For decades health professionals focused primarily on cholesterol (especially LDL cholesterol) as the chief culprit in heart disease. Now, other blood fats are considered important, especially triglycerides (TGLs). These lipids show up in your bloodstream when you consume more calories than you burn. We like to see TGLs under 150 mg/dL or, better yet, less than 100. When triglycerides go over 500, it is worrisome since elevated TGLs could lead to heart disease or pancreatitis. This reader wants to know the pros and cons of fish oil (omega-3 fatty acids) for lowering triglycerides and whether it might contribute to prostate cancer.
Q. I have really high triglyceride levels (over 600). My cardiologist wants me to take fish oil supplements to get the triglycerides down.
I’m worried, though, because I have read that fish oil could increase the risk of prostate cancer, which runs in my family. I feel torn between my heart health and my prostate risk.
I’d like to know more about this problem before I start taking supplements. What can you tell me?
A. Fish oil and a low-carb diet can help bring down triglycerides, so your cardiologist is justified in this recommendation (Journal of Clinical Lipidology, Jan-Feb., 2014).
Prescription-Strength Fish Oil:
Although most people buy fish oil over the counter there are actually a couple of prescription-strength fish oil products on the market that require a doctor’s prescription. They include Lovaza (omega-3-acid ethyl esters) and Epanova (omega-3-carboxylic acids). Both contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). There is also Vascepa (icosapent ethyl) which only contains EPA. All three have FDA approval for lowering triglycerides. Because they are considered prescription drugs they have been proven to lower triglycerides and are quite pure. They do come with a hefty price, however.
Fish Oil and Prostate Cancer:
The connection between fish oil and prostate cancer risk is confusing. There have been studies suggesting that fish oil may protect against prostate cancer progression (Cancer Prevention Research, Jan., 2014).
Other studies indicate that men with higher levels of omega-3 fats from fish oil are more susceptible to prostate cancer (Journal of the National Cancer Institute, online July 10, 2013). What is more than a bit confusing about this study is that people who ate fatty fish also appeared to be at increased risk for prostate cancer.
Contradictory Evidence: Fish and Prostate Cancer
Other research has suggested that a diet that is high in vegetables, fruits, fish, legumes and whole grains is associated with a lower risk of prostate cancer (Cancer Prevention Research, June, 2015). A study from New Zealand found that men with prostate cancer who were switched to a Mediterranean-style diet with more olive oil, vegetables, nuts and fish experienced less DNA damage than men following a Western-style dietary pattern (Nutrients, Jan. 2015).
A review of 36 studies over the last 20 years concluded that there is no consistent evidence of a link between fish oil and prostate cancer (Journal of the American College of Nutrition, online, Nov. 23, 2015).
How to Deal with Contradictory Evidence?
If you are more than a little confused about the pros and cons of fish and fish oil, we totally understand. We share your confusion.
There are data supporting the value of fish consumption in protecting against cardiac mortality (Journal of the American Heart Association, Jan. 26, 2016). Lowering triglycerides with fish oil, especially when under medical supervision, seems like a sensible approach. Whether doing so will increase your risk for prostate cancer down the road remains uncertain.
We would encourage you to ask your cardiologist and your urologist to discuss these complicated issues between themselves, keep you well informed of their assessment and then follow your progress carefully over coming years.
We will continue to keep you and all our readers updated on the latest research regarding fish oil, heart disease and prostate cancer so please keep visiting The People’s Pharmacy for the latest health news. Better yet, sign up for our free online newsletter. We promise to keep you informed of new research as soon as it appears in the medical literature. Sign up by putting your email address in the right hand ribbon just above The People’s Pharmacy Store icon and thanks for asking an important question!