The People's Perspective on Medicine

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!
Fish oil capsules, close-up

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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    Citations
    • 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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    I, too, would like to know whether these results were from mostly men, or an equal number of men and women. And I bet they haven’t studied just women. I also would like to know the amounts of DHA and EPA in the studies.

    I take omega-3 fatty acid supplements for their effect on brain health, arthritis, and general inflammation. They are one of my bigger expenses on a very low income, but I still think it is worth it.

    The results come from 13 different trials. They included women, but we couldn’t tell if numbers of men and women were equal.

    I began taking omega-3 shortly after recovering from heart attack and open chest bypass surgery. The cardiologist at the time said it was good, it was easy to take, and I never stopped. That was started in 2002, and to date I’ve had no cardiac problems, and I’m still playing golf at 87.

    I have taken fish oil capsules for many years & have not had any heart problems. Maybe I wouldn’t have anyway, but if I believe it will protect me, it will, right?

    I nevet stopped taking it when all the negative publicity came out. I had heard that it was also good for inflammation. I had to eliminate it for a few days before a procedure years ago and within days my fingers felt arthritic. I had a CT Angiography 3 weeks ago and have zero calcification and clear arteries. I am 69 years old and will continue to take my fish oil.

    I had been taking over the counter fish oil for many years, but recently stopped it because I saw an ad for the new prescription fish oil, that stated OTC fish oil might raise
    my LDL cholesterol. Despite having drastically changed my diet, eating habits, and losing about 40 pounds, my numbers have remained high. I began to think something else was the cause for this.
    Is this possible?

    I was diagnosed with a 90 percentile probability of a heart attack, based on heart CT calcium scoring, 13 years ago. I have been taking 3000 IU of Fish Oil for the last 13 years, and no coronary events so far. I’ve passed every cardiac stress test with flying colors. I continued to take it when the “it doesn’t work” research came out, because I have personally observed that it helps with my dysthymia (long term moderate depression). I’d like to see more data collected specifically on women, since endocrine levels affect heart disease and women’s hormonal systems are vastly different from men’s.

    Would be great to see a comparison of this latest fish oil study analysis with the research on eating more oily fish (salmon, mackerel) itself.

    Even though eating oily fish means a lower amount of the oil itself, there could be some benefit in eating the fish along with its oil.

    Anytime a “report” is published I question the funding source. There is always a back story oftentimes by a company with a product to sell.

    Hi Joe,

    If we applied your criteria about funding there would be no pharmaceuticals on the market. Is that your goal?

    So, here we go again. Because of the huge size of fish oil capsules, I turned to krill oil. When I asked my doctor’s opinion, he shrugged and said it was probably no better than fish poop, he didn’t think much of it. Where does krill oil fit into this study?

    I take 3 capsules today; buy from a company in New Zealand. Despite the conflicting research, I am going to continue to take.

    Like Bernie Sanders, I had a stent placed, in my case in my lad, which showed 60% blockage, my troponin levels were 4.5 (out of 100%) and my stress test two weeks later showed an ejection fraction of 69 (the high end of normal). That was twelve years ago. Today my cardiologist puts me in his “hall of fame” on my yearly check-up. I take a high quality marine Omega 3 fatty acid (2 grams daily). I owe my good heart health to Omega’ 3’s, CoQ10, magnesium, and L-arginine, and a positive life style. Seems to do my brain good also. My only prescription medicine is a 12.5mg beta blocker. I’m 80 years old. I never ping-pong with the latest news, but go with what works for me.

    * Be nice, and don't over share. View comment policy^