Fish oil supplements: things to know before you use
- Saneka Chakravarty, MD, FACC
- Nov 11, 2024
- 2 min read
Updated: Feb 12
The Importance of Omega-3 Fatty Acids
Omega-3 fatty acids are essential nutrients crucial for various bodily functions, yet they are not naturally produced by our bodies. Therefore, they must be obtained through diet or supplementation.
Growing Market for Omega-3 Supplements
The fish oil supplement market was valued at $720 million in the U.S. in 2023 and is expected to grow as demand for health supplements increases. This highlights the significance of omega-3s and their perceived health benefits.
Types of Omega-3 Fatty Acids
There are three primary types of omega-3 fatty acids:
1. DHA (Docosahexaenoic Acid) – Found in fatty fish like salmon, mackerel, and sardines, DHA plays a vital role in brain function and development.
2. EPA (Eicosapentaenoic Acid)– Also derived from fatty fish, EPA has been linked to cardiovascular benefits, particularly in individuals with existing heart disease.
3. ALA (Alpha-Linolenic Acid)– A plant-based omega-3 found in flaxseeds, walnuts, chia seeds, and canola oil. The body converts ALA into DHA and EPA, but the conversion is limited.
Health Benefits and Risks of Omega-3 Supplements
Omega-3 fatty acids support growth, development, inflammation reduction, and brain function. However, higher doses do not always equate to better health.
Potential Benefits:
- May reduce cardiovascular risk in individuals with established heart disease.
- EPA appears to offer more cardiovascular benefits than DHA in certain populations.
- Some studies suggest omega-3s could enhance memory in individuals with neurocognitive disorders, though further research is needed.
Potential Risks:
- Mixed results regarding fish oil supplementation for preventing heart disease or cancer in the general population.
- Large studies have shown an increased risk of atrial fibrillation with fish oil supplements.
- Possible elevation of bad cholesterol (LDL) and liver enzymes, though the clinical significance remains unclear.
- Side effects may include bleeding risk, acid reflux, and fishy burps.
Key Scientific Studies on Fish Oil Supplementation
1. A 2019 study in the New England Journal of Medicine found no benefit of fish oil supplementation in preventing heart disease or cancer.
2. Another New England Journal of Medicine study found no benefit of omega-3s in patients with diabetes for preventing heart disease.
3. Additional reviews suggest that omega-3 fatty acids have limited proven benefits beyond selected high-risk populations.
4. A 2022 systematic review explored the effects of omega-3s on brain function but emphasized the need for further research.
Take-Home Message
- Fish oil supplements show promise for specific high-risk cardiac patients, particularly when other risk factors are controlled. EPA appears to be the most beneficial in this group, with pure EPA available only as a prescription medication (Vascepa).
- Certain elderly individuals with poor oral intake and neurocognitive dysfunction may also benefit from omega-3 supplementation.
- For the general population, the risks (such as atrial fibrillation) may outweigh the benefits.
- The benefits of eating whole foods rich in omega-3s(such as fish, nuts, flaxseeds, and soy) likely stem from the combination of nutrients, not just EPA and DHA.
- If omega-3s were the sole beneficial component of seafood or nuts, supplements would be an ideal alternative—but current evidence does not support this assumption.
Thus, while omega-3s are essential, their supplementation should be approached with caution and tailored to individual health needs.
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