Fish Oil

The Truth About 4 Popular Heart Health Supplements

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Watching your cholesterol levels is a smart idea, especially since one in three people have high levels of “bad” cholesterol: low-density lipoprotein (LDL). If you’re facing an increased risk for high cholesterol and you’re struggling to manage it, you might consider reaching for supplements or other over-the-counter products. But you should think twice before you do that, says Seth Martin, M.D., M.H.S ., Johns Hopkins cardiologist and co-director of the Advanced Lipid Disorders Center.

“Some people try supplements instead of prescription medications because they think it’s a safer way to address health issues,” he says. “But many of those supplements don’t benefit the heart like people think.”

Fish Oil

Advocates of fish oil supplements containing omega-3 fatty acids (nutrients found in foods such as fish that are important for normal metabolism) say they’re good for heart health and prevent heart attacks , strokes , heart failure and coronary heart disease . But there is no substantial evidence that proves over-the-counter fish oil supplements can do any of those things.

Prescription fish oils are used in medical practice. However, they’re prescribed to help people with severe triglyceride disorders, not high cholesterol. Omega-3 therapy with prescription fish oil can reduce triglycerides by 30 to 50 percent in those with levels that are at 500 mg/dL or more, and who are at an increased risk of getting pancreatitis.

“Typically, you wouldn’t get that kind of triglyceride lowering with over-the-counter supplements. That’s because the dose of active ingredients is substantially less than what’s in prescription fish oil and can even be less than advertised,” Martin says. “Over-the-counter fish oil supplements may also contain large amounts of other unwanted saturated fats, which could increase your bad cholesterol.”

Over-the-counter supplements aren’t regulated for quality and contents, so you don’t know what you’re really getting. Rather than taking a supplement, Martin notes that eating a heart-healthy diet that includes fish, unsaturated fats and limited simple sugars, and performing regular physical activity, is the safest way to control triglycerides and cholesterol.

Red Yeast Rice

Red yeast rice is used in foods such as Peking duck and in Chinese medicine. When red rice is fermented with certain strains of yeast, it creates a very low-dose statin. Statin drugs are commonly prescribed for reducing high levels of bad cholesterol.

Although some people want to take red yeast rice because they feel it’s more natural and safer than prescription statin drugs, it’s not regulated by the FDA or tested in any way to make sure it’s safe.

“I don’t feel comfortable recommending red yeast rice because each formulation may vary in strength and have other unknown contaminants that could be toxic,” says Martin.

An analysis of red yeast rice supplements found that four out of 11 products contained a substance called citrinin. This develops during the culturing process if the environment isn’t carefully controlled. Citrinin has been found to cause kidney failure in animals and genetic damage in human cells.

On the other hand, prescription statins are heavily regulated and have a proven track record of being safe and well tolerated by the vast majority of people.

CoQ10 Supplements

Coenzyme Q10 (CoQ10), a nutrient produced by the body and used for cellular energy, is often touted as being vital if you’re taking statin drugs to lower cholesterol. Proponents of CoQ10 say it helps reduce muscle pain, which can be a side effect of statin use, and is an important energy source that the body needs.

“No solid evidence supports benefits of taking CoQ10 supplementation while taking statins,” Martin says. “If you’re taking statin drugs and have muscle aches, the next step is talking to your doctor about changing your prescription.”

There are several different statin drugs and they can be given at various doses. Finding the one that works for you is a better route than taking a supplement to try to counteract ill effects of your current prescription.


When cholesterol and other substances build up on your artery walls, they create something called plaque, which narrows the passageways and restricts blood flow. Even worse is when a blood clot forms on a ruptured plaque and blocks the artery entirely, cutting off the flow of oxygen to part of your body. A heart attack occurs when blood flow to your heart is cut off. When the blocked artery leads to your brain, a stroke is the result.

Studies show that aspirin can help prevent heart attacks and strokes caused by blood clots because it reduces your blood’s ability to form clots. “Taking a low-dose aspirin is most effective if you’ve already had a heart attack or stroke. Also, if you’ve had a stent or heart surgery, you should be on platelet blocking therapy,” advises Martin. “But if you’re someone who is more likely to have heart disease because of certain risk factors, you may or may not need aspirin therapy. It’s an individualized decision to make together with your health care provider.”

Talking to your doctor before starting any new supplement or taking aspirin is always advised. Your health care provider can offer insight about whether they are right for you.

The Omega-3 that IS worth the hype

SALT LAKE (ABC4) — There has been confusion over fish oil supplements and questions if there are any benefits to them in fighting cardiovascular disease and other issues.

Some studies have shown the lack of benefits of fish oil but not all are created equal. Many researchers say there is an exception.

When it comes to diving into the debate over fish oil we’re really talking about the active ingredients of Omega-3 fatty acids. Researchers are focusing on DHA and EPA components of Omega-3s. They are essential nutrients we need and we get them from the foods we eat.

“We have to recognize not all fish oil are Omega 3s. The component of interest is actually Omega-3,” said Viet Le, Pa-C said.

Omega-3 fatty acids can be found in plants, flaxseed, some nuts, and in fish. The confusion surrounds fish oil because there are plenty of fish oil supplements out there.

Researchers have been concentrating efforts on the components of Omega-3s.

“The Omega-3s we are looking at is eicosapentaenoic acid, EPA and docosahexaenoic acid or DHA. This is the crux of it. Prescription-strength is different from off the shelf, Viet Le, Pa-C said.

Viet Le is a certified cardiovascular physician assistant at Intermountain Healthcare in Utah and has researched this subject at length.

He says beware of off-the-shelf fish oil supplements because you don’t know what is in them and what amounts.

But prescription grade and FDA approved fish oil is different.

In a clinical trial called “REDUCE-IT,” researchers investigated a prescribed medication called Vascepa.

“Its EPA only that is the Omega-3 version it uses and it’s an EPA at 4 grams that showed great outcome of cardiovascular events. So heart attacks, deaths, stroke, etc., said Viet Le.”

The confusion has come with other research such as in the STRENGTH trial where it used both EPA and DHA.

“It showed neutral effect using those two medications combined in one. They don’t mix well together,” Viet Le said.

Results from combining EPA and DHA have been inconclusive that’s why many doctors do not recommend off-the-shelf fish oil supplements.

“We just don’t know what you’re getting off-the-shelf, I’m not aware of any benefit with off-the-shelf supplements. Prescription is going to be a way of it. EPA alone has been shown to be beneficial but EPA with DHA has not. It’s neutral,” Viet Le said.

Add to the confusion? Vascepa, a prescription grade EPA, is technically not a fish oil but often is lumped into that category.

“It’s been said to be a fish oil but it’s not. It’s actually synthetic. Both DHA and EPA separately have important functions in the body,” Viet Le said.

There’s even talk perhaps EPA alone could help fight against COVID-19. “I hold out hope because they’re essential to the body. EPA reduces inflammation,” said Viet Le.

As a cardiovascular physician assistant at Intermountain Healthcare, Viet Le’s main goal for his patients is to prevent heart disease and other major health issues.

“Come back to the basics with lifestyle first. Let’s not develop a coronary disease to begin with but I want people to know EPA and other Omega-3s that we’re studying now at least with EPA has shown to be beneficial and another tool to use and give hope to people. We have tools but start with lifestyle first,” Viet Le.

More studies need to be done on EPA and DHA separately.

The takeaway? Prescription fish oil or prescription EPA found in Vascepa has been found beneficial for many health conditions.

Eric Carter