Is Fish Oil Good for Your Health? What the Studies Show
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En español | Even those who regularly pop little more than a multivitamin might be wondering if they should be taking fish oil — what with the constant news about how omega-3 fatty acids might help our health. And at least 10 percent of all Americans already take the supplement hoping to keep their hearts strong.
But can popping such a pill really protect your ticker? While a study published last year in the New England Journal of Medicine showed that taking a fish oil supplement could reduce the chance of a heart attack by up to 40 percent in those who didn't regularly eat fish, it didn't pass the test of reducing both heart attacks and strokes in a study population. In general, most in the medical community remain dubious. “The data to date, if one looks at large randomized clinical trials, which is the highest level of evidence, shows that supplements haven't been found to have any significant cardiovascular benefit,” says Deepak Bhatt, M.D., executive director of interventional cardiovascular programs at Brigham and Women's Hospital in Boston.
In 2014, JAMA Internal Medicine featured a review done on fish oil research published in major journals between 2005 and 2012. Twenty-two of the 24 studies showed no benefit. And the National Institutes of Health website has weighed in with this: “Research indicates that omega-3 supplements don't reduce heart disease.”
The news isn't much more encouraging for other health conditions. Fish oil may relieve symptoms of rheumatoid arthritis and lessen the need for pain medications, but only a little, research shows.
As for brain health, a 2012 review of data on thousands of older adults found that those who downed omega-3 fatty acid supplements had no fewer dementia diagnoses or better scores on short-term memory tests than those who popped a placebo. A report released by the AARP-founded Global Council on Brain Health (GCBH), a group including neurologists, nutritionists and researchers, which analyzed studies done on supplements claiming to boost cognition, found insufficient evidence to recommend any — fish oil included — for brain health for most adults.
Enter the Fish Oil Rx
But supplements are no longer the only way to pop fish oil, which brings us to some big news on the omega-3 fatty acid front: a prescription medication Vascepa (icosapent ethyl), which has proven to be something of a game-changer for those with certain conditions.
Made from one type of omega-3 fatty acid, called eicosapentaenoic (or EPA), extracted from sardines and anchovies and purified, the pill has been shown to help reduce the chances of heart attacks and strokes for those who have a history of cardiovascular disease or major risk factors for it, such as diabetes or high blood pressure.
According to the New England Journal of Medicine, those who took the drug in a randomized controlled study had a 25 percent reduced risk of major cardiovascular events. Vascepa is already approved and in use for those with very high levels of triglycerides. And it's expected to get expanded approval this month, allowing it to be prescribed to a larger audience. The drug is designed to be taken in addition to statin medications (which reduce LDL, or bad cholesterol).
Physicians believe the benefit may come because the medication contains only EPA at high levels — the amount of fish oil in the daily recommended dosage is 4 grams — unlike other supplements that contain both EPA and docosahexaenoic acid (DHA), another type of omega-3 fatty acid, at much lower doses. In fact, says Bhatt, who was the trial's lead investigator, “You'd have to take 20 to 25 over-the-counter supplements a day, or consume 20 to 25 servings of fish a week, to potentially get that level of EPA.” High doses of omega-3 aren't appropriate for everyone because they may pose risks, such as a slight increase in bleeding, so Bhatt suggests talking to your doctor to see if you're a good candidate for the drug.
Omega-3 Supplements for Health
MAYBE WE haven't struck oil after all.
Omega-3 fatty acid supplements were once thought to deliver the same cancer-fighting, heart-saving, brain-preserving benefits as real fish—but without the stinky hassle of cooking or eating something many Americans don’t cook or eat very much of.
That’s why, when omega-3 dietary supplements hit the U.S. market a few decades ago, people were immediately hooked—and supplement manufacturers started pulling in the big bucks. The fish oil market has a 2022 projected value of $12.8 billion and is forecasted to grow an additional 6.8 percent in ten years to $23.8 billion.
Unfortunately, a large and growing body of research from the last decade warns that omega-3 fatty acid supplements may now have a catch.
While research in the 1990s initially suggested benefits from dietary fish oil supplementation, these new studies—including several high-profile reviews published in trusted journals—no longer support many of the original health claims marketers used to sell their supplements.
