For years, fish oil supplements were promoted as an important way to boost health and particularly heart health. But accurate research has shown mixed results on their impact, despite some supplement companies continuing to promote their products as having a big influence on health.

Still, nearly 10% of U.S. adults take fish oil supplements. Now, a new study finds that many fish oil companies make claims that are untested, and that a wide variety of amounts of omega-3 fatty acids — the core healthy fats in fish oil — are in their supplements.

What the study says

The study finds that the majority of fish oil supplements on the market make health claims that aren't backed up by clinical trial data.

What are the key findings?

For the study, researchers analyzed the labels of more than 2,800 fish oil supplements and found that 2,082 (or nearly 74%) made at least one health claim. Of those, only 399 (19.2%) used a qualified health claim that was approved by the Food and Drug Administration (FDA). (A qualified health claim means that the statements are supported by scientific evidence.)

But nearly 81% of those supplements made claims about the structure or function of what the supplements could do, such as saying that they "promote heart health," with cardiovascular claims being the most common.

The researchers also found "substantial variability" in the supplements' daily dose of omega-3s EPA and DHA — two major compounds in fish oil.

The researchers noted in the study's conclusion that most fish oil supplement labels make health claims "that imply a health benefit across a variety of organ systems, despite a lack of trial data showing efficacy." There is also "significant" diversity and quality in the daily dose of EPA and DHA in supplements, "leading to potential variability in safety and efficacy" between them.

Joanna Assadourian, lead study author and a fourth-year medical student at University of Texas Southwestern Medical Center, tells Yahoo Life that "based on what I’ve seen personally in the grocery store and pharmacy, I was not surprised to find such high rates of health claims on fish oil supplements. What was surprising, though, was just how broad the types of claims being made was — from heart and brain health to joint health, eye health and immune function."

The study's co-author, Dr. Ann Marie Navar, associate professor of medicine at University of Texas Southwestern Medical School, tells Yahoo Life that "as a preventive cardiologist, I see patients in clinic all the time taking fish oil with the belief it is helping their heart. They are often surprised when I tell them that randomized trials have shown no benefit for fish oil supplements on heart attacks or strokes."

Navar adds: "And we’ve all been in the supplement aisles of the grocery store or pharmacy and seen the massive number of products all claiming different types of potential health benefits. We wanted to better characterize what types of claims are being made on fish oil supplement labels."

What experts think

It's worth noting that supplements are a largely unregulated industry in the U.S. Companies can put new supplements on the market without FDA approval — they're just expected to adhere to FDA guidelines about safety and labeling. The agency also monitors reports of adverse events after products are up for sale.

"This is an important reminder that supplements are not FDA regulated, and you may not truly know what is in the bottle, despite what the label says," Dr. Ali Haider, an interventional cardiologist at NewYork-Presbyterian Queens, tells Yahoo Life. "This also highlights that the ‘health benefits’ touted by many supplement manufacturers are often not based on real evidence and are misleading. Patients need to be aware and educated before spending money on unhelpful products."

This is an issue with all supplements, Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Disease Program at MemorialCare Saddleback medical center in Laguna Hills, Calif., tells Yahoo Life. "I always tell patients to be cautious with supplements because any manufacturer can put anything they want in a pill and say whatever they want about it," he says. "Fish oil is no different."

Why do so many people continue to take fish oil supplements despite this? "Many people take fish oil because of longstanding beliefs about its potential health benefits, particularly for heart health," registered dietitian Scott Keatley, co-owner of Keatley Medical Nutrition Therapy, tells Yahoo Life. "The supplement industry, anecdotal evidence and earlier studies have often promoted these benefits. Once a narrative becomes deeply embedded in popular culture, it can be difficult to change, even when new evidence emerges."

When doctors use DHA and EPA in clinical practice, "it's generally at doses of 2 to 4 grams a day to help lower triglyceride levels in patient with high triglycerides," Haider says. (Triglycerides are levels of fat in the blood.) But, she adds, "studies have not shown that fish oil supplements reduce your risk of heart attack or stroke."

