatement of the research process because the review misses many study problems, biases and deficits, even as he skips all of the author caveats, limitations and positive outcomes.
The review also ignores the hundreds (even thousands) of studies that show beneficial outcomes for fish oil in many areas of health and prevention (more important links below).
Peskin’s abstract reveals a consistent pattern of misstatements, omissions, exaggerations and unproven generalizations. Those should have been a clear indication of a slanted, unscientific review, yet Hindawi reviewers seemed not to notice these obvious problems (more about Hindawi below).
Peskin’s review is filled with a writing style I can only describe as serial exaggeration, using a few poorly-done studies to heighten his exaggerated claims and negative findings for the abstract, setting the stage for the review’s weak, add-on material, often introduced with other bold claims that are neither proven nor properly sourced.
None of the review abstract studies indicated actual harms or dangers for fish oil (remember, only 2 studies even used fish oil), undercutting Peskin’s central claims of danger or harm.
As mentioned earlier, fish oil comes in several forms, including ethyl ester and triglyceride forms. These links explore the ethyl ester vs. triglyceride issue (the triglyceride form is often better absorbed, yet his cited studies used the ethyl ester form).
http://www.fxmed.co.nz/science-validates-triglyceride-form-of-fish-oil-to-have-up-to-70-higher-absorption-than-the-ethyl-ester-form-which-is-widely-available/
http://www.drmichaellange.com/research/natural-triglyceride-vs-ethyl-ester-form-fish-oil-technical-papers/
http://www.ascentahealth.com/omega-3-and-you/the-science/fish-oil-triglycerides-vs-ethyl-esters-comparative-review-metabolism-absorption-stability/
What fish oil manufacturer’s have done for a decade
I’m including this information to offer a better perspective on current (and past) industry practices. Peskin’s review seems to exclude current industry practices, some going back more than a decade, to the early 2000s. Back when Peskin was signing the Texas Injunction against his misrepresentations and illegal medical claims, along with the $100,000 fine paid to the state of Texas, industry was already working on standards for fish oil, including possible issues of oxidation or contamination.
1. Nature Made, a brand of fish oil I’m using now, is independently tested for potency, bioavailability and purity by the USP (U.S. Pharmacopeial Convention), an independent testing organization for drugs and supplements.
2. Nature Made said they add natural vitamin E as an antioxidant because they are aware of the potential for oxidation and they check the Anisidine value to monitor oxidation during shipping and storage of the raw fish oil. And their oil is made from wild fish, not farm raised.
3. The fish oil is stored under nitrogen gas to minimize oxidation from air exposure. Once received at their final packaging facility, the fish oil is tested again and quickly encapsulated into a softgel to prevent oxidation.
4. The softgel seals the fish oil and provides a barrier to keep out oxygen, which prevents the softgels from going rancid. They have ongoing testing of the softgels for possible oxidation going past their expiration date to make sure they are still healthy.
5. Like most manufacturers, they recommend that the product be stored in a cool, dry place, and to use by the expiration date right on the label. And the version I use is the Triglyceride form, often more bioavailable then the ethyl ester form as outlined above.
Here is a link to another company that uses similar methods to minimize or prevent oxidation:
http://www.nutraingredients-usa.com/Suppliers2/Summit-session-to-focus-on-freshness-of-omega-3s
More industry links for quality standards and testing
Here are links about common industry practices for fish-oil quality and safety. These undercut just about all of Peskin’s review claims of fish oil dangers or harms, based on oxidation/peroxidation:
This link is to the IFOS and their testing standards (including peroxide, Anisidine, oxidation, heavy metals, etc. The IFOS has been around for 10 years, since 2004, and has certified many dozens of fish oil products):
http://www.nutrasource.ca/ifos/get-certified/what-ifos-tests-for.aspx
An article showing that fish oil manufacturers have had quality and safety measures since the early 2000s:
http://www.nutraingredients-usa.com/Regulation/Omega-3-suppliers-hit-back-at-misguided-Proposition-65-attack
The GOED site showing their strict standards for fish oil manufacturing and they also have many dozens of supplement members:
http://www.goedomega3.com/consumers
And the CRN debunking the 2010 fish oil lawsuit in California, which Peskin apparently supported or was involved in:
http://www.crnusa.org/CRNPR10CRNNoSafetyIssueswFishOil030210.html
Biased through and through
The above links address comprehensive fish-oil quality, safety standards and testing from several organizations, covering hundreds of manufacturers. Peskin’s review skips all of this critical material, again showing how much bias permeates every level of his review.
The review largely excludes any coverage of these detailed industry practices, while it includes no research or testing of his own for the hundreds of fish oil supplements on the market now. These glaring omissions for current fish-oil supplements again undercuts his flimflam review even more (if that’s possible).