So if you're taking an omega-3 supplement because you think it may prevent heart disease, boost your brainpower, slow the progression of age-related macular degeneration, or stave off prostate cancer—you might want to reconsider.
Is fish oil just another form of snake oil? Quite possibly. Despite early buy in from doctors and their respective professional associations, many are now making an about-face on the supplement in terms of recommendations.
Luckily, there's a simple step you can take, starting today, to drastically improve your heart health (not to mention your overall health in general) and it doesn't involve buying or taking a single pill.
What Is Fish Oil Anyway?
THE LINK between consuming fish oil and good health go way back.
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The Bible has anecdotes of people using fish gallbladders to treat blindness. The Spaniards believed fish bile cured madness. And when your grandpa was a pup, he probably had to swallow cod-liver oil to prevent rickets, a bone disorder caused by vitamin deficiency.
But modern research into the protective health effects of oily fish began around the 1970s, when scientists homed in on polyunsaturated fat intake. That’s when a landmark study from Denmark revealed low rates of coronary artery disease and diabetes among indigenous Greenlanders with a fish-rich diet.
From that point on, the scientific community quickly began building a case for the link between fish consumption and good health.
Later research identified the polyunsaturated omega-3 fatty acids (EPA and DHA, primarily) as the beneficial silver bullet; these are found in high concentrations in such oily fish as sardines, mackerel, and herring. The findings implied that omega-3s from fish lowered blood levels of triglycerides, potentially reducing the risk of conditions like heart disease and cancer.
Additional data over the ensuing decades appeared to support these claims, and by the mid-1990s, the American Heart Association was all in. In 1994, it staged a conference about the therapeutic benefits of omega-3 fatty acids. Supplement companies took notice.
Is Taking a Fish Oil Supplement as Good as Eating Fish?
AMERICANS DON'T really do oily fish.
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Average intake of omega-3-rich fish among U.S. men is a measly 1.4 ounces a week, a 2014 Nutrition Journal study found. Some guys may not like the taste; others might think fish is too expensive, too smelly, or too complicated to cook.
So the supplement industry, sensing an untapped market, decided to address those concerns. The result: a convenient capsule that delivered the goods in one easy swallow. Later the formula was refined to eliminate the fish burps of early omega-3 supplements.
Supplement producers started sending out fleets of warship-size trawlers to harvest omega-3-rich fish. They brought in lobbyists to push legislation that would codify the benefits of fish oil into federal product labeling guidance. Those efforts proved so successful that by 2004, the FDA allowed dietary fish oil supplement labels to state that the capsules may reduce coronary heart disease risk.
The government’s optimism remained guarded, however; the FDA stated that the research was “not conclusive.” But that disclaimer did little to stem the tide of American consumers hungry for omega-3s in a capsule—or companies that were eager to deliver it to them.
Peter Dazeley
But when you look at the entirety of omega-3 research, one thing sticks out: Most of the data on the benefits of omega-3s came from studies that looked at consumption of fish, not fish oil supplements. Only recently have the supplements been studied in a more comprehensive way, and the results raise worrisome questions.
One concern is that over-the-counter supplements may not deliver the fish oil dosage promised on the label. In fact, of 32 commercially available supplements analyzed by researchers in Australia and New Zealand in 2014, only three had levels of EPA and DHA equal to or greater than those advertised on the label. What’s more, two-thirds of the research samples contained less than 67 percent of the EPA and DHA advertised.
So how does this happen? Scientists speculate that in the production process, fish oil may become exposed to the air. This exposure can result in oxidization, reducing the total EPA and DHA concentration of the oil. In fact, some liquid gels contain additional flavorings meant to mask the telltale rancid odor of oxidized fish oil, according to a 2014 report published by Consumer Lab.
“Fish oils, like any nutritional supplement, are not regulated by the FDA the way prescription drugs are, so you can never be quite sure of what you’re getting,” says James Stein, M.D., a professor of cardiovascular research at the University of Wisconsin. That doesn’t necessarily mean they’re dangerous; it just means you might not be getting all you’ve paid for.
And even if your supplement does deliver the right dose, you may not be receiving all the promised health benefits.