Navar admits that the messaging around fish oil supplements is "confusing," chalking it up to evolving science and slow administrative processes. "Epidemiologists first found that people who eat more fish and who have higher levels of EPA and DHA in their blood have less heart disease," she explains. "This led people to think there could be a benefit to fish oil. In fact, this type of data is what led the FDA in 2003 to approve a qualified health claim for fish oil that it may lower the risk of coronary heart disease."

But several large, high-quality, placebo-controlled randomized trials since then haven't shown any benefit for the general population to take fish oil to prevent heart disease. "Despite these two trials showing no benefit, many people still believe fish oil has some benefit," Navar says. "The landscape here is really confusing — even though large clinical trials show no benefit for prevention of heart disease, the 2003 FDA qualified health claim is still active." As a result, manufacturers of fish oil supplements can legally make claims like "promotes heart health," even though accurate data doesn't support that, she says.

Why it matters

There are two FDA-approved fish oil-based drugs, "but they're for very specific indications, like people with high triglycerides," Chen says. For everyone else, fish oils aren't really recommended.

"There is potential harm in taking fish oil supplements," Chen says. "They may have additives and fillers, and we don't know what they are." Fish oil can also raise the risk of bleeding and atrial fibrillation, he says.

"I tell my patients that large, placebo-controlled trials have failed to show any benefit for prevention of heart attacks and strokes, so if they are taking it to try to lower their risk of those, they can stop," Navar says. "There are far more effective pills to lower the risk of heart attack and stroke — and fish oil supplements aren’t usually covered by insurance, so they can get expensive."

Chen recommends speaking to your doctor before taking a fish oil supplement. "Initially, we thought that fish oil was better for treating heart disease than it turned out to be," he says.

Assadourian agrees, saying: "Supplement labels can be confusing even for the most savvy of consumers. Patients should talk to their doctor about what supplements they are taking and why they are taking them — they may be surprised to learn that they are not getting the health benefits they think they are."

The staff and students of ITMO’s Research Center “Strong AI in Industry” have come up with an algorithm that can tell if an ECG recording displays symptoms of a heart attack – all in one second. Trained on over 20,000 ECGs, the model is accurate in 85% of cases and can immediately highlight those parts of the recording that can be associated with a heart attack.

Cardiovascular diseases are one of the main causes of death globally. According to the WHO, they for as much as 17.9 million deaths every year, more than half of which are to heart attacks. This pathology is caused by a disturbance in blood supply to the cardiac muscle. After a heart attack, every minute is important, which is why it is crucial to call for an ambulance at its first symptoms.

Heart attacks can be diagnosed with an ECG or electrocardiogram that can detect bloodflow-related changes to the cardiac function. An ECG can be used to detect different types of heart attacks.

However, an ECG often has to be complemented with several more tests, including those processed at a lab, to issue a final diagnosis. During emergencies, there is no time to wait for the results of additional tests, meaning that clinicians have to work with the data they have on hand.

A plethora of AI methods that provide assistance during ECG-based diagnostics are currently in development. For instance, several years ago a group of researchers from Stanford University and University of California, San Francisco a deep neural network that can automatically detect and classify arrhythmia. Their model was trained on 91,232 single-lead ECGs from 53,549 patients (“single-lead” denotes the placement of electrodes used to record an ECG. There are 12 common leads typically used to record an ECG – Ed.).

In 2020, researchers from South Korean Sejong Medical Research Institute with an algorithm that can detect a heart attack in a six-lead ECG.

A solution from ITMO

The team at ITMO’s Research Center “Strong AI in Industry” is working on their own algorithm that will assist clinicians in diagnosing heart based on ECG data.

For this project, the researchers relied on the classification of QRS complexes by scientists from Birla Institute of Technology & Science (India). One QRS complex registers a single heart cycle, during which the ventricles contract and the blood is pumped into the aorta. The team from ITMO has updated the model, training it on the entire ECG recording (not just data from selected leads). Now, the algorithm can detect patterns characteristic of a heart attack in an ECG, whereas before it could predict only specific properties of QRS complexes.

