Fish Oil

Your Guide to Omega-3s

Omega-3 Fatty Acid Benefits, Uses & Foods Rich in Omega-3s

Has science proven the beneifts of omega-3 fatty acids?

Animal studies

In studies involving animals (dogs, rats, and marmosets), omega-3 fatty acids were found to prevent ventricular fibrillation (see MedicineNet article on heart attack) when given to animals just prior to experimentally induced heart attacks. Omega-3 fatty acids were also found to terminate ventricular fibrillation in animals undergoing experimentally induced heart attacks. Therefore, scientists suspect that omega-3 fatty acids may prevent ventricular fibrillation of the heart in the event of a heart attack in humans. Since ventricular fibrillation is the most important cause of sudden death among heart attack victims, omega-3-fatty acids is believed to prevent sudden death.

Evidence from observational studies: Two large, long-term observational studies have been published on the relationship between dietary intake of fish oil and omega-3 fatty acids and risk of heart disease and sudden cardiac death; The Nurses' Health Study and the Physician's Health Study.

The Physician's Health Study began in 1982 when more than 20,000 healthy male physicians were followed for 11 years. Lifestyle, coronary risk factors, and diet data were collected at entry, and life style and diet data were collected via questionnaires at 12 months and 18 months. The results of the study were published in JAMA 1998, vol. 279, p. 23. The title of the article is "Fish consumption and risk of sudden cardiac death." The study found that men who consumed one or more fish meals per week had a 50% lower risk of developing sudden cardiac death than men who rarely ate fish (less than one fish meal per month).

In a separate article, scientists compared blood levels of omega-3 fatty acids in 94 of these men who died of sudden cardiac death against living men matched for age and smoking habits. They found that high levels of omega-3 fatty acids in the blood were associated with a low risk of cardiac sudden death. Men with the highest blood levels of omega-3 fatty acids had an 80% lower risk of sudden cardiac death than men with the lowest blood levels. High omega-3 fatty acids in the blood are usually due to a high consumption of fish.

The Nurses' Health Study began in 1976 when more than 80,000 female nurses completed life style and diet questionnaires. They were followed for 16 years for the development of coronary heart disease. Omega-3 fatty acid consumption was calculated from the questionnaires. The result of the study was published in JAMA vol 287. No.14, p. 1815. The title of the article is "Fish and omega-3-fatty acid intake and risk of coronary heart disease in women." The study found that compared to women who rarely ate fish (less than one fish meal per month), women who ate fish once a week had a 29% lower risk of developing coronary heart disease. Those who ate fish five times a week had a 34% reduction in the risk of coronary heart disease and a 45% reduction in the risk of death from heart disease (usually sudden cardiac death).

Controlled Studies: Controlled studies are prospective studies that randomly (by chance, e.g., by a flip of a coin) assign subjects to two groups, a treatment group and control group. Subjects in the treatment group are given the medication (or diet) being tested, while the subjects in the control group are usually given an inert substance (placebo).

Two controlled studies on omega-3 fatty acids and fish oil have recently been published. The GISSI-Prevention trial studied the effect of omega-3 fatty acids on sudden death and the recurrence of coronary heart disease in patients who recently survived a heart attack. The Lyon Diet Heart Study studied the effect of a Mediterranean diet (see discussion below) on the recurrence of coronary heart disease in patients who recently survived a heart attack.

The GISSI-Prevention trial randomly assigned more than 11,000 patients with recent heart attacks to four treatment groups; omega-3 fatty acids (850 mg capsule daily), vitamin E, both, or neither (control). The study subjects in all four groups were followed for 3.5 years. Study results were published in Circulation, 2002; 105:1897-1903. Subjects given omega-3 fatty acids had a 20% lower death rate from coronary heart disease than subjects in the vitamin E and control groups. Omega-3 fatty acids were particularly effective in preventing sudden cardiac death (45% reduction in sudden cardiac death). The scientists believed that the benefits of omega-3 fatty acids are in the prevention of ventricular fibrillation. Vitamin E was found to have no benefit compared to controls.

The Lyon Diet Heart Study randomly assigned 600 subjects who survived recent heart attacks to either the Mediterranean diet or a prudent Western diet (diet low in saturated fat and cholesterol). The Mediterranean diet is rich in omega-3 fatty acids, as well as monounsaturated fats, fruits, vegetables, and nuts. The study subjects were followed for 4 years. The results of the study were published in Circulation, 1999; 99:779-785. The subjects eating the Mediterranean diet had more than a 50% reduction in sudden cardiac death and in repeat fatal or nonfatal heart attacks as compared to the Western diet group.