I downloaded the Peskin PDF file from Hindawi and used the PDF search capability. I searched for the following terms and phrases in Peskin’s review:
softgels (the standard form for most fish oil supplements)
quality practices
quality standards
safety testing
safety tests
manufacturing tests
peroxidation tests
None of these terms show up in Peskin’s review! Do you think he addressed any of these areas if the words aren’t even there? Do you begin to see how incredibly shallow, unscientific and amateurish the Peskin Review is?
As mentioned previously, these industry manufacturing and testing practices are done to address the big, bad bogeyman in Peskin’s review: peroxidation/ROS. You’d think he would have researched these critical details and included studies or tests to demonstrate that industry was being putting consumer’s health at risk. Instead, the lack of diligence, research and support for these claims demonstrates the review’s persistent bias and lack of scientific credibility.
Peskin’s review ignores the differences between the various forms, formulations and dosages of fish oil, a completely unscientific approach. All forms are simply assumed to be fish oil, equally bad, whether in bottles, like cod liver oil, individual softgels, large or small caps, or doses in any form (triglyceride, ethyl ester, algae based, whatever), and they are all considered to be just fish oil in the review.
As a reminder, science is about careful design and analysis; it’s about precise language and quantitative accuracy, carefully following established protocols and methods, and a quantifiable search for truth, supported by credible replication. These qualities are supposed to set science apart from opinion, conjecture and fiction.
But as others have correctly observed, Peskin’s work seems to come from a biased, pseudo-scientific, amateur point of view, pumped up with uninformed opinion, exaggeration and fictional claims.
Where are Peskin’s studies?
Given Peskin’s wild claims that fish oil is harmful from its quick oxidation under normal conditions (both at room temperature and in the body), I would expect him to cite numerous, replicated studies on modern fish-oil softgels from multiple manufacturers, testing the different softgels at different temperatures (such as 70, 80, or 90 degrees F or equivalent numbers in C), with different storage situations and expiration dates, showing their resulting peroxidation levels and expected harms to health.
I would also expect to see large, credible clinical trials in human subjects that replicate clear cut, unmistakable blood or urine tests showing significant, even toxic levels of ROS and peroxidation from fish oil supplements, with all confounders tracked and accounted for (stress, diet, smoking, inactivity, poor sleep, age, gender, prescription drug use), as all can contribute to levels of oxidative stress, and including and all other FA intake. But where are Peskin’s studies?
Peskin provides no credible studies of fish oil softgel supplements or other replicated, credible human trials. Peskin’s claims, assertions and citations read more like a work of science fiction then a work of science. His review is filled with unsupported theories and claims (in spite of his claims of proof everywhere), loosely strung together with often irrelevant side meanderings and obtuse or contradictory citations with little credible support or details.
Ever more bias and poor citations
Peskin’s review contains numerous mismatched claims and sloppy science as shown in its many citations, one’s that don’t support its claims in clear or direct ways. Some citations actually undercut his claims (this would add pages more so I’ll use a few examples for now). Remember his past academic and professional work? This persistent problem follows the same pattern of exaggerations, fiction, puffery and the claimed credentials like doctor and scientist he never earned.
And did you know? He is tied to sales of his books, speaking engagements, and has an EFA formula he created, all based on attacking fish oil in favor of his alternatives. He has an obvious agenda and as such, lacks critical scientific objectivity.
Early on, I challenged the Hindawi people about Peskin’s reference numbers 17 and 18 (essentially the same study published by different journals), and how those studies proved his central claims that fish oil oxidizes rapidly at room temperature and in the body, because those citations don’t support those claims in a credible or scientific way. Those studies compare life spans for a several mammals, birds and other species. There is nothing that speaks to the quantitative analysis of fish-oil softgels or their oxidation in specific forms or conditions.
In fact, reference numbers 17 and 18 trace back to a 1954 study (Holman RT, Autoxidation of fats and related substances), now 60 years old, which appears to be a very early in vitro or lab study with questionable credibility and NOT applicable to modern fish-oil softgel manufacturing and packaging as outlined above. In other words, it’s irrelevant!
In addition to the exaggerated study claims and mismatched citations, Peskin also quotes his own studies and uses circular citations that take you back to this same review (for example, citation #60 for the Iowa Experiment lists his very review as the source).
Note: I finally found his IOWA Experiment (a PDF file) and it’s a few pilot studies (34 total subjects mixed and matched in a few homey experiments), filled with the same bravado Peskin is known for. The file includes more unseemly, self-congratulatory statements and puffery: Things like “A remarkable result” and “Highly Significant” are included in that so-called study. Sorry, no real scientists talk or write like that!
And that Iowa Experiment would never be accepted by a legitimate journal because it’s so amateurish. It’s a pilot study with small numbers of subjects, a total lack of confounder tracking, a lack of baseline measurements or other thorough, credible scientific analysis. Peskin’s review again demonstrates belief over science when it says this in section 19 of the review:
The highly statistically significant results and excellent NNTs of IOWA confirm the theoretical predictions of both the failure of fish oil to increase arterial compliance and the significant (predictable) success of PEOs to improve arterial compliance across all populations.