In order to achieve that, the researchers wrote a piece of software in PyTorch (a machine learning framework based on the Torch library) and used a Siamese neural network. Then, the algorithm was trained to detect heart attacks on data from a containing equal amounts of information on ECGs of healthy patients and those with heart attacks. This data was then used to test the model, which demonstrated accurate results in 85% of cases. Moreover, the algorithm requires just one second to make its decision on an ECG sample.

Additionally, the researchers added the Grad-CAM tool to the model, which is a machine learning approach that interprets a model and visualizes the results it provides. Thanks to this addition, the new algorithm can produce an ECG graph, highlighting the sections that contain patterns characteristic of a heart attack.

According to Natalia Gusarova, the head of the project, an associate professor at the Faculty of Infocommunication Technologies, the algorithm can make a decision based on ECG data from about five heartbeats. This means that now a five-second-long recording would be enough to provide a diagnosis, compared to the 20-second-long one in the regular procedure.

Vladimir Shilonosov, one of the algorithm’s developers and a student at the Faculty of Software Engineering and Computer Systems, adds that another advantage of the new solution is that it uses FewShot, a technology that makes it possible to additionally train the model on specific data (e.g., ECGs from patients of a certain hospital) to increase its accuracy.

This also means that the model can be specifically adapted for use at a given hospital – usually, the data parameters are slightly different between the medical institutions because they rely on different ECG devices and work with varying patient groups. Thanks to this feature, the model can be used to diagnose heart attacks in selected groups, i.e., the elderly or people with cardiovascular diseases.

What’s next

As per the team’s ideas, the algorithm can be used as a support system for faster and more accurate heart attack diagnostics. The developers have already planned clinical trials at the Almazov National Medical Research Center. Importantly, the algorithm is not meant to replace healthcare professionals but rather draw their attention to specific areas of an ECG.

In the future, the group is planning to train the model to detect other cardiovascular diseases, such as stenocardia and coronary heart disease.

“Even though there are a number of big data-based AI decision support systems for ECG diagnostics, these models are not readily used in practice. That is because they are non-transparent: clinicians can’t follow their analysis step-by-step and therefore don’t trust their results. In our algorithm, we used the concept of explainable AI and tried to make its inner processes transparent. That’s why our model offers a highlighted ECG graph as a basis for its decision,” adds Vladimir Shilonosov.

Doctors treated a robot in Trieste, Italy. Is this a scene straight out of a science fiction movie? Not this time. The robot is HAL s5301, one of the most advanced patient simulators in existence. The product of a collaboration between Italian company Accurate, headquartered in Cesena, and American organization Gaumard, HAL s5301 first came to Europe this past May, when it was set up at the University of Trieste's Cattinara Hospital in its Medical Simulation and Advanced Training Center.

HAL s5301 was created to supply students the chance to practice key medical techniques used in emergency medicine, intensive care, and surgery. The aim is to simulate the hospital setting: the robot, managed by a "control room," simulates a clinical case proposed by a teacher, and the students try to make the diagnosis in as real-life a scenario as possible. HAL is a humanoid robot that can not only move its arms and eyes and even sweat, but can also speak and recognize tone, thanks to artificial intelligence. 

More importantly, it reproduces cardiac, respiratory, vascular, and cerebrovascular physiology. Doctors can apply real tools of clinical practice, like stethoscopes, defibrillators, sensors, probes, and ventilators, to the robot. You can even insert a catheter or do a blood draw. At the end of the session of simulated diagnosis, the debrief allows students and professors to identify errors and highlight corrections and strategies. 

The Latest Model 

Accurate and Gaumard's robot is just one of the accurate examples of an approach used in medical teaching and training in Italy and worldwide. The first steps in the use of simulation in the medical field date back to 1963, when neurologist Howard S. Barrows introduced the use of "simulated patients" in his classes; these were actors who acted out different medical conditions. The first robotic simulators arrived not long after, with the Sim One and Harvey mannequins between 1968 and 1969. Harvey, a cardiology simulator capable of imitating various functions such as blood pressure; jugular, venous, and arterial pulsation; and normal and abnormal heart sounds, was the first great success of simulation in clinical training. It is continually being updated and is still on the market today. 

