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Fish Oil for Heart Health

Oil from fish contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); both are omega-3 fatty acids.

Where is it found?
EPA and DHA are found in mackerel, salmon, herring, sardines, sablefish (black cod), anchovies, albacore tuna, and wild game. Cod liver oil contains large amounts of EPA and DHA. Fish oil supplements typically contain 18% EPA and 12% DHA, though more purified (i.e., higher in EPA and DHA) fish oil supplements are sometimes available. In addition, DHA is available in a supplement that does not contain significant amounts of EPA.

Who is likely to be deficient?
Some researchers and doctors believe that most people who eat a typical western diet are likely to be consuming less-than-optimal amounts of EPA and DHA. To a very limited extent, omega-3 fatty acids from vegetable sources, such as flaxseed oil, can convert to EPA.

At least four studies have reported a reduced blood level of omega-3 fatty acids in people with depression.

People with rheumatoid arthritis have been found to have decreased levels of omega-3 fatty acids, such as are found in fish oil, in their joint fluid and blood.

How much is usually taken?
EPA and DHA, the omega-3 fatty acids found in fish oil, lower blood pressure, according to an analysis of 31 trials. The effect was dependent on the amount of omega-3 oil used, with the best results occurring in trials using unsustainably high levels: 15 grams per day—the amount often found in 50 grams of fish oil. Although results with lower intakes were not as impressive, trials using over 3 grams per day of omega-3 (as typically found in ten 1,000 mg pills of fish oil) also reported significant reductions in blood pressure. One double-blind trial reported that DHA had greater effects on blood pressure than EPA or mixed fish oil supplements. DHA is now available as a supplement separate from EPA.

Presumably, healthy people who frequently eat fatty fish (several times per week) have no need to supplement with fish oil. How much EPA and DHA, if any, should be supplemented by healthy people who do not eat much fatty fish, remains unclear.

Most researchers studying the effects of EPA and DHA in humans who have a variety of health conditions have given those people at least 3 grams of the total of EPA plus DHA—an amount that may require 10 grams of fish oil, because most fish oil contains only 18% EPA and 12% DHA.

The health benefits for people with Crohn’s disease have been reported with a special, enteric-coated preparation of purified EPA/DHA manufactured from fish oil. This preparation of purified fatty acids has also been reported to not cause the gastrointestinal symptoms that often result from taking regular fish oil supplements, again suggesting unique benefit.

In one trial, the maximum amount of fish oil tolerated by people being treated for cancer-related weight loss was reported to be approximately 21 grams per day. However, in people who do not have cancer, the maximum tolerated amount may be different.

Are there any side effects or interactions?
While those with heart disease and diabetes have often been reported to benefit from supplementation with fish oil, both groups should check with their doctor before taking more than 3 grams of fish oil per day for several months. Elevations in blood sugar and cholesterol levels may occur in some people who take fish oil.

The increase in blood sugar appears to be related in part to the amount of fish oil used. Some evidence suggests that adding vitamin E to fish oil may prevent the fish oil-induced increase in blood sugar levels. In other research, the impairment of sugar metabolism sometimes caused by supplementation with fish oil has been prevented by the addition of half an hour of moderate exercise three times a week.

While supplementation with fish oil consistently lowers triglycerides, the effect of fish oil on LDL ("bad") cholesterol varies, and in some people, fish oil supplementation has been reported to increase LDL levels. People who took fish oil and who also took 15 grams of pectin per day were reported to have reductions in LDL cholesterol. This suggests that pectin may overcome the occasional problem of increased LDL cholesterol reported in people who supplement with fish oil. The LDL-cholesterol raising effect of EPA and DHA has also been reported to be prevented by taking garlic supplements (or presumably including garlic in the diet) along with EPA and DHA.

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