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Fish oil supplements: things to know before you use

Updated: Nov 14

Importance of Omega 3 Fatty Acids

Fish oil, loaded with omega 3 fatty acids, is necessary for bodily function and is not manufactured by our bodies. We must obtain it from our diet.

Fish oil supplement market size was valued at 720 million is US in 2023 and expected to grow as demand for health supplements grow. Let’s examine the value this is delivering.


Types of Omega 3 Fatty Acids

Two key omega 3 fatty acids needed by our body comes from fatty fish like salmon, mackerel, sardines etc. They are:

  • DHA (docosahexaenoic acid)

  • EPA (Eicosapentanoic acid)

Omega 3 fatty acids can also come from plant sources. Plant origin fatty acids are called alpha-linolenic acid, found in foods like flax seeds, walnuts, chia seeds, and canola oil. Once consumed , our body converts alpha linolenic acid to DHA and EPA.


Benefits and Risks of Omega 3 Fatty Acids or Fish oil supplements

While omega 3 fatty acids play an important role in growth, development, reduction of inflammation, and brain function, supplementation in higher doses do not always lead to better health.

Some considerations:

  • Omega 3 fatty acids can reduce cardiovascular risks in people with established heart disease.

  • EPA has shown more promise than DHA in this selected population with heart disease.

  • Studies have shown mixed results on the benefits of fish oil supplementation in preventing heart disease or cancer in general population

  • Limited research has indicated enhanced memory in individuals with neurocognitive disorder. Further extensive studies may be necessary. The current studies may have included those with nutritional deficiencies or insufficient oral intake.

  • Most large studies showed an increased risk of atrial fibrillation with fish oil supplementation.

  • Fish oil supplements may increase bad cholesterol levels and liver enzymes, a finding of unknown clinical significance at this time.

  • Additionally, fish oil may elevate the chances of experiencing bleeding, acid reflux, and fishy smell/burping.


Two fishes with a few fish oil supplement pills around them


Key Scientific Studies on Fish Oil Supplementation

  1. Fish oil can reduce cardiovascular risks in people with established heart disease.

  2. EPA shows more promise than DHA in selected populations with heart disease.

  3. A 2019 study in the New England Journal of Medicine showed no benefit of fish oil supplementation in preventing heart disease or cancer.

  4. Another study in the same journal found no benefit of omega 3 fatty acids in patients with diabetes in preventing heart disease.



Take Home Message

Fish oil supplements have shown promise in selected high risk cardiac patients, especially after other risk factors have been controlled. EPA shows the most promise in this group, between the different types of available omega 3 fatty acids. Pure EPA is only available as a prescription medicine at this time (Vascepa).

Other than highly selected cardiac patients, certain elderly individuals with poor oral intake and neurocognitive dysfunction may benefit from fish oil supplements.


Using fish oil as “health supplement” in the general population may have more risks than benefits, especially risk of atrial fibrillation.

If the benefits of eating seafood or nuts came only from omega 3 fatty acids, then fish oil supplementation could be a good lternative to eating nutritious food. The evidence so far does not point that way. It is likely , that the combination of nutrients in fish products(or nuts/soy/flaxseed) is more beneficial than just two isolated nutrients EPA and DHA for most of us.


References-

4- Dighriri IM, Alsubaie AM, Hakami FM, Hamithi DM, Alshekh MM, Khobrani FA, Dalak FE, Hakami AA, Alsueaadi EH, Alsaawi LS, Alshammari SF, Alqahtani AS, Alawi IA, Aljuaid AA, Tawhari MQ. Effects of Omega-3 Polyunsaturated Fatty Acids on Brain Functions: A Systematic Review. Cureus. 2022 Oct 9;14(10):e30091. doi: 10.7759/cureus.30091. PMID: 36381743; PMCID: PMC9641984.




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