Fish Oil

Fish oil can be bought just about anywhere these days and many people use it. Some complain about fishy burping problems that some brands may cause and some do not like the nausea that comes along with it. These are probably the main side effects of this supplement, although arrhythmias have been documented as well at higher doses. I want to delve into fish oil today a bit and talk about some uses for this supplement.

Fish oil is actually composes of omega-3 fatty acids. These are essential fatty acids meaning they are absolutely necessary for human life as we know it. They complement omega-6 fatty acids which are also essential for human life. We as humans cannot make these and thus their “essential” status. Some of the more common are EPA or eicosapentanoic acid, DHA or docosahexaenoic acid, and ALA or alpha-linoleic acid. I’m going to refer to all omega-3 as n-3 as they are commonly known in scientific communities (especially since it shorter to type!)

N-3’s are found in many types of food including, you guessed it, fish and other seafood. Raw milk is also a source. Some greens such as spinach or kale can provide n-3 but the best sources by far are animal. Nothing like some baked salmon or halibut fresh from the water. In Seattle markets these are readily available and make me salivate just thinking about them. Alas, I don’t live in Seattle and must make do with living in desert. I do like tuna, but eating it out of the can just isn’t the same as a nice tuna steak cooked medium rare encrusted with herbs and sesame seeds. It has been recommended that everyone have fish twice a week. It’s a great idea, especially if you like fish like myself, but sometimes because of location or economics, just not the most practical. Enter supplements like fish oil.

Nothing like some good ol’ fish to get some omega-3
I’ve seen some site like Mercola advertise krill oil and others do calamari oil. All the studies that I know of (at least the big ones) have been done with fish oil. Lets look at some of these and see what happened.
First lets look at GISSI-Prevenzione, a trial done in Italy with patient who had recently (within the last 3 months) suffered a heart attack. A total of 11,323 people were looked at. Patients received n-3, vitamin E, both or placebo. After 3 months total mortality was significantly reduced. At 4 months the risk of sudden death was reduced significantly and at ~8 months coronary, cardiovascular and cardiac deaths had also decreased. There was a decrease in the benefit of reduction of sudden death toward the end of the follow-up that the researchers partially attribute to a decline of adherence to the regimen, but only 4% stopped because of side effects.1  It’s also interesting to note that the group that had the fish oil had higher cholesterol levels up until the end of the study when they returned to baseline levels yet the protection from events was still present.
Another trial from Japan, JELIS, studied men and women who had hypercholesterolemia with or without heart disease. Patients were given a statin with or without EPA, one of the n-3 supplements. After a 5 year follow-up, a 19% reduction in major coronary events was found. That is to say coronary events happened in 3.5% of the control group and 2.8% of EPA group. It is a small absolute reduction to be sure, but considering this is on top of using a statin, I don’t consider it all that bad. It would be interesting to see a head to head trial of statin vs fish oil and see which comes out on top, both in terms of events and side effects. Other differences were found that trended toward reduced events with EPA, but non were statistically significant. 2
A meta analysis looking at studies of n-3 supplementation vs control diet and placebo showed that there was a significant difference between the two groups of deaths to fatal heart attack, sudden death and overall mortality. 3
A dietary study which sheds some light on the matter was the Lyon-Heart study done in France. Patients were given two different diets with differing levels of fat, and different types of fat. The intervention group had a diet that was similar to a “mediterranean” diet that emphasized fish and poultry over other meats as well as lots of greens. The standard diet allowed for no more than 30% calories from fat, no more than 10% from saturated fat and less than 300mg cholesterol/day. Stephan Guyenet does an excellent job of describing it more in-depth at
What the trial found was that after 4 years, mortality was reduced by 70% and cardiovascular deaths by 76%. As Stephan points out, cholesterol between the two groups was the same. Cholesterol didn’t change but cardiovascular mortality did. This is one of many reasons I’m not a fan of statin drugs. One of the keys of this study was the high amount of omega-3 in the diet and the low amount of omega-6. As pointed out earlier, they are both absolutely essential to human health. But the amount needed is small and a refined western diet has a large amount of omega-6 fats in just about everything. 4

Heart Healthy my butt!

Achieving a balance, just like in everything else is the key to good health. A ratio of 3-4:1 omega-6:omega-3 is probably a good balance for humans. There are some variations to this based on different epidemiologic data. The problem remains however here in western civilization that we consume far too much omega-6 fat, and it’s in everything. If you see vegetable oil on the ingredients, try looking for an alternative. Canola, corn, safflower and soybean are just a few. Avoid them and get some good source of n-3 from fish, grass-fed milk, flax, cod liver oil or a good fish oil supplement. Trying to overdo a fish oil supplement to make up for intake of omega-6 is the wrong approach. Reducing omega-6 is far better.
Proper diet and exercise are always going to lead to better improvements in cardiovascular health than any chemist in a lab could every do. It’s amazing to me how many healthcare professionals don’t take the time to research some of these basic tenants of medicine. Remember let thy food be thy medicine.
1. Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della opravvivenza nell.Infarto Miocardico (GISSI)-Prevenzione.2002; 105: 897-1903. Circulation 2002; 105: 1897-1903
2. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet March 2007 369:1090-1098
3. Bucher HC, Hengstler P, Schindler C, et al. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002 Mar; 112(4):298-304
4. De Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343:1454-1459.

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.


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