What you need to know about fish oil and what experts say about the latest heart health findings

In the wellness world, few things are as common and confusing to swallow as advice about vitamins and supplements and whether they have any benefits.

Research published last month in the journal BMJ Medicine examined the risk-versus-benefit profile of fish oil on heart health, suggesting from a multi-year study that regular intake of fish oil may be slightly INCREASES the risk of cardiovascular events, including atrial fibrillation and stroke, in people who did not have a high risk.

In those who already had cardiovascular disease, researchers found a benefit from taking fish oil supplements and how the disease progressed.

Fish oil supplements may be the most common type of omega-3 supplement that people can take over the counter. They’re often in capsule form, and people reach for them because other research has linked omega-3 intake to potential benefits for a variety of health concerns, including rheumatoid arthritis, cognition, and even things like ADHD. More recently, she has linked omega-3 supplementation with reduced anger.

But the fact that fish oil supplementation may not be beneficial for heart health in the general population “is not a new issue, just a new paper on the issue,” Dr. Andrew Freeman, a cardiologist with National Jewish Health in Denver.

He added that over-the-counter fish oil supplements are different from the “highly purified” forms of fish oil, including Lovaza and Vascepa, that people can get from their doctor with a prescription to lower triglycerides. (High triglycerides contribute to cardiovascular risk.)

While far from the final word on the benefits and risks of omega-3 supplements (there were limitations to this study, including the large fact that people self-reported their fish oil intake so this research may not reflect dosage), it raises questions that continue to struggle with supplement recommendations in general, such as the fact that they are not regulated for safety or effectiveness by the US Food and Drug Administration, and the fact that we must get most of our nutrients from food and diet.

Certain eating patterns that focus primarily on plant-based foods full of healthy fats, lean protein, and some sources of food-based fish oil (including diets such as the Mediterranean diet) continue to be associated with positive health findings. These diets may be rich in omega-3 fatty acids and other nutrients, but replicating these benefits in supplement form has proven difficult.

Another important caveat is that people take supplements (including omega-3s and fish oil) for a variety of reasons beyond heart health, so advice on whether you should take one depends on you, your diet, and your health goals, which may vary. throughout life.

“There’s not a lot of evidence for omega-3 supplements in general,” said Dr. Navya Mysore, a primary care physician based in New York, in an email. If someone is interested in adding one to their routine for any health concern, she said, it’s a good idea to consult with a doctor before “making a personalized decision for yourself.”

Read more: Omega-3 rich foods offer many benefits for heart, hearing and overall health

What did the study find? Advantages and limitations

The BMJ Medicine study followed more than 400,000 participants, aged 40 to 69, enrolled in the UK Biobank study, tracking their health events and self-reported lifestyle and dietary factors, including whether they regularly took fish oil supplements, their regular food intake and more.

After several years of follow-up, the researchers found that fish oil supplementation in people who already had cardiovascular disease was beneficial, but in the general population (ie, those without cardiovascular disease), regular fish oil intake was associated with increased risk for the first time. heart disease and stroke.

The strengths of the study are that it is large and was able to track the incidence of cardiac events. The researchers also gathered details on several factors that can affect heart health, such as smoking, heavy drinking and overall diet. However, it “did not account for behavioral differences in populations with different cardiovascular profiles,” the researchers wrote. It also cannot account for all the health-influencing behaviors that can influence one’s health choices, which are extremely complicated to disentangle and pin down into cause or effect.

Also, most of the study participants were white, the researchers noted, so whether the same connection might be drawn to people of other races isn’t known from this study alone. And most importantly, it didn’t take into account the dose of fish oil people were taking or the specific brands or types.

Should people base their decisions on this study? Certainly not

The latest findings shouldn’t panic you into thinking that your omega-3s or fish oil pills are heart problems in a bottle; As the study authors noted, more research is needed on the link between cardiovascular events and fish oil, and this comes on the heels of ongoing research into the comprehensive and complex relationship between omega-3s and various health benefits when it comes to supplement form. At least for the general population, much of it has been contradictory or inconclusive.

According to Dr. Gregory Katz, a cardiologist at NYU Langone, this study alone is not enough to definitively sway the argument for the benefits of fish oil.

“To change clinical practice, only a randomized trial allows you to see cause and effect,” Katz said in an email. “A study like this doesn’t tell you if the fish oil caused the irregular heartbeat.”

But, he said, “There has been a signal in some of the clinical trials on high-dose omega-3 supplements — that there may be an increased risk of an irregular heartbeat called atrial fibrillation,” which increases the risk of stroke.

When asked whether vegan or vegetarian omega-3 supplements would be better — those that come from ALA instead of DHA and EPA, the evidence is also murky, since ALA is a “precursor in the body to DHA and EPA, which are active omega-3s,” Katz said, adding that the way it is converted to active omega-3s is not as efficient and may be “not as beneficial.”

So this all comes back to the same advice: Get omega-3s (and all other nutrients) from food when possible. If this is not possible, talk to your doctor about starting a dietary supplement or using additional vitamins. Because people may be interested in taking omega-3 for a variety of health reasons beyond heart health, you should talk to someone who understands your health history so you can weigh your risks and benefits.

In a major summer review last updated in 2023 that looked at the available studies on omega-3 and omega-3 supplements for a whole list of health conditions, including cardiovascular disease, the National Institutes of Health Office of Dietary Supplements concluded that “the consumption of fish and other types of seafood as part of a balanced diet promotes heart health, especially when seafood is consumed in place of less healthy foods.” But the evidence for protective heart health benefits from supplements is stronger in people with existing disease.

However, recent findings bring some much-needed nuance to supplements.

“Not everyone is the same,” Freeman said of the latest fish oil study. “Not all drugs are the same and what may seem benign may not always be so.”