The GISSI-Prevention trial found that omega-3 fatty acids prevented sudden cardiac death, but did not prevent repeat heart attacks. The Lyon Diet Heart Study found that the Mediterranean diet not only prevented sudden cardiac death, but also prevented the recurrence of both fatal and nonfatal heart attacks. The reasons for the difference in the two studies are not clear. Perhaps there are additional cardiac protective factors in the Mediterranean diet.

10 Best Sources for Omega-3 Fatty Acids

Omega-3 fatty acids are essential fatty acids that are not made in our bodies, so we must get them from our diet. There are three forms: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and alpha-linolenic acid (ALA). There is evidence from studies, according to the Mayo Clinic, that suggests consuming the recommended amounts of DHA and EPA through either fish or fish oil supplements lowers triglycerides, slows hardening of the arteries, and lowers blood pressure. In addition, they also may reduce the risk of heart attack, abnormal heart rhythms, and strokes in people with cardiovascular disease.

How much of omega-3 fats are enough?

The World's Healthiest Foods cites the guidelines issued by the Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids in 1999, which recommend that omega-3 fats should be at least two percent of the total daily calories. Someone consuming 2,000 calories a day would need to eat at least four grams of omega-3 fats. Two tablespoons of flaxseeds have 3.5 grams of omega-3 fats, and a four-ounce serving of salmon has 1.5 grams of omega-3 fats.

Fish oils contain both DHA and EPA, while flaxseeds, certain oils, vegetables, and spices contain ALA.

Where does that leave vegetarians and vegans who rely on ALA as their source of omega-3 fats?

The World's Healthiest Foods recommends they increase the amount of ALA-rich foods they consume to "ensure sufficient production of its important derivatives, EPA and DHA."

There are many companies that produce high-quality omega supplements since often we can't get enough from our diet every day. There are also vegan supplements made from flax or algae.

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Here is our top ten list of omega-3 rich foods:

1. Seafood: Seafood high in omega-3s include salmon, sardines, halibut, herring, mackerel, oysters, trout, tuna, shrimp, or scallops. There are a lot of great fish oil supplements, but if you prefer to eat the real thing, eat fish a few times a week to get sufficient EPA and DHA.

The rest of the list contains omega-3s with alpha-linolenic acid (ALA):

2. Flaxseed (meal and oil)

3. Walnuts

4. Broccoli, cauliflower, winter and summer squash

5. Green leafy vegetables such as kale, spinach, and collard greens

6. Olive oil, walnut oil, and mustard oil

7. Chia seeds

8. Hemp seeds

9. Basil or parsley (fresh)

10. Dried herbs such as cloves or oregano

Bottom Line

We need essential fatty acids in our diet for their amazing health benefits so make sure to consume foods from our list every day or explore quality supplements to fill in the gaps.

Read next:

Omega-3 Fatty Acids and Brain Health

What You Need to Know About Different Types of Omega Fatty Acids

Your Guide to Omega-3s

The buzzy term "fatty acids" may not sound very appetizing, but working these important nutrients into your diet helps with bodily functions both big (heart and brain health) and small (the membranes around your cells), according to the National Institutes of Health (NIH). Omega-3s, found in plant oils and fish, are essential fatty acids that your body can’t produce on its own — you’ve got to include them in your meals. Omega-3s, found in plant oils and fish, are essential fatty acids that your body can’t produce on its own — you’ve got to include them in your meals.

To bring you up to date, here’s the full rundown on omega-3s, including how much you should consume, whether to add a supplement to your diet, and the health risks to consider.

Omega-3s: What They Are

Omega-3s are part of the family of polyunsaturated fatty acids (PUFA). They are essential fatty acids (EFA) that can be broken down into alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

“Omega-3s are named for the placement of the last double bond in the molecule, which is three positions from the omega tail,” explains Melissa Majumdar, RD, a spokesperson for the Academy of Nutrition and Dietetics and the nutrition coordinator for the Brigham and Women’s Center for Metabolic and Bariatric Surgery in Boston.

ALA is the precursor to EPA and DHA, which means your body can convert very small amounts of ALA into the other two fatty acids, notes Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics in San Francisco.

Eric Carter