Fish Oil and Cardiac Health-An Update

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Supplements and traditional medicine have a serious love-hate relationship. On the one hand, many physicians recommend them, but supplements have been a thorn in the side of traditional pharma for years. Fish oil is one of the best-researched supplement options out there, but the research findings keep pinging back and forth. Now large new studies have concluded that fish oil is likely very good for your heart.

Fish Oil and Omega 3 Fatty Acids

The idea behind fish oil began with Innuits in Greenland. It was noted by early researchers that many were overweight, but heart disease was rare. When their diets were examined, they ate lots of fish and used fish oil like salt, seasoning, or butter. Studies soon connected their fish oil intake with their great cardiac and overall health and lack of disease.

Fast forward a few decades and researchers broke down the components of fish oil into two components – DHA and EPA. However, while fish oil has had quite a ride in moving from the natural health world into mainstream medicine, that has been a bumpy ride of late. Let’s dig in.

EPA and DHA

Fish oil’s health effects have been tied to Omega 3 fatty acids. There are two main types of omega-3s called docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). EPA supports the immune system, heart, and reduces inflammation. Hence EPA is often used to help orthopedic pain. DHA is focused on neurologic issues such as the central nervous system, brain, and eyes.

The Fish Oil Pushback

While about a decade ago fish oil was all the rage in cardiology circles, several studies were published showing no benefit in some heart issues like arrhythmia. Hence, these past few years, fish oil has lost ground in traditional medicine. So, when I saw brand new large analyses on fish oil, I was curious which way the ball would bounce. Would it turn out that after decades of research fish oil was useless for your heart or essential?

New Research

The new studies are meta-analyses. These take many studies and re-pool all the data into new groups:

  • More than 125,000 patients were included in this recent study where high and low dose fish oil were compared (more or less than 1g of omega 3 content) (1). High dose fish oil was associated with a 21% lower risk of cardiac death, 29% lower heart attacks, and 26% lower risk of angina. On the other end of that spectrum, there was an almost 50% increased risk for bleeding and a 35% increased risk of afib.
  • The second study looked at more than 81,000 patients and also looked at high versus low dose fish oil and again high dose was associated with good things (2). All deaths due to heart disease were reduced by 9% and there was a 17% reduction in heart attacks. Those numbers got better when they looked at higher doses. Only the administration of more than 1 g per day of n-3 PUFA (omega 3s) was effective in reducing the risk of cardiac death (-35 %) and heart attacks (-33 %). The efficacy of EPA administered alone was better in terms of risk reduction for heart attacks (-30 %) than the combined EPA + DHA supplementation.

What Should You Take?

I did a quick search on Amazon and saw that most fish oil brands had an Omega 3 content of over 1,000 mg (1g). However, only a few were heavily focused on EPA. Hence, look for something with a 3-4 to one ratio of EPA to DHA. In addition, your fish oil shouldn’t smell fishy, as that means it’s oxidized and not as helpful.

The upshot? Fish oil is now making a comeback in traditional medicine. These two large studies argue for both high dose omega 3 content and that an EPA focused supplement is your best bet. However, if you have a history of heart arrhythmias, you may want to consider skipping fish oil. Also, anyone concerned about excessive bleeding should also stay away.

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(1) Lombardi M, Chiabrando JG, Vescovo GM, et al. Impact of Different Doses of Omega-3 Fatty Acids on Cardiovascular Outcomes: a Pairwise and Network Meta-analysis. Curr Atheroscler Rep. 2020;22(9):45. Published 2020 Jul 16. doi:10.1007/s11883-020-00865-5

(2) Casula M, Olmastroni E, Gazzotti M, Galimberti F, Zambon A, Catapano AL. Omega-3 polyunsaturated fatty acids supplementation and cardiovascular outcomes: do formulation, dosage, and baseline cardiovascular risk matter? An updated meta-analysis of randomized controlled trials [published online ahead of print, 2020 Jul 4]. Pharmacol Res. 2020;160:105060. doi:10.1016/j.phrs.2020.105060

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3 thoughts on “Fish Oil and Cardiac Health-An Update

  1. Rod Sellers

    Who wouldn’t be concerned about excessive bleeding?

  2. Rod Sellers

    Hi, I wouldn’t mind a reply on my question, I have been using fairly large doses of high quality fish oil for several years as per Regeenex recommendations.
    The “ Excessive bleeding “ comment has little context?
    Thank you Rod

    1. Chris Centeno, MD Post author

      If you have a bleeding disorder than fish oil is not a good match as it does reduce clotting time. However, if you don’t, then I wouldn’t worry about it.

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