Yes, some smaller studies have revealed heart health benefits, but the bulk of the research has yet to prove that nonprescription supplements can reduce the risk of cardiovascular-related death, delay cognitive decline, ease depression, or prevent prostate cancer—four of the most promising claims regarding omega-3s.
“Many of fish oil’s earlier touted benefits have not been replicated in large randomized controlled clinical trials,” says MH advisor P. Murali Doraiswamy, M.D., of the Duke Institute for Brain Sciences. “The hype exceeds the science.”
Should You Take a Fish Oil Omega-3 Supplement?
MORE LONG-TERM research is needed to see if over-the-counter omega-3 supplementation can live up to the buzz.
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For now, if you want the preventive benefits of omega-3s, especially for your heart, your best bet is to eat real fish.
“Studies show that generally healthy people who eat more fish and have good blood levels of omega-3s have a lower risk of fatal heart disease,” says Dariush Mozaffarian, M.D., dean of the Friedman School of Nutrition Science & Policy at Tufts University. Omega-3 effects in controlled trials include several benefits: improved heart rate, enhanced blood vessel function, and greater oxygen flow to the heart itself.
The Centers for Disease Control and prevent backs this up. "Extensive research has been done on omega-3s, especially the types found in seafood (fish and shellfish) and fish oil supplements," according to its website. "Research indicates that omega-3 supplements don’t reduce the risk of heart disease. However, people who eat seafood one to four times a week are less likely to die of heart disease."
Plus, fish is an excellent source of protein, vitamins, and minerals, and it’s lower in calories than many other protein-rich foods. “Fish is more than just omega-3s,” Dr. Mozaffarian says. “It also contains zinc, important amino acids, and vitamin D.”
Still not biting because of the taste or smell? The good news is that you don’t have to subsist entirely on anchovies and sardines. A variety of fish species, with diverse flavor profiles, pack a wallop of omega-3s.
And don’t let concerns about mercury in seafood dissuade you from eating it. A JAMA review found that the heart health benefits of fish outweigh the risks associated with consuming toxins found in some fish. If you’re still worried, eat smaller seafood (try shrimp or sardines), which don’t carry the toxin load of larger swimmers (like swordfish), says Men’s Health nutrition expert Mike Roussell.
So here’s the bottom line for the average guy: Eat at least two servings of fish that are high in omega-3s each week and cook them in a healthy way to avoid loading up on excess calories. (Sorry, fish-and-chips lovers.)
If you just can’t stomach a fish-forward diet, ask your doctor if you might need a prescription for omega-3s to make up for the lack of seafood on your plate. But that should be a last resort. Also be aware that fish oil supplements, both in prescription and over-the-counter forms, have the ability to thin your blood and increase your risk of bleeding and bruising.
“If you regularly eat fatty fish, supplementation isn’t necessary,” says Alan Aragon, M.S., author of The Lean Muscle Diet.
In even simpler terms, go fish. Here are nine omega-3 powerhouses to try.
Fish With the Highest Amounts Of Omega-3
OMEGA-3 CONTENT PER 3 OZ COOKED ATLANTIC HERRING 1,712 mg PACIFIC MACKEREL 1,571 mg CHINOOK SALMON 1,476 mg WILD COHO SALMON 1,168 mg RAINBOW TROUT 840 mg CANNED SARDINES 835 mg WILD SWORDFISH 764 mg MUSSELS 665 mg OYSTERS 530 mg
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How Omega-3 Fatty Acids Benefit Your Health
These days almost anyone who is trying to lead a healthier lifestyle has heard of omega-3 fatty acids. Either you have read about them in the news, or a well-meaning friend or family member has told you to take them.
What you’ve heard is true: omega-3 fatty acids may benefit your health in several ways.
However, there is some conflicting information out there about omega-3 fatty acids. This confusion can sometimes create more questions than answers. This article answers some common questions about omega-3 fatty acids and shares how they may benefit your health.
Before we dive into the omega-3 fatty acid benefits, let’s answer some common questions about this powerful compound.
What are omega-3s fatty acids?
