Is fish oil good for your heart?

There is a lot of conflicting information out there.  So let’s take a look at fish oil and what this means for your heart.

All omega 3 fatty acids are essential fatty acids, meaning our bodies do not make them so we need to consume them.  Essential fatty acids are a major building block in all of our cell membranes, are vital for normal cellular metabolism, and are precursors to a family of hormones called prostaglandins, which regulate the inflammatory cascade.

Omega 3’s can come from animal sources (fish oil) in the form of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).  Omega 3’s can also come from plant sources in the form of alpha-linoleic acid (ALA).

Studies show that fish oil lowers triglycerides (a bad kind of cholesterol).  In fact, the evidence is so strong that the FDA approved a medication called Lovaza, which is concentrated fish oil, to treat high triglycerides.  

In recent years, medical science has come to that inflammation promotes the vascular injury and plaque formation that cause heart attacks and strokes.  It is a known fact that Omega 3 fatty acids put an important damper on this inflammation via prostaglandins.  So it would make sense that fish oil would decrease the rates of heart attack.

However, when researchers did a meta-analysis of 20 previous research studies (pooling their data into one study), fish oil did not seem to lower the overall rates of heart attack.   JAMA. 2012;308(10):1024-1033. doi:10.1001/2012.jama.11374.

Let’s take a closer look at this study.  First of all, there is an inconsistency between the individual studies—fish oil supplements in varying strengths were used.  They also did not control for participants consuming Omega 3 fatty acids in their diet.  If the treatment group is taking a supplement, but the participants in the control group (not receiving the supplement) is eating a lot of salmon, how can you say the treatment doesn’t work? 

I talked about the anti-inflammatory properties of fish oil and how medicine now believes inflammation is what promotes the development of vascular injury and plaque.  It is possible that the true benefit of fish oil is not about treatment, but about prevention.  If these anti-inflammatory effects are most important to prevent cardiac inflammation and is only seen over multiple years, then this study would have been blind to this effect.

Let me get to the heart of the matter.  I remain convinced that fish oil makes a tremendous impact in our health, including heart health.  These nutrients found in fish oil are essential to the health of every cell of our bodies, and the typical American diet is deficient in these nutrients.  It is an established fact that inflammation contributes a major role in many chronic diseases, like cancer, diabetes, and heart disease, and it is an established fact that essential fatty acids regulate inflammation.  So…… I make an effort to eat foods that contain essential fatty acids on a regular basis and I take a fish oil supplement every day.  I frequently recommend fish oil to my patients for many reasons, including hormone balance, skin issues, joint issues, diabetes, as well as heart disease prevention.  I believe in the old adage that an ounce of prevention is worth a pound of cure.

However, all fish oil supplements are not created equal.  There is mercury, lead, PCB’s, dioxins, and other toxins in those fish from which fish oil is derived.  The larger the fish, the more toxins are in it.  And I certainly don’t want to be doing something for my health and end up putting poison in my body!  So look closely at any fish oil supplement you are considering buying.  Research the supplement company online. 

The U.S. has no regulation for nutritional supplements so you must find a supplement company you trust.  How do you know what company makes a quality fish oil that has toxins removed?  

There are two organizations that have standards for toxin levels of fish oil.  The European Pharmacopeia Society (EPS) and the Council for Responsible Nutrition (CRN).  Supplement companies who pay for third party independent assays of their fish oils products and whose products meet or exceed these standards are the supplements that I want to take.  For your reference, below is a chart of the EPS and CRN standards (and lack of U.S. standards).