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Fish Oil for the Heart? Is It Good After All?

Fish oil for the heart has been on a roller coaster. It has been good for the heart, ineffective for the heart and now, once again, very good for the heart!

Please strap on your seat belt. Here is another huge medical flip flop! A really big controversy has to do with fish oil, also known as omega-3 fatty acids. Is fish oil for the heart helpful or is it useless? Nutrition scientists have been arguing about this for years. An impressive new study by some very heavy hitters suggests that, in fact, fish oil is good for the heart (Journal of the American Heart Association, Oct. 2019). The more the merrier.

The History of Fish Oil:

Starting more than 40 years ago, epidemiologists reported that the Greenland native Inuits had much lower rates of heart disease. The scientists attributed this benefit to foods high in marine fatty acids.

An article in the Mayo Clinic Proceedings (June, 2000) noted that the Greenland research led to: 

“… more than 4,500 studies to explore this and other effects of omega-3 fatty acids on human metabolism and health. From epidemiology to cell culture and animal studies to randomized controlled trials, the cardioprotective effects of omega-3 fatty acids are becoming recognized. These fatty acids, when incorporated into the diet at levels of about 1 g/d, seem to be able to stabilize myocardial membranes electrically, resulting in reduced susceptibility to ventricular dysrhythmias, thereby reducing the risk of sudden death. The recent GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico)-Prevention study of 11,324 patients showed a 45% decrease in risk of sudden cardiac death and a 20% reduction in all-cause mortality in the group taking 850 mg/d of omega-3 fatty acids.”

The Tide Turns on Fish Oil for the Heart:

Subsequent studies of fish oil produced mixed results. Randomized controlled trials published in the New England Journal of Medicine found no cardiovascular benefit from omega-3 fatty acids (N Engl J Med, Oct. 18, 2018; N Engl J Med, Jan. 3, 2019).

A meta-analysis published in JAMA Cardiology (March 1, 2018) concluded: 

“This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease.”

Case closed, right? Fish oil for the heart turned out to be a nothingburger. In case you have been living in a cave, a “nothingburger” is something that turns out to be a dud. The Urban Dictionary describes it as:

“something with high expectations that turns out to be average, pathetic, or overhyped.” 

Fish Oil for the Heart Resurrected!

Here is why we told you to strap on your seatbelt. Perhaps now would be a good time to make sure it is tight! A comprehensive meta-analysis by renowned Harvard scientists has found that people taking fish oil supplements have a lower risk of heart attacks, heart disease and death from cardiovascular disease (Journal of the American Heart Association, Oct. 2019).  The higher the dose, the greater the benefit.

There were 13 randomized controlled trials in this analysis with more than 120,000 participants. The weight of the evidence now suggests that omega-3 supplements can save lives.

Two of the world’s most renowned epidemiologists, Frank Hu, MD, PhD, and JoAnn Manson, DrPH, MD, are affiliated with Harvard. In our opinion, they are cautious and conservative when it comes to dietary supplements like fish oil for the heart.

Here is what they and a colleague say about this most recent meta-analysis of omega-3 supplements:

“The current updated meta‐analysis incorporating data from 13 RCTs [randomized controlled trials], including 3 recent large trials, suggests that marine omega‐3 supplementation is associated with lower risk of MI [heart attack], total CHD [coronary heart disease], total CVD [cardiovascular disease], and death from CHD or CVD causes. Such inverse associations may be particularly evident at higher doses of marine omega‐3 supplementation.”

The doses that were included in these studies ranged from 376 mg per day to 4,000 mg per day. A typical dose was around 800 to 900 mg per day.

What Do You Think?

Here’s the Flip-Flop-Flip. For decades we were told that fish oil for the heart was a good thing. Then we were told fish oil for the heart was worthless. Now we are being told that, based on the latest and best research, fish oil is good for the heart. Whiplash? We’re hardly surprised. 

Share your thoughts about fish oil (omega-3 fatty acids). Have you found it helpful? Have you stopped taking it because of the negative publicity? Will you consider restarting this dietary supplement? Let us know what you think of the latest research in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • ASCEND Study Collaborative Group, "Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus," N Engl. J. Med, Oct. 18, 2018, doi: 10.1056/NEJMoa1804989
  • Manson, J.E., et al, "Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer," N Engl. Med., Jan. 3, 2019, doi: 10.1056/NEJMoa1811403
  • Aung, T., et al, "Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals," JAMA Cardiology, March, 2018, doi: 10.1001/jamacardio.2017.5205
  • Hu, Y., et al, "Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-Analysis of 13 Randomized Controlled Trials Involving 127 477 Participants," J. Am. Heart Assoc., Oct. 2019, doi: 10.1161/JAHA.119.013543
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