Various studies have indicated that simulators are beneficial, especially for students, in honing individual and team skills in all sorts of specialties. A 1987 study showed that the Harvey simulator improved the diagnostic skills of medical students in some areas. Nowadays, we have proof of the teaching benefits afforded by simulators, covering a wide range of surgical skills and more: from keyhole surgery to stroke management, from venous catheterization to EEG interpretation. 

More realistic simulator mannequins, like Gaumard's HAL s5301, newly in use in Trieste, as well as the SimMan (Laerdal, Norway) or METI-HPS (CAE Healthcare, Sarasota, Florida) can now imitate a range of symptoms and vital signs that respond to treatment and can be linked, for example, to software that simulates hemodynamic parameters. They also allow students to repeatedly simulate and train themselves in responding to rare or unexpected events, and even to hone nontechnical skills, such as working as a team, making decisions in an emergency, and communicating. 

Educational Worth

Even mannequins without HAL s5301's level of sophistication are an integral part of the medical curriculum in Italy. One example is the four high-fidelity simulators (three adults and one child) in use at University of Turin's Advanced Medical Simulation Center. "High-fidelity scenarios are usually postgraduate training tools, but we also use our high-tech simulators for third-year medical students who learn to take vital signs, read ECG traces, and recognize situations that are clinically unstable," said Grazia Papotti, MD, the center's coordinator. "Different scenarios are simulated using role play to teach students how to tackle physical examinations and approach the diagnostic process, working as part of a team. In their sixth year of study, when they are close to graduating, we switch to SimTo for training in an emergency setting," 

The aim, said Alberto Milan, MD, another coordinator at the center, is to enable students to overcome their self-doubt. "There is a feeling that students can ask questions and make mistakes more freely, which ultimately means they learn at a much faster rate." 

And the students seem to support this. Miriam Rosso, who underwent training involving the use of simulators at the University of Turin, told Univadis, "This experience was essential to my learning, because it meant that by the time I got to my hospital placement, I already felt pretty confident in my ability to approach patients and how to correctly distinguish different clinical signs. In my sixth year, the simulated training was even more useful, as the setting was emergency medicine and urgent care. Without a doubt, if I hadn't had training with the simulator, I would have been much more insecure and disoriented during my first shift at the hospital."

Virtual Alternatives

As with any technology, simulator mannequins have been met with criticism. Above all, robots tend to be costly. HAL s5301 costs around $100,000. Add to that $16,000 in service costs, and you can generally expect to pay up to $250,000 dollars for a realistic simulator. 

Can similar results be achieved without spending so much money? Maybe. One aspect still to be clarified in scientific literature is whether the use of simulators translates into better patient outcomes. The few systematic reviews available find no statistically significant advantage of training with simulators, compared with traditional teaching, when it comes to patient outcomes in endoscopy or in the surgical field. 

In the case of the University of Turin, we have to make do for now with perceived competence, but more in-depth studies analyzing quantifiable skill acquisition are on the horizon. "By analyzing a large amount of scientific data collected to date (from March 2021 to July 2023 we have trained 3500 medical students), we can show that students significantly Strengthen their perceived competence for each of the practical tasks for which they undergo training. We will also try to obtain objective measurements and to compare our students with cohorts of students who have undergone traditional training without simulation techniques,” said Papotti. 

It is interesting to note that, when comparing different types of simulation technology, virtual reality techniques seem, at least in some cases, to be as useful as mannequins, and are 22 times cheaper. A 2021 randomized pilot study found no differences between robotic mannequins and virtual reality simulations in managing emergency medicine cases. A 2023 study on diagnostic bronchoscopy had similar results.

Conversely, at least two studies, one from 2021 and the other 2022, showed that students were more comfortable and found it more informative to practice with human-simulated patients than with robots, which were perceived as being less realistic. 

