Taking fish oil pills won't protect against heart attacks and strokes for people who already have heart disease, a new review of research finds. Fish oil contains omega-3 fatty acids. Many studies have found a lower risk of death from heart disease and stroke for people who eat fatty fish at least twice a week. The new study looked at people who took fish oil in the form of pills. It combined the results of 14 prior studies. They included more than 20,000 people who had heart and artery disease. People took half a gram to 5 grams of fish oil daily. Researchers kept track of people for 1 to 5 years. In that time, taking fish oil pills made no difference in whether people died from heart disease or any other cause. It also did not affect their chances of heart attack, congestive heart failure, stroke or so-called mini-strokes. The journal Archives of Internal Medicine published the research review. HealthDay News wrote about it April 9.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Omega-3 supplements, such as fish oil capsules, have been heavily promoted to improve heart health. But the hype for these supplements may be overblown. Research has reached similar conclusions about vitamin E, selenium and other supplements.
Our bodies definitely need omega-3s. Without them, we would become very ill. But just because we need some omega-3s from food, it does not mean that taking a lot more makes you healthier.
There are three main types of omega-3 fatty acids:
Eicosapentaenoic acid (EPA) Docosahexaenoic acid (DHA) Alpha-linolenic acid (ALA)
Alpha-linolenic acid is an essential fatty acid. This means we must get ALA from food because our bodies can't make it from other chemicals. Our bodies can convert ALA to EPA and DHA. However, it's not an easy conversion. So it's better to get EPA and DHA from food.
EPA and DHA are found mainly in fish, so they're sometimes called marine omega-3s. ALA is found in plant-based foods, such as flaxseed, walnuts, and canola and soybean oils.
There's good evidence that eating fish rich in omega-3s lowers the risk of heart disease. And a plant-based diet also is well known to be good for your heart. However, it's not clear that the omega-3 ALA in these foods is the reason for better heart health. In fact, most evidence suggests that ALA has a much smaller effect than the marine omega-3s.
It's natural to think that fish oil or other omega-3 supplements would be as heart-healthy as a diet rich in omega-3s. Many people with heart disease take these pills to reduce their risk of heart attack and sudden death. But do they really work?
A study published online April 9 by the journal Archives of Internal Medicine looks at this question. The results suggest that omega-3 pills don't reduce the risk of heart attack or sudden death in people with known heart disease. These results are somewhat surprising given the general belief that omega-3 pills are helpful. But some older studies also had shown similar results.
What Changes Can I Make Now?
Get your omega-3s from food sources. Fish that have the most EPA and DHA per ounce are:
SalmonMackerelAnchovySardinesHerring
Flaxseeds and walnuts are loaded with ALA. But you need to eat a lot more ALA-rich foods to get the same health benefits as eating fatty fish a couple times per week.
Fish can be expensive. So, if your budget is tight or you are worried your diet is not rich enough in omega-3s, it's quite reasonable and safe to take omega-3 pills. The daily dose should be between 250 to 500 milligrams. (Note that a fish oil capsule contains other ingredients. A 1-gram capsule contains about 300 to 350 grams of omega-3s.
What Can I Expect Looking to the Future?
Omega-3 fatty acid supplements do lower blood triglyceride levels. Doctors will continue to prescribe these for this purpose.
The results of this study are surely not the last word on omega-3 supplements and heart health.
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