February 2019

Fish oil for heart health: does it help or not?

The fish oil debate continues. Over the years, research on using fish oil for heart health has been conflicting and confusing. Whether fish oil SUPPLEMENTS offer the same benefits as regularly eating fish continues to be a point of contention.

In 2018, the American Heart Association recommended that healthy people eat 1-2 servings of fish weekly to lower the risk of heart disease. This recommendation was based on previous research that showed modest benefits. However, a new meta-analysis found that increasing fish oil intake from the diet OR supplements offers no benefit. The reason for this conflicting data is likely because most of the studies included in the analysis evaluated only fish oil SUPPLEMENTS rather than dietary fish intake. So, while fish oil supplements don’t appear to help healthy people prevent heart disease, eating fish regularly, especially if it replaces a less healthy protein, might modestly reduce the risk for heart disease. Also, fish has nutritional benefits beyond heart disease prevention. People should continue to eat fish and other foods that provide omega-3 fatty acids.

For people with existing heart disease, previous research suggested that eating fish 2-3 times weekly can reduce the risk of death by 30%. However, new research shows that eating more fish doesn’t reduce the risk for heart attack, chest pain, or death. Similarly, increasing fish oil intake with supplements has little to no effect on existing heart disease.

Tell your patients that the benefit of fish oil for heart disease is still controversial. Their best bet is to eat 1-2 servings of non-fried fish weekly. Fish oil supplements don’t appear to help, so it’s best to put that money towards a healthier diet instead. But make sure patients don’t confuse fish oil SUPPLEMENTS with PRESCRIPTION fish oil products including Lovaza, Omtryg, and Epanova. These prescription products are FDA approved for treating very high triglyceride levels and contain higher doses of omega-3 fatty acids than supplement products. Patients advised to take these prescription products should continue to do so. For more details on fish oil, check out our recently updated monograph.

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