This sweeping overstatement for a small pilot study is more brag and swag, not science! With only 34 total people in that study, and even smaller numbers in a few sub-set comparisons handled in a mishmash of different mini-tests, the IOWA study proves nothing on its own. And the Peskin review, so rife with questionable and manipulative citations, referencing his own exaggerated work and this IOWA Experiment is a new low and an apparent breach of research ethics and integrity (remember that earlier link about research ethics?).
The Peskin review also makes liberal use of the term “21st century” to attempt to sway us that this is new? Or is this done to make his work sound more dramatic and important? Again and again, the review exposes an amateur approach to science and its pervasive bias for all to see.
Peroxidation in fish oil is non-existent in many human studies
Peskin’s fear mongering about peroxidation and ROS is only theoretical; he never provides credible documentation, testing or proof that his claims are supported in human subjects, as the above material clearly shows. And many of the studies he cited in his abstract and elsewhere found no significant adverse effects from the fish oil and inflammation or ROS in human subjects.
The following links are to a range of human studies that actually tested fish oil peroxidation and oxidative stress in human subjects. Not only did they find no significant adverse effects or harms from fish oil/algae-based oils, many of these studies had outcomes that conflict with Peskin’s claims of harm, showing benefits, even at doses around 4 grams/day (Peskin claims these are overdose amounts).
Why did Peskin’s review ignore these studies? Maybe it’s because they undercut his wild, unfounded claims in actual human subjects:
http://www.ncbi.nlm.nih.gov/pubmed/24225668
http://www.ncbi.nlm.nih.gov/pubmed/23952918
http://www.ncbi.nlm.nih.gov/pubmed/22103753
http://www.ncbi.nlm.nih.gov/pubmed/20540666
http://www.ncbi.nlm.nih.gov/pubmed/14583341
http://www.ncbi.nlm.nih.gov/pubmed/20303788
http://www.ncbi.nlm.nih.gov/pubmed/22136711
http://www.ncbi.nlm.nih.gov/pubmed/24077434
http://www.ncbi.nlm.nih.gov/pubmed/16278686
http://www.ncbi.nlm.nih.gov/pubmed/23010452
http://www.ncbi.nlm.nih.gov/pubmed/10451477
http://www.biomedcentral.com/1471-2318/13/41/abstract
As you can see, many studies show the opposite effects for the one’s Peskin claims for fish oil (no dangers or harms, multiple benefits, such as lower inflammation and less oxidative stress, not more). It’s probably 10:1 in favor of fish oils/omega-3 fats. That’s an indication that good studies are being replicated and junk ones like Peskin’s rely on are not being replicated. In short, there is little support for Peskin’s claims and much that contravenes them.
In short: Peskin’s review is an exercise in grandstanding. As other’s have observed, Peskin’s writings and presentations are liberally dosed with fiction, conjecture and flimsy evidence to support his overblown positions.
My inescapable conclusion is this: Peskin’s review is one of extreme bias, sloppy methodology, poor science and serial exaggeration. The review appears to demonstrate research misconduct and scientific fraud:
http://www.codex.uu.se/en/etik6.shtml
http://en.wikipedia.org/wiki/Scientific_misconduct
Here is Peskin’s review:
http://www.hindawi.com/journals/jl/2014/495761/
Hindawi blunders too
In spite of the terrible bias, quality, errors and omissions in Peskin’s review, Hindawi saw fit to publish it. Apparently no one checked Peskin’s credentials, conflicts with books or supplements, initial studies (the ones I debunked), omissions of study limitations and positive outcomes, or lack of accurate citations for his review before approving it for publication. If Hindawi had done even basic checks of Peskin and his work, I don’t think they would never have published his review!
Then again, maybe the money was more important than publishing good science? It seems that the Hindawi review process is not at all rigorous or credible. Given these serious problems, I must urge a boycott of all Hindawi research publications.
Rebuttal closing
I know there was lots of detail here but that’s what is required to address the level of misinformation, poor science and misconduct in this review, falsely published as scientific by a site that claims it does peer review. I had a duel purpose in exposing the extreme bias, sweeping distortions, omissions and junk science put out by Peskin. I also wanted to expose the claims of Hindawi concerning their “peer review” process.
I urge everyone who goes through this material to rebuke Peskin’s claims at every opportunity (you can use parts of this work with permission), as well as boycott all Hindawi published research. You should now realize that Hindawi’s willingness to accept money from amateur pseudo-scientists like Peskin opens the door to the denigration of science on a global scale. This fraudulent review deserves the strongest condemnation from everyone in the science community!
As I included many links in the content above, there are no source links at the end of this post!
NOTE: If there are any updates from Hindawi or Peskin’s junk science review, I’ll add them here:
© 2014 by Steve Carney/End Sickness Now