However, it must be said that even during simulation using mannequins, it is still possible to add verbal human feedback, as Papotti confirmed. "In some cases, we can simulate making the mannequin speak using a tutor or actor's voice from the control room. Some mannequins let you do this directly; for others, we make do by tying a small amplifier under the bed. 

"The student is fully aware that it isn't the mannequin talking, but this method is nearly always more effective in helping them immerse themselves in the scenario and relate fully with their pretend patient. This is excellent practice: the students begin to understand how difficult it is and how careful they must be when choosing the language they use and the tone they take when communicating with their patients."

Being Too Precise

Finally, there is a risk that simulations could be misleading, as feared in a 2015 debate on the topic. Indeed, neither mannequins nor other simulation methods are capable of correctly imitating all symptoms and types of illness. For example, in the field of neurology, human simulators cannot correctly imitate epileptic seizures, aphasia, or stroke. An actor imitating an epileptic seizure will, in reality, be acting out seizures recognized by an expert eye to be psychogenic. These are different and require alternative treatment to that used for epileptic seizures. 

Conversely, a mannequin runs the risk of being too "honest" in its imitation of symptoms, without the ambiguities doctors are faced with in real life. The risk of "mistraining" also results from the imperfect anatomic accuracy of mannequin simulators, as has been shown in various studies. For example, one 2021 study on premature neonate respiratory tract simulators found numerous differences between infant anatomy and the simulated one, which may lead to medical students being taught — and therefore putting into use — excessively intensive ventilation techniques, potentially endangering patients. 

Medical students are aware of these limitations, as Miriam Rosso noted: "As realistic as these clinical cases are, they remain somewhat standardized (they hardly include all of the comorbidities that 'real' patients have on a daily basis), and interaction with the patient is reduced (taking their history, accurately investigating their pain, et cetera)."

Therefore, to ensure that students receive a full and accurate learning experience, simulator mannequins must only be used by appropriately trained teachers, who are capable of understanding and maneuvering around the potential limitations of simulators, said Papotti. "To ensure high-quality training, even tutors will need specific training, monitoring, and support in the use of such devices. The technology is complex and requires care and skill. 

"It's my belief that, if a student learns incorrectly, the cause will never be the simulator's lack of realism, but rather a failing on the part of the person who planned the activity or supported it as a tutor or facilitator. Tutors must always provide honest feedback on which aspects are most and least realistic. They must have a wealth of experience in the field and put it to good use."

This article was translated from Univadis Italy, which is part of the Medscape professional network.

Their findings demonstrated that increased levels correlated with reduced flow-mediated dilation—a preliminary sign of arterial health issues.

This may come as a surprise: a medical pairing that adds up to trouble. It has to do with bacteria in your mouth and cardiovascular disease.

Research points to a link between gum disease and heart disease.

Dr. Susan Anderson directs the dental hygiene program at Hodges University in Fort Myers. She said despite science connecting the dots, she finds few people pay attention.

“It’s interesting that there are people who still think that there is no connection between oral health and general health,” she said, “but there is. Anything that goes on in the mouth, any bacteria that’s in the mouth, can travel throughout the body.”

It is why she stresses the importance of oral exams when training her students. “There are things that we see as dental professionals in the mouth before it actually manifests itself in the body,” Anderson said, “so when we see inflammation in the gums, oftentimes, there is also inflammation being created within the valves of the heart.”

The sticky plaque that builds up around teeth is different from the cholesterol plaque found in arteries, but people with gum disease are two to three times more likely to have a heart attack or stroke, most due to the chronic inflammation going on in the mouth and the spread of bacteria.

Periodontist Dr. Cynthia Deragon also teaches at Hodges.

During her time in private practice, she saw a lot of gum disease and tooth decay that could cause trouble down the road.

“The mouth just happens to be a very common place where people have chronic disease. They don’t understand or feel the pain of it,” said Deragon. “If they avoid going to the dentist, not realizing that they actually have inflammation in their mouths and that can lead to cardiac problems.”

So here is something to chew on: Keeping your teeth clean is good for your heart.

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