In the health world, there are few things that are hard to believe, such as advice about vitamins and supplements and how they work.
A study published in BMJ Medicine last month looked at the risk and benefit profile of fish oil on heart health, and found that years of research suggests that taking fish oil regularly may have a small positive effect on heart health. increase The risk of cardiovascular events, such as atrial fibrillation and stroke, was reduced in people who were not at high risk.
Researchers have found benefits from taking fish oil supplements in people who already have cardiovascular disease and a slowing of disease progression.
Fish oil supplements may be the most common omega-3 supplement on the market. They are often sold in capsule form, and people choose them because other studies have shown that taking omega-3s may help with a variety of health issues, including rheumatoid arthritis, cognitive function, and even ADHD. More recently, taking omega-3 supplements has been linked to reduced anger.
But the fact that fish oil supplements may not be beneficial for heart health in the general population “isn’t a new issue, just new papers on the issue,” Dr. Andrew Freeman, a cardiologist at National Jewish Health in Denver, told CNET.
He added that over-the-counter fish oil supplements are different from “highly refined” fish oils such as Lovaza and Vascepa that are available by prescription from a doctor to lower triglyceride levels (which are linked to cardiovascular disease risk).
While it is far from a definitive conclusion on the benefits and risks of omega-3 supplements (the study has limitations, including the major fact that it is not reflective of participants’ fish oil intake, as it was self-reported), it does raise questions that continue to run up against recommendations for supplements in general, including the fact that supplements are not regulated by the U.S. Food and Drug Administration for safety or effectiveness and that we are supposed to get the majority of our nutrients from food and diet).
Certain dietary patterns that are primarily plant-based and rich in healthy fats, lean protein, and some dietary sources of fish oil (including diets such as the Mediterranean diet) continue to show positive health benefits. These diets may be rich in omega-3 fatty acids and other nutrients, but replicating their effects in supplement form has proven difficult.
Another important note: There are many reasons to take supplements (including omega-3s and fish oils) beyond heart health, so advice on whether you should take a supplement depends on you, your diet, and your health goals, which may change throughout your life.
“There isn’t a lot of evidence on omega-3 supplements in general,” Dr. Navya Mysore, a primary care physician in New York, said in an email. People interested in taking a daily omega-3 supplement because of health concerns should talk to their doctor before “making a personal decision for themselves,” she said.
read more: Foods rich in omega-3s offer many benefits for your heart, hearing, and overall health
What did the study find? Strengths and limitations
The BMJ Medicine study followed more than 400,000 participants aged 40 to 69 who were part of the UK Biobank study, tracking participant-reported health events, lifestyle and dietary factors, including whether they regularly took fish oil supplements and their usual food intake.
After several years of follow-up, the researchers found that while taking fish oil supplements is beneficial for people who already have cardiovascular disease, for the general population (people without cardiovascular disease), taking fish oil regularly increases the risk of developing heart disease and stroke for the first time.
The strengths of this study are that it was large and tracked the incidence of heart attacks. The researchers also collected details of several factors that may affect heart health, such as smoking, excessive drinking, and general diet. However, the researchers wrote, “it does not take into account behavioral changes in populations with different cardiovascular profiles.” It also cannot account for all health-influencing behaviors that may affect health choices. Health behaviors are notoriously difficult to isolate and narrow down to a single cause or effect.
The researchers also note that because most of the study participants were white, it’s unclear whether the association would be similar in people of other races. And, importantly, the study didn’t take into account the amount of fish oil people were taking, or the specific brand or type.
Foods that naturally contain omega-3 fatty acids include seafood, nuts, seeds, vegetable oils, and some fortified foods.
Should people make decisions based on this study? Probably not.
Don’t be put off by the latest findings and think that omega-3 or fish oil pills are a masked cure for heart problems. As the study authors point out, the link between cardiovascular disease and fish oil requires further research, and this comes at the end of ongoing research into the comprehensive and complex relationship between omega-3 and various health benefits when taken in supplement form, much of which is contradictory or inconclusive, at least for the general public.
Dr. Gregory Katz, a cardiologist at New York University Langone, said the study alone isn’t enough to conclusively shake the debate about fish oil’s benefits.
“To change clinical practice, only randomized trials can really establish causality,” Katz said in an email. “Such studies do not tell us whether the fish oil caused the arrhythmia.”
But, he said, “there have been indications in some clinical trials of high-dose omega-3 supplements that they may increase the risk of an irregular heartbeat called atrial fibrillation,” and that atrial fibrillation does increase the risk of stroke.
When asked whether vegan and vegetarian omega-3 supplements (derived from ALA rather than DHA or EPA) would be better, Katz said the evidence is also equivocal because ALA is “a precursor to DHA and EPA, which are the active omega-3s in the body,” adding that the way it is converted to active omega-3s is less efficient and so it may “not be as useful.”
So, it all comes down to the same advice: get your omega-3s (and all other nutrients) from food whenever possible. If that’s not possible, talk to your doctor about taking a supplement or using additional vitamins. Some people are interested in taking omega-3s for a variety of health reasons other than heart health, so you should talk to someone who understands your health history and weigh the risks and benefits.
In a large abstract last updated in 2023, which reviewed the available research on omega-3 and omega-3 supplements for a variety of health conditions, including cardiovascular disease, the National Institutes of Health’s Office of Dietary Supplements concluded that “Consuming fish and other types of seafood as part of a balanced diet promotes heart health, especially when seafood is consumed in place of less healthy foods.” However, the evidence that supplements protect heart health is stronger in people with existing diseases.
But the latest findings shed some much-needed nuance when it comes to supplements.
“Not everyone is the same, not all drugs are the same, and what may seem harmless may not necessarily be so,” Freeman said of the latest fish oil research.