Omega-3 fatty acids are essential polyunsaturated fats. The term “essential” means that the body cannot make them on its own. Therefore, you must consume omega-3 fatty acids through food every day.
How many omega-3s fatty acids are there?
There are three main types of omega-3s:
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) come from fatty fish such as salmon, herring, sardines, tuna, trout, and mackerel. Since EPA and DHA come from fish, they are often called fish oils.
Alpha-linolenic acid (ALA) is the most common omega-3 fatty acid in most Western diets. ALA comes from plant foods such as vegetable oils, flaxseeds, and nuts.
Which omega-3 fatty acids benefit me?
All omega-3 fatty acids are healthy fats. However, EPA and DHA from fish oil are the most studied. The research shows that these two types of omega-3 fatty acids may be beneficial for various conditions.
How do omega-3 fatty acids benefit my health?
Omega-3 fatty acids benefit several different health conditions. Below are some examples of ways in which omega-3 fatty acids may benefit your health.
Heart Health
A heart-healthy diet is rich in EPA and DHA. One research study concluded that the more fish you eat, the lower risk you may have of stroke and heart failure.
Due to the strength of the evidence for fish oil, the U.S. Food and Drug Administration (FDA) has approved the following health claim: “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
The American Heart Association (AHA) recommends eating a variety of fish (particularly fatty fish) at least two times per week. Consider adding salmon, sardines, trout, herring, tuna, or mackerel to your weekly meal plan.
Ideally, increasing omega-3 fatty acid intake through foods is preferable. However, those not getting enough omega-3 through diet alone should consider taking an omega-3 fish oil supplement.
Joint Health
Studies have shown that omega-3 fish oil may also support healthy joints and mobility in adults and those who participate in high-intensity exercise.
It is thought that Americans consume more omega-6s fatty acids (from vegetable oils, nuts, and seeds) than omega-3s fatty acids. Many healthcare professionals believe bringing these two essential fatty acids into better balance is a good idea for overall health. But don’t do this by cutting back on healthy omega-6 fats. Instead, add some extra omega-3s to support a long-term healthy, and active lifestyle.
Pregnancy
Omega-3 fatty acids are particularly important during pregnancy. Research suggests that they help support brain development, eye health, and healthy gestational length. DHA is also important for a baby’s mental and visual development during pregnancy and throughout infancy. Experts recommend that pregnant and breastfeeding women consume at least 200 mg of DHA every day.
Remember, growing babies cannot produce their own DHA efficiently, so babies depend on their mothers to get DHA. Therefore, a mother’s DHA reserve decrease during pregnancy as her DHA transfers from her to her baby.
How Omega-3 Fatty Acids Benefit Your Health
Mood Booster
Recent research has started to look at omega-3 fatty acids’ role in overall sense of well-being. Although the results are mixed, a few studies find an association between a higher intake of omega-3s and happiness.
How much omega-3 fatty acids do I need?
Healthy individuals who eat fatty fish more than twice a week may not need to take an omega-3 (fish oil) supplement. For generally healthy people who do not eat fish often, taking a fish oil supplement may be beneficial. Remember, before deciding to take any supplement, speak with your healthcare provider to make sure it is the best choice for you.
Is it safe to take omega-3 fatty acid (fish oil) supplements?
The FDA has ruled that daily intake of EPA and DHA up to 3 grams (3,000 mg) is safe.
The most common side effect of low-quality fish oil supplements is a fishy aftertaste. However, higher-quality fish oil supplements that have been molecularly distilled and steam-deodorized should not have this problem. If you experience a fishy aftertaste, try keeping your fish oil supplement in the freezer.
Some people can experience an upset stomach when taking fish oils, especially at higher doses. Taking fish oil supplements with food can help to reduce any stomach upset.
People taking certain medications such as blood thinners or having a surgical procedure should speak to their healthcare providers before taking any fish oil supplements.
How can I tell if my fish oil supplement is free from contaminants?
Choose an independently tested and certified fish oil. These types of certifications guarantee content accuracy, purity, and freedom from contaminants. Organizations like NSF® International USP® provide third-party testing and certification for dietary supplements. In addition, the International Fish Oil Standards (IFOS) program offers lot-specific fish oil test results for several products on the market.
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