In the world of wellness, few things are as common and as confusing to swallow as advice about vitamins and supplements and their benefits.
Research published last week in the journal BMJ Medicine examined the risk/benefit profile of fish oil on heart health, suggesting, based on a multi-year study, that regular intake of fish oil can increase the risk of cardiovascular events, including atrial fibrillation and stroke, in people not at high risk.
In those who already had cardiovascular disease, researchers discovered the benefits of taking fish oil supplements and how the disease progressed.
Fish oil supplements are perhaps the most common type of omega-3 supplement that people can get over the counter. They often come in capsule form, and people seek them out because some research has looked at omega-3 intake as potentially beneficial for a variety of health conditions, including rheumatoid arthritis, cognition, and even issues like ADHD.
But the fact that fish oil supplementation is not beneficial for the heart health of the general population is “not a new problem, just a new paper on the issue,” Dr. Andrew Freeman, MD, told CNET. cardiologist at National Jewish Health in Denver.
He added that over-the-counter fish oil supplements are different from “highly purified” forms of fish oil, including Lovaza and Vascepa, which people can get from their doctor with a prescription to reduce 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 fact that people self-reported their fish oil intake), (this research does not reflect dosage), it raises questions that continue to run up against recommendations for supplements in general, such as the fact that they are not regulated for safety or effectiveness by the Food and United States Drug Administration, and the fact that we are supposed to get the majority of our nutrients from food and nutrition.
Certain eating habits that focus largely on plant-based foods rich in healthy fats, lean protein, and some food-based sources of fish oil (including diets like the Mediterranean diet) continue to persist. be linked to positive health outcomes. These diets may be rich in omega-3 fatty acids and other nutrients, but it has proven difficult to replicate these benefits in supplement form.
“There is not a lot of evidence to support omega-3 supplements in general,” Dr. Navya Mysore, a New York-based primary care physician, said in an email. If someone wants to add one to their routine for a health issue, she says, it’s a good idea to consult a doctor before “making a personalized decision for yourself.”
Learn more: Foods rich in omega-3 provide many benefits for heart, hearing and overall health
What did the study reveal? Strengths 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, lifestyle and dietary factors they reported, including whether they regularly took fish oil supplements, their regular food intake and more.
After years of follow-up, researchers found that fish oil supplementation was beneficial in people who already had cardiovascular disease, but that in the general population (i.e., those without cardiovascular disease), Regular intake of fish oil was associated with an increased risk of primary infection. 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 collected details on certain factors that can influence heart health, such as smoking, excessive alcohol consumption and general diet. However, they “did not take into account behavioral changes in populations with different cardiovascular profiles,” the researchers write. It also cannot account for all health-affecting behaviors that can influence a person’s well-being choices, which are notoriously difficult to separate and pin down to a single cause or effect.
Additionally, most study participants were white, the researchers noted. Therefore, it is unclear from this study alone whether the same connection can be made with people of other races. Importantly, it didn’t take into account the dosage of fish oil people were taking or specific brands or types.
Some foods that naturally contain omega-3 include fish and seafood, nuts and seeds, vegetable oils, and some fortified foods.
So… should people stop taking omega-3 supplements?
The latest findings shouldn’t freak you out and make you feel like your omega-3 or fish oil pills are heart trouble in a bottle; As the study authors noted, more research is needed on the link between cardiovascular events and fish oil, and this follows ongoing research into the comprehensive and complex link between omega-3s. and the different health benefits when presented in supplement form. At least for the general population, most findings have been contradictory or inconclusive.
This study alone isn’t enough to definitively sway the argument for the benefits of fish oil, according to Dr. Gregory Katz, a cardiologist at NYU Langone.
“To change clinical practice, only a randomized trial can see cause and effect,” Katz said in an email. “A study like this doesn’t tell you if fish oil is causing irregular heartbeats.”
But, he said, “some clinical trials of high-dose omega-3 supplements have shown a signal that there may be an increased risk of an irregular heart rhythm called atrial fibrillation,” which 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 DHA and EPA, which are the active ingredients. omega-3s,” Katz said, adding that the way they are converted to active omega-3s is not as efficient and may be “not very useful.”
So it all comes down to the same advice: get your omega-3 (and all other nutrients) from your diet 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-3s for a variety of health reasons other than heart health, you should talk to someone who understands your medical history so you can weigh the risks and benefits.
In a major summer review last updated in 2023, which examined available studies on omega-3 and omega-3 supplements for a range of health conditions, including cardiovascular disease, the Office of Dietary Supplements of the National Institutes of Health concluded that “eating fish and other types of seafood as part of a balanced diet promotes heart health, especially when seafood is eaten at the place of less healthy foods. But the evidence for the protective benefits of supplements on heart health is strongest in people with existing disease.
The latest findings, however, highlight some essential nuances for supplements.
“Not everyone is the same,” Freeman said of the latest fish oil study. “Not all medications are the same, and what may seem harmless is not always the case.”