UPDATE: Should I Take Fish Oils - or Not

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A few years ago I wrote this post: Do You Take Omega 3 Fish Oils? Are You Taking Enough? A few of my awesome readers have sent me links to later studies that shed more light on the fish oil issue. I want to bring this topic up to date and also answer a few of the questions I’m asked about fish oils.

As I wrote in my earlier post, fish oil supplements at a dose of 4.000 mgs a day are recommended for people with high triglycerides (one of the four numbers in a cholesterol profile). I also wrote about taking that same dose for prevention and heart heath – even if your triglycerides are normal. Use of fish oils for prevention has not been supported by more recent studies.

Diet Trumps Supplements

A major change of tune coming out of medical organizations in recent years (like the American Heart Association) has to do with dietary recommendations versus supplements. Whether it’s fish oils or calcium or any of the other vitamins and minerals we need, it is now widely accepted that the best way to obtain nutrients is by eating foods that are rich in them. Organized medicine is gradually coming to accept that food is medicine and supplements can’t compensate for a poor diet – but THAT is a topic for a whole other blog post. Let me stick to fish oils.

The American Heart Association now recommends that the best way to get fish oils is to, yep, eat fish! They recommend eating fatty fish at least twice a week – salmon, mackerel, herring, lake trout, sardines and albacore tuna. They also still recommend omega 3 supplements at a dose of 3 to 4 grams (3,000 to 4,000 mgs)/ day for people with high triglycerides in consultation with your medical provider.

The National Library of Medicine has posted an extensive list of the known and possible benefits of fish oils at this link.

Now to the Questions:

Question # 1: I have been taking liquid fish oil in order to get my 4 g Omega-3 fatty acids each day. I’d like to try taking a capsule – since I don’t really want to travel with a bottle of fish oil. Can you recommend an enteric capsule with good quality concentration of Omega-3s that I can take (without taking a handful of them) instead of the liquid oil?

Answer: Since fish oil capsules are made from the fish oils themselves there are no enteric-coated forms. The most common strengths are 1200 mg and 1000 mg, so you would need to take three or four to get your 4 grams. I’ve seen some “triple” strength capsules advertised as high as 1,500 mg, but you would still need to take 2 or 3 to get to a 4 gram dose. Lovaza is a smaller 1000 mg capsule, which is available by prescription. If your insurance covers it and you get a prescription from your provider, it might be easier to travel with. I buy my fish oil supplements at vitamin shops and I only buy well-known brands. I like to think these are going to fresher and of reliable quality. But since vitamins are not FDA regulated it’s a matter of “let the buyer beware”. If you find there’s a “fishy” quality to the supplement you can store them in the refrigerator, which sometimes helps, or try a different brand.

Question #2: Which is better, omega 3 fish oils or krill oil.

Answer: Here’s a link to a New York University Medical Center review of the studies to date comparing omega 3 fish oils and krill oil. Bottom line – more and better studies are needed.

Question #3: Omega 3 fatty acids are known to do very well for healthy organs, but it is actually not true. It is good for heart health and curing breast cancer, but is linked to increase the chances of prostate cancer. Also, as per this study, fish, which is also known for improving brain health, fails to do the same.

Answer: I think you bring up very good points and concerns. In medicine – whether as a patient or a provider – one must always weigh the risks and the benefits of any course. You don’t always have the benefit of full knowledge when determining treatments. Weighing a prostate cancer risk against a cardiovascular disease risk and coming up with a strategy that is likely to be helpful, not harmful and that takes into account your unique circumstances requires a partnership between a clinician and a patient. I think this essay on the National Library of Medicine’s website addressed the prostate risks with fish oils very well: NLM Director’s Comments Transcript Fish Oil Linked to Prostate Cancer Risk.

Question #4: Your site still indicates a very favorable outcome for taking fish oil supplements but the last study I read said that such supplements had no favorable impact on the heart.

Answer: You are absolutely right. Let me share this quote from Howard Weintraub, Clinical Director of the Center for the Prevention of Cardiovascular Disease at New York University School of Medicine, New York University Medical Center about how he is viewing the question you raise. (His interview can be read in its entirety this link: NEJM Study on the Use of Fish Oil for Prevention of Cardiovascular Events.)

“If you pool a bunch of cardiologists, internists, and even primary physicians and ask, “Do you use fish oil?” they’d probably say, “Well, you know, if someone wants to use it, it’s okay.” So, if you’re on fish oil and you’re tolerating it, then continue. However, would [I] instigate, provoke, or insist upon fish oil being used to prevent cardiovascular-related mortality and morbidity? The answer is probably no. If you’re wondering whether you need it, the answer is also no. On the other hand, we don’t have enough information in the dyslipidemic population, and particularly in people with triglycerides over 500, to say that fish oils are dead. That’s where we are now.”

So, as with all things related to your health, it’s ultimately going to be up to you to decide what to do. I suggest reviewing all the possible risks and benefits listed on the National Medical Library’s website and read what the American Heart Association recommends. Then discuss your unique circumstances with your medical provider. For all the talk about fish oils, they do not appear to pose any great risk and may offer some benefit but they are but one part of cardiovascular protection – and probably one of the least important parts. A healthy lifestyle and diet, weight control and exercise are ultimately going to do more to prevent cardiovascular disease than anything else you can